Reading through these posts, along with MANY others, I wanted to ask you if you feel that I should contact my PCM directly to see about getting my chronic migraines added to my referred conditions for my MEB, or if it would be easier to wait til I get to the FPEB portion of the process?
As a starting point, in every case where you are fighting for a retirement finding, one of the best ways to improve your chances of that result is having as many conditions as possible listed as failing to meet retention standards (or being "referred conditions," which is a term often used, but a little inartfully, in my opinion). With that said, I think whether talking to your PCM directly at this point is a delicate question. If there is a good and honest relationship between you and your provider, this may make sense. The problem is that this can potentially backfire. In the worst cases I have seen, sometimes the provider is annoyed or skeptical when a patient comes to them with a question about adding additional conditions. Sometimes, they will also be misinformed or unaware of the regulations and will say something like, "well, your board is already submitted, we can't change it now." (Which is wrong; but they sometimes think this is the case, or they don't want to look bad by having missed an issue, or they can simply be lazy and not want to do the additional work to update the paperwork). A really poor result I have seen is that the PCM or provider will write a note that gets into your IDES case file that says something like, "Patient is concerned with MEB and wants to add [condition]. Explained to member that condition is well managed and does not interfere with duties. Suspect benefit-seeking behavior." (There are many little "code phrases" that providers use that are really detrimental to a case or argument, like "this patient is well known in the clinic," or "Patient returns to clinic to discuss frustration with MEB and concerns about not getting maximum benefits."). While these types of notes are not helpful, if the evidence is there, then they are not deadly to the argument for the condition being ultimately found unfitting. However, they are certainly not helpful. The big problem is that it can be hard to know at times what type of reaction you might get before raising the issue. In some cases, you may have a great provider who is open to the discussion. It's really a judgment call as to whether having that discussion makes sense.
What I usually tell folks is that you should start with a good understanding of what makes the condition fail retention standards. For most disabilities, there is an element of interference with duties. Remember, the PCMs, specialist providers, doctors, and other providers are mainly concerned with the treatment of conditions. That is where their focus is and they often don't like or care much about the administrative actions that are part of the IDES process. With those ideas in mind, I often think it makes sense to approach providers in the expected context- as a patient seeking treatment, not as a member trying to get an administrative action. If migraines cause someone to be unable to work, or make them leave work, a patient would naturally be expected to mention that in seeking treatment. "Doctor, the migraines are bad about twice a week, and I have to leave work when they hit. The meds I am on help, but not enough to keep me from missing duty. Is there other treatments we can try? Or is there a neurologist or specialist I can see to get more help?" Or maybe the discussion is about the impact of side effects of the meds or other treatment. That type of discussion "makes sense" as it is seeking treatment not an admin result, and is less likely to get a negative reaction in cases where the member does not know how the provider will react.
The other piece that I think is important is making sure the command or your supervisor is tracking the impact. If a member has one condition that is seen as keeping you from performing, sometimes the command or supervisor is not tracking the other condition. Folks can become known as "the back guy," or the "knee gal," and no one really sees or tracks the other conditions. When it comes time to argue for additional conditions (either at the MEB level or the PEB level), if there is no command comment on the impact of other conditions, well, it is much less likely that this condition will be found unfitting.
Being that I’m still early in my MEB process, what're your thoughts on possibly getting the migraines added as a referred condition for “unfit”? P3 profile for my knee only received DIV surgeon signature as of today (30JAN2024).
Every case is unique in its own way, and I don't know whether you can or will succeed with getting an unfit finding for your migraines. My comments above describe some of the common issues people face with arguing for additional conditions. My experience has shown that a great number of cases are not adequately addressed at the MEB level, which causes more risk of getting a poor finding at the PEB level. I approach cases with the idea that you have to know what your goal is for both an outcome and what you want for findings that get you to that result. The way to do that is by systemically looking at what conditions cause an impact on duty performance and then work to get the evidence that shows that, but carefully and without triggering a note or finding that ends up hurting the case.
I don't (and can't) give legal advice to non-clients, so take my comments as my general thoughts. I hope all goes well for you!
