MEB: Degenerative Arthritis and Bulging Disc

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RICAF

PEB Forum Regular Member
Registered Member
Hello all, I am currently being med-boarded for a few issues. I have a chronic foot injury (screw insertion and plantar fasciates 2X surgeries) as well as lower degenerative arthritis and my L5/S1 disc bulging causing a lot of back pain.

I am currently being scheduled for my VA exams. I understand ROM is a big factor, and admittedly I have a lot of trouble with daily activities such as carrying items, walking for more than a few minutes at a time and shooting pains through my back and legs. Even bending to tie my shoes is cumbersome and puts me in a lot of pain. My foot is in a lot of pain all the time and extended weight bearing is difficult. Also, where the screw insertion is, the area swells throughout the day the more active I am.

With my back/spine issue, it has limited my mobility even further and there are times I have to call my boss and let him know I'm not able to come in to work due to the pain levels. I have also been recommended recently by a surgeon to have a back fusion. I have been dealing with the back issue for about 3 years now and it has steadily gotten worse as far as mobility and pain levels.

Can anyone tell me what to expect during the exams and what they will cover? Also, with the different injuries prompting the MEB, what type of percentage have you seen on average for these types of MEBs?

Any advice or guidance anyone can give is really appreciated.
 
RICAF said:
Hello all, I am currently being med-boarded for a few issues. I have a chronic foot injury (screw insertion and plantar fasciates 2X surgeries) as well as lower degenerative arthritis and my L5/S1 disc bulging causing a lot of back pain.

I am currently being scheduled for my VA exams. I understand ROM is a big factor, and admittedly I have a lot of trouble with daily activities such as carrying items, walking for more than a few minutes at a time and shooting pains through my back and legs. Even bending to tie my shoes is cumbersome and puts me in a lot of pain. My foot is in a lot of pain all the time and extended weight bearing is difficult. Also, where the screw insertion is, the area swells throughout the day the more active I am.

With my back/spine issue, it has limited my mobility even further and there are times I have to call my boss and let him know I'm not able to come in to work due to the pain levels. I have also been recommended recently by a surgeon to have a back fusion. I have been dealing with the back issue for about 3 years now and it has steadily gotten worse as far as mobility and pain levels.

Can anyone tell me what to expect during the exams and what they will cover? Also, with the different injuries prompting the MEB, what type of percentage have you seen on average for these types of MEBs?

Any advice or guidance anyone can give is really appreciated.
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Welcome to the PEB Forum! :)

First, I would highly recommend that you become very familiar with 38 CFR VASRD for the Spine and the Foot at URL https://www.ecfr.gov/cgi-bin/text-i...a7af47c1a&mc=true&node=se38.1.4_171a&rgn=div8 to include reviewing the DoVA webpage entitled "Compensation - List By DBQ Form Name" at URL https://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp for detailed information about what to expect from a parameter point of view.

From an U.S. Army perspective when I was previously in the DoD IDES MEB/PEB process for at least a lumbar medical condition, the DoVA C&P Examination was thoroughly performed by my assigned VA clinician albeit he didn't use the highly recommended "goniometer" for ROM measurements as suggested in 38 CFR VASRD §4.46 Accurate measurement at URL https://www.ecfr.gov/cgi-bin/text-i...9574052987&mc=true&node=se38.1.4_146&rgn=div8.

As such, ensure to make an inquiry about the proper use of the highly recommended "goniometer" if the DoVA clinician decides not to use the tool when performing any ROM measurements. Unfortunately, there are other authorized methods which the DoVA VBA seem to tolerate as proof for ROM measurements. A famous one is the "eye balling" method in which the DoVA clinician shall watch your every move to determine ROM. For example, he/she may ask you to take off your shoes or upon exam completion put your shoes back on. If you are able to bend over to put on your shoes and/or tie the shoe strings from a sitting/standing position then that's equal to a certain ROM measurement; historically between either a 10% rating or a 20% rating in my experienced opinion. If you can't do it or if it's painful then stop bending immediately and make sure you inform the DoVA clinician as to why!

