MEB Question

[Wabbles]

Hi all,

I am currently an active duty army SM. I joined in February of this year and was supposed to attend flight school through the warrant officer route. Prior to enlisting, I had a back injury that had mostly healed, and I received a waiver for it. Unfortunately, basic training aggravated the injury, and when I arrived at WOCS, the flight surgeon ordered an MRI after reviewing my waiver.

The MRI revealed a severely herniated L4-L5 disc along with severe spinal stenosis. I’ve completed physical therapy without success and have seen two surgeons, both of whom recommended a spinal fusion. I’m not willing to undergo a spinal fusion and would like to avoid surgery altogether, so I declined. At this point, my main concern is my long-term health rather than flying. Even if I did undergo surgery, I doubt the army would clear me to fly.

I recently consulted with my PCM to discuss my options. I asked about initiating a MEB, as I’ve been stuck in the barracks for nearly six months now with little to no improvement. Initially, my PCM was hesitant, but after realizing I don’t have an MOS yet, they agreed to look into an MEB. I was then placed on a temporary profile with all ones in PULHES (not sure if that’s relevant).

My PCM later informed me that the IDES physician said I haven’t taken the appropriate steps yet and that I need to see pain management first. I have that appointment scheduled for tomorrow. I’m assuming they’ll recommend epidural injections, which I’ve been trying to avoid because I don’t want a temporary solution that could ultimately worsen the injury. But I’m willing to get them if necessary.

I’m feeling a bit hopeless about this situation. Am I going about the process correctly? Is there anything else I can do to initiate an MEB?

I appreciate any advice. This isn’t what I envisioned when I joined the army but maybe I shouldn’t have enlisted with a prior injury in the first place.

 

[Wabbles]

I should add - I had an MRI prior to joining the army as well.

 

[Jumper9012]

Hi all,

I am currently an active duty army SM. I joined in February of this year and was supposed to attend flight school through the warrant officer route. Prior to enlisting, I had a back injury that had mostly healed, and I received a waiver for it. Unfortunately, basic training aggravated the injury, and when I arrived at WOCS, the flight surgeon ordered an MRI after reviewing my waiver.

The MRI revealed a severely herniated L4-L5 disc along with severe spinal stenosis. I’ve completed physical therapy without success and have seen two surgeons, both of whom recommended a spinal fusion. I’m not willing to undergo a spinal fusion and would like to avoid surgery altogether, so I declined. At this point, my main concern is my long-term health rather than flying. Even if I did undergo surgery, I doubt the army would clear me to fly.

I recently consulted with my PCM to discuss my options. I asked about initiating a MEB, as I’ve been stuck in the barracks for nearly six months now with little to no improvement. Initially, my PCM was hesitant, but after realizing I don’t have an MOS yet, they agreed to look into an MEB. I was then placed on a temporary profile with all ones in PULHES (not sure if that’s relevant).

My PCM later informed me that the IDES physician said I haven’t taken the appropriate steps yet and that I need to see pain management first. I have that appointment scheduled for tomorrow. I’m assuming they’ll recommend epidural injections, which I’ve been trying to avoid because I don’t want a temporary solution that could ultimately worsen the injury. But I’m willing to get them if necessary.

I’m feeling a bit hopeless about this situation. Am I going about the process correctly? Is there anything else I can do to initiate an MEB?

I appreciate any advice. This isn’t what I envisioned when I joined the army but maybe I shouldn’t have enlisted with a prior injury in the first place.

Since it’s a preexisting injury, the likelihood of an MEB is slim. Unfortunately you also have to exhaust all treatment efforts (typically for a year) before your PCM puts in a MEB. It’s not something you can initiate yourself

 

[Wabbles]

Since it’s a preexisting injury, the likelihood of an MEB is slim. Unfortunately you also have to exhaust all treatment efforts (typically for a year) before your PCM puts in a MEB. It’s not something you can initiate yourself

I ended up going to pain management for an epidural and then had a less invasive surgery shortly thereafter. The surgeon performed a micro discectomy at the L4-L5 level about two weeks ago. Currently recovering on con leave.

