Army Doc needs advice

Good Morning my fellow peers. I just wanted to get some advice regarding my status through this MEB process. I am currently a specialty doc in the Army. I have currently been active duty for 11yrs. I was debating on staying in the military however felt that I could not keep up with the pace of things. So my husband and I then believed it was time to seperate once my obligation was up. Long and behold on my terminal leave I was diagnosed with a very rare and debilitating autoimmune condition. Which in hind site is likely the cause of my fatigue and exhaustion. I was then advised that I need to go through a medical board. By the grace of God my active duty orders were extended and I started the IDES process. I completed the MEB process and was found medically unfit secondary to 3 unfitting conditions and have a permanent P3 profile. Then I started the PEB process and in two weeks I was found to be fit. Reviewing my 199 it looks like a cut and paste of my OER which was completed prior to my start of symptoms and diagnosis. Since this diagnosis I have been on con leave for the past 4 months. I still have symptoms and just coming off con leave I still have physical restrictions. I am also going through physical therapy. I know I am a doc but I am very concerned if I will be able to keep the pace of my duties. I do not feel at this point I can work a full time job on the civilian side with all my current side effects . My lawyer thinks I should appeal however I keep hearing that Doctors will always be found fit as our mos is mostly thinking??? But you have to realize we work long hours. My meds cause insomnia and difficulty with concentration. And I am experiencing a lot of fatigue. I have always pulled my weight as a soldier and a Doc but since this rare disease diagnosis I am afraid for my future occupation as a doc. If anyone has some insight or advice it would be deeply appreciated. I would hate to appeal if it will not work out in my favor to be found unfit so I have some protection for my family as I am the sole provider.
 
Request a Formal PEB...

Only thing that is concerning to me is that you mentioned that you are just coming off of con leave and are going through physical therapy. This would indicate that your condition(s) are not stable and could potentially change in the future.

If the Army continues to find you fit for duty after the formal PEB, request to transfer to a WTU while you continue to rehabilitate.
 
@michi418,

Welcome to the PEBFORUM!!

I am sorry to hear of your health problems and the issues with your military career.

You indicate that you have an attorney, so, understand that we do not offer legal advice here and we cannot second guess or now the full details of your case that you attorney has reviewed.

That said, I can offer a few comments.

Good Morning my fellow peers. I just wanted to get some advice regarding my status through this MEB process. I am currently a specialty doc in the Army. I have currently been active duty for 11yrs. I was debating on staying in the military however felt that I could not keep up with the pace of things. So my husband and I then believed it was time to seperate once my obligation was up. Long and behold on my terminal leave I was diagnosed with a very rare and debilitating autoimmune condition.

If I understand correctly, you were referred through the IDES process while on terminal leave. Given your post (and some of the below quotes from your post), it seems to me that if your goal is to leave the military, once any fit finding is made, you should be able to outprocess normally under your original basis before you were referred to the IDES process.

If I am missing something, let me know. But, I think your "worst case" scenario was having to continue on active duty after a fit finding. That would not be the case. If fit and returned to full duty, you should be able to separate under the basis for your pre-IDES referral.

Which in hind site is likely the cause of my fatigue and exhaustion. I was then advised that I need to go through a medical board. By the grace of God my active duty orders were extended and I started the IDES process. I completed the MEB process and was found medically unfit secondary to 3 unfitting conditions and have a permanent P3 profile. Then I started the PEB process and in two weeks I was found to be fit.

Just a quick clarification. The MEB does not find Soldiers fit or unfit. They find whether or not conditions or disabilities fail retention (or separation) standards under AR 40-501


Reviewing my 199 it looks like a cut and paste of my OER which was completed prior to my start of symptoms and diagnosis. Since this diagnosis I have been on con leave for the past 4 months. I still have symptoms and just coming off con leave I still have physical restrictions. I am also going through physical therapy. I know I am a doc but I am very concerned if I will be able to keep the pace of my duties. I do not feel at this point I can work a full time job on the civilian side with all my current side effects .

This is a common thing I have seen with physican cases.

Your points about the OER comments being used "against you" (especially, with the OER being before significant medical "events) is common, in my experience.

The time on con leave seems significant, though, maybe not. If your time on con leave resulted in remediation and improvement in your condition, then this is an issue that might indicate you are now fit. It really takes looking at your current level of impairment and impact on your ability to perform your reasonably expected duties.

I would look to your CART metrics.

I understand why you would mention "full time jobs on the civilian side." However, you should not focus on that. This is not the standard for military unfitness.


My lawyer thinks I should appeal however I keep hearing that Doctors will always be found fit as our mos is mostly thinking??? But you have to realize we work long hours. My meds cause insomnia and difficulty with concentration. And I am experiencing a lot of fatigue. I have always pulled my weight as a soldier and a Doc but since this rare disease diagnosis, I am afraid for my future occupation as a doc.

