Looking for guidance, helps, tips etc

Jansr08

PEB Forum Regular Member
Registered Member
My husband is in an E7 AGR. (National Guard)
He st rated having mental health issues and I found this website by searching up information.


He began seeking behavioral health treatment approx. 1 mo. ago.
Never given a command behavioral health evaluation, as his command let him self-refer.

Been going to psychotherapy, psychiatrist and has been granted convelescent leave for first 2 weeks he was out.

After finally getting into a civilian psychologist , (no MTF or military doctors available) he recommended 30 days additional. (Return to modified duty in a month) he's been given a temp profile for Behavioral Health.
So hes been on leave, waiting for the convelescent packet to be submitted.

According to our state, 30+ days must go through NGB. Problem is, this packet has not even been submitted yet. This leave would be ending a in couple weeks.
According to info I have been told, it will most likely be denied and he will be charged the 30 days. (He has enough leave to cover the 30 days, but would have no more leave)
I understand we can submit an appeal, which I would like to start working on now.

Besides the frustrations in general with the entire process and the possibility of it being denied (which I believe is ridiculous) can anyone give me some tips in doing the appeal?

Our state is broken, this whole process has been a mess and I'm doing what I can with my limited knowledge (searching regulations NGR and AR) to help my husband get the treatment he needs while keeping him out of trouble, legal, regulations etc.

Any tips, info would be appreciated.
 
To be honest, I've never heard of convalescence leave being used in this way. Generally it is used post surgery when getting out of bed in general is ill advised.

AR 600-8-10 covers leave policy. I don't think this is happening correctly.

Based on my experience, what I imagine happened. E-7 comes in with the stuff saying doc says he needs convalescence leave. He hands it to the training room guy, probably an E-5. E-5 knows convalescence leave is limited to 30 for the commander, but he doesn't know who approves more. He assumes it someone higher, he assumes the E-7 can get what he wants/needs, he doesn't want to tell the E-7 no. He just says NGB approves, but has no real clue. This would then get routed through battalion, brigade, but they say nope, we can't process that. He doesn't quite know what to do with it, its really just sitting in a pile at this point. E-7 asks about it, oh, well, you know, they're probably going to disapprove it. Sometimes that works to make the situation go away. Nobody takes the time to look at the regulation.

This should be coming from a MTF. I don't think the MTF will approve it, nor do I think you can appeal that decision. The problem I see is if he's so bad he can't show up to work and do anything at all they're going to ask why isn't he getting in-patient treatment? There should be realistic restrictions, something tailored to his condition and what he has discrete problems with. Not being able to go to a rifle range is pretty normal. Maybe the doc will write something about confrontations and stressful situations, something that will say put him in a desk job pushing around papers. I could see something crazy as not even being able to wear the uniform being tried. I could see the command looking at the restrictions and saying ok, just call in every day so we know you're alive. I just don't think 6 weeks of convalescence is going to fly for someone who is ambulatory. Then we have the problem of even getting the request to the MTF. Normally the MTF generates it, I don't think they would normally get a request from outside to approve it.

What I think could happen is the commander authorizes 30 days. He then signs in and the commander authorizes another 30 days. I don't see anything preventing this, as long as there is a day between leaves. This should be noticed by higher. I think they'll have a problem with it. The commander is going to be scrutinized more than the MTF that this makes sense. I think they will see him as a high risk Soldier and will want, at a minimum, daily accountability. Even for an E-7.

To avoid the convalescence changed to ordinary leave I would sign in and get the period reduced as close to the 30 days the commander can sign off as he can. Then talk about a new convalescence leave, or more realistically, some real restrictions he can operate under.
 
Thanks for your insight and I understand the pointment about being bad not to go in at all, but not going the in patient route. He's not been recommended to get in patient help by any dr. Part of the ailments have been panic and anxiety attacks.


We went to an active duty post (it was af) but they didn't consider him "at risk" and scheduled a routine appointment. He went to that, only was seen by a social worker type person (not a psychologist or psychiatrist) who told him to s3 his pcm and get a referral forcivilian provider (the psychiatrist at the afb was pcs-ing and they wouldn't schedule appts until over a month out)

My idea was the same, have his commander do the max amount he could sign off for, but the medical liason said because it's the same incident, eventually, the packet would have to go to ngb.
We are already working on getting some sort of modified duty/schedule so he can return sooner if possible.
 
Sorry for my typos, I'm on a mobile.

I meant to say I see your point* and he was told to see his pcm*
 
Doh, ANG, I was thinking ARNG for some reason. I apologize, so yeah, they do things a little differently. AFI 36-3003.