My flight surgeon seems to think getting an upslip to fly is going to be near impossible because any history of back surgery is disqualifying for class 1 flight physicals and I’d need to request an exception to policy instead. They also told me that they believe this situation will lead to a medical separation.

So with that, my goal is to put my health first and prevent re-injury. Since I am not going to be cleared to do that job I joined for I want out. My understanding is that if I am put on a P3 profile after reaching a post-surgery MRDP I will be recommended for a MEB.

Is this correct and do you have any advice?

 

[trommj]

BTW, I had a host of back injuries, did epidurals for a while as they were giving me relief...until they were not anymore. After three different consults/opinions and years with this pain/issue, I had a two-level spinal fusion L3-L5 with laminectomy. Good decision for me as it cleared up a lot of pain and other issues. Still had a ton on problems, but that is another story.

After the back surgery, my PCM and I discussed the MEDBOARD option vice VOL RETIREMENT (I have been in a while, over 20 years Active). Made most sense in my situation for him to recommend me for medboard.

However, my PCM stated that we needed to at least wait 6 months post-op and have my PT done. He said he couldn't in good conscience do it earlier. Same as with you...he wanted to reach a post-surgery MRDP before we went forward. So, I also had to wait. Made sense and wasn't a big deal.

He did the P3 write up and submission.
Permanent Profiles need a second signature, and P3s and P4s need the local MEB doctors to do them, I guess. That second signature on a P3 or P4 officially starts the MEDBOARD.
So yes, PCM has to put you in for P3 or P4 and you need that second signature. Then you are on your way.

There are a lot of rules for pre-existing conditions with service aggravation...both for the VA and Military. For an Army MEDBOARD, you can go look at AR 635-40 and the associated DA PAM. I believe they have sections in there about your situation. Once in the MEDBOARD, you will be assigned MEB counsel. Unless you want to hire a private attorney. They should know all these rules. Veterans Service Organization (VSO) may also be able to advise on the VA side. They are free to use.

If MEB finds conditions do not meet retention standards and PEB finds them unfitting, then you will be out. The VA C&P exam you do will be critical here as well as the proposed VA ratings. If combination of unfit conditions is 10% or 20%, you get medical severance (plus whatever you get for VA). So, one big lump sum from Army and then VA forever onward. Note there are special rules where the initial payments of VA are reduced to recoup the disability severance lump sum you get from Army (unless combat related injuries). Lawyer can tell you those details.
If 30% of more, you get medical retirement which will probably be partially or wholly offset by your VA check depending on your ratings.

With as little time as you have in, I don't think the disability severance would be much at all. Years of service/pay matter in that computation. Might not be a lot if you get disability retirement for 30% of more either. Again, lawyers can help you do the math, so you know what to expect.

Others on this forum certainly will know more! Good luck!!

 

[Wabbles]

BTW, I had a host of back injuries, did epidurals for a while as they were giving me relief...until they were not anymore. After three different consults/opinions and years with this pain/issue, I had a two-level spinal fusion L3-L5 with laminectomy. Good decision for me as it cleared up a lot of pain and other issues. Still had a ton on problems, but that is another story.

After the back surgery, my PCM and I discussed the MEDBOARD option vice VOL RETIREMENT (I have been in a while, over 20 years Active). Made most sense in my situation for him to recommend me for medboard.

However, my PCM stated that we needed to at least wait 6 months post-op and have my PT done. He said he couldn't in good conscience do it earlier. Same as with you...he wanted to reach a post-surgery MRDP before we went forward. So, I also had to wait. Made sense and wasn't a big deal.

He did the P3 write up and submission.
Permanent Profiles need a second signature, and P3s and P4s need the local MEB doctors to do them, I guess. That second signature on a P3 or P4 officially starts the MEDBOARD.
So yes, PCM has to put you in for P3 or P4 and you need that second signature. Then you are on your way.