I would mention or ask what is the downside to appealing and demanding an FPEB? You can't do worse than your current outcome (which, I assumed was continued out processing and separation). Is there any reason not to demand an FPEB? Again, your attorney has the advantage of having seen your entire case file and knows more about your case than anyone reading your post.

In the past, it was exceedingly hard for physicians to be found fit. In the previous versions of AR 635-40, the standard applied to Army physicians (and General Officers) was whether or not there was "any position" you could hold. In the more recent updates to the regulation, this language has been removed (however, there remains a mandatory Army Physical Disability Agency review of any physician unfit findings and SECARMY needs to approve- but, in reality, this will be conducted by a designee).


If anyone has some insight or advice it would be deeply appreciated. I would hate to appeal if it will not work out in my favor to be found unfit so I have some protection for my family as I am the sole provider.

I again don't see any downside to appealing.

Request a Formal PEB...

This seems the right course of action based on what you have stated. It also seems to concur with your attorney's advice.

Only thing that is concerning to me is that you mentioned that you are just coming off of con leave and are going through physical therapy. This would indicate that your condition(s) are not stable and could potentially change in the future.
Not sure about this. "Stability" is an issue for Permanent vice Temporary retirement. The standard for this would not necessarily be driven by being on convalecent leave.

If the Army continues to find you fit for duty after the formal PEB, request to transfer to a WTU while you continue to rehabilitate.

Not sure if this is a possibility after a fit finding. Intrinsic in a fit finding would be clearance for separation- which I understand you were already undergoing. The only thing that I can think of about this suggestion is that you could argue that your case is not ready for adjudication and you should be given more time to rehabilitate. Then, under such a finding of the FPEB- basically that your case is not ready for adjudication, you might be able to go to a WTU.

Additionally, I just want to offer that I have seen a HUGE uptick in physician PEB cases over the past year. Like by a factor of 10. Used to be that you would very rarely see MC/physicians even go to an MEB. I have seen a lot of physican cases- in the last six months, I have seen 2-3 times the cases that I had seen in the past ten years.

I hope all goes well for you. Best of luck!!
 
Last edited:
@michi418,

Welcome to the PEBFORUM!!

I am sorry to hear of your health problems and the issues with your military career.

You indicate that you have an attorney, so, understand that we do not offer legal advice here and we cannot second guess or now the full details of your case that you attorney has reviewed.

That said, I can offer a few comments.



If I understand correctly, you were referred through the IDES process while on terminal leave. Given your post (and some of the below quotes from your post), it seems to me that if your goal is to leave the military, once any fit finding is made, you should be able to outprocess normally under your original basis before you were referred to the IDES process.

If I am missing something, let me know. But, I think your "worst case" scenario was having to continue on active duty after a fit finding. That would not be the case. If fit and returned to full duty, you should be able to separate under the basis for your pre-IDES referral.



Just a quick clarification. The MEB does not find Soldiers fit or unfit. They find whether or not conditions or disabilities fail retention (or separation) standards under AR 40-501




This is a common thing I have seen with physican cases.

Your points about the OER comments being used "against you" (especially, with the OER being before significant medical "events) is common, in my experience.

The time on con leave seems significant, though, maybe not. If your time on con leave resulted in remediation and improvement in your condition, then this is an issue that might indicate you are now fit. It really takes looking at your current level of impairment and impact on your ability to perform your reasonably expected duties.

I would look to your CART metrics.

I understand why you would mention "full time jobs on the civilian side." However, you should not focus on that. This is not the standard for military unfitness.




I would mention or ask what is the downside to appealing and demanding an FPEB? You can't do worse than your current outcome (which, I assumed was continued out processing and separation). Is there any reason not to demand an FPEB? Again, your attorney has the advantage of having seen your entire case file and knows more about your case than anyone reading your post.

In the past, it was exceedingly hard for physicians to be found fit. In the previous versions of AR 635-40, the standard applied to Army physicians (and General Officers) was whether or not there was "any position" you could hold. In the more recent updates to the regulation, this language has been removed (however, there remains a mandatory Army Physical Disability Agency review of any physician unfit findings and SECARMY needs to approve- but, in reality, this will be conducted by a designee).




I again don't see any downside to appealing.



This seems the right course of action based on what you have stated. It also seems to concur with your attorney's advice.


Not sure about this. "Stability" is an issue for Permanent vice Temporary retirement. The standard for this would not necessarily be driven by being on convalecent leave.



