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DOD Policy Memo 2008 NDAA: Independent Medical Advisor

Jason Perry

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"E3.P1.2.6.1.2. Upon request of a Service member referred into the DES, an impartial physician or other appropriate health care professional (not involved in the Service member’s MEB process) is assigned to the Service member to offer a review of the medical evidence presented by the narrative summary or MEB findings. In most cases, this impartial health professional should be the Service member’s primary care manager (PCM).The impartial health professional will have no more than 5 calendar days to advise the Service member on whether the findings of the MEB adequately reflect the complete spectrum of injuries and illness of the Service member.

E3.P1.2.6.1.3. After review of findings with the assigned impartial health care professional, a Service member shall be afforded an opportunity to request a rebuttal of the results of the MEB. A Service member shall be afforded 7 calendar days to prepare a rebuttal to the convening medical authority. The convening medical board authority shall be afforded 7 calendar days to consider the rebuttal and return the fully documented decision to the Service member. In the case of a MEB rebuttal, the MEB shall not be forwarded to the PEB until the rebuttal is finalized and MEB results indicate the Service member may be unfit for duty. The fully documented rebuttal will be included with the MEB information sent to the PEB. Exception to timelines may be granted by an authority appointed by the Secretary concerned.

E3.P1.2.6.1.4. Medical evaluation participants shall be trained in accordance
with this issuance and existing policy."

The important things to draw from this are as follows:

YOU HAVE TO REQUEST THE IMPARTIAL PHYSICIAN. It doesn't say in this regulation that you have to do it in writing, but I would.

It will likely be your PCM assigned. If your PCM wrote any part of your Narrative Summary, I would object to the PCM being assigned to you for this purpose. Also, consider asking for a specialist if your condition is not of a general nature but requires the expertise of a specialist to accurately review.

Timelines:

Once you ask for it, the Impartial Physician has 5 days to respond. I think that if you just ask them to review, you will likely get poor assistance. Unless there is something glaring, they are likely to just agree. I would consider asking them, in writing, the answer to specific questions. I would not just throw random questions, but specific questions based on your condition, its impact on your function, and specific rating issues. I would also be aware of the issue of the response not helping/hurting your case. I would argue that this is for your benefit, and so should not be used against your interests independently, but it is a much stronger position if you can get an attorney (civilian or JAG) to draft the questions (thus invoking attorney-client work product privilege).

After the 5 days, you then have 7 days to submit a rebuttal to MEB.

The MEB Convening Authority then has 7 days to respond to your rebuttal. The Policy states that all of this will be included in your case file forwarded to the PEB. I think it is proper for the response to be included. This is why I think it is key to have good legal advice before submitting your rebuttal. Again, I have concerns with damaging comments, and I believe that you could invoke the privilege in a subsequent court case. BUT, I strongly suspect that this may not necessarily be successful at the PEB. This will be an interesting issue to see how the courts treat this issue. Key to making this point will be objecting to any damaging info.

I have doubts that the timelines will be adhered to. This policy is like an unfunded mandate. The result of this is to impose more work on the MTF/MEB section but without putting more resources against the problem. We will have to see how this plays out, but note that there are also requirements for the military to stand up more MEBs and PEBs if they fall behind on case processing timelines. This provision may actually provoke this requirement if it is used widely.

I think this is a great tool to use in preparing your case. As this is implemented, we will see how this plays out. Anyone who has experiences, good or bad, and feels comfortable sharing them should post the positives or negatives.
 

donaldbrantley

PEB Forum Regular Member
hey i did ask for an independent reveiw, my peblo called my case manager and had him set it up with my PCM, i never got to speek to my PCM. i dont know what my case manager said to my PCM but all the PCM did, was sent a hand written letter stating that he had reveiwed the MEB packet and agreed that i was being treated for everything listed, but he failed to mention the two things that was not listed on the MEB packet.

so i guess it didnt help
 

Jason Perry

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I would say that this does not come close to meeting the requirements of the law. If you do not get a good outcome, this is a likely basis for appeal.
 

CLNavy

PEB Forum Regular Member
Registered Member
I was never even told of this option. In fact since I have already reached/exceeded the maximum amount of LIMDU time allowed during a Navy career they sent my paperwork straight to the PEB process and skipped the MEB entirely this time.
 

