Illegal Command Referral for Mental Health Evaluation during PEB

USAF Captain

PEB Forum Regular Member
Registered Member
Last April I gave birth to my son at a MTF and nearly died when my nurse administered a large dose of the wrong drug. When I returned to work following my maternity leave I experienced many PTSD symptoms, high anxiety, emotional outbursts, etc. related to this near death experience. My commander stated that I was clearly in no state to be at work, so I made an appointment with my PCM who immediately referred me to neuropsychology. A staff psychologist was soon seeing me and diagnosed me with PTSD. She put me on convalescent leave on an as needed basis (renewing my convalescent leave every 30 days). My continued inability to return to work prompted a medical review, including sessions with a senior psychiatrist, and triggered a med board that has led to a formal PEB.
While on signed convalescent leave my commander ordered me to work on more than one occasion to sign paperwork despite the fact that my PTSD symptoms were triggered by being on base, as noted by my psychologist. I was also told to complete my ancillary training while on convalescent leave, which I managed to do mostly by borrowing my husband’s work laptop, but was unable to complete due to access issues I was unable to resolve despite tech support help [at my recent meeting with the commander he said usually he would just cancel a members convalescent leave and have them come in to complete training, this was not the first time my convalescent leave was brought up in a threatening manner]. I was then asked to schedule myself for a PT test, which I told the unit I felt fit enough to do, but my PTSD symptoms made it impossible for me to take the test at the base I’d been stationed. [During my later recent meeting with my CC he said this was “crazy”). I asked if I could take the PT test at any nearby base, but was told no, so I said I would schedule an appointment with my PCM to see if my PTSD symptoms warranted a PT profile.
At a recent meeting, my commander said I needed to report to work to sign a Referral to Healthcare Counseling, he explained by phone that he wanted me to be seen by an AF psychologist because of my long absence from work.
My husband had to take off time from his work in order to drive me to base as my anxiety gets so bad it’s unsafe for me to drive on my own. When we met with the CC he presented the letter referring me to a new doctor, the letter accused me of missing medical appointments, refusal to complete training, refusal to PT test, and refusal to come into work. These accusations are all false, or at least highly misleading. Any and all work that I have missed has been while I was on convalescent leave. My attending psychologist records that I have been cooperative and working on my recovery in every way.
The referral letter listed many references; I read them all. (DoD Directive 6490.1, DoD Instruction 6490.4, Section 546 of Public Law 102-484, AFI 44-109) There is not a single reference to referring a member under the current care of a military health provider. In fact, all the regulations were written in such a way that clearly communicates that a commander is to use the referrel in order for the member to be evaluated, diagnosed, and given treatment. My psychologist, has not only evaluated me, diagnosed me, but has as written my NARSUM for my med board which has been underway for some months. I think it will be clearly seen that my commander is taking great liberties with the regulations he has cited, and is manipulating the evaluations process.
I expressed to my commander that forcing of me to see a new psychologist was effectively “Dr. Shopping,” considering that my case has been through my PCM, a psychologist, a psychiatrist, an AF psychologist, and an informal PEB, which initiated a formal PEB. By that count my case has been through five separate levels. After explaining this to my commander he expressed that he did not think I needed to be out on convalescent leave, and that had talked to another doctor (the one I have been referred to see) who believed if I was seen by them they could return me to work. I again expressed to CC that this was clear interference in my medical care based on his personal doubts regarding my current doctor’s prognosis, and it frightened me immensely that my command had so much control over my healthcare. I explained how many sessions and how much time I had spent on my recovery with my doctor that had led to her assessment that I continued to need convalescent leave, and how very traumatic it would be for me to rehash all the details once again with a new doctor. My commander informed me that the new doctor I would be assigned to had mentioned that it would not be necessary for me to go through the same sessions, but rather an assessment could be made to return me to work just by reading my records. My husband and I again explained that picking a doctor that had already agreed that I can be returned to work prior to even seeing me was clearly undue influence on my medical care. My commander reiterated that I had been out for a long time, and said this was not normal for PTSD. He said he did not agree with the way my current doctor was handling my care.
Additional info:
-One of the main points being made for this referral is the fact that my current doctor is not “Air Force.” However, she is DOD working IN my assigned MTF. This hospital is joint military, even if not solely AF, and treats the bulk of the military’s returning vets many of whom suffer from PTSD. Also, My doctor has already coordinated with an AF psychologist at the base I am assigned. She told My doctor that based on my records it was clear I was doing everything I could to recover.
-Another point being made is that my current Dr has not been able to “fix me” and return me to work. However, my doctor did speak to my commander, about the possibility of my returning to work, on more than one occasion. She told the CC I would most likely return to the work environment but be unable to perform any duties for some time and would need time to just overcome intense anxiety. The CC said that would not be possible (something I reminded him of at our recent meeting, and he again agreed that that was not a possibility).
-A major limiting factor in my recovery has been my inability to take medications, this is due to the fact that I am nursing my very young infant, and then just recently, became pregnant again.
-CC said he had spoken to my PEBLO about referring me to an AF mental health provider, my PEBLO said this was permissible based on an inaccurate reading of AFI 10-203. She said that AF Providers have “final authority.” However, My PEBLO was unaware that my case had already been signed off on by the AF side, when the AF psych reviewed my doctor’s recommendations and signed off on them. [AFI: 10-203 2.12.4. AF providers will only consider recommendations from civilian (non-MTF) clinical consultants that are related to, or describe, functional limitations. AF providers retain the final authority on deployment, medical retainability, and physical limitation recommendations 3.7. External duty limitations (civilian or sister service). All AF personnel must report
changes in physical status to their AF military medical unit. Duty limitations from a non-AF provider are a recommendation and must be entered on an AF Form 469 by an AF provider to be valid. AF providers retain final mobility recommendation authority.]