There are a lot of rules for pre-existing conditions with service aggravation...both for the VA and Military. For an Army MEDBOARD, you can go look at AR 635-40 and the associated DA PAM. I believe they have sections in there about your situation. Once in the MEDBOARD, you will be assigned MEB counsel. Unless you want to hire a private attorney. They should know all these rules. Veterans Service Organization (VSO) may also be able to advise on the VA side. They are free to use.

If MEB finds conditions do not meet retention standards and PEB finds them unfitting, then you will be out. The VA C&P exam you do will be critical here as well as the proposed VA ratings. If combination of unfit conditions is 10% or 20%, you get medical severance (plus whatever you get for VA). So, one big lump sum from Army and then VA forever onward. Note there are special rules where the initial payments of VA are reduced to recoup the disability severance lump sum you get from Army (unless combat related injuries). Lawyer can tell you those details.
If 30% of more, you get medical retirement which will probably be partially or wholly offset by your VA check depending on your ratings.

With as little time as you have in, I don't think the disability severance would be much at all. Years of service/pay matter in that computation. Might not be a lot if you get disability retirement for 30% of more either. Again, lawyers can help you do the math, so you know what to expect.

Others on this forum certainly will know more! Good luck!!

Thank you for the helpful insight! Regarding the post-op MRDP.. is 6 months the standard? I haven’t been able to find anything in regulation that gives a specific timeframe to reach MRDP, so I assume it is dependent on the individual, their injury, and the providers opinion. I don’t want to sit in a barracks twiddling my thumbs for another 6 months if I can avoid it.

 

[trommj]

The Army documents you probably want to look at and have handy are:
AR 635-40 (Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
DA PAM 635-40 (Procedures for Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
(635-40 is about to be republished. They are doing away with the DA PAM and just having one reg going forward)
AR 40-501 (Standards of Medical Fitness, dated 2019)
AR 40-502 (Medical Readiness, dated 2019)
DA PAM 40-502 (Medical Readiness Procedures, dated 2023)

The general definition is in AR 40-502 (pages 36-37 & also on Page 12):
"Medical Retention Determination Point
The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349–SG, section 4) and passing one aerobic ACFT event and perform the duties required of their MOS, grade, or rank."

So, the longest standard is the administrative Medical Readiness Determination Point (MRDP), which is 12 months.
The other one can be shorter and is provider-subjective - the clinical MRDP.
(see AR 40-501 Page 7).

Basically, a CDR or Provider observes/diagnoses a condition that does not meet retention standards. And that starts the 12-month clock. Basically, by putting you on a Temporary Profile. So, you can get help/treatment, and they can see if the condition improves or at least stabilizes. But you cannot be on Temp Profile longer than 365 days.

This is referenced in DA PAM 40–502 (page 18) when they talk about the duration of a Temporary Profile:
"Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected."

So that last sentence is KEY. You can reach MRDP earlier than 12 months: Once they have done all they can for your, if your provider still think you don't meet retention standards, they can say you reached clinical MRDP at any point prior to those 12 months. Up to the provider.

Then this is all the technical stuff from that point on....

Once at MRDP, they change the temporary profile to permanent. AR 40-502 (page 12):
"f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the significance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signatures. A physician approving authority will review all permanent “3” and “4” profiles. (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic ACFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349–SG, must be referred to DES in accordance with AR 635–40." (i.e., MEDBOARD).

If you look at Chapter 3 of AR 40-501 (Standards of Medical Fitness), it lists by body part all the conditions that do not meet retention standards. Usually when the provider starts the P3 or P4 profile at MRDP, they reference a specific section in this chapter.

There are the other two catch-alls mentioned in that Chapter (see bolded sentence above).

"... cannot perform any of the functional activities in section 4 in DA Form 3349–SG..." - Look at the profile form. It lists 5-6 functional activities. If the Provider says you permanently cannot do one of them, then P3/P4 and MEDBOARD (basically...you cannot "soldier" anymore).

