Anxiety Disorder not a boardable condition?

A

Airforcematt

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My NARSUM is in the process of being re-written. One of the conditions listed is "Anxiety with depressive mood" - I feel that since the anxiety is causing me significant issues in the workplace and at home that it qualifies as a boardable condition. I sent my PCM an email about this and he sent me the below response.

Yes, I have spoken with [Mental Health Doctor] and he said that anxiety is not a
boardable condition. Only major depression or psychosis.

V/R

PCM
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As I understand AFI 38-123 section 5.3.12 Anxiety IS a boardable condition if it's having an effect on your work AND/OR if it's a recurring problem (both true in this case)

Can anyone who's seen something similar confirm/deny this for me?
 
Afmatt,

My PEB, for 'Anxiety Disorder', wrote the following:

2. The PEB found that the following conditions, although medically unacceptable, are not unfitting, independently or combined:

a. Anxiety Disorder (MEB Dx2 ) is not unfitting.

Since it is not unfitting, I don't even know if I get a military rating for it. This is another one of those interesting conditions. Anyone else know?

On my 3947, it is written as follows:

2. Anxiety Disorder, Not otherwise specified (IAW AR 40-501, 3-33)

VA Dx: Posttraumatic Stress Disorder, mild

So, the military has it as Anxiety Disorder and the VA has it as PTSD. What is interesting is I have the LOD for PTSD, have been diagnosed thru the Army for PTSD, but the MEB doctor (after a 5 minute interview) changed PTSD to Anxiety Disorder (despite my wishes).

We'll see what happens.

Draco
 
PtDraco said:
Afmatt,

My PEB, for 'Anxiety Disorder', wrote the following:

2. The PEB found that the following conditions, although medically unacceptable, are not unfitting, independently or combined:

a. Anxiety Disorder (MEB Dx2 ) is not unfitting.

Since it is not unfitting, I don't even know if I get a military rating for it. This is another one of those interesting conditions. Anyone else know?

On my 3947, it is written as follows:

2. Anxiety Disorder, Not otherwise specified (IAW AR 40-501, 3-33)

VA Dx: Posttraumatic Stress Disorder, mild

So, the military has it as Anxiety Disorder and the VA has it as PTSD. What is interesting is I have the LOD for PTSD, have been diagnosed thru the Army for PTSD, but the MEB doctor (after a 5 minute interview) changed PTSD to Anxiety Disorder (despite my wishes).

We'll see what happens.

Draco
Click to expand...

Interesting... I also think what I'm dealing with is PTSD - not anxiety, saw a civilian psychiatrist while I was in the states on leave and She diagnosed me with PTSD. The military psychiatrist disagrees quite strongly and went as far as to tell me I could have gotten in trouble for seeking care outside the military (I paid for the visit out of pocket)

Are you appealing the change from PTSD to Anxiety? Let me know how it goes.
 
Did some further digging into AFI 48-123 - quotes below, emphasis is mine.


5.3.12. Axis I Diagnosis, and Other Mental Conditions. MEB is indicated in those
instances when a mental health condition precludes satisfactory performance of duty [I'm currently not allowed to work unsupervised due to my Anxiety] or
worldwide assignability or deployment. An MEB must be done when a condition has caused
or is expected to cause significant duty impairment or limitations for greater than one year
and for conditions in which there is recurrent impairment [This has been an issue since 2008] or recurrent impairment is
expected

5.3.12.2. Mental conditions requiring MEB:
5.3.12.2.1. Conditions that are expected to have persistent duty impairment (more
than 1 year despite treatment).
5.3.12.2.2. Conditions associated with recurrent duty impairment (2 or more episodes
of impairment in 12 months).
5.3.12.2.3. Conditions which require continuing psychiatric support (e.g. weekly
psychotherapy in order to function) beyond one year.
5.3.12.2.4. Conditions requiring use of lithium, anticonvulsants, or antipsychotics for
mood stabilization.
5.3.12.2.5. Individuals who experience recurrent depression or anxiety disorders, [Again, I was seen for this in 2008, dealt with it on my own for a couple years then seen here for it the past few months as it started reaching a level I couldn't handle on my own]
require psychiatric medication for greater than one year, who have been hospitalized
for a psychiatric condition, require an evaluation by a military mental health provider.
These cases warrant careful consideration of fitness for duty, worldwide assignability
and deployability, given that adequate mental health support may not be available in
all locations. Serious psychiatric illnesses (refer to criteria in 5.3.12.2.1-4 above) that
result in hospitalization require a MEB. For ANG members on long-term
antidepressant maintenance therapy even if asymptomatic or in remission, a WWD
evaluation must still be forwarded to ANG/SGPA for consideration
Click to expand...

