I apologize for the longggg post, but there's alot of info here that I really need perspective on. Yes, I am a medical officer so that off the bat screws me at the medical board. My husband is a retired disabled combat vet (enlisted 82nd airborne), I joined the Army to be a GOOD physician because lord knows the soldiers and their families need someone who treats them right and tells the TRUTH about whatever medical condition they have and not downplay it because I have seen it happen. I planned to stay until retirement, but I just can't anymore. Between my conditions and my husband's the military is not going to be able to accomodate the flexibility I need for both of us. What can I do? I am going to appeal, but based on the below information, am I in a losing game? I feel that this NARSCUM is basically saying they don't believe I am in pain and blowing me off. Any help is appreciated.
In the NARSCUM, the MEB physician downgraded my L3 to an L2, reported no having orthopedics notes/evidence to support my claim. They absolutely had these notes as she later copy and pastes the patient instructions portion of an orthopedics note. This is the actual assessment from the orthopedic surgeon: “Despite relatively benign MRI findings, clinically patient has bilateral medial tibial stress syndrome with recurrence with an form of running, short or long distances. As patient is in the military, recommend deferral of any physical training that requires running, especially with added weight. Patient to defer from sprint, drag, carry type exercises etc. paperwork filled out today to reflect above restrictions in detail.” “Return to clinic on an as-needed basis.” There is also x-ray evidence of one episode of tibia stress fractures which they also had.
In addressing my neck pain, the MEB physician concluded that because I had not been seen in the past two years and I treat with OTC, it is not added to my profile and is fit for duty. I happen to be a physician so I don't need to go to the clinic to know how to treat my neck, however there are multiple visits documented, and also later she does report that I take gabapentin, which is NOT over the counter medication. . I take Gabapentin 600mg TID daily now, during a flare I increase to 1200mg TID, and have missed work or adjusted my schedule when possible. I now have decreased strength in my right arm and hand which started approximately 9-12 months ago. Decreased strength is documented in the VA exam and recent orthopedics clinic notes (see Neck summary). I have attempted swimming for cardiovascular exercise due to my stress fractures, but this exacerbated my neck pain. The MEB physician did not have the most recent ortho notes for my neck.
My anxiety and depression have essentially not been treated, except with medication (I take two medications daily). I also believe I have PTSD for multiple life threatening traumatic events (not combat related). My husband is a disabled combat vet (enlisted 82nd airborne, ALL THE WAY!), one of these traumatic events involved him having a flashback and putting me in a choke hold down on the ground, I almost passed out until (excuse for the details) I was finally able to reach far enough behind me to grab his balls and twist as hard as I could, and it still took a few seconds for him to snap out of it and let go. Theres just one for you (my life has been a damn mess).
My PTSD screen for the general medical exam was positive, however the VA contracted psychologist concluded that I did not meet criteria for PTSD. I have reviewed the VA questionnaire and answers by the provider. He did not report the 2 traumatic events that I did discuss with him. He also answered “No” to questions that I reported “yes” to and to questions that I was not asked in our appointment. Specifically in the “Stressors” and “PTSD Diagnostic Criteria” sections. He essentially lied my reporting NO on answers I reported YES to and by omission of events that I described to him. I also discussed with him the trauma of giving a child up for adoption when I was 16 years old and how that has manifested in extreme anxiety and panic attacks regarding my children. This was not reported. Any psychologist should know that giving a child up for adoption at that age without any therapy or counseling (ever) can absolutely lead to PTSD. I know this is not service related but it is a big issue that has grown worse over time because I have resisted discussing it ever. (I am now in counseling).
The MEB physician frequently reports that the "SM reported symptoms are inconsistent with her ability to successfully complete ~10 years of rigorous medical training" This is the biggest bullshit of it all. First of all, you think it's looked down up to go to the doctor as a soldier, it even more unspoken/looked down up when you are a physician in residency training. You suck it up. And I did. I also have modified my work to prevent pain or further injury. I have also worked through severe pain, which has or will worsen my condition and I cannot continue to do this. I completed my training despite this and furthermore I DID NOT HAVE THESE CONDITIONS FOR MY ENTIRE TRAINING, THEY STARTED 7 YEARS AFTER MY TRAINING STARTED.
I disagree with the medical relevance in considering medical condition by the statement “considering MAJ Pagan has not yet been assigned to a permanent party officer or staff physician, due to having been in training since 2011”. This fact should not be considered in what level my profile is determined.
I understand that I have been in training, go it. However, especially in regards to my neck, I cannot let the army injure me to where I cannot perform any function of my job and be able to get a civilian job at some point in my life. Luckily, I chose a specialty that if forced to I could work from home; this isn't an option in the Army if my conditions forced me to need to do this.
In the NARSCUM, the MEB physician downgraded my L3 to an L2, reported no having orthopedics notes/evidence to support my claim. They absolutely had these notes as she later copy and pastes the patient instructions portion of an orthopedics note. This is the actual assessment from the orthopedic surgeon: “Despite relatively benign MRI findings, clinically patient has bilateral medial tibial stress syndrome with recurrence with an form of running, short or long distances. As patient is in the military, recommend deferral of any physical training that requires running, especially with added weight. Patient to defer from sprint, drag, carry type exercises etc. paperwork filled out today to reflect above restrictions in detail.” “Return to clinic on an as-needed basis.” There is also x-ray evidence of one episode of tibia stress fractures which they also had.