Not sure if this is a possibility after a fit finding. Intrinsic in a fit finding would be clearance for separation- which I understand you were already undergoing. The only thing that I can think of about this suggestion is that you could argue that your case is not ready for adjudication and you should be given more time to rehabilitate. Then, under such a finding of the FPEB- basically that your case is not ready for adjudication, you might be able to go to a WTU.

Additionally, I just want to offer that I have seen a HUGE uptick in physician PEB cases over the past year. Like by a factor of 10. Used to be that you would very rarely see MC/physicians even go to an MEB. I have seen a lot of physican cases- in the last six months, I have seen 2-3 times the cases that I had seen in the past ten years.

I hope all goes well for you. Best of luck!!

Thank you Mr. Perry. With your experience how often have you seen physician cases deemed unfit? Is it rare in a FPEB?
 
Thank you Mr. Perry. With your experience how often have you seen physician cases deemed unfit? Is it rare in a FPEB?
In the past (say before the last six to eight months and going back 15 years or more) it was exceedingly rare- read as next to impossible- for a military physician to be found unfit. From 2005-2016, I only saw a single case where a military physician was found unfit. And during that time, some of the cases clearly showed unfitness. More recently, I have seen a shift. Recently, I have seen more cases with unfit findings. In the Army, I attribute this to the changes in AR 635-40.

I still believe that there are some "unique" issues with physician cases. However, things are getting more fair/equitable regarding these cases, in my opinion.
 
Hey, I’m a doc going through the same thing. I was found fit after a brief and cursory look for a condition that is clearly unsuiting for military service.

I also am facing severe underemployment if and when I leave service. I have come to terms with the fact that I won’t be medically retired, even though 1. Every other person with my condition is retired medically, even if they have only been in a brief period of time, and 2. I can no longer deploy, and 3. The military clearly exacerbated my condition, if it didn’t cause it completely. Initially when I was returned to duty with a fit determination, I felt trapped, as if the military were telling me that I had to keep working at the pace I had previously, which had caused me to be unwell. What I have found, though, is that the MEB/PEB seems to keep physicians because the military is happy to benefit from whatever contribution we can make. If you find yourself in a position where there is no rebuttal or second look, as I did, then take this opportunity to show the Army what you can do while staying well (ie pain free, no fatigue, happy and balanced). Do what you would be capable in a civilian job. People will resent you, but one of two things will happen. Either you will find that you are “allowed” to do this, and in so doing, you receive regular physician pay for a part time job... or your modified work will be bad for morale and your commander or treatment team will be forced to request another MEB.

This will feel like malingering. I know, because I am doing it. It sucks. But it isn’t. The Army has decided to keep you, even though your NARSUM presumably spelled out the fact that you can’t work full time. Once I accepted that, I spoke to my commander about what I could do while staying well, and I have had very little pushback working 9-2 with longer patient appointment periods and one day off for medical appointments each week. Think of it this way: your commander would definitely rather have you there for 20 hours a week than for zero because you are on con leave. It’s harder to reschedule patients because of a flare than to have to decrease the number of referrals you take and send the rest into the community.

I was initially resentful that I was being passed over for a military retirement, which especially for a mid career physician, is a decent amount of money. Now my viewpoint is that I CAN stay in until 20or whenever, and get the same retirement, in the meantime working in a way that keeps me healthy. I feel grateful that the military is paying me to do a job that keeps me healthy. I hope you can craft a similar setup. I think coming off of your significant con leave should set you up for that. Best wishes to you!
 
Hey, I’m a doc going through the same thing. I was found fit after a brief and cursory look for a condition that is clearly unsuiting for military service.

I also am facing severe underemployment if and when I leave service. I have come to terms with the fact that I won’t be medically retired, even though 1. Every other person with my condition is retired medically, even if they have only been in a brief period of time, and 2. I can no longer deploy, and 3. The military clearly exacerbated my condition, if it didn’t cause it completely. Initially when I was returned to duty with a fit determination, I felt trapped, as if the military were telling me that I had to keep working at the pace I had previously, which had caused me to be unwell. What I have found, though, is that the MEB/PEB seems to keep physicians because the military is happy to benefit from whatever contribution we can make. If you find yourself in a position where there is no rebuttal or second look, as I did, then take this opportunity to show the Army what you can do while staying well (ie pain free, no fatigue, happy and balanced). Do what you would be capable in a civilian job. People will resent you, but one of two things will happen. Either you will find that you are “allowed” to do this, and in so doing, you receive regular physician pay for a part time job... or your modified work will be bad for morale and your commander or treatment team will be forced to request another MEB.

This will feel like malingering. I know, because I am doing it. It sucks. But it isn’t. The Army has decided to keep you, even though your NARSUM presumably spelled out the fact that you can’t work full time. Once I accepted that, I spoke to my commander about what I could do while staying well, and I have had very little pushback working 9-2 with longer patient appointment periods and one day off for medical appointments each week. Think of it this way: your commander would definitely rather have you there for 20 hours a week than for zero because you are on con leave. It’s harder to reschedule patients because of a flare than to have to decrease the number of referrals you take and send the rest into the community.