Is there any other relevant regulation where I can find more information about what is considered fit/unfit for the USAF and/or DOD? Any other USAF folks been down this road before?
 
afmatt said:
Did some further digging into AFI 48-123 - quotes below, emphasis is mine.




Is there any other relevant regulation where I can find more information about what is considered fit/unfit for the USAF and/or DOD? Any other USAF folks been down this road before?
Click to expand...
DoDi 1332.38.........scroll down towards the bottom.

Also, depending on your MOS you might need to look at the regs (flight surgeon handbook is one example) for your MOS if it's aviation, dive duty, etc.
 
pittpan2005 said:
DoDi 1332.38.........scroll down towards the bottom.

Also, depending on your MOS you might need to look at the regs (flight surgeon handbook is one example) for your MOS if it's aviation, dive duty, etc.
Click to expand...

Good advice. Thanks. Did some more digging and found that Anxiety is actually listed as unfitting for my career field. Putting together an email to my PCM now to refute what my MH provider told him. We'll see what he has to say.
 
afmatt, FYI I was boarded with Anxiety as a failing claim...
 
grizz13 said:
afmatt, FYI I was boarded with Anxiety as a failing claim...
Click to expand...

Thanks. The crux of what is going sideways with my process thus far seems to be the "one" guy at MH. Thankfully my PCM has been great through all this - hopefully he'll help the MH provider see reason when I email him quoting regulations chapter and verse.
 
All you can do is be the squeaky wheel right now, besides it's not the MH docs position on how to rate things... It's the big DoD and VA not little 'ol him!
 
Okay - so I received a response from the psychiatrist here on base. Don't feel comfortable putting the whole response in here but I will a quote a few parts/key points from it as I could use some feedback on how to proceed.

Point #1
...Your Axis I diagnosis is "Adjustment Disorder with Anxiety and Depressed Mood", or "Anxiety Disorder NOS", neither of which are diagnoses that would require an MEB. The psychiatric medical board would kick back a MEB that has a basis on a "NOS" or "Not otherwise specified" diagnosis, because by definition in the DSM-IV TR the diagnosis is used when there is a symptom present but it does not meet criteria for an Axis I Anxiety Disorder.
Click to expand...

Ugh. The Adjustment Disorder crap again. I know that "Anxiety Disorder NOS" has been used as a med board by some folks on here - anyone have any thoughts on how I can prove that to him as a fact? Perhaps I can find an appeals case related to it - will have to do some digging...

Point #2
He goes on to talk about Unfitting vs Unsuiting conditions and basically say this is a case for the VA, not for the military to decide.
As it stands, Adjustment Disorders (either with depression or anxiety or both) are actually categorized as "Unsuiting Diagnoses" which would require administrative action (ie. Separation, not medical retirement) if your command felt that you were unable to perform your tasks due to that diagnosis alone. In your situation, I would not recommend a psychiatric MEB, and I do not believe your diagnosis is Unfitting for Military Duty. Therefore, it will not be added to your NARSUM that is being written by Dr. XYZ. That being said, if you are meeting with a formal board and they recommend medical retirement, a VA evaluation would take your psychiatric diagnosis into account when they come to a decision regarding your VA service connection.
Click to expand...

I did some research in a copy of the DSM IV-TR (Wife is a Psyc student) and REALLY don't feel like I should fall under adjustment disorder, it simply doesn't fit.

All that said I have a question (and I'll probably post this one in the general MEB forum under it's own thread cause it's significant)
I'm currently going through the MEB on the base level. It's VERY informal - I haven't had to sign any paperwork or had any sort of a inbrief with my PEBLO. Is the NARSUM that has been written for this point in the process the ONLY chance I'll have to get my mental health issues listed as potentially unfitting or will I have another chance after my C&P exams to have it listed? Frustrated with the lack of clarity in the process and trying to figure out if I should push for an IMR now or if it should come later down the line.
 
You can go through the PCBR after you get out, but is it really worth fighting the DoD for it? Most likely you would be placed on TDRL and have to deal with the military for up to 5 more years... If you feel that it is such a claim that is suspected as a "Fails to Meet Retention Standards" you should do an IMR as soon as you get your NARSUM.

I am just asking the question to ensure you are thinking clearly on the subject... No offense Matt.
 
