MEB conditions that can get rated

S

swissmiss4u76

PEB Forum Regular Member
Good morning,

I am an AD Army spouse that is trying to understand the process to better support my soldier.

After having 2 surgery for a herniated nucleus pulpous (HNP) last summer, my husband finally got a permanent profile from an Army neuro surgeon that should have started the MEB process. Apparently, there was a "glitch" in the system (the doc had to electronically submit the profile) so he couldn't submit it. The condition listed by the neuro surgeon was: Back degenerative spine disease
Well, after about 4 weeks, my husbands unit's PA finally electronically submitted a permanent profile, however, he changed the diagnose to Chronic lower back pain with HNP.
The MEB doc approved the profile, and my husband had his first briefing yesterday. Nobody, not the nurse case manager or MEB doc have caught the wrong diagnose. I am a nurse myself and the fact is, he no longer has a HNP, because it's been taken care of by the surgery. I am worried that the PEB will return him fit for duty with the reasoning that his HNP has been resolved. Since the first permanent profile was written by a specialty doctor outranking the PA, shouldn't it have prevalence over the PA's? What are my husband's rights with this?

Also, and even more important:
At the briefing my husband was told that he will only be rated on the conditions listed on his profile. My husband was diagnosed with PTSD 3 years ago, has been on meds and in therapy since, and has several other minor issues (shoulder, knees and hips). They are all documented in ALTA, he has been seen by doctors and received treatments for it, however, they are not listed on the permanent profile. Is this true that the PEB will not consider those conditions for a rating? Is this legal?

Thanks for the answers in advance. Just trying to understand the process better while protecting my husbands rights for the best possible outcome.
 
Welcome aboard Swissmiss, I'm a relative newbie and a nurse as well, I've been in the MEB process for about 15 months now.

The only conditions the MEB/PEB looks at are ones that are listed on the profile and are recommended by the physician as non-retainable, most usually a condition that has a permanent profile of 3 or 4. This is legal, as Army disability is only on what keeps the Soldier from serving. As you go through the process, all other conditions will be rated by the VA. PTSD, shoulder issues, knees, hips will be evaluated and rated by the VA if they are not severe enough to be considered fit/un-fit for duty.

As for the profile, you and your husband should approach the case manager about the change in diagnosis to start to get it changed back. If that fails, go to the MEB physician who does the Phase I and II physicals, that your husband sees. If you still do not get a satisfactory answer you can take it to the chief of medicine at the hospital, the DCCS (Deputy Commander for Clinical Services). Profile diagnosis have to be worded a certain way to meet guidelines, if the provider puts a diagnosis on the profile that is not in the system, it may not be boarded, so the right answer may be not changing the profile....

Sorry if i sound vague but hopefully Jason or one of the other Vets can shed more light on your situations.

Best of Luck!
 
Pursuant to DoDI 1332.38:

E3.P1.3. Physical Disability Evaluation

E3.P1.3.1. Purpose. The physical disability evaluation element of the DES shall determine the fitness of Service members with medical impairments to perform their military duties; and for members determined unfit for duty-related impairments, their entitlement to benefits under Chapter 61 of 10 U.S.C. (reference (b)). Physical disability evaluation shall be conducted by PEBs and include the elements in subsections E3.P1.3.2. through E3.P1.3.5., below.


ALL unfitting medical conditions must be evaluated...

That's why it's essential that you take charge at every step of the PDES process. YOU have to make sure that everything that is wrong with you and is unfitting is put in your MEB before it goes to the IPEB. Use the built in appellate process (impartial review, rebuttal statement, FPEB, etc. etc. etc.)...

Garbage in garbage out...simple as that.
 
Two sections from DoDI 1332.38. Bottom line -All medical conditions are to be covered by the MEB and all conditions can contribute to unfitness. Make sure all conditions are covered in the MEB with full clinical data to include the minimum data of the applicable AMIE worksheet.

