Air Force MEB process and what entitlements to expect?

TWL1980

TWL1980

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Just got notified of MEB by the Air Force. I've been Active Duty for 13 yrs 7 months. The issue I have is my shin muscle has protruded thru my fascia tissue that incases the muscle and ligament ect. So can't complete the full 1.5 mile/a half PT test run. Surgery has been rated below a 50% success rate by 2 different off base orthopedic surgeons so Air Force don't want to complete the surgery. I have dealt with this for 4 years now being on waivers exempting me from the run and now the Air Force decided for MEB. My other leg just started the same issue right after my paperwork was sent from the PEBLO to the VA. Any info on what I have to look forward to would be helpful and what should I hope to happen besides hopefully the Air Force IPED will say return back to duty and be exempted from the run/walk of the PT test we have to do for the rest of my career which I don't see happening. Thanks
I am awaiting my VA interview for this issue.
 
Fascial hernia's could be a sign of exercise induced compartment syndrome, which would/could require multiple compartment release(s). They could also just be small hernia's. A leg doctor with experience in diagnosing and treating these is your best recourse for care and in this case your best recourse for a positive outcome.

The fact of the matter depends on a lot of information, such as, can you still deploy, can you still do your job/all aspects of your AFSC? Do you require medications that affect you in anyway etc. This could very well lead to a "fit for duty" determination if you can do everything else, and have no issues passing the rest of your PT test, then this helps your case, as well as depending on what rank you are etc.

IF you are found unfit with just fascial herniations, untreated, they will be rated at 10% each leg likely (depending on severity), and with bilateral factor applied still only equal 20%(22% rounded down). IF a doctor diagnosis compartment syndrome, then the rating will depend on the residuals of the surgery such as the amoutn of muscle damage/scarring, the actual scar and any nerve damage etc.

The general consesus is, you have to kinda figure out what you want the outcome to be and then plan and act accordingly, if you wanna fight to stay in, make sure your commander/supervision know this for when your letter is due, if you wanna get out, then make sure every single potentially rateable item is listed at your VA appointment so that you get your full exam etc.

Having seen case where both non surgical and surgical methods where completed, I can say that usually the outcome for just lower extremity exercise induce compartment syndrome rarerly result in a >30% rating unless there is multiple compartments on each leg and extensive inter-compartment pressures are demonstrated and noticeable muscle scaring and/or sloughing of the soft tissue (think big divots). The useal outcome for those not properly diagnosed and put out on just the fascial hernia's (which are never listed as such) is also less than 30%. So if your seeking retirement instead of severance, it will be a difficult fight.
 
Thanks for the info. Yes the issue occurred during my PT test in 2010. My MEB is only for my left leg only. But my right leg has started the same issue but not reported due to it just starting after my MEB was submitted. It only affects me after I been running for 1/2 mile and forces me to stop due to I have no flexibility in my ankle. But I have been experiencing back problems also I was going to have the VA check into and also report my right leg to VA along with acid reflux and head aches daily due to my back.

I'm looking for info if the VA only reports 10% just for the left leg but I gain more percentages to equal over 30% then the Air Force will only take the VA's 10% for the left leg and offer severance and I will get the remaining percentage of VA pension? My fight is trying to prove to them that this 1 leg issue doesn't effect my job and try to stay in till 15 years and apply for TERA so I can get my reduced retirement and claim my VA benefits verses a medical retirement since I will be less than a year by the time they reach the verdict of my outcome. Cause medical retirement sucks for me especially if the VA finds me at a low percentage. But correct me if I'm looking at it wrong thanks
 
My plan I would love to see in my eyes is if I can't get it approved to stay in and receive TERA which I should qualify in Jan 2016 which will be 8 or so months when all the final decisions on this MEB will be completed. If not I guess it would be better for me to get the lowest % to not qualify for medical retirement for my compartment syndrome on the one leg and hope with everything compiled will equal or exceed 60% from VA and accept the severance pay and move on down the road. I will come out with the most money and benefits for myself. So now this bumpy journey will begin.
 
Your best bet, is to get the treatments you can while on active, trust me, I have lived and reathed this stuff for years, and the new systems introduced on the outside are far worse than while your in. with that said, if you have not visited the VA yet MSC yet to list conditions etc. then you can list all conditions you suspect/have and after your VA exam your PCM will draft your NARSUM, this is what lists potential unfitting conditions, if they do not list all the conditions you think are unfitting you can appeal the narsum via an IMR (independent medical review) and if that doesnt come back with the additional conditions listed as potentially unfitting, you can attach a memo (btw this adds 2-3 weeks to the process). The memo goes to the PEB board, and is evidence of your complaint, they will review all conditions especially after they recieve the VA ratings. If you do not agree with those ratings, you can appeal for a fromal board or/and a one time review etc.