This is not a situation I ever anticipated I would be in, I am used to being the top ranked CGO in my unit receiving kudos for a job well done. In fact I was CGO of the year, at this very unit, shortly before I left to have my baby. I suffered a medical mistake that nearly cost my life and has had very terrible consequences, which have resulted in a med board and likely means the end of my military career. If this were not bad enough, now my unit is harassing me while on convalescent leave and infringing on my rights to unbiased medical treatment, and is overtly seeking new care for me that will prove to offer a diagnosis/prognosis that better fulfills the commander’s desires.
The PEB reg clearly state: AFI 36-3212 1.13. “Unlawful influence. No one may attempt to coerce or, by any unauthorized means, influence the PEB or the outcome of any disability case. “ Referral after already being treated is clearly unauthorized coercion/influence.

I'm very interested in your advice and or experience in similar situations!!
 
sister ive been in this process for almost a year if my commander would have told me he was trying to change my doctor i would have gave him a road map of where he could put his referral. Ive never even heard of a commander even trying to do that, maybe its just an airforce thing?? If i was u id get a lawyer, like monday 0900!
 
I had ran into a similar but not all the same with one of my soldiers under me. He was assigned to me since I was currently in the MEB/PEB and that he was being advised by a off base provider he was unfit to continue duty in the army due to PTSD. And keep in mind his off base psychologist was a Tricare referal by his PCM. After his diagnosis came in and I took him to the Commander he refused to take it and stated that he out sourced the Gov't (Army) by using a off base psychologist. The commander said he was in violation of UCMJ article 52 or 61 not exactly for sure what it was but he did make referal to a certian UCMJ. To sum it up the commander threatened to charge him with malingering to gain monetary gain from the Gov't and VA. I pulled him out of the Commaners office and we used other options thru the chain of command to no evail no one would step in and help. He went back to his PCM and asked for a referal to a Army psychologist to get a second opinion and basically got told by the On base psychologist that his medical case did not meet the profile for PTSD and that the story he gave for what had caused the PTSD was not supporting to cause PTSD. Now to sum it up he is back at the unit with no profile for his medical and being lableled by NCO's and being refused re-enlistment by the CO and now being assigned a new PCM all of his referals were botched and he is now not allowed to be seen by his off base psychologist since his new PCM says off base providers do not understand PTSD and are to quick to make a diagnosis and are not properly trained to identify the residuals of PTSD.
 
USAF captain with what your experiencing, I wonder if seeking the advice of an ombudsman and suggestion to be moved to a WTB/WTU be in a favoring position for you. Sorry for what you went through also no slack bayonet and turion 1973 as for your soldiers experience LORD HAVE MERCY seems the military is always down playing treatment for or diagnosing PTSD and referring to it as an adjusmnet or personality disorder.
 