PtDraco said:
Afmatt,

My PEB, for 'Anxiety Disorder', wrote the following:

2. The PEB found that the following conditions, although medically unacceptable, are not unfitting, independently or combined:

a. Anxiety Disorder (MEB Dx2 ) is not unfitting.

Since it is not unfitting, I don't even know if I get a military rating for it. This is another one of those interesting conditions. Anyone else know?

On my 3947, it is written as follows:

2. Anxiety Disorder, Not otherwise specified (IAW AR 40-501, 3-33)

VA Dx: Posttraumatic Stress Disorder, mild

So, the military has it as Anxiety Disorder and the VA has it as PTSD. What is interesting is I have the LOD for PTSD, have been diagnosed thru the Army for PTSD, but the MEB doctor (after a 5 minute interview) changed PTSD to Anxiety Disorder (despite my wishes).

We'll see what happens.

Draco
Click to expand...
When the VA and Army diagnosis for me did not match I had to go back and be reevaluated by the Army to get an actual diagnosis mine was the same way.....
 
grizz13 said:
You can go through the PCBR after you get out, but is it really worth fighting the DoD for it? Most likely you would be placed on TDRL and have to deal with the military for up to 5 more years... If you feel that it is such a claim that is suspected as a "Fails to Meet Retention Standards" you should do an IMR as soon as you get your NARSUM.

I am just asking the question to ensure you are thinking clearly on the subject... No offense Matt.
Click to expand...

No offense taken - good questions :)
The "Potentially Unfitting" condition I'm being boarded for is my back, I have Degenerative Disc Disease and am on a waiver for pretty much everything. The reasoning I'm fighting for them to add the mental issues is that I feel very strongly that they came about as a result of my service. I don't want to go into specifics - that a bit personal but I think they are trying to dodge retiring me by not referring my MH issues and giving me <30% rating for my back. TDRL is not ideal - however with the plans I have moving forward and with my medical issues I'd prefer to have Tricare and a retirement + base access than a severance and kick in the pants on the way out the door.

All that said, today I did what I should have done a couple days ago and called the JAG/Area Defense Counsel and spoke with them about where I am. At this point the ADC says that I don't "formally" have a leg to stand on and raising any more of a stink will just hurt me by possibly prejudicing the members of the local board against me. They did say however that once my package has been looked at and met the board that they will help me file for an appeal based on the fact that not all of my current conditions were listed on my NARSUM with full clinical data IAW DODI 1332.38 quoted below.


DODI E3.P1.2.3 Content. MEBs, TDRL physical examinations, and Reserve component physical
examinations shall document the full clinical information of all medical conditions the Service
member has and state whether each condition is cause for referral into the DES. (See enclosure
4 of this Instruction.) Clinical information shall include a medical history, appropriate physical
examination, medical tests and their results, medical and surgical consultations as necessary or indicated, diagnoses, treatment, and prognosis. MEBs shall not state a conclusion of unfitness
because of physical disability, assignment of disability percentage rating, or the appropriate
disposition under Chapter 61 of 10 U.S.C. (reference (b)).
Click to expand...

Based on the above quote and the email I have from the MH provider stating he would not add it because it was unfitting + The civilian diagnosis I have for PTSD + Whatever documentation that comes out of the IMR I feel like I stand a decent chance of having my issues added. Just frustrating that I have to jump through these hoops...
 
maparker said:
Have you claimed this condition with the VA? Are you in the IDES?

Mike
Click to expand...

Not in IDES yet Mike - just at the MEB process at the local level.
 
PtDraco said:
Afmatt,

My PEB, for 'Anxiety Disorder', wrote the following:

2. The PEB found that the following conditions, although medically unacceptable, are not unfitting, independently or combined:

a. Anxiety Disorder (MEB Dx2 ) is not unfitting.

Since it is not unfitting, I don't even know if I get a military rating for it. This is another one of those interesting conditions. Anyone else know?

On my 3947, it is written as follows:

2. Anxiety Disorder, Not otherwise specified (IAW AR 40-501, 3-33)

VA Dx: Posttraumatic Stress Disorder, mild

So, the military has it as Anxiety Disorder and the VA has it as PTSD. What is interesting is I have the LOD for PTSD, have been diagnosed thru the Army for PTSD, but the MEB doctor (after a 5 minute interview) changed PTSD to Anxiety

Disorder (despite my wishes).