Now for the bad news, if you are in an MEB, any phase what so ever, you cannot apply for TERRA. Now if you chance it, and don't list much on your VA questionaire, and only go up for the one leg, you may get a fit finding and get to stay in until terra IF IT IS STILL AUTHORIZED AT THAT TIME, it can and does go away frequently, and my AFSC was never authorized it, the three times it appeared in the 17+ years i was in.

If I were to be in your shoes, knowing what I know now, and depending on your situation, I would push for them to find out why your having these issues(like I said chances are it exercise induced compartment syndrome, but Im not a doctor), trying to get those conditions fixed, and at the same time listing every condition i had possible, to get a full and fair examination, that you can use to fight your case for either outcome you so choose. For instance if you want to stay in, it may be that the surgeries would help you and leave you in less pain, so you can do your job, or if they do nothing to help you, you can state as such and fight to get the other stuff as unfitting and go for the 30% or greater. The main thing to remember is, no need to lie or embellish, tell the truth and fight for whichever outcome you want to occur. In todays downsizing Air force however, it may be that every minor conditin is suddenly unfitting and your shown the door as quickly as possible as I have seen things that people had 5 years ago and stay in with not even a med board, all of a sudden being called unfitting and people being booted.
 
I appreciate all the info you have shared. And I am awaiting my initial telephone interview with the VA for them to schedule my VA visit in Sacremento Ca. I hope the outcomes are in my favor to benefit me. I will post my results once I have them. Thanks again for the assistance from 1 TSgt to another.
 
Have you had the needle compression test? I went to my doctor for the same issue back in Mar/Apr 2014 and was just diagnosed with B/L Chronic Exertional Compartment Syndrome (CECS) on Tuesday. They had me do every test imaginable. I gave blood, X-Rays, Bone Scans, EMG, Cuff Test, Cuff Test After Exercise, Ct Scan, and FINALLY gave me the needle compression test. I was an immediate candidate for surgery since my pressures were so high. I also have asthma and haven't ran/walked a PT test in 7 years. My doc said it won't affect my career at all (I also have a desk job) unless the surgery doesn't work. I've also read about people having the same issue soon after their surgery, but I have two friends that both had the fasciotomy and they swear it's changed their life. Right now I'm planning to get the fasciotomy, then if doesn't work, then start looking at what my next options are.
 
(Weekend golfer)The Air Force hasn't done nothing but X-Ray, Ultra-sound, MRI, and all showed nothing but the spongy knot is visible without running. Then when I run it gets more firm and painful as crap which forces me to stop running. The last stop was off base orthopedic surgeon at my last duty station. With his recommendation the Air Force said don't do surgery due to its not effecting my everyday life except the PT test. So I recently PCS'd back overseas and met my new PCM and they did all the same follow ups X-ray and then straight to Navy Ortho Surgeon and same outcome. He didn't see but a 60% success rate long term without possible causing more issues in the future so he declined doing the surgery so he recommended IRILO and a permanent running waiver. So PCM processed the IRILO and got denied and now full MEB in process. My AFSC is civil engineer 3E171 (HVAC ). Right now I am the NCOIC of Readiness and the UDM so office job so I'm hoping for return to duty until I can submit for TERA in 16 months unless I can remain in for the full 20yrs.
 
Weekend golfer--- also quick question on your two friends who had this type of surgery. How did it change their life? Was it in a good way or bad way?
 
One friend is a Weapons Troop and has to walk the flight line. He said he can walk faster than he used to, and he can walk his whole shift. He said he was in the gym 3 weeks after surgery. He said he's also able to run the pt test when he couldn't before. My other friend (civilian) was so bad she couldn't walk from one store to another in the mall without having to sit down to take a break. Since her surgery she doesn't have that problem anymore, and has since picked up running. She also joined a Crossfit gym recently, and says she has no problems chasing her kids around the house anymore. Both swear by the surgery and are very glad they did it. My pain comes on after about 5 min of jogging. It's a done deal when I move from toe strike to heel-toe strike. The pain gets so bad I have to stop. The tops of my feet and toes go numb and I have to concentrate very hard to lift my toes. This is called "foot drop." My toes drag the ground and trip me up sometimes. Power walking is worse and brings on my pain in less than a minute. My ortho surgeon explained CECS like trying to blow up a balloon in a water bottle. The muscles have no room expand when they fill with blood during exercise. It's a very rare diagnosis, and he claims the success rate is more like 78%. He's only had 4 that complained about their symptoms a year after surgery.

