Limited Duty ???

I am a E6 in the Marine Corp with 10 years active duty, I did not have this medical condition before I entered active duty in 1996.

I suffer from severe migraines w/aura and photophobia resulting in dizzy spells and occasional blackouts.
I was put on limited duty back in 2004 for approximately 8 months, I told the neurologist they were under control with the meds because I didn't want to be put out so he took me off limited duty..However they have proggressively gotten worse to the point where I am depressed and have panick/anxiety attacks. I was dropped from training at DI school and now being relieved as a recruiter (good of service) because of this medical condition I was just recently in a car accident in a goverment vehicle because I had a 3-day migraine and got a dizzy spell and blacked out. I have tried every medicine and treatment plan under the sun that the neurologist has precscribed, to no evail....
Does any one know if they will put me back on limited duty or put me straight to a MED board? The last thing I want to do is be discharged but these migraines and depression are to the point where I can't do my daily duties...
Thanks
Smithis
 
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What are they telling you?

Sfxer02,

Welcome to PEB Forum. I am sorry to hear about your conditions.

It is difficult to know what they will do. Probably the best indicator is what they are telling you. Has your doctor given any indication about what he wants to do?

I urge you to read over the threads here on Migraines. Servicemembers are getting shafted on this condition every day, so you need to know how to properly document your conditions so that if you are boarded you can get the benefits that you are entitled to receive.
 
Jason,

Thanks for the reply.

Well I am in a unique situation because I am out on recruiting duty so all I have is civilian doctors. So I am assuming the process wont' start until I get back to the fleet and see a military doctor. I am assuming I will be put up for a board, I read that you can only be on limited duty for 12 months total is that correct? I already have 8 months of limited duty under my belt, and 12 moths is the most for a career..?

as far as being shafted, are service members with migraines being discharged without benefits they deserve? What shall I do to ensure I get everything I deserve?

Also, will it hurt me my case that I was taken off limited duty once before?

Thanks for everything you do
 
Temporary Limited duty

sfxer02,

No thanks are necessary. It completely baffles me why DOD or the Services do not provide this info to servicemembers. You would think they would feel obligated to as leaders.

SECNAVINST 1850.4E states "
j. Temporary Limited Duty (TLD)
(1) For members of the Navy and Marine Corps, the period of TLD shall not exceed 16 months per career, cumulative, before the member either is referred to the PEB for evaluation or is returned to military duty.
(2) If TLD originally is granted for 8 months, and extension or renewal is needed, the MTF shall submit the request to BUPERS (PERS-821) or CMC (MMSR-4), as appropriate, based on a medical evaluation that additional TLD months likely will be sufficient to restore the member to military duty."​

You also only get put on TLD as a recommendation of an MEB. So, it seems to me given your history, eventual referral to a PEB is likely.​

In my experience, migraines are one of the worst conditions to try to get properly rated by the services. Read this thread for a discussion of the issues and some steps to take to get properly rated: http://www.pebforum.com/showthread.php?t=23 . Once you finish, feel free to post questions here or in that thread.​
 
Jason,

That is some bull****, on how they put all these requirements and not let us servicemembers know until it is too late and we are sitting on a PEB wondering why we didn't meet the the criterion for a proper rating.

1. Those requirements in the other thread you linked me too, are they DOD wide or just Army I.E prostrating, neurologist oulined plan for dealing with migraines etc...?

I am in the Marine Corp and now more confused on what I should do to make sure I get the proper rating if I am eventually put to a PEB which is likely given my history with this medical condition.


2. Since my migraines have turned into me having depresion and anxiety/panick attacks, could this turn into them trying to put me out on some kind of personality disorder (which rates nothing)?

3. Would it benefit my case to go to sick call EVERYTIME I have a migraine which is 2-3 times week?

If my questions are off base or not something I should not be asking please let me know.
Thanks again
 
I think it is illegal

Tony,

Seems to me that this deviation from the VASRD by the services is totally illegal.

Anyway, the Army specific guidance does not apply to USMC cases. The DODI guidance does. The SECNAVINST 1850.4E also has Navy/USMC specific guidance: "(4) 8100 - Migraine"Prostrating" means that the service member must stop what he or she is doing and seek medical attention and is incapacitated.
(a) The number of prostrating attacks per time period (day, week, month) should be recorded by a neurologist for diagnostic confirmation.
(b) Documentation of these visits to the medical department representatives must be available in the medical record. Estimation of the social and industrial impairment due to migrainous attacks should be made.
(c) The Medical Board report must contain the types of medications that the member has tried, both prophylactically and abortive and the results of each medicine." (Emphasis added).

So, it seems to me that the Army's policy of having a neurologist plan allowing for you to just go home will not suffice. The sections I bolded above appear to require you to go the doctor and be incapacitated and have that noted EVERY TIME. Subsection (a) seems to require at least some of this to be documented by a neurologist over a specific period of time. What concerns me a great deal is the part of Subsection (b) that I put in italics. That suggests to me that they may be substituting the rating in the VASRD section on migraines for the rating system used for mental disorders.