Hmmmm. We were talking one day about members having their diagnosis changed in order to reduce compenstion and my psychiatrist told me that nobody could change my PTSD to adjustment disorder or anything else without going through her. It seems to me that the doc that made the PTSD diagnosis should be notified/involved. Maybe this is where you should begin. Good luck with this. I think the MEB doctor did you wrong and this is a battle that was already fought and lost in Washington state when all those PTSD diagnosis were reduced to Adjustment Disorder in order to control compensation for diagnosis. It was a big thing and largely published. Do you have a psychiatrist or therapist?


Draco
Click to expand...
 
MEB results are back and I'm formally referred to IDES/the PEB. Mental issues have one line on the document and they're not in the "Potentially Unfitting Diagnosis" section. I'm going to file for an IMR tomorrow and use the IMR + the rebuttal to try and get it added before the NARSUM goes to the PEB.

Any suggestions\advice from folks who have been down this road before?

Right now I have an MFR written up that quotes the DOD regulation talking about the fact that all conditions should be covered with full diagnostic data + the fact that even if a condition by itself may not be enough to be unfitting if it stands alone if it's making/being made worse by another unfitting claim then it should be rated by the DOD. I also specifically reference my mental health issues and ask them to take a look at it. Toying with the thought of trying to get the tendon issues in my feet added/rated too but they just started hurting a couple weeks ago. My PCM has been awesome through all of this - hope he doesn't take exception to the IMR :/

Also got a MFR finished up today with my OIC detailing how my issues are impacting my work. I wrote the draft, he polished it up and signed it. Not sure if I can get it in the PEB file but I'm sure going to try!
 
Appealing is your best option, but don't get stressed out if the MEB does not add it to your NARSUM as a "fails to meet retention standards". It would be great if they did, but that appeal serves a much greater purpose. It puts all that information about your MH stuff in front of the PEB and makes them aware of it. Your appeal, along with their response will go up with your packet.

Remember, the MEB does not decide whether you are fit, or unfit, the PEB does. Furthermore, they are not allowed to word things to say you are fit or unfit. The appeal and the IPR are going to be great in your situation. Think of it as building a great foundation for the case you are building. You may not get answers you agree with along the way, but if you keep good documentation and exercise your rights, that stuff will help later.

Lastly, remember to be respectful and use tact when dealing with people you disagree with. There is no better way to drop a hammer on yourself than getting into altercations with Drs or medical personnel.
 
ranger2992 said:
Appealing is your best option, but don't get stressed out if the MEB does not add it to your NARSUM as a "fails to meet retention standards". It would be great if they did, but that appeal serves a much greater purpose. It puts all that information about your MH stuff in front of the PEB and makes them aware of it. Your appeal, along with their response will go up with your packet.

Remember, the MEB does not decide whether you are fit, or unfit, the PEB does. Furthermore, they are not allowed to word things to say you are fit or unfit. The appeal and the IPR are going to be great in your situation. Think of it as building a great foundation for the case you are building. You may not get answers you agree with along the way, but if you keep good documentation and exercise your rights, that stuff will help later.

Lastly, remember to be respectful and use tact when dealing with people you disagree with. There is no better way to drop a hammer on yourself than getting into altercations with Drs or medical personnel.
Click to expand...

Good reminder on the tact - I'm struggling to keep from being angry but I have a good relationship with my providers right now (at least on the surface) and I intend to keep it that way. Keep reminding myself what my mentor taught me years ago - never write with emotion & stick to the facts/regulations and everything will be alright.

So today it came out that the PEBLO mis-informed me. The "MEB" that he said was complete is not. My Review in Lieu Of (RILO) "MEB" is finished. I will now be sent to the states TDY to a VA hospital. Once I do that THEN my formal NARSUM will be written and I'll have a chance to take advantage of the IMR. He is new to the whole process so it doesn't really bother me but I'm sure glad I pretty much have the AFI's/DOD regs memorized. Supposed to have my telephone interview with my VA MSC in a couple weeks. Now the waiting game begins...
 
Today I got my complete medical records I requested a month ago. After reviewing themI'm really freaking out a bit - among other issues my mental health summaries make me sound like I'm simply over-reacting to stress. Despite the fact that I have an email FROM the doc that's handling my meds at Mental Health saying my diagnosis is "Anxiety NOS" all my records talk about is stress and a "Adjustment Disorder". I seriously want to throw something right now. If I'm just stressed why the heck am I on two different medications for anxiety and a third so I can sleep through the night without waking up in fear that something is wrong? Argggggghhh!!!

Moving forward my plan is to seek MH care via skype outside the military somehow. Already asked for a referral through tricare and was shut down since there is mental health available on base... I'm also going to start writing notes about my sessions and condition in a journal-ish document. Think I'll take it to legal and have it notarized every week or so.
 
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