MEB Question

jkwalker86

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I have a question in regards to MEB... any input or usernames of people who have posted the same thing before for me to read would be gread.

I am a active duty captain, branched infantry, commissioned in 2010 and had 2 years in the guard before.

Around July 2013 I hurt my back doing PT in Afghanistan. Not sure if the injury was just from that, or if it was the straw that broke the cames back. I went to the PA there and he did dry needling and gave me some stretches, told me it was muscular and to stay off of it for 2 weeks and I would be good to go. Well, I stayed off of it for 2 weeks and didnt recover. Any time I tried to workout where I was moving around a lot or putting pressure of my back, it would start hurting again. When I say hurting, I would say 10-10. It hurt to sit, stand, lay, get up, walk.... no way around it.

Fast forward to block leave in december ... I chose not to do any PT during block leave to give me time to heal. On the last week I was bending over going through a pile of laundry and it gave out again. Again it hurt 10-10. Typically took a few days to get down to a 1-10.

Started work back in Jan and went to the TMC where they took some x-rays. All they was was I had scoliosis and that I needed to do phycal therapy. So thats what I did... and I continued to do PT, but I just had to listen to my body and only do what I knew I could do.

Fast forward to March. I PCSed to Benning for MCCC. Got more x-rays done, EMG, MRI, and back in physcal therapy. MRI showed 3 herniated dicsk, degenerative disc disease, thecal sac compression, and my scoliosis. When I went to the neurologist he said he did not recommend surgery, said I wouldnt be fit for duty within the next year, recommended my PCM give me a P3 profile and initiate MEB.

Well, we didnt do that. I put in a request through TRICARE to go to an offpost neurosurgeon for a second look. If he says the same thing, I am thinking about initiating MEB. I wouldnt be able to do the job I needed to do as an Infantryman, and feel getting started on my next career sooner than later would be a good choice.

Now, here is my question. The pain is not constant. I usually can feel it a little, and a little discomfort, but it only hurts if i work out, run, lift weights, or put pressure on my lower back. That is when the severe pain comes back. Typically is stays around for a few days and gradually goes back down to a 1.

If the pain is not constanct, and is only triggered my physical activity with my back, how would that be looked at during the MED process? I can also feel it in the morning when I wake up, just feels kid of sore and takes a few minutes to get loose.

Any input would be great. Thanks.

Josh
 
The back will be rated based of range of motion most likely. When the pain starts is the rating criteria.

If you can bend 90 degress forward it gets a 0% rating, at least 61 degress gets 10%, at least 31 degress is 20%, less than that is 40%, your spine is definetly not frozen, so no higher rating. If you can still bend and touch your toes without pain, the rating will be 0%. It is important to distiguish between what you can do and what causes you pain for rating purposes. You say the pain only comes during activities, but I'll bet your flexibility is jacked.

From your functional description it sounds like you are able to do the 7 basic tasks on the profile. Depends on how the lifting weights plays into the moving 40 lbs 100 ft and how the running plays into evade firex. It may be looking at a MAR2, or maybe just a P2.

http://www.militarydisabilitymadeeasy.com/thespine.html
gives a good breakdown on all the measurements and criteria.
 
Thanks. My flexibility is pretty good when I back is not hurting. I can reach down and touch my toes. It just hurts when I workout or put pressure on my back.

For example... rucking, high intensity workouts where you move around a lot, lots of strain on back turning different directions, in the gym i cant clean, jerk, squat, press ... all of that puts too much pressure on my back... if I do that, I can barely walk the next few days.

Running... I typically ran a 13:00 on the APFT. Right now I cant run faster than an 8 minute mile. It seems like when I try to get faster than that, the impact is greater because I am trying to run faster and I just cant do it. Last 2 APFTs I have been between 16:00-16:10 ... I know I can run 8 minute miles without feeling completely miserable after... so I just try to stick with that pace.

Here is what is going through my head. I am an infantry captain with no ranger tab. With the officer separation boards going on currently, an infantry captain with not tab, a messed up back (whether I end up having surgery or not), without any liklih
 
I have a question in regards to MEB... any input or usernames of people who have posted the same thing before for me to read would be gread.

I am a active duty captain, branched infantry, commissioned in 2010 and had 2 years in the guard before.

Around July 2013 I hurt my back doing PT in Afghanistan. Not sure if the injury was just from that, or if it was the straw that broke the cames back. I went to the PA there and he did dry needling and gave me some stretches, told me it was muscular and to stay off of it for 2 weeks and I would be good to go. Well, I stayed off of it for 2 weeks and didnt recover. Any time I tried to workout where I was moving around a lot or putting pressure of my back, it would start hurting again. When I say hurting, I would say 10-10. It hurt to sit, stand, lay, get up, walk.... no way around it.