I was initially resentful that I was being passed over for a military retirement, which especially for a mid career physician, is a decent amount of money. Now my viewpoint is that I CAN stay in until 20or whenever, and get the same retirement, in the meantime working in a way that keeps me healthy. I feel grateful that the military is paying me to do a job that keeps me healthy. I hope you can craft a similar setup. I think coming off of your significant con leave should set you up for that. Best wishes to you!


Thanks Gdawg for your comments. When was your FPEB. And I wonder the more specialized you are if that plays a role on you being fit or unfit? Reviewing my file I found out my commanders statement was inconsistent in what I have been going through in the last 4 months. ( still not able to see patients). I wonder if that played a role. But you hit it right on the head, feeling trapped. My issue is I am always used to pulling my own weight, and it feels really bad not be able to. I dont want anyone to resent me. Its just a difficult feeling all the way around. Thank you again for your input. I will keep you posted on my FPEB.
 
Routinely being absent from the clinic to obtain one's own health care plus profiles might motivate command to see things differently. I'm not talking abouting malingering, rather putting your own health on par with the health of your patients. It is understandable that MC folks get more scrutiny; but not to an extreme where verified conditions get ignored.
 
Hey, I’m a doc going through the same thing. I was found fit after a brief and cursory look for a condition that is clearly unsuiting for military service.

I also am facing severe underemployment if and when I leave service. I have come to terms with the fact that I won’t be medically retired, even though 1. Every other person with my condition is retired medically, even if they have only been in a brief period of time, and 2. I can no longer deploy, and 3. The military clearly exacerbated my condition, if it didn’t cause it completely. Initially when I was returned to duty with a fit determination, I felt trapped, as if the military were telling me that I had to keep working at the pace I had previously, which had caused me to be unwell. What I have found, though, is that the MEB/PEB seems to keep physicians because the military is happy to benefit from whatever contribution we can make. If you find yourself in a position where there is no rebuttal or second look, as I did, then take this opportunity to show the Army what you can do while staying well (ie pain free, no fatigue, happy and balanced). Do what you would be capable in a civilian job. People will resent you, but one of two things will happen. Either you will find that you are “allowed” to do this, and in so doing, you receive regular physician pay for a part time job... or your modified work will be bad for morale and your commander or treatment team will be forced to request another MEB.

This will feel like malingering. I know, because I am doing it. It sucks. But it isn’t. The Army has decided to keep you, even though your NARSUM presumably spelled out the fact that you can’t work full time. Once I accepted that, I spoke to my commander about what I could do while staying well, and I have had very little pushback working 9-2 with longer patient appointment periods and one day off for medical appointments each week. Think of it this way: your commander would definitely rather have you there for 20 hours a week than for zero because you are on con leave. It’s harder to reschedule patients because of a flare than to have to decrease the number of referrals you take and send the rest into the community.

I was initially resentful that I was being passed over for a military retirement, which especially for a mid career physician, is a decent amount of money. Now my viewpoint is that I CAN stay in until 20or whenever, and get the same retirement, in the meantime working in a way that keeps me healthy. I feel grateful that the military is paying me to do a job that keeps me healthy. I hope you can craft a similar setup. I think coming off of your significant con leave should set you up for that. Best wishes to you!
 
In the past (say before the last six to eight months and going back 15 years or more) it was exceedingly rare- read as next to impossible- for a military physician to be found unfit. From 2005-2016, I only saw a single case where a military physician was found unfit. And during that time, some of the cases clearly showed unfitness. More recently, I have seen a shift. Recently, I have seen more cases with unfit findings. In the Army, I attribute this to the changes in AR 635-40.

I still believe that there are some "unique" issues with physician cases. However, things are getting more fair/equitable regarding these cases, in my opinion.


Hi Mr. Perry, I just wanted to update you. I was found unfit after giving updated information for the FPEB. Thank you so much for your advice to proceed with the appeal. I was really going to give up even in the setting of my illness worsening before this forum ( and also the advice of my lawyer and colleagues). Now I wait for my VA rating. This is a great forum.
 
Hi Mr. Perry, I just wanted to update you. I was found unfit after giving updated information for the FPEB. Thank you so much for your advice to proceed with the appeal. I was really going to give up even in the setting of my illness worsening before this forum ( and also the advice of my lawyer and colleagues). Now I wait for my VA rating. This is a great forum.

I am glad that all worked out well for you!

And your thanks means a lot. It is very motivating to hear the forum making a positive impact.

Best of luck in the future!
 
Top