I've complained about my calves for years, and doctors have always said "shin splints" with that condescending look like I'm just trying to get on a profile, then sent me home. It was my exercise physiologist who finally told me about CECS. I told him about my symptoms and he suggested I go get tested for CECS. If it weren't for him caring and actually listening to my problem, I'd probably still think that I just have really bad shin splints. I'm not a doctor, but if it's a bad problem for you now, more than likely, it will never go away without a release (if it is CECS). I'm at 14 years, and have a good shot to make MSgt. I agree with Twitch. I plan to try to get everything fixed on active duty while it's free. If it doesn't work, then I think I have a better shot at a medical retirement. My NEW PCM says that in her experience, people only get 10% per leg and is separated on 20%. After 14 years...20% and a separation is not good enough for my family and me! My career field isn't eligible for TERA since we are short on Tech's and MSgt's so I'm doing what I can to keep my retirement. Good luck brutha! Feel free to hit me up with any questions you have. I'll do my best to answer.
 
That gives me some good info to carry forward with me. Only question I have is it to late for me to request that type of surgery since my. MEB is all ready in the work and awaiting interview with the VA or do I go to the VA let them exam my whole body and let them hopefully justify it as fit for duty and them request surgery so it forces the Air Force to do the surgery or is it something I need to request on my own. My only fear is the Ortho docs here at Navy Hospital is telling me all this nonsense of not a easy surgery to heal from. But my compartment syndrome is in my shin area. So not sure if ours is the same. I'm afraid they will rate it like you said 20%. But my right leg has started doing the same thing so if they combine them it would be 40% VA I'm assuming and the. If they find the issues I'm having in my upper, mid, and lower back, my GERD, and daily headaches, along with a slight case of PTSD which I have never reported to the Air Force cause I was afraid to I'm just wondering if I could get a high enough VA percentage to cope with receiving the severance for the one leg that the MEB is for. So my personal outcome I would like to see is 20% DoD with severance pay and 60-70% VA. If not return to duty and let me finish my time out till TERA which I'm sitting at 13.7 yrs. and receive 35% DoD regular retirement and 50+% from VA. I would be satisfied with but yes a full 20 Would he nice but hard with our career field always cutting people with cutback cause of overmanned. Let me know your thoughts on my possible outcomes
 
Since the MEB has already started, I'm not sure what exact options you have. I think your chances of staying in (if that's what you want) are higher if your MEB paperwork shows that you are taking steps to get well. All I can speak for is my current situation. My PCM is helping me to avoid another MEB, but I already elected to have the surgery. She basically said it's really up to me whether I want to pursue separation/retirement by refusing treatment, or elect to have the treatment and stay in. If things go south after the surgery, then eventually it will be out of her hands and mine and I'll have to cross that bridge when I get there. I am also having some ongoing back pain. I just had an MRI and waiting for the results. My PCM and Chiro think I have a herniated disc. Again, she said I shouldn't worry as long as I am taking the necessary steps to get treated.

I went to the emergency room one night back in 2008 because I woke up and couldn't breath. They had me do a methacholine challenge and I tested positive for adult onset asthma. Everyone had me all freaked out and it wasn't a big deal at all. My MEB was fast tracked, returned to duty within 2 weeks with a stupid assignment code. (I say stupid because I can't deploy, but I've deployed before.) I chose to get treated and did everything my doc asked of me. I went to my commander and explained my situation. He knew I wanted to stay in and helped me fight to stay in. If I hadn't fought to keep my job, I'm sure things would have went different. My best advice is go with your instincts. I have CECS in both legs on both sides of my shins. The rating is per leg which is usually 10% based on what my PCM stated. That's a total of 20% for both legs, not one. I also saw on here last night a guy stated he got 20% per leg and was like a 14 Tech if my memory serves me. I don't know if he had the surgery or not, but that's good news to read.

EOD MSgt Joseph Deslauriers who lost both legs and an arm and is still active duty. I think it really just depends on how much you want to put up with the BS to stay in. It's a scary situation and affect our whole family...I know how you feel. Good luck, man. Please keep me posted on your situation as I'll keep you updated with mine. Wish you all the best.
 