Fast forward to block leave in december ... I chose not to do any PT during block leave to give me time to heal. On the last week I was bending over going through a pile of laundry and it gave out again. Again it hurt 10-10. Typically took a few days to get down to a 1-10.

Started work back in Jan and went to the TMC where they took some x-rays. All they was was I had scoliosis and that I needed to do phycal therapy. So thats what I did... and I continued to do PT, but I just had to listen to my body and only do what I knew I could do.

Fast forward to March. I PCSed to Benning for MCCC. Got more x-rays done, EMG, MRI, and back in physcal therapy. MRI showed 3 herniated dicsk, degenerative disc disease, thecal sac compression, and my scoliosis. When I went to the neurologist he said he did not recommend surgery, said I wouldnt be fit for duty within the next year, recommended my PCM give me a P3 profile and initiate MEB.

Well, we didnt do that. I put in a request through TRICARE to go to an offpost neurosurgeon for a second look. If he says the same thing, I am thinking about initiating MEB. I wouldnt be able to do the job I needed to do as an Infantryman, and feel getting started on my next career sooner than later would be a good choice.

Now, here is my question. The pain is not constant. I usually can feel it a little, and a little discomfort, but it only hurts if i work out, run, lift weights, or put pressure on my lower back. That is when the severe pain comes back. Typically is stays around for a few days and gradually goes back down to a 1.

If the pain is not constanct, and is only triggered my physical activity with my back, how would that be looked at during the MED process? I can also feel it in the morning when I wake up, just feels kid of sore and takes a few minutes to get loose.

Any input would be great. Thanks.

Josh

Welcome to the PEB Forum! :)

Hmm, at this point in time, are you still capable of performing your assigned MOS duties to include all basic military soldiering functions? It seems that a P2 profile may be appropriate if you are still capable of performing all MOS requirements as an Infantryman to include all basic military soldiering functions, and you want to remain in the U.S. military on active duty.

Otherwise, despite the advances in modern medicine and the best efforts of patients, some military service members cannot be returned to a full-duty status. In this event, it will be necessary for the military service member to be referred to the Integrated Disability Evaluation System (IDES).

As such, the IDES process begins whenever a military service member's medical providers determine that the military service member's ability to continue military service is questionable due to a physical or mental impairment. It is the impact of the medical condition(s) upon the military service member ability to perform duties appropriate to his or her rank and job skill that is important.

Moreover, it is important to remember that the DoD IDES process is a performance-based system. Simply because a military service member has a medical condition does not mean that the military service member cannot continue to serve on active duty or in the reserve component/national guard.

To that extent, a military service member with a serious medical condition can be found fit when the evidence establishes that the military service member can perform his or her duties. The mere fact that one or more medical conditions exist does not constitute an unfit determination. Also, the inability to deploy to austere environments is only one factor in determining unfitness.

In reference to the DoD IDES MEB/PEB process officially published timeline, please view my following PEB Forum URL thread for a detailed explanation about the entire DoD IDES process:

http://www.pebforum.com/site/threads/a-detailed-explanation-of-the-dod-ides-meb-peb-process.22807/

With that all said, please take care and continue to enjoy life as an Active Duty military soldier or potentially as a military veteran! :cool:

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

Best Wishes!
 
Thanks for your input!

Here is what my findings were from my MRI:

Mild disc desiccation and disc space height loss are noted at L4-L5. A transitional vertebra (lumbarized S1) was noted on the radiographs. The conus terminates at L1. Modic 1/2 change noted in L5-S1. Otherwise no significant focal abnormal marros signal is identified throughout the limits of the examination.
L4-L5: a bulging disc/right paracentral disc bulge causes mild thecal sac compression and mass effect on the exiting right L4 nerve root. There is a tiny annular tear.
L5-S1: A circumferential/left paracentral disc bulge causes mild to moderate thecal sac compression and mild mass effect on the exiting S1 nerve roots, left greater than right. There is minimal right neuroforaminal narrowing.
Impression:spondylitic changes and bulging discs as above.

Here is the write up from the neurologist a couple weeks ago:

1. Lumbar Spondylosis 721.3: The low level of his lumbar symptoms at low physical exertion really means that he needs to permanently limit his exertion. From an interventional standpoint, his symptoms do no rise above radiofrequency denervation The chromicity of his symptoms indicate that he would not obtain a long term axial pain relief from epidural injection. There is no good medication option and he does not require surgery.
My opinion is that the SM will not imporve to the point to allow him to perfrom their militart duty within the year. As such, I would put them in permanent 3 category. Dr. XXX (Head of MEB) instructed me not to write permanent profiles that would initiate a medical board procedure. I would otherwise intiate MEB personally, but he wants this to be done by the PCM so that it will be more wholistic in scope I willrestrict my concerns to the spine.
 