PARATROOPER

PEB Forum Regular Member
PEB Forum Veteran
i requested a IMA over 2 weeks ago and still have no word about anything. My PEBLO told me that my meb case manager was the one that sets up the appointments to have my issues taken care of. What I was told was that I would be given a ROM exam by a independent DR. and also I would be sent to the VA hospital for my PTSD eval since the C&P docs here basically just flat out lied on my C&P paperwork stating that I never had been seen for PTSD and the best part was that I was never given a ROM test by the C&P physical doc yet he wrote that I had 80 degrees forward flexion on my diagnosis ..... and sated he performed 3 repetitions of a ROM test for my Thorocolumbar spine.

I was basically told that my IMA will happen whenever it happens because they are being inspected by whoever it is inspects VA workers at MTF's to ensure they are up to par and they dont have time to precess my paperwork .... how ironic is that ?
 

fdmckeever

Moderator
PEB Forum Veteran
Paratrooper,

I think you have the high ground now with these folks and even though the process is not fast at the very least they are likely scrambling to deal with their obvious failures. You can wait them out, be patient and continue to take care of yourself.

fdm
 

carnelli53

Moderator
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I agree with fdmckeever, while you may have to wait it is in your best interests to wait for the IMA. In the ideal turn of events, your IMA will have a much different opinion than the apparently manufactured one of your original doctor (an opinion that is hopefully favorable to your case).
 

PARATROOPER

PEB Forum Regular Member
PEB Forum Veteran
thanks for the info guys. I will wait it out and continue to document everything. I am debating on asking my pain clinic doc to perform a ROM test on me at this months visit I understand that his findings will not override anything done by the military docs but would it be a good idea to have this and at least include an unbiased ROM test in my meb packet?
 

fdmckeever

Moderator
PEB Forum Veteran
This would give you an idea of how the test is properly conducted so you will at least have that experience on your side. I would ask the pain management folks to follow the guidleine describe in this link:https://www.hrc.army.mil/SITE/.../ROM__(NDAA)_04162008.doc

I don't know if I would share the results with anyone, especially an IMA. I would keep the results for comparison or to dispute a wildly different IMA result. Just my opinion.

fdm
 

PARATROOPER

PEB Forum Regular Member
PEB Forum Veteran
That's exactly what I will do. I called my PEBLO and my case manager 3 times each today and left messages and never got a return phone call .... again. I went up there but neither one was in their office or so the reception desk told me. I'll continue to stalk them until I get a response. So much for the PILOT PROGRAM being a streamlined version of the meb process im on month 6 and still haven't even been able to get a legit narsum put together because of this.
 

fdmckeever

Moderator
PEB Forum Veteran
It is a great cat and mouse production. My PEBLO actually took a two week cruise while my package was at the PEB. You can perservere.
 

PARATROOPER

PEB Forum Regular Member
PEB Forum Veteran
Update on my IMA situation:

basically I called , called , and called some more, harassing everyone that had anything to do with my MEB and it eventually worked by way of tossing up the regulations to the col at the hospital... and what do you know the very next day I had my IMA physical appointment. SO basically the IMA doc confirmed that my C&P doc had to of either fudged or left the ROM numbers from another patient on my paperwork because on the C&P exam ( the one where I never took a ROM test...) he put 80 degrees forward flexion . Today at the IMA even when on pain meds my 3 repetitions where 65 60 59 for forward flexion .... thats about a 20 % decrease in my forward flexion compared to the C&P obviously without pain meds I would score lower but I did not know the test was comming so fast or I wouldnt have taken my meds this morning.

Will this override the previous findings or is this just something else for the MEB/PEB to consider when finding on my case ?

I am going to include a letter stating how this interferes with my day to day life with my packet but I am unfortunately still waiting for my IMA PTSD screen since I provided enough proof on the C&P PTSD doc to show he either lied completely or left another patients findings on my paperwork so the VA is giving me a PTSD eval from a military mental health doc when I can get in for an appointment. any suggestions on this one as to how to let this guy know how this is affecting me ?
 

Jason Perry

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Update on my IMA situation:

Will this override the previous findings or is this just something else for the MEB/PEB to consider when finding on my case ?
By itself, any input or info from the IMA is evidence that you can use to argue for a change to your MEB. The MEB Approving authority may look at it and decide that your MEB should be changed. Whatever happens, the PEB should also consider all of this as evidence.
 

PARATROOPER

PEB Forum Regular Member
PEB Forum Veteran
By itself, any input or info from the IMA is evidence that you can use to argue for a change to your MEB. The MEB Approving authority may look at it and decide that your MEB should be changed. Whatever happens, the PEB should also consider all of this as evidence.

thanks for the info. Not sure what I would do without all the info you guys have put together here.
 
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