Thanks for the info. I'm trying to stay in and apply for TERA since this issue has become and issue. I would come out with better overall money results with TERA if they don't elect me back for full duty and stay in for 20 yrs. My PCMs have done nothing for further treatment. They never sent me for pressure tests or nothing. They been giving me waivers for to exempt me from my PT test running portion. That's all and that's why I'm not happy with this MEB. I feel my PCMs have screwed me. I been following everything they told me to do and this is what I get. So I'm not happy with this. I will defiantly keep you posted as I speak to my PEBLO on other routes before they send me to the VA in Sacremento CA for my full exam. I am sure they will find me unfit for my one leg that the MEB is for. Only issue I have is my right leg is doing the same but never reported it and now back issues along with GERD. So I'm not sure how the Air Force will see it once the report is back. So thanks for the luck and good luck to you. Chat ya later
 
Well man after a brief interview with my PCM it looks like the tides are turning. Now, they are considering me for a MEB. She suggested that I rethink my surgery as the success rate is so low, just as you stated. Not sure what to think anymore. She told me to start preparing for the worst and looking at my next career options. My condition is scheduled to be reviewed, then I'll find out if they are going to go through the MEB or not. I hate how little of information they give you on this stuff. I'll find out more next month during my follow up
 
We'll I leave tomorrow to Sacramento to the VA for my exams. I just met with my PCM to get my sleep study and back MRI results and didn't get to hear on the way I interpreted the results. The sleep apnea study came back with the sleep study doctor recommend me for a. CPAP machine using a 9.0 cm level. My PCM said it stated I didn't have sleep apnea that it said to conduct sleeping exercises to where I don't sleep flat of my back cause that's when the sleep apnea is the worse. PCM told me to sleep with a pockets tee shirt on and put a tennis ball in the pocket to keep me from sleeping on my back or other ways to keep on my side thru the night which doesn't make since to me at all. When I go to sleep I don't know how I sleep till I wake up. And my back MRI showed a bright highlighted benign hemangioma is my #6 vertebrae of my thoracic spine. Which is blood vessels knotted up in my back but they said that isn't the cause of my back pain and nothing to worry about but I beg the differ. So my 14 yrs of the AF is going down the drain. Without being rated on sleep apnea unless the VA looks at the record different might get me the 50% sleep apnea/hypopnea then I can kiss any compensation good bye and I will get booted with no benefits which sucks for all the blood sweat and tears I have poured into the Air Force along with 3 deployments and sacrifices I have made. So I feel your pain with the leg issues.
 
TWL1980 said:
We'll I leave tomorrow to Sacramento to the VA for my exams. I just met with my PCM to get my sleep study and back MRI results and didn't get to hear on the way I interpreted the results. The sleep apnea study came back with the sleep study doctor recommend me for a. CPAP machine using a 9.0 cm level. My PCM said it stated I didn't have sleep apnea that it said to conduct sleeping exercises to where I don't sleep flat of my back cause that's when the sleep apnea is the worse. PCM told me to sleep with a pockets tee shirt on and put a tennis ball in the pocket to keep me from sleeping on my back or other ways to keep on my side thru the night which doesn't make since to me at all. When I go to sleep I don't know how I sleep till I wake up. And my back MRI showed a bright highlighted benign hemangioma is my #6 vertebrae of my thoracic spine. Which is blood vessels knotted up in my back but they said that isn't the cause of my back pain and nothing to worry about but I beg the differ. So my 14 yrs of the AF is going down the drain. Without being rated on sleep apnea unless the VA looks at the record different might get me the 50% sleep apnea/hypopnea then I can kiss any compensation good bye and I will get booted with no benefits which sucks for all the blood sweat and tears I have poured into the Air Force along with 3 deployments and sacrifices I have made. So I feel your pain with the leg issues.
Click to expand...

Welcome to the PEB Forum! :)

In retrospect, I was officially diagnosed the medical condition OSA with mandated CPAP machine while on active duty several years ago. Indeed, I have pre-surgery severe lumbar issues/challenges/problems and post-surgery severe lumbar issues/challenges/problems along with other physical medical conditions; therefore, using the CPAP machine continues to be a huge challenge at this point!

Hmm, I read a potential conflict of verbiage within the Sleep study. :confused: In that, as based on the comments in the Sleep study "...sleep study doctor recommend me for a. CPAP machine using a 9.0 cm level" albeit your PCM commented that the Sleep study stated "...I didn't have sleep apnea...to conduct sleeping exercises to where I don't sleep flat of my back cause that's when the sleep apnea is the worse." It seems that the Sleep study made a suggestion as to a method to potentially minimize the sleep apnea symptomatology at this point!

Moreover, do you have a copy of the official Sleep study? If not, I would strongly suggest that you obtain a copy then read the document from cover-to-cover for yourself! In my opinion, if the medical evidence shows/validates an official diagnosis of Sleep Apnea and the mandated use of the CPAP machine, I wouldn't foresee a concern with the DoVA D-RAS to military service-connect and award a DoVA 50% proposed rating!

Lastly, please remain "positively proactive" while in the DoD IDES MEB/PEB process and never default acceptance to any injustices; fight then continue to fight some more until receipt of your desired expectations supportive via medical evidence and/or medical documentation! Take care and enjoy life! :cool:

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
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