In addressing my neck pain, the MEB physician concluded that because I had not been seen in the past two years and I treat with OTC, it is not added to my profile and is fit for duty. I happen to be a physician so I don't need to go to the clinic to know how to treat my neck, however there are multiple visits documented, and also later she does report that I take gabapentin, which is NOT over the counter medication. . I take Gabapentin 600mg TID daily now, during a flare I increase to 1200mg TID, and have missed work or adjusted my schedule when possible. I now have decreased strength in my right arm and hand which started approximately 9-12 months ago. Decreased strength is documented in the VA exam and recent orthopedics clinic notes (see Neck summary). I have attempted swimming for cardiovascular exercise due to my stress fractures, but this exacerbated my neck pain. The MEB physician did not have the most recent ortho notes for my neck.
- Elbow Flexion 4/5, Elbow Extension 4/5 , Wrist Flexion 3/5, Wrist Extension 3/5
- X-rays obtained 28Apr2022, report degenerative spondylolisthesis (anterolithesis) C2 over C3, C3 over C4, and C4 over C5\
- Back Condition- MEB physician notes that my back condition has been present throughout my medical training, which is not true. My thoughts:
- I disagree with the MEB physician’s conclusion that my back condition has been present throughout my medical training. I did have a muscle strain from lifting a patient in 2013 for which I was seen in the clinic, however I had no pain after this even until 2017. This acute event occured approximately 2 days postop from my robotic assisted hysterectomy (I was the patient), and progressed to daily axial and radiculopathy pain. At the time of initial injury, MRI showed mild disc bulge at L5-S1. Recent x-rays show facet joint osteoarthritis (see back summary). The orthopedic physicians reading also showed spondylolisthesis of the lumbar spine and significant loss of disc height. MRI is scheduled for 13May2022. This also affects my functional capabilities at work and home. I have attempted stationary bike for cardiovascular exercise due to my stress fractures, but this exacerbated my back pain.
- With my own medical knowledge, osteoarthritis and presumed intervertebral disc disease (loss of disc height) also will only progress with age. Further pathologic conditions may be identified on my upcoming MRI.
- The medical record shows multiple clinic visits and pain management procedures (medial branch block and RFA) for this condition, which has continued to worsen. My recent orthopedic evaluation and imaging to show pathology that will deteriorate further over time. Even without further deterioration, my current condition limits my ability to perform ACFT events and functional activities required for service in the military.
My anxiety and depression have essentially not been treated, except with medication (I take two medications daily). I also believe I have PTSD for multiple life threatening traumatic events (not combat related). My husband is a disabled combat vet (enlisted 82nd airborne, ALL THE WAY!), one of these traumatic events involved him having a flashback and putting me in a choke hold down on the ground, I almost passed out until (excuse for the details) I was finally able to reach far enough behind me to grab his balls and twist as hard as I could, and it still took a few seconds for him to snap out of it and let go. Theres just one for you (my life has been a damn mess).
My PTSD screen for the general medical exam was positive, however the VA contracted psychologist concluded that I did not meet criteria for PTSD. I have reviewed the VA questionnaire and answers by the provider. He did not report the 2 traumatic events that I did discuss with him. He also answered “No” to questions that I reported “yes” to and to questions that I was not asked in our appointment. Specifically in the “Stressors” and “PTSD Diagnostic Criteria” sections. He essentially lied my reporting NO on answers I reported YES to and by omission of events that I described to him. I also discussed with him the trauma of giving a child up for adoption when I was 16 years old and how that has manifested in extreme anxiety and panic attacks regarding my children. This was not reported. Any psychologist should know that giving a child up for adoption at that age without any therapy or counseling (ever) can absolutely lead to PTSD. I know this is not service related but it is a big issue that has grown worse over time because I have resisted discussing it ever. (I am now in counseling).
The MEB physician frequently reports that the "SM reported symptoms are inconsistent with her ability to successfully complete ~10 years of rigorous medical training" This is the biggest bullshit of it all. First of all, you think it's looked down up to go to the doctor as a soldier, it even more unspoken/looked down up when you are a physician in residency training. You suck it up. And I did. I also have modified my work to prevent pain or further injury. I have also worked through severe pain, which has or will worsen my condition and I cannot continue to do this. I completed my training despite this and furthermore I DID NOT HAVE THESE CONDITIONS FOR MY ENTIRE TRAINING, THEY STARTED 7 YEARS AFTER MY TRAINING STARTED.
I disagree with the medical relevance in considering medical condition by the statement “considering MAJ Pagan has not yet been assigned to a permanent party officer or staff physician, due to having been in training since 2011”. This fact should not be considered in what level my profile is determined.
I understand that I have been in training, go it. However, especially in regards to my neck, I cannot let the army injure me to where I cannot perform any function of my job and be able to get a civilian job at some point in my life. Luckily, I chose a specialty that if forced to I could work from home; this isn't an option in the Army if my conditions forced me to need to do this.