To answer your question, if I wanted to get properly rated, I would go to the doctor's every time I had an attack. Doing so, it seems sets you up for something else, though. If the doctor ( especially if you go to MTF) tells you to take your meds and stay home if you have an attack and instead you go to the MTF, you have to be careful that you don't mention anything about ratings or PEB. I have seen cases where the PEB will use any mention of benefits by a servicemember as a basis for questioning the truth of what you say. So if you go, just go and seek treatment. Don't discuss legal requirements.

The personality disorder separation is something to be aware of but I would not be as worried about that as I would for them not rating your depression. Do you think the depression is unfitting (i.e., does it keep you from performing the duties of your grade and MOS)? If you believe it does, please read over the threads on mental disorders. You will see what challenges there are in getting that properly rated, too.​
 
So I gather from your response, I should go to the MTF any time I get a migraine and just not talk aout ratings or PEB's and get it documented in my med record?

It is also impossible for me to go to a neurologist every time I have a migraine, I must be referred by my PCM then set the appointment up and that usually is a 2-3 week process.

I am just starting to get worried about getting hassled from my command and the threat of malingering will be coming soon I am sure. Even though my migraines and dizzy spells are documented back to 2004.
 
From a ratings point of view

Tony,

Yes, I would consider going to the MTF. Realize that this will likely hasten your referral to the Physical Disability Evaluation System (PDES). So, you have to weigh the decision to try to get your condition properly documented on the impact this will have on your referral to the PDES. If you want to properly document your condition, the regulation appears to require documentation of your seeking medical care.

I want to point out the distinction between medical treatment and getting your condition documented. This is a real problem with the PDES. Medical treatment is a completely different function than the legal/administrative requirements of the PDES. The two systems are not in sync on these issues.

The other approach would be to let the system run its course and then in the middle of the process ask for referrals to the neurologist. The problem with this is that the PEB's can view this as an attempt to "game" the system. This conflict between the medical treatment function and the PDES function puts servicemembers in a completely unfair position. It is, in my opinion, a flaw in the system. To me, if the regs require a certain testing or examination to document the condition for rating purposes, the onus should be on the service to get that documentation. However, that is not how it usually plays out now. As an aside, this conflict was part of the rationale for the Army coming up with its policy to allow for a neurologist to okay staying at home. I am continuing to look to see if there are any similar Navy policies.

As far as getting hassled by chain of command, this is a real issue, too. I can't tell you what to do. However, you are always entitled to seek medical treatment and they should not hassle you for this. I know the reality is often times different.
 
Thanks

Any help with policies would be greatly appreciated, I would like to have all the ammo I need to come out on top and get what I deserve.
 
Tony,

I agree with Jason. Do not discuss MEB/PEB with anyone in the medical community until you are actually put in for it. Then you will be assigned a PEBLO and that is the person to discuss it with.

Once the MEB is completed, they will most likely forward it to a IPEB. If the results from the IPEB come back with a rating you do not agree with, then go to the JAG office and get a Lawyer and file an appeal to the Formal PEB. The Lawyer is free and on your side.

Brian
 
Jason,

When I was put on limited duty back in 2004, the neurologist flat out asked me if I wanted to stay or go...obviously I said stay. So he put me on limited duty to try to get them under control.

So what shall one do if a doc ask that question?

Also will me being on limited duty and being taken off hurt my case as far as the MEB/PEB making a unfit/fit decision?

Thanks
Tont
 
Only the person asked that question can answer

Tony,

The problem with your question is that in hindsight you can second guess yourself till the cows come home but it won't do you any good now.

That being said, I would break down my answer into two parts. The first is the medical part. If not being on limited duty will make your condition worse or keep you from getting better, then I would say go on limited duty. If not, don't. But from a legal perspective, I think I would say if you want to maximize your chances for a fit finding, if at all possible, stay off limited duty. On the other hand, if you think fit finding is not possible or likely, I say go on limited duty (especially if you think your condition will not get better or may get worse). That way you give yourself a chance, but you also have more time to build a better case for yourself and your base retirement pay will possibly increase in the time it takes you to get referred to the PEB. The Servicemember being asked this question has to weigh both the medical and the legal ramifications and then decide what is best for them.

As far as what effect your being on and then off limited duty impacting your fit/unfit finding, I think the answer holds true for all cases like yours. If I were trying to argue that you are fit, it is better in my view that you never were on limited duty. However, I think this is a very small factor in the decision process. Outweighing it by far is your current condition and what your chain of command says about your current ability to perform your duties. These two factors weigh much more so into the fit/unfit decision than any period of limited duty. So, I don't think it matters much to your final disposition, especially if you are going to be found unfit. Once you are at the unfit level, the previous limited duty becomes irrelevant to the rating decision.

I hope this answered your question. I know it was not short and sweet, but it sums up what I think.
 
Jason,


Yep that answered my question.

Thanks
 
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