"...cannot complete an aerobic ACFT event..." - You cannot do the run or any other alternate aerobic event. If on the profile form, they list you cannot permanently do those activities, then P3/P4 and MEDBOARD

But that really isn't all that important to you...whatever the reason the PCM starts you P3/P4...doesn't really matter much.
As long as your PCM believes you have reached your clinical MRDP (i.e., condition is stable, no further functional progress is expected, and you still don't meet retention standards), they can start you on the MEDBOARD journey. Need that second physician to approve it though.

 

[Wabbles]

The Army documents you probably want to look at and have handy are:
AR 635-40 (Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
DA PAM 635-40 (Procedures for Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
(635-40 is about to be republished. They are doing away with the DA PAM and just having one reg going forward)
AR 40-501 (Standards of Medical Fitness, dated 2019)
AR 40-502 (Medical Readiness, dated 2019)
DA PAM 40-502 (Medical Readiness Procedures, dated 2023)

The general definition is in AR 40-502 (pages 36-37 & also on Page 12):
"Medical Retention Determination Point
The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349–SG, section 4) and passing one aerobic ACFT event and perform the duties required of their MOS, grade, or rank."

So, the longest standard is the administrative Medical Readiness Determination Point (MRDP), which is 12 months.
The other one can be shorter and is provider-subjective - the clinical MRDP.
(see AR 40-501 Page 7).

Basically, a CDR or Provider observes/diagnoses a condition that does not meet retention standards. And that starts the 12-month clock. Basically, by putting you on a Temporary Profile. So, you can get help/treatment, and they can see if the condition improves or at least stabilizes. But you cannot be on Temp Profile longer than 365 days.

This is referenced in DA PAM 40–502 (page 18) when they talk about the duration of a Temporary Profile:
"Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected."

So that last sentence is KEY. You can reach MRDP earlier than 12 months: Once they have done all they can for your, if your provider still think you don't meet retention standards, they can say you reached clinical MRDP at any point prior to those 12 months. Up to the provider.

Then this is all the technical stuff from that point on....

Once at MRDP, they change the temporary profile to permanent. AR 40-502 (page 12):
"f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the significance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signatures. A physician approving authority will review all permanent “3” and “4” profiles. (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic ACFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349–SG, must be referred to DES in accordance with AR 635–40." (i.e., MEDBOARD).

If you look at Chapter 3 of AR 40-501 (Standards of Medical Fitness), it lists by body part all the conditions that do not meet retention standards. Usually when the provider starts the P3 or P4 profile at MRDP, they reference a specific section in this chapter.

There are the other two catch-alls mentioned in that Chapter (see bolded sentence above).

"... cannot perform any of the functional activities in section 4 in DA Form 3349–SG..." - Look at the profile form. It lists 5-6 functional activities. If the Provider says you permanently cannot do one of them, then P3/P4 and MEDBOARD (basically...you cannot "soldier" anymore).

"...cannot complete an aerobic ACFT event..." - You cannot do the run or any other alternate aerobic event. If on the profile form, they list you cannot permanently do those activities, then P3/P4 and MEDBOARD

But that really isn't all that important to you...whatever the reason the PCM starts you P3/P4...doesn't really matter much.
As long as your PCM believes you have reached your clinical MRDP (i.e., condition is stable, no further functional progress is expected, and you still don't meet retention standards), they can start you on the MEDBOARD journey. Need that second physician to approve it though.

Again, thank you so much for this info. It’s incredibly helpful for me. Unfortunately, it sounds like I will be sitting around twiddling my thumbs until my PCM declares I’ve reached an MRDP. I have a follow up with them this week so we’ll see how it goes.

 

[Wabbles]

The Army documents you probably want to look at and have handy are:
AR 635-40 (Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
DA PAM 635-40 (Procedures for Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
(635-40 is about to be republished. They are doing away with the DA PAM and just having one reg going forward)
AR 40-501 (Standards of Medical Fitness, dated 2019)
AR 40-502 (Medical Readiness, dated 2019)
DA PAM 40-502 (Medical Readiness Procedures, dated 2023)

The general definition is in AR 40-502 (pages 36-37 & also on Page 12):
"Medical Retention Determination Point
The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349–SG, section 4) and passing one aerobic ACFT event and perform the duties required of their MOS, grade, or rank."