You are right onedaycloser downgrade and degrade SM's. I my self lucky in a most unlucky case with my TBI claim I laid up in a hospital bed with a frature to my left side of skull and not to forget 3wks of coma. What I get a good kick out of and I humor myself with my injury since we all at one point have got to say I told you so to the Doctors. Everytime I go to a new doctor and they read why I'm there for in there computer, before they ever open my medical records is the first reaction I get once they enter the treatment room. They have that first look when the doc enters the room "oh anouther TBI faker in my treatment room". I let them go on and ask what I'm there for, I give my story and they give the normal response have you tried Motrin do you drink enough water the typical get out of my treatment room get over it go back to work. I give my story again the doc then looks at my medical records and turns to me and say with a very, I'm a dumb ass look on the Doc's face and usually the same words pour out of there mouths "Holy Shit what the hell are you still in the military for" then I hear for the next 45 minutes how I slipped thru the medical cracks. I tell them the same thing listen to you patients and not lable them before you even enter the room and have the whole story. I love it everytime it gives a good knee slap and a laugh :)
 
Hang in there USAF Captain stay proactive with your case. It took me seven yrs to get to where I'm at now and finally get the Doc's to listen to me.
 
Lol that was humorous on the doctors behalf after seeing the facts. But, I applaud you for being so strong and having a sense of humor as well turion1973. I really wonder in a sad disbelief, are our military doctors trained to deter soldiers away from proper treatment or diagnoses just to continue with the engraved mentality of mission first everything else just suck it up and drive on.
 
Thanks for the replies! Keep 'em coming! I have decided to file an IG complaint but worry that my command's sorry attempts to stretch these regs to cover their actions will be enough for IG to let them off the hook. What I'm most upset about is that the more I share my story the more I hear of this happening to other people. I really expected more from my service and I'm ashamed to see what some leaders are doing to their people.

Onedaycloser: I am not aware of an ombudsman? is this somebody in the MEB/PEB process? And what does it take to get transferred to a WTB/WTU? Can I request that?

Wow turion1973. Man, I'm impressed by your positive outlook. I've been really blessed with great doctors, everybody I've seen has been 100% supportive of my needs and seems to feel my diagnoses is pretty rock solid. For me its just my command being very anti-Doctor's orders/recommendations.
 
USAF captain to my knowledge the ombudsman is appointed to the major military post to assist wounded warriors in addressing any medical concerns to their units that are being ignored or unresolved in a timely manner. I am sure the ombudsman has other responsibilities as well but thank GOD the ombudsman at Ft. Hood, TX has helped me resolve DTS issues as well as get into WTB/WTU. I would ask around your installation regarding wanting to schedule or walk-in to see your nearest ombudsman. As far as the IG is concerned, it would not hurt to make mention to them of your issues so if ever needed you can show a trail of seeking assistance. Good luck with everything and let me or the forum know how things workout for you GOD BLESS.
 
USAF Captain,

I'm not seeing anywhere in your posts that you have talked to legal. I would go speak with MEB legal office as soon as you can, discuss your situation and ask what your options are.

As far as your diagnosis being changed by another doc or whatever...I wouldn't worry about it. If the MEB and VA C&P have confirmed diagnosis of PTSD, you're good.

You are being harassed by a superior officer--something a lot of us on this forum can attest to. :) Go to legal.

Also, Warrior Transition Unit probably isn't an option at this point since you are this far along in your Med board. But, on top of speaking with MEB legal office, I would have a sit down with your behavioral health commander/head--tell her/him what is going on.

Lastly, what is your main concern with your current situation?
 
I did have a C&P doctor try to change one of my diagnosis on my cognitve disorder secondary to TBI and when it put on my NARSUM the doctor did give me my cognitive diagnosis but was found fit for duty. But when my packet was sent to the PEB they did take my cognitive disorder secondary to TBI and found me unfit for duty. ceilingfan is correct one doctor trying to change a diagnosis is like my MEB attorney said in his own words a opinion based on his own point of view. And since he was just a MD and not a Neurophysiologist the VA or the MEB would not take any change in medical diagnosis, that you will be considered based on the doctor's who are trained in there field to make the correct diagnosis.
 
USAF captain, ceiling fan gave some excellent advice and I agree fully with everything he mentioned. As for myself, my Med Board started in June 2012 after being diagnosed with fibromyalgia and I was assigned to WTB in November 2012 while awaiting the peb decision. All I can say is GOD IS GOOD and onedaycloser hooah.
 
ceilingfan,

I just talked to the Area Defense Council! They were a HUGE help. I had tried to talk to JAG, but they just said "we represent the command, get a civilian lawyer." Don't know why they didn't point me to the ADC that does work with folks getting referrals. ADC concurred that the CC was out of line to ask for a second medical opinion under the guise of a "referral for mental health."

ADC also said it would be difficult for a diagnosis to be changed.