So, the neurosurgeon, IMO, is kinda hinting at that you need additional unfitting condition if they can be supported. He seems asking the PCM to profile other conditions if possible. It may be wise to do the un-infantry thing and get all the tiny aches and pains and symptoms looked into. If you're like any infantry peeps I know with 6+ years of service there are other conditions out there that may very well be unfitting. Back is always hard to hit the magic 30%.

From the sound of the neurosurgeon he expects it to get worse quickly, so by the time this is all done you may end up eligible for a 40% for the back. The exam to determine rating is supposed to be an example of typical case, not your best case. Its hard to seperate from your story how you can say your flexibility is good w/o pain when things you do on a regular basis causes pain and effects your flexibility. If you went into an exam after a typical day of activity, nothing too crazy like running a marathon, but typical fitness and moving around, maybe playing with or carrying a child, just normal things you'd like to do the rest of your life, you'd still be able to touch your toes? Low physical exertion is when he said the symptoms start. Don't go into an exam and fake it, but if you're feeling particularly good that day, tell the examiner what your typical day looks like.

I don't see any reason why you could not be a signal officer or a AG or anything like that, so you could easily make a case for staying in if you wanted to, especially if you're still passing the APFT. You may even make a case for staying infantry, a profile can't be used against you in OERs and such. No way of going to ranger school. Generally, in my experience, ranger tab is mostly for getting your command slot, but if you're in school, have they already slotted you for a command? They used to only send people to the course immediantly before command. As long as you can get a command, and can keep passing the APFT, I think you may avoid it from making an infantry career impossible. Staff time and battalion command isn't as physically stressing. You'll always get looks for not having a tab, but there are chances for your work to overcome that. A PL in your situation is likely out of the infantry, but you may not be. Biggest support for staying in, if you choose too, will be them profiling you as being able to do the 7 basic Soldier tasks. You tell the PCM you can and 9 times out of 10 they'll write the profile saying you can. Your story kinda goes both ways, you have pretty legit injuries, but you also seem to have a pretty strong ability to embrace the suck.
 
Thanks for your input!

Here is what my findings were from my MRI:

Mild disc desiccation and disc space height loss are noted at L4-L5. A transitional vertebra (lumbarized S1) was noted on the radiographs. The conus terminates at L1. Modic 1/2 change noted in L5-S1. Otherwise no significant focal abnormal marros signal is identified throughout the limits of the examination.
L4-L5: a bulging disc/right paracentral disc bulge causes mild thecal sac compression and mass effect on the exiting right L4 nerve root. There is a tiny annular tear.
L5-S1: A circumferential/left paracentral disc bulge causes mild to moderate thecal sac compression and mild mass effect on the exiting S1 nerve roots, left greater than right. There is minimal right neuroforaminal narrowing.
Impression:spondylitic changes and bulging discs as above.

Here is the write up from the neurologist a couple weeks ago:

1. Lumbar Spondylosis 721.3: The low level of his lumbar symptoms at low physical exertion really means that he needs to permanently limit his exertion. From an interventional standpoint, his symptoms do no rise above radiofrequency denervation The chromicity of his symptoms indicate that he would not obtain a long term axial pain relief from epidural injection. There is no good medication option and he does not require surgery.
My opinion is that the SM will not imporve to the point to allow him to perfrom their militart duty within the year. As such, I would put them in permanent 3 category. Dr. XXX (Head of MEB) instructed me not to write permanent profiles that would initiate a medical board procedure. I would otherwise intiate MEB personally, but he wants this to be done by the PCM so that it will be more wholistic in scope I willrestrict my concerns to the spine.

Indeed, you are quite welcome! :)

In my opinion, it seems that a referral into the DoD IDES MEB/PEB process should occur at least from the neurologist write-up alone. That said, your PCM should initiate and complete the necessary paperwork at this point while asking for your opinions/intentions about contining military service!

Once referred, a determination of all medical conditions shall be made by the MEB physician (e.g., the NARSUM) as to what medical conditions are "medically acceptable" and "medically unacceptable" for continued military service.

Naturally, I am unsure as to whether the DoD IDES PEB process shall find you "fit for duty" or physically "unfit" for continued military service.

Nonetheless, you are now definitely armed with sound insightful information to combat the DoD IDES process to ensure that any "programmed" potential injustices do not occur. ;)

With that all said, please take care and continue to enjoy life as an Active Duty military soldier or potentially as a military veteran! :cool:

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

Best Wishes!
 
