Hello. I am an active duty Marine infantry officer with 11.5 years in service. Any advice or wisdom is greatly appreciated.
I had surgery to repair a ruptured achilles on 1 Aug 2022. I had the same PCM from the time of the incident until May of 2023. He was a civilian who PCS'd with his active duty spouse last month (May 2023). My first LIMDU period went from 1 Aug 2022 to 1 Feb 2022 according to the AMEBR paperwork which I have in my possession and indicates a "good to excellent" clinical prognosis/ability to return to fully deployable. My PCM put me on a second 6 month period of LIMDU and prior to departing he told me he completed the paperwork to have my LIMDU expire just shy of the 12 month mark, on 28 July 2022.
Later, I inquired about the LIMDU status with my local deployability coordinator who told me to bring a NAVMED 1300/3 to my next meeting with a PCM.
When I saw the PCM, prior to presenting the NAVMED for signature to get off LIMDU, I told her I needed a refill of hydrocodone 5mg x 30 pills to have on hand in case of flare ups. I revealed that I had a flare up after taking leave and a 6 hour commercial flight which more or less incapacitated me for a week, that I like to have this prescription on hand for such circumstances. My back has been worse since the achilles injury, I think this is because I haven't been able to exercise to the extent that I need to in order to maintain strength. IHer notes of the meeting indicated with regards to my back that "this has been a long term strategy without clear goals or monitoring in place (5 opiod fills of varying strength and number in the last 1 year)"
My most recent MRI on my back (Apr 2022) showed the following:
The PCM noted that she "did not clear [me] from LIMDU at this time for Achilles tendon rupture. Overall suspect limited duty would also be indicated in the long term for severe chronic low back pain with known anatomic correlates, lack of definitive treatment to date and ongoing treatment with opioids."
I tried to explain to her that I work a desk job right now, that I finished company command with no significant physical issues (aside from having opiods for lower back flare ups) prior to coming to this job, and I am certain to be in a desk job for the next 3 years after I PCS in September. She nonetheless refused to sign the paperwork to clear me of LIMDU under the auspices of protecting me from hurting myself.
I ran a partial PFT due to my LIMDU status earlier this month (June 2023), exempted from the 3 mile run. I achieved the maximum score on the pull ups and timed plank.
I guess my questions are as follows:
1. Can the doctor refuse to clear me from LIMDU that was assigned for my Achilles tendon because in her judgement I should be on LIMDU for my back pain?
2. Does it not matter if I can easily complete the requirements of my rank/grade and billet?
3. What are the implications of having a LIMDU status for greater than 12 months?
This sort of "care" that the new doctor provided me with makes me want to withhold revealing that I occasionally have back pain. I am now concerned that I could be medically forced out of the USMC before I am ready to depart.
For what its worth, I am currently attending an in residence master's degree program with a 4 year service commitment that will bring me to 16 years of service, I have two kids under 2 years old, and a stay at home spouse who is a 1st grade teacher by trade.
I'm open to elaborate further if necessary. Any input or wisdom is greatly appreciated.
I had surgery to repair a ruptured achilles on 1 Aug 2022. I had the same PCM from the time of the incident until May of 2023. He was a civilian who PCS'd with his active duty spouse last month (May 2023). My first LIMDU period went from 1 Aug 2022 to 1 Feb 2022 according to the AMEBR paperwork which I have in my possession and indicates a "good to excellent" clinical prognosis/ability to return to fully deployable. My PCM put me on a second 6 month period of LIMDU and prior to departing he told me he completed the paperwork to have my LIMDU expire just shy of the 12 month mark, on 28 July 2022.
Later, I inquired about the LIMDU status with my local deployability coordinator who told me to bring a NAVMED 1300/3 to my next meeting with a PCM.
When I saw the PCM, prior to presenting the NAVMED for signature to get off LIMDU, I told her I needed a refill of hydrocodone 5mg x 30 pills to have on hand in case of flare ups. I revealed that I had a flare up after taking leave and a 6 hour commercial flight which more or less incapacitated me for a week, that I like to have this prescription on hand for such circumstances. My back has been worse since the achilles injury, I think this is because I haven't been able to exercise to the extent that I need to in order to maintain strength. IHer notes of the meeting indicated with regards to my back that "this has been a long term strategy without clear goals or monitoring in place (5 opiod fills of varying strength and number in the last 1 year)"
My most recent MRI on my back (Apr 2022) showed the following:
- Degenerative disc disease (L4-5, L5-S1)
- Disc dehydration
- Disc height loss
- Anterior spondylosis
- Endplate marrow change
- Endplate edema
- Vertebral body edema
- Facet arthropathy with retrolisthesis (L4-5, L5-S1)
- Canal stenosis
- Foraminal narrowing
- Lateral recess narrowing
- Broad based bulge with bilateral protrusions contacting L4 nerve roots
- L2-3 – Circumferential bulge, mild-to-moderate neural foraminal narrowing
- L3-4 – Broad-based bulge with moderate bilateral foraminal narrowing with narrowing of lateral recesses
- L4-5 – Broad-based bulge and facet arthropathy with mild-to-moderate canal stenosis narrowing the lateral recesses. Severe bilateral neural foraminal narrowing with bilateral protrusions with contact of the exiting L4 nerve root
- L5-S1 – Broad-based bulge with central protrusion and annular fissure with mild-to-moderate canal stenosis, narrowing the lateral recesses, contacting the S1 nerve roots, with severe bilateral neural foraminal narrowing with bilateral protrusions contacting the exiting L5 nerve roots.
The PCM noted that she "did not clear [me] from LIMDU at this time for Achilles tendon rupture. Overall suspect limited duty would also be indicated in the long term for severe chronic low back pain with known anatomic correlates, lack of definitive treatment to date and ongoing treatment with opioids."
I tried to explain to her that I work a desk job right now, that I finished company command with no significant physical issues (aside from having opiods for lower back flare ups) prior to coming to this job, and I am certain to be in a desk job for the next 3 years after I PCS in September. She nonetheless refused to sign the paperwork to clear me of LIMDU under the auspices of protecting me from hurting myself.
I ran a partial PFT due to my LIMDU status earlier this month (June 2023), exempted from the 3 mile run. I achieved the maximum score on the pull ups and timed plank.
I guess my questions are as follows:
1. Can the doctor refuse to clear me from LIMDU that was assigned for my Achilles tendon because in her judgement I should be on LIMDU for my back pain?
2. Does it not matter if I can easily complete the requirements of my rank/grade and billet?
3. What are the implications of having a LIMDU status for greater than 12 months?
This sort of "care" that the new doctor provided me with makes me want to withhold revealing that I occasionally have back pain. I am now concerned that I could be medically forced out of the USMC before I am ready to depart.
For what its worth, I am currently attending an in residence master's degree program with a 4 year service commitment that will bring me to 16 years of service, I have two kids under 2 years old, and a stay at home spouse who is a 1st grade teacher by trade.
I'm open to elaborate further if necessary. Any input or wisdom is greatly appreciated.