Mike

E3.P1.2.3. Content. MEBs, TDRL physical examinations, and Reserve component physical examinations shall document the full clinical information of all medical conditions the Service member has and state whether each condition is cause for referral into the DES. (See enclosure 4 of this Instruction.) Clinical information shall include a medical history, appropriate physical examination, medical tests and their results, medical and surgindicated, diagnoses, treatment, and prognosis. MEBs shall not state a conclusion of unfitness because of physical disability, assignment of disability percentage rating, or the appropriated sposition under Chapter 61 of 10 U.S.C. (reference (b)).

And

E3.P3.4.4. Overall Effect. A member may be determined unfit as a result of the overall effect of two or more impairments even though each of them, standing alone, would not cause the member to be referred into the DES or be found unfit because of physical disability.
 
Swissmiss4u76,

It is true that the Army side of the PEB will only rate conditions deemed "unfit". However, all conditions, whether on a profile or not, should be listed in your husbands MEB packet before being sent to PEB and VA. Don't let anyone tell him that a condition should not be listed on his MEB packet. If he has been to sick call ever, even if only one time, for any condition he should list it in his conditions. Let the PEB decide what is "unfitting" and worthing of rating, not anyone else before it goes there. Besides, the VA will rate conditions even if they are not unfitting for military service.

As for his PTSD, if he has a good relationship with his therapist, have him look into having his PTSD listed on his profile. This will have to be done by a psychiatrist, normally the director of behavioral health. But if he can get his therapist in favor of adding PTSD to his profile then the psychiatrist should be willing to do so. Also, he could try to schedule an appointment with the head of behavioral health and speak to him/her directly about getting any behavioral health issues added to a profile.

SapperNurse gave really good advice about your husband getting his profile updated: "As for the profile, you and your husband should approach the case manager about the change in diagnosis to start to get it changed back. If that fails, go to the MEB physician who does the Phase I and II physicals, that your husband sees. If you still do not get a satisfactory answer you can take it to the chief of medicine at the hospital, the DCCS (Deputy Commander for Clinical Services)." Because essentially the MEB physician has the freedom to update or add things your husbands physical side of his profile. Cutting out a middle man such as his PEBLO or case manager and going directly to the source (MEB physician) may be his best course of action.
 
Good Morning,
thank you all for the responses.
The PA agreed to change/update the profile and resubmit it. Case Manager and Med Board Doc are aware of it too- seems to be too easy to be true, but we shall see.
As far as the "ratable" conditions go: has anyone gotten a link to the referenced DoDI? When I google it, I do not come up with the right reference it seems. I will also ask the PEBLO/Nurse Case Manager, as we have another briefing next Wednesday that I am allowed to attend. My husband might have just misunderstood (so I hope).
If not, and his "other" conditions are not listed in his NARSUM ( I assume that's where they would be mentioned) what would be the steps to get them on? Are we entitled to legal counsel? We are stationed overseas (Germany) and I cannot hire a civilian lawyer that has experience with such things, so I would have to go with the on-post Legal Office.
Thanks again.
 
Yes, you are most definitely entitled to legal counsel! If your post has a MEB legal outreach office that is where I would go first. That is great news about the profile. The military rarely operates that smoothly. It is always a treat when it does. ha.
 
This will get you to the PDF for "DoD 1332.38, November 14, 1996, incorporating change 1", that maparker and I were referencing to:

Google

Download it and save. There have been some changes to DoDI 1332.38 due to the NDAA 2008 but that can be found also.

Insofar as ratable conditions, that comes from 38 CFR Part 4, Veterans Administration Scheduled Rating Disabilities (VARSD). This the guide the IPEB/PEBs are "required by law" to use when rating disabilities. As in all claims, the medical conditions presented to the boards should match the ratable conditions.

http://ecfr.gpoaccess.gov/cgi/t/tex...&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38

As you will see it's quite large. However, I have downloaded it all to a word doc. for my own use and turned it into a pdf file. It makes it a lot easier to go through it to find what you need without having to be online. If you want a copy, PM with an email address and I'll send it to you.

If you care to, read this post for a quick overview of the system...

Physical Disability Evaluation System in a Nutshell

Regards,

-duck
 
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