Involuntary Medical Seperation

IAM

PEB Forum Regular Member
Registered Member
I’ve been placed in a MEB involuntarily upon in-processing my new duty station with a p2 profile for sleep apnea. This is because they said I was non-compliant with using the CPAP in accordance with AR40-501. Insomnia has been my chief complaint for years and still is. I was referred for a sleep study in 2013 and was found to have severe OSA. Now I’m being separated for the apnea, when I’ve been seen several times in the past for the insomnia not allowing me to use the machine at all times. Now I’ll probably get separated with nothing after 10 years of service. Any advice or expertise out there?
 

tony292

PEB Forum Regular Member
PEB Forum Veteran
OSA requiring a CPAP should be a 50% VA rating. And thus it should be a medical retirement if found unfit for OSA.
 

IAM

PEB Forum Regular Member
Registered Member
The issue is being non compliant for not using it often per AR 40-501, which triggered the MEB upon inprocessing at my new duty station. The machine hasn’t been helpful in the past due to insomnia. I feel better in the morning without it then with it. I have brought this issue up to many providers with no solutions. So I stopped using it to prevent further sleep issues. I know I’ll still receive 50% VA but the DOD side, I may receive nothing due to not being compliant. That’s my issue/frustration/worry.
 

IAM

PEB Forum Regular Member
Registered Member
OSA requiring a CPAP should be a 50% VA rating. And thus it should be a medical retirement if found unfit for OSA.
The issue is being non compliant for not using it often per AR 40-501, which triggered the MEB upon inprocessing at my new duty station. The machine hasn’t been helpful in the past due to insomnia. I feel better in the morning without it then with it. I have brought this issue up to many providers with no solutions. So I stopped using it to prevent further sleep issues. I know I’ll still receive 50% VA but the DOD side, I may receive nothing due to not being compliant. That’s my issue/frustration/worry.
 

JoePlasm

Well-Known Member
PEB Forum Veteran
Registered Member
I assume you want to fight it from the comment about being pushed out at 10 with nothing to show for it.

I won't ask you the specific of your OSA diagnosis as this isn't the place. Low AHI like 6 (less than 10 really) can happen without actually having OSA. It can be from sleeping position, medication or alcohol taken night of study, seasonal allergies, and so on. In these cases a CPAP will make symptoms WORSE.

If your primary complaint is insomnia, and you don't have witnessed episodes of apnea (spouse, team mate when in field, etc) then the easiest option to you is to request a new sleep study and argue the OSA diagnosis is erroneous (as you do not improve with CPAP) and thus the lack of compliance is irrelevant and that section fo 40-501 no longer applies.

Insomnia from PTSD, etoh use, mental health issues, and any other number of medical diagnosis, will not improve with CPAP.

If you are feeling better without the CPAP (and it not just a mask fit issue) and your sleep Dr has adjusted or reduced settings and still no improvement then likely you don't actually have OSA.

If you're having troubles with you case and your initial diagnosis did not do a "test of cure" study and redo the sleep study while on CPAP, then request that for purpose of adjusting the settings.

You should be having yearly follow up with sleep doc for review of your settings and compliance, if you haven't had those either, then you should insist on that first to see if adjusted settings can fix the compliance issue.

If you feel like your PCM is supportive but you can still get appt with sleep doc, tell the sleep Dr straight up you want to stay in service and don't think you actually have OSA because you're worse with CPAP, not better, and ask his advice on re-evaluation of diagnosis. Sleep Dr.s are so Jaded from SMs coming expressly to get OSA for 50% VA, that if you tell them you want to stay in and avoid OSA diagnosis, they'll likely hug you and do cheetah flips.



These are all just options for you (from a soon to be retired PCM) to choose from and ways for you to get back in with a sleep doc.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
I’ve been placed in a MEB involuntarily upon in-processing my new duty station with a p2 profile for sleep apnea. This is because they said I was non-compliant with using the CPAP in accordance with AR40-501. Insomnia has been my chief complaint for years and still is. I was referred for a sleep study in 2013 and was found to have severe OSA. Now I’m being separated for the apnea, when I’ve been seen several times in the past for the insomnia not allowing me to use the machine at all times. Now I’ll probably get separated with nothing after 10 years of service. Any advice or expertise out there?


Look at this from AR 635-40:


"5-18- Failure to comply with prescribed treatment
a. There are many conditions, such as neuropsychiatric disorders, asthma, hypertension, epilepsy, diabetes, and certain injuries, which may be improved sufficiently by treatment to prevent disability or to significantly decrease it. If a Soldier unreasonably fails or refuses to submit to medical or surgical treatment, therapy, take prescribed medications, or to observe prescribed restrictions on diet, activities, or the use of alcohol, drugs, or tobacco, that portion of the disability that results from such failure or refusal will not be rated where the following is clearly demonstrated—
(1) The Soldier was advised clearly and understandably of the medically proper course of treatment, therapy, medication, or restriction(s) and documented by a physician.
(2) The Soldier’s failure or refusal was willful or negligent and not the result of mental disease or a physical inability to comply.
b. MTFs will forward MEB cases involving a refusal to submit to recommended medical care to TSG for determinations under the provisions of AR 600–20 before forwarding the case to the PEB. Failure to comply with treatment recommendations regarding the taking of appropriate dosages of prescribed medications is not, by itself, considered refusal to submit to medical care."
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
I am not a doctor and I can't provide medical advice. However, you might resolve the issue by complying now (i.e., start using the prescribed CPAP). You might also need to have some adjustments to the device. Maybe it is a different mask/device. Maybe it is titration of the device (i.e., settings/oxygen flow, etc.). Maybe you need a BiPap. Best to discuss with your provider, and one way or another, see if you can comply and make this a non-issue.
 

chaplaincharlie

Super Moderator
Staff Member
PEB Forum Veteran
Lifetime Supporter
Registered Member
OSA requiring a CPAP should be a 50% VA rating. And thus it should be a medical retirement if found unfit for OSA.
OSA is rarely found unfitting!. The military's rationale is they can provide a plug from the machine.
 

chaplaincharlie

Super Moderator
Staff Member
PEB Forum Veteran
Lifetime Supporter
Registered Member
I am not a doctor and I can't provide medical advice. However, you might resolve the issue by complying now (i.e., start using the prescribed CPAP). You might also need to have some adjustments to the device. Maybe it is a different mask/device. Maybe it is titration of the device (i.e., settings/oxygen flow, etc.). Maybe you need a BiPap. Best to discuss with your provider, and one way or another, see if you can comply and make this a non-issue.
If you are having a legitimate compliance issue (there are some) then you might inquire about an INSPIRE implant.
 
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