So, the longest standard is the administrative Medical Readiness Determination Point (MRDP), which is 12 months.
The other one can be shorter and is provider-subjective - the clinical MRDP.
(see AR 40-501 Page 7).

Basically, a CDR or Provider observes/diagnoses a condition that does not meet retention standards. And that starts the 12-month clock. Basically, by putting you on a Temporary Profile. So, you can get help/treatment, and they can see if the condition improves or at least stabilizes. But you cannot be on Temp Profile longer than 365 days.

This is referenced in DA PAM 40–502 (page 18) when they talk about the duration of a Temporary Profile:
"Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected."

So that last sentence is KEY. You can reach MRDP earlier than 12 months: Once they have done all they can for your, if your provider still think you don't meet retention standards, they can say you reached clinical MRDP at any point prior to those 12 months. Up to the provider.

Then this is all the technical stuff from that point on....

Once at MRDP, they change the temporary profile to permanent. AR 40-502 (page 12):
"f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the significance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signatures. A physician approving authority will review all permanent “3” and “4” profiles. (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic ACFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349–SG, must be referred to DES in accordance with AR 635–40." (i.e., MEDBOARD).

If you look at Chapter 3 of AR 40-501 (Standards of Medical Fitness), it lists by body part all the conditions that do not meet retention standards. Usually when the provider starts the P3 or P4 profile at MRDP, they reference a specific section in this chapter.

There are the other two catch-alls mentioned in that Chapter (see bolded sentence above).

"... cannot perform any of the functional activities in section 4 in DA Form 3349–SG..." - Look at the profile form. It lists 5-6 functional activities. If the Provider says you permanently cannot do one of them, then P3/P4 and MEDBOARD (basically...you cannot "soldier" anymore).

"...cannot complete an aerobic ACFT event..." - You cannot do the run or any other alternate aerobic event. If on the profile form, they list you cannot permanently do those activities, then P3/P4 and MEDBOARD

But that really isn't all that important to you...whatever the reason the PCM starts you P3/P4...doesn't really matter much.
As long as your PCM believes you have reached your clinical MRDP (i.e., condition is stable, no further functional progress is expected, and you still don't meet retention standards), they can start you on the MEDBOARD journey. Need that second physician to approve it though.

Update: I saw my surgeon, who placed permanent restrictions on rucking, squatting, and deadlifting 2/mo post-op. I updated my PCM and have been placed on a permanent profile, which I can see in MEDPROS, and referred to the MEB. However, I spoke with the IDES coordinator today and they said that my MEB was denied because I have not reached MRDP and to follow-up with my PCM. She also mentioned typically needing to wait 6/mo post surgery for a MEB and to do physical therapy in the meantime. I started physical therapy last week.

I have an appointment with my PCM next week, but does this sound correct? I’m confused now because I thought the MEB referral/P3 was my PCM signaling I have reached “clinical" MRDP.

 

[trommj]

Sorry to hear.
As I mentioned, it does take 2 docs to get into MEB. PCM putting you in for P3/4 perm profile with referral to MEB, and MEB doc agreeing.

I would go back to PCM to ask if MEB doc gave any reasons why for denial? Maybe PCM can talk to/ask MEB doc? Might be you are only 2 months post op, and MEB doc feels PCM should wait till 3, 4, or 5-6 months post op for reaching clinical MDRP? I suppose it could be that you had a pre-existing injury on your back, but I would think they would let MEB/PEB determine all that as part of the process.

You may also want to consider talking to civ attorney in the area that deals with MEDBOARDs. Often you can a free 1/2 or hour consultation.

 

[Wabbles]

That makes sense. Sounds like my PCM did their part but the MEB doctor wants to see me recover longer/do physical therapy before making a final decision.. or at least thats what I think. I will ask my PCM what specifically the MEB doc is looking for regarding MDRP.

I don’t think the injury being pre-existing would factor in to the MEB docs decision at this point since the injury is documented as worsening during service and warranted a surgery but that’s just my guess.