My greatest concern is the ACTUAL referral appointment. I really am stressed about having to see a new psych who has clearly been given the job of "get this person back to work no matter what!"

Thanks onedaycloser...I hope they can move me to a WTB (I think), how much better are they than being in your command?
 
ceilingfan,

I just talked to the Area Defense Council! They were a HUGE help. I had tried to talk to JAG, but they just said "we represent the command, get a civilian lawyer." Don't know why they didn't point me to the ADC that does work with folks getting referrals. ADC concurred that the CC was out of line to ask for a second medical opinion under the guise of a "referral for mental health."

ADC also said it would be difficult for a diagnosis to be changed.

My greatest concern is the ACTUAL referral appointment. I really am stressed about having to see a new psych who has clearly been given the job of "get this person back to work no matter what!"

Thanks onedaycloser...I hope they can move me to a WTB (I think), how much better are they than being in your command?

Okay...let us clarify by asking a few questions. Where exactly are you in the med board process? You mentioned in your original post that you were getting ready for formal-PEB...is that correct? Have you been found unfit?

Does your instillation have an 'MEB Legal Outreach Office'?...Your PEBLO should know.

As previously mentioned, I would reach out to your psychologist, at your MTF, who originally made the diagnosis of PTSD? Inform your psychologist of what is going on, and she could reach out to this referral-psych and say, "hey, my patient is being referred to you because her command is...retarded (obviously more professional terms will be used but you get the point), not because any medical professional nor patient disagree with the diagnosis." Just an option.

Another thing would be to research the VARSD in regards to how mental conditions are rated. You want to be honest but you also want to be aware of the language and talking points--if you will--used in diagnosing and rating. Good luck.
 
USAF captain, In my opinion WTB/WTU is definitely alot better prepared and resourced to assist a wounded soldier in their recovery be it back to the fight or out of the service. With your current situation at hand, make mention to your current behavioral health personnel that you may be changing to a military provider in the very near future. Give them a chance and if you do not like their treatment be professional about it and then request through your PA or PCM that you wish to be referred or seen by another behavioral health specialist. This covers you in the event your coc mentions you did not comply with their treatment plan or request. Fortunately, in my experience with my old coc trying to get things to work in their favor the plan ultimately ended up working in my favor. It is almost like networking you never know who knows someone that knows someone of higher importance. GOD IS GOOD hang in their and wish you the best of luck.
 
Also USAF captain ceiling fan makes some interesting points. My point exactly when I mentioned you never know who knows someone else that can assist you with your situation. I have learned alot but still need to learn alot more by visiting this forum. I give a special shout out to the founder Mr. Jason perry
 
Okay...let us clarify by asking a few questions. Where exactly are you in the med board process? You mentioned in your original post that you were getting ready for formal-PEB...is that correct? Have you been found unfit?

Does your instillation have an 'MEB Legal Outreach Office'?...Your PEBLO should know.

As previously mentioned, I would reach out to your psychologist, at your MTF, who originally made the diagnosis of PTSD? Inform your psychologist of what is going on, and she could reach out to this referral-psych and say, "hey, my patient is being referred to you because her command is...retarded (obviously more professional terms will be used but you get the point), not because any medical professional nor patient disagree with the diagnosis." Just an option.

Another thing would be to research the VARSD in regards to how mental conditions are rated. You want to be honest but you also want to be aware of the language and talking points--if you will--used in diagnosing and rating. Good luck.

My bad, I am only now starting the PEB process, I have not gone through a IPEB (only the board that recommends the PEB process). Guess I have a lot to learn about this situation I am in. I went to the CDE, but refused to participate....I'm not sure what repercussions will come of that. It was what ADC advised, though.
 
My bad, I am only now starting the PEB process, I have not gone through a IPEB (only the board that recommends the PEB process). Guess I have a lot to learn about this situation I am in. I went to the CDE, but refused to participate....I'm not sure what repercussions will come of that. It was what ADC advised, though.
Are you talking about the MEB? Have you had your VA C&P exams?
 
USAF captain we all still have alot to learn. As ceiling fan mentioned for clarification purposes do you mean the meb process and have you had your c&p exams conducted by va? as for anything we may have already done in the past, just make certain that we have good justification for our actions. I would suggest and it is only a suggestion, that we give people the benefit of the doubt before we elect not to honor their services. Unless, we feel strongly they are violating a policy or doing something illegal. Otherwise, smile and remain professional and make mention to your coc or pa that I would like to seek services else where. Worst thing that can happen is your asked to provide a cause for your decision.
 
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