For the AF, the commander always does the first 30 days. Anything in excess of that takes more. They let the hospital commander approve up to 90 days, but only if he's in an inpatient status. The HQ personnel people would need to review and approve his extra 2 weeks. There isn't an appeal that I can see, what looks like is if they disapprove it, you'd just send up another request that's better articulated. If unsuccessful, it does seem clear that they shouldn't charge for the full 30 days, but rather the 2 weeks the commander couldn't approve.

The problem with getting it approved seems to be the in-patient status. They clearly understand being put up in a hospital for more than 30 days. There seems to be a clear expectation that if a condition is so severe that being out of work for more than 30 days is needed, then hospitalization is called for. The AF leaves less room for a commander to fudge things in special circumstances.
 
No, you were right, it's ARNG. But the only active duty hospital (mtf) we have reasonably close is an AFB. We were sent there. My husbands PCM is Air Force as well.
 
AR 600-8-10 does not provide for an appeal, so your original question is quite hard to answer. So I apologize if I have not helped clarify things at all or provide any path forward. Its hard to understand where exactly the problem lies.

Paragraph 5-3 e. from AR 600-8-10 seems quite clear. Hospital commanders are the only approval authority for requests in excess of 30 days (or in excess of 42 days for childbirth).

So there is something missing. Who is saying that NGB has to approve 30+ days? You said your state says that, but states of course don't speak, someone is saying this is what your state rules are. What regulation or policy makes them believe that? Exactly who is providing push back? It sounds like its the medical liaison. In the end, whoever is providing you your information appears to be talking out of the wrong end.

The military loves rules. And people who enforce the rules have very narrow views. Sometimes it takes a little creativity, and working around them rather than through them. Its probably easier to just smile and nod and tell them yup, ok, back on duty, got it, and then sign in from leave. What's the real goal? Getting leave approved or getting him the break he needs? It sounds like the commander is supporting him, there are many ways for the commander to work the second issue. Hell, they can just make a new leave form, sign him out and then when he signs in, "misplace" the leave form. Leave forms don't do anything until they reach finance. Its really only when the commander is making it an issue that you have to run through official hoops and beg to the higher authorities.
 
Thank you for the replies. It does help guide me better.
So ARNG (our state) is telling us that there is an NGR regulation that states 30+ days goes to NGB for approval. I also found a memo published by NGB stating so, but I can't say if it's still in effect as I haven't called anyone at NGB to clarify.

I've never understood why the Guard (maybe only our state?) Makes new rules instead of following ARs. I understand some things have to be modified but sheesh..anyways that's another rant.

I'm confused about MTF or hospital commander approved/recommending con. Leave. Although his PCM is an LTC (AF) at a "satellite" clinic, who would that exactly be? When we went to the AFB, they simply told him they couldn't see him in a timely manner so get a referral from your PCM, we've been working primarily with civilian providers at this point and they are not very well rehearsed in military forms etc.
I guess the goal was/is to let him decompress and adjust to meds while at home and beginning therapy. His panic and anxiety attacks caused alot of difficulties in day to day activities and they are difficult to know what triggers them. He was not sleeping but 2 hrs a night for about 2 weeks. Like I said, no Drs recommendedicated in patient services, even when we called the tricare nurse advice line at 3 am. (Panic attack again).

Having leave available is probably something that doesn't need to be a priority, but if he could have it there if he needs it, it's there. Unfortunately, his leave process is automated, so there is no accidentally losing any forms.

The push back is coming from the SSO, state surgeon office, who is not a medical professional, or a dr. Or therapist. It is from that office that the push is coming from.

Thanks again for you're replies. Sorry if I wasn't clear or was confusing. I'm just trying to do what I can to support my husband and educate myself on these different processes and regulations.
 
It is not unusual to find NGRs that conflict with ARs. The key in looking at the ARs is on the first or second page, in the section that states "Applicability." If the AR is applicable to National Guard members, the AR trumps anything else (absent a delegation of authority to the NGB/NG personnel...often this is not provided for; what does that mean? It means that there are many instances where the NG is "making up rules" that are not provided for by regulation. Depending on the situation, this is something that may be able to be fought out....in others, not so much).

Not really clear on what the exact issue is- is it getting convalescent leave approved?

After finally getting into a civilian psychologist , (no MTF or military doctors available) he recommended 30 days additional. (Return to modified duty in a month) he's been given a temp profile for Behavioral Health.
So hes been on leave, waiting for the convelescent packet to be submitted.