This holding pattern is becoming incredibly taxing mentally so I’m really hoping they can get me an answer. I’ll update again when I know more. Again, I appreciate your input.

 

[Wabbles]

PCM confirmed I must wait 6 months post-op to be considered at MRDP and reconsidered for a MEB. So I will continue to hold until then.

 

[James wilson]

The Army documents you probably want to look at and have handy are:
AR 635-40 (Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
DA PAM 635-40 (Procedures for Disability Evaluation for Retention, Retirement, or Separation, dated 2017)
(635-40 is about to be republished. They are doing away with the DA PAM and just having one reg going forward)
AR 40-501 (Standards of Medical Fitness, dated 2019)
AR 40-502 (Medical Readiness, dated 2019)
DA PAM 40-502 (Medical Readiness Procedures, dated 2023)

The general definition is in AR 40-502 (pages 36-37 & also on Page 12):
"Medical Retention Determination Point
The MRDP is reached if a medical condition which has been temporarily profiled has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349–SG, section 4) and passing one aerobic ACFT event and perform the duties required of their MOS, grade, or rank."

So, the longest standard is the administrative Medical Readiness Determination Point (MRDP), which is 12 months.
The other one can be shorter and is provider-subjective - the clinical MRDP.
(see AR 40-501 Page 7).

Basically, a CDR or Provider observes/diagnoses a condition that does not meet retention standards. And that starts the 12-month clock. Basically, by putting you on a Temporary Profile. So, you can get help/treatment, and they can see if the condition improves or at least stabilizes. But you cannot be on Temp Profile longer than 365 days.

This is referenced in DA PAM 40–502 (page 18) when they talk about the duration of a Temporary Profile:
"Duration: The profiling provider will write the profile for the entire length of the expected recovery up to 90 days (except as directed in paras 4–8d (tuberculosis) and 4–9 (pregnancy)). The profiling provider will extend and modify the profile for the temporary condition, to communicate with the command, until the Soldier reaches the point in their evaluation, recovery, or rehabilitation where they have returned to full duty or the profiling provider determines that the Soldier has achieved the MRDP. MRDP may occur before the 12-month administrative timeline if the condition is stable and no further functional progress is expected."

So that last sentence is KEY. You can reach MRDP earlier than 12 months: Once they have done all they can for your, if your provider still think you don't meet retention standards, they can say you reached clinical MRDP at any point prior to those 12 months. Up to the provider.

Then this is all the technical stuff from that point on....

Once at MRDP, they change the temporary profile to permanent. AR 40-502 (page 12):
"f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the significance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signatures. A physician approving authority will review all permanent “3” and “4” profiles. (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic ACFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349–SG, must be referred to DES in accordance with AR 635–40." (i.e., MEDBOARD).

If you look at Chapter 3 of AR 40-501 (Standards of Medical Fitness), it lists by body part all the conditions that do not meet retention standards. Usually when the provider starts the P3 or P4 profile at MRDP, they reference a specific section in this chapter.

There are the other two catch-alls mentioned in that Chapter (see bolded sentence above).

"... cannot perform any of the functional activities in section 4 in DA Form 3349–SG..." - Look at the profile form. It lists 5-6 functional activities. If the Provider says you permanently cannot do one of them, then P3/P4 and MEDBOARD (basically...you cannot "soldier" anymore).

"...cannot complete an aerobic ACFT event..." - You cannot do the run or any other alternate aerobic event. If on the profile form, they list you cannot permanently do those activities, then P3/P4 and MEDBOARD

But that really isn't all that important to you...whatever the reason the PCM starts you P3/P4...doesn't really matter much.
As long as your PCM believes you have reached your clinical MRDP (i.e., condition is stable, no further functional progress is expected, and you still don't meet retention standards), they can start you on the MEDBOARD journey. Need that second physician to approve it though.

That breakdown actually makes a lot of sense, especially the part about MRDP and how the timeline can move earlier depending on the provider. A lot of people don’t realize it’s not always a fixed 12-month process.