The MEB being initiated is the right way to do things, probably. But there are 3 ways, the right way, the wrong way and the Army way. They left the door open for you to influence the Army way by saying to evaluate the overall condition. Seen plenty of people direct things the way they wanted at this point. Hardest thing, IMO, at this stage is deciding what you want and what you can handle and judging how well your crystal ball is working.
 
Well, at first when I got the results, I was shocked. I figured he would recommend me for surgery. I go Thursday to an off post neurosurgeon for a second look. If he pretty much says the same thing, that he doesnt think surgery would help, I am REALLY considering pursuing MEB. I figure that eventually it would catch up to me and I would be a victim of the OSB since I would be in IN officer with no tab..... with history of back problems. With the downsizing, I just dont see why they would keep a broke IN captain when they could retain a healthy officer instead of me. So the way I look at it now is I could have the opportunity to start my next career... starting sooner rather than later, or use my GI Bill to get my Masters. There has just been a lot going through my head. Its really a lot to take in.
 
Take the MEB brother, its not worth destroying your body. Your still young and your health is important. I was infantry for 17 years when my MEB was initiated the Dr said if i had gone 5 more years i would have been in a wheel chair. Get all you can, get it fast, and get the hell out of dodge!
 
Well, at first when I got the results, I was shocked. I figured he would recommend me for surgery. I go Thursday to an off post neurosurgeon for a second look. If he pretty much says the same thing, that he doesnt think surgery would help, I am REALLY considering pursuing MEB. I figure that eventually it would catch up to me and I would be a victim of the OSB since I would be in IN officer with no tab..... with history of back problems. With the downsizing, I just dont see why they would keep a broke IN captain when they could retain a healthy officer instead of me. So the way I look at it now is I could have the opportunity to start my next career... starting sooner rather than later, or use my GI Bill to get my Masters. There has just been a lot going through my head. Its really a lot to take in.

Indeed, it's definitely a lot to comprehend at this point albeit it seems that you are being "positively proactive" which shall yield favorable results at the end of the day in my opinion. Take care and continue to enjoy life! :cool:

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

Best Wishes!
 
Update:

Went to an off post Neurosurgeon today. He said surgery could be a possibility. He recommended me have a discogram/discography done. Essentially they would inject some sort of ink into my good discs and bads dics. From my understanding, there should be no reaction in the good discs, but if injecting into my bad discs recreates the pain, then surgery would bea go. From my understading, they would go in and replace the bad discs and put screws in to fuse everything together. Any opinions on this? I am going tomorrow morning to schedule the appointment with pain management for the discography/discogram.
 
Don't forget the option of a branch transfer. I started in the combat arms (Infantry/Air Defense) was moved to MI when I made captain and then moved to the Acquisition Corps at the 9 year mark. Then the wheels began falling off medically. Had I stayed combat arms or MI, I would have been thrown out on my ear for medical issues. Instead I stayed to 21.5 years and retired (and the Army sent me to get my masters).

Mike
 
Update:

Went to an off post Neurosurgeon today. He said surgery could be a possibility. He recommended me have a discogram/discography done. Essentially they would inject some sort of ink into my good discs and bads dics. From my understanding, there should be no reaction in the good discs, but if injecting into my bad discs recreates the pain, then surgery would bea go. From my understading, they would go in and replace the bad discs and put screws in to fuse everything together. Any opinions on this? I am going tomorrow morning to schedule the appointment with pain management for the discography/discogram.

In retrospect, I spent a total of 32+ years in the U.S. Army as an enlisted soldier then an NCO and finally as a Senior Commissioned Officer. Due to combat tours in support of OIF and OEF, I had an ALIF L4-L5 disc fusion lumbar surgery then was involved in three automobile accidents (one as a pedestrian) within 18 months after surgery; my lumbar back was in a very bad condition which eventually led to the referral and acceptance into the DoD IDES MEB/PEB process. I was one month from submitting my retirement paperwork for a Length of Service military retirement when my physical health (e.g., lumbar back and other conditions) to include mental health (e.g., PTSD - combat nightmares, PCS, and other conditions) started to degraded expeditiously.

With that all said, the referral and acceptance into the DoD IDES MEB/PEB process was the best course of action for me albeit it took a glorious 618 calendar days for official completion due to multiple DoD IDES legal appeals to rectify intentional injustices; most were corrected while on active duty and I am in the process of correcting the remainder as a military veteran!

Bottom line, please take care of yourself NOW while still on Active Duty in the U.S. military in my opinion! If medical surgery is required then consider all of your options and schedule the surgery if that's your final decision. Afterwards, if a referral into the DoD IDES MEB/PEB process is mandated then accept it and lean forward in the foxhole (e.g. move on to your next career or just enjoy all post-military endeavors as a military veteran). Take care and enjoy life! :cool:

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

Best Wishes!
 
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