Also, the DoVA clinician will be taking mental notes about your facial expressions during the C&P examination. If it's painful then ensure that you show a painful expression; this is not the time to hold back on anything. If you need assistance with taking off and/or putting on your socks and/or shoes then make sure you inform the DoVA clinician during the C&P examination. Again, this is not the time to hold back on anything! Don't be too proud to ask for help because it could potentially yield unfavorable results which won't accurately reflect your medical condition's symptomology; the bottom line resulting in unfavorable and inaccurate DoVA disability rating(s). Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
Can anyone explain how ROM is determined? Do you just bend until it hurts or is that not even a factor?
 
RICAF said:
Can anyone explain how ROM is determined? Do you just bend until it hurts or is that not even a factor?
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Reference the below diagram from 38 CFR VASRD to view how ROM is suppose to be officially calculated with the recommended assistance of a goniometer.

In addition to what is posted above, yes; it is highly suggested to immediately stop bending upon the start of any pain. Take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 

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ROM is highly contentious. Some examiners use a goniometer others don't. Some tell patients move to the point of pain others don't. Multiple measurements are supposed to be taken, but not all examiners follow the process. In my case the measurements appeared to be very casual, but the rating turned out fair.

If you don't agree with the rating when it comes back you can always ask for a VARR. In which case your injury will be reevaluated.
 
chaplaincharlie said:
ROM is highly contentious. Some examiners use a goniometer others don't. Some tell patients move to the point of pain others don't. Multiple measurements are supposed to be taken, but not all examiners follow the process. In my case the measurements appeared to be very casual, but the rating turned out fair.

If you don't agree with the rating when it comes back you can always ask for a VARR. In which case your injury will be reevaluated.
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So if the examiner doesn't tell you to move to the point of pain would it be smart to stop at that point anyways and notify them?
 
I would just move to where it hurts and say that's painful.
 
Thank you for the recommendations. I have my first visit this Saturday which is a mental health appointment. Then they are setting up the physical and hearing appointments.

I'm assuming ROM will come into play at the general physical they are scheduling.
 
I went through this about 8 months ago. Like chaplincharlie the ROM portion of my exam was very casual the doctor used a goniometer however there was really no instructions other than bend as much as you can go. Take the advice and stop as soon as pain starts DO NOT go to the point in which its excruciating. Pain tolerance differs from person to person so you'll only hamstring yourself. I unfortunately did not listen to this and missed the 30% rating by 5 degrees of movement which gave me 10% for my back and 10% for nerve pain. Fortunately i had other conditions which put me at 70%.
 
So my forward flexion on initial attempt was listed as 25 and after 3 attempts was listed at 15.

Any idea on which one they will use and what the potential percentage result would be off of that?
 
i'm surprised you got your measurements so fast I was told to wait for my PEBLO to inform me. I'm not sure which measurement they'll use but all of them are under 30 degrees so it should be 20% and 10% for nerve damage.
 
Results from the exam only took about 5 days to get back. They've already reviewed my file as of Friday and submitted it forward. PEBLO said next time I hear anything it will be with proposed ratings.

I was able to review my exam paperwork and for my medboarded injuries specifically in addition to the NARSUM write up, it's looking like they have validated the severity of the injuries. So I guess time will tell, I hope between both feet injuries, a screw in my foot and the back injury with limited ROM I'll get a decent percentage. Very nervous about the whole thing at this point.
 
So, just got a call from my PEBLO. They determined I was unfit for duty and are giving me 80% DoD 90% VA. At this point, I'm in shock to say the least but very relieved. I never thought I would come close to this type of rating even though I am legitimately injured (I just feel unlucky sometimes!). Very excited, but again, still in shock.

Thanks to everyone who gave me advice and answered my questions. I call the VA tomorrow and then the PEBLO to start getting a road map for retirement.
 
RICAF said:
So, just got a call from my PEBLO. They determined I was unfit for duty and are giving me 80% DoD 90% VA. At this point, I'm in shock to say the least but very relieved. I never thought I would come close to this type of rating even though I am legitimately injured (I just feel unlucky sometimes!). Very excited, but again, still in shock.

Thanks to everyone who gave me advice and answered my questions. I call the VA tomorrow and then the PEBLO to start getting a road map for retirement.
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Indeed, great news and congratulations on the receipt of favorable IPEB findings! Enjoy and take care!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
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