I am wondering, what is the exact issue? Your husband cannot return to duty? He needs 30 days of convalescent leave? I would wonder what his unit/commander (and on the AGR side, the AO) is stating. If they are willing to "informally" cover him, no problem. If they are saying, "report for duty or you are AWOL," that is a different matter.

According to info I have been told, it will most likely be denied and he will be charged the 30 days. (He has enough leave to cover the 30 days, but would have no more leave)

I am not sure what this "30 days" is about....


He began seeking behavioral health treatment approx. 1 mo. ago.
Never given a command behavioral health evaluation, as his command let him self-refer.

Been going to psychotherapy, psychiatrist and has been granted convelescent leave for first 2 weeks he was out.

Is he in an inpatient program? Are the issues to do with substance abuse/ASAP?

Not sure "convalescent leave" is the right "angle" here....I am not sure if he is just "recovering at home," which does not sound like the case that is likely and does not make much sense in the context of a mental health condition.

I really think that I would need more details to understand what is going on. I have a few suspicions about the issues raised, but, need clarification to understand the situation better.
 
There are no substance abuse issues. He began having anxiety and panic attacks, which seemed to be triggered? by stress involving his job. He was not sleeping except around 2 hours a night, just up panicking, worried, emotional. This won't on for about a week or 2.
He's kind of showed signs of not being himself over the past year. Not sleeping regularly, no motivation, getting angry easily, just simply looking defeated and just not himself. I'm his wife, but i could tell my husband was not himself. I've been encouraging him to seek help, but stubbornness, and negative stigma made him believe he could get over it himself. When he lost control of his emotions, felt like he didn't want to live, he decided he to get help. When he went to work the next day, he told his supervisor how he was feeling, his supervisor took him to the closest military hospital (about and hour away). The military hospital sent him home with a follow-up appt for the next week. That was it.
His commander put him on leave and told him to stay home until his appt. After the appt, he was told to see his pcm and get a referral for civilian providers because of the lack of military drs. available. Got referrals (from pcm) Went to civilian Dr. appt and he recommended 30 days off from that point. His commander has not asked for him to return to duty and submitted the convelescent leave.
His command is hoping he won't be charged, as they want him to adjust to his meds and whatver the dr recommends (for example, he can't be left alone because he begins to feel vulnerable, and begins extreme panicking)

The letter I seen from NGB and a form from the commander both state that the convelescent leave could be denied but that decision can be appealed within 10 days of the first decision.
 
Where, if required or needed, should a command directed behavioral health evaluation come into the process of seeking help?

My husbands command is aware of his condition, but because he sees a civilian provider who is not familiar with military forms, we are having difficulty getting the SF 513 (for the profile?) Completed.
 
The first 30 days of convalescent leave would be approved by his commander, based upon the reccomendation of the treating physician, and additional time would have to be granted by the hospital commander of the MTF in which he is being treated (I know you said he went off post, however the referral comes from a MTF).

There is no excuse that the MTF is not able to review the treatment notes from your husband's off base provider and create a temporary profile based upon his current medical condition.

If it were me, I would show up at his off base provider, get a copy of all relevant medical notes, take them to the nearest MTF and have patient adminstration attach them to his behavioral health records.

He will also need to initiate a line of duty (LOD) investigation to establish service connection for the condition(s).
 
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Thank you to everyone who replied. It has given me guidance to look too (the ar covering leave).
Additionally, we plan on taking what we have from the civilian provider and bring that to the mtf (we have an upcoming appointment scheduled by the command) hope that th eyes consider the treatment and diagnosis already completed by the civilians. Thanks againg for the information, it is very helpful.
And thanks for mentioning the LOD. I was thinking it had to be done but we didn't get a clear answer from the BN liason. .
 
Following up on my post from October 2015.
Husband has been in therapy for depression and anxiety as well as medications, he was allowed to continue his recruiting duties, however, his anxiety has increased despite medications, and has once again become a limiting factor in his abilities to perform his recruiting duties. He has had no trouble with other assigned duties or have any other physical limitations beside a permanent profile unrelated to this situation.

We have not received additional paperwork for med board or anything, but the command is recommending a"fit for duty" eval at Ft. Irwin.
He attends all his therapy appointments and h3 continues to try the "mindfulness"techniques and breathing which is supposed to help him through his anxiety episodes.

What is the "fit for duty" eval and what does it consist of? Will this begin a med board and possible separation?
Should they try to reassign him to another duty position besides recruiting?

He has just over 17 years of active service.
 
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