MEB to PEB

First let me say this site is very helpful. The INCAP, MEB, PEB, etc process is confusing and convoluted.

I am a Field Grade Officer with 17.5 years of Guard time and 12 years Active. The below listed issues occurred while on Active Duty. I have LODs for my Cervical Spine and Lower Back, both occurring in Iraq while flying. I also had skin cancer in Iraq, Hemorrhoids (Led to surgery), Sinus Issues (Led to surgery) and PTSD.

My listed diagnoses and MEB Board findings (NARSUM report):

1. Cervicalgia secondary to degenerative disc disease C4-C5/C5-C6 vertebral spondyosis and foraminal stenosis.
Fails retention standards

2. Cervical Radiculopathy refractory.
Meets Standard

3. Cervical fusion with residual pain.
Meets Standard

4. Lumbago secondary to lumbar spondylosis and degenerative discs lumbar L1-L2 disc extrusion, L4-L5 disc protrusion.
Meets Standard

5. Bilateral sciatic radiculopathy.
Meets Standard

6. Post dislocated elbow.
Meets Standard

7. Chronic sinusitis.
Meets Standard

8. Post bilateral submucous resection of inferior turbinate secondary to hypertrophy and septoplasty secondary to deviated nasal septum.
Meets Standard

9. Recurrent Basal cell carcinoma skin cancer on upper back with post excisions and scars.
Meets Standard

10. PTSD
Meets Standard

I am speaking to my IMR doctor in the morning (April 25) over the phone to fight the following:

Issue 1: My P3 profile for my cervical spine and lower back was L3 (Neck) and L3 (lower back) but changed to an L3 (neck) and L2 (lower back) without explanation.

Issue 2: The NARSUM and VA Progress Evaluation notes failed to list Severe Sleep Apnea and Hemorrhoids (with post surgery). It was on the VA forms and medical documentation was provided and covered in the MEB physical. I am asking it be added to the NARSUM. No explanation for it missing.

Issue 3: How does my Cervical Radiculopathy refractory 'meet the standard' when I am in pain all the time and on pain medication? I have pain levels from 4-5 resting to 7-8 after too much activity. I can't lift more than 30 pounds without pain, sit more than 20-30 minutes, drive more than 30 minutes. The VA doctor listed my Left Side Mild and Right Side Moderate pain. I was in so much pain during our physical that I had to stop my physical and take 15 minutes to rest.

Issue 4: Same as above. How does my Lower Back meet standards with ROM issues and pain? Pain was listed by VA doctor as Mild Both sides.

Issue 5: The ROMs the VA doctor listed are inaccurate. She did not measure my ROM using an instrument, but rather she sat 5 feet away and said turn your head around. She listed some arbitrary numbers, too lazy to even make them different:

Cervical Spine ROM by VA Doctor:
Forward Flexion: 0 to 35 degrees (Normal 0 to 45)
Extension: 0 to 35 degrees (Normal 0 to 45)
Right lateral flexion: 0 to 35 degrees (Normal 0 to 45)
Left lateral flexion: 0 to 35 degrees (Normal 0 to 45)
Right rotation: 0 to 60 degrees (Normal 0 to 80)
Left rotation: 0 to 60 degrees (Normal 0 to 80)

Following my attorney's counsel I had my primary doctor measure my ROM and he had a Physical Therapist with a Goniometer take all my measurements listed below:

Cervical Spine:
Forward Flexion: 0 to 5 degrees (Normal 0 to 45)
Extension: 0 to 10 degrees (Normal 0 to 45)
Right lateral flexion: 0 to 10 degrees (Normal 0 to 45)
Left lateral flexion: 0 to 15 degrees (Normal 0 to 45)
Right rotation: 0 to 30 degrees (Normal 0 to 80)
Left rotation: 0 to 30 degrees (Normal 0 to 80)

Clearly the VA doctor failed me. I am hoping during my IMR and on appeal I can get this fixed. The VA doctor did the same thing with my Lower back:

Lumbar Spine ROM by VA doctor:
Forward flexion: 0 to 70 degrees (Normal 0 to 90)
Extension: 0 to 20 degrees (Normal 0 to 30)
Right lateral flexion 0 to 20 degrees (Normal 0 to 30)
Left lateral flexion: 0 to 20 degrees (Normal 0 to 30)
Right rotation: 0 to 20 degrees (Normal 0 to 30)
Left rotation: 0 to 20 degrees (Normal 0 to 30)

What the PT with a goniometer measured:

Lumbar Spine:
Forward flexion: 0 to 25 degrees (Normal 0 to 90)
Extension: 0 to 10 degrees (Normal 0 to 30)
Right lateral flexion 0 to 10 degrees (Normal 0 to 30)
Left lateral flexion: 0 to 20 degrees (Normal 0 to 30)
Right rotation: 0 to 15 degrees (Normal 0 to 30)
Left rotation: 0 to 15 degrees (Normal 0 to 30)

This is a big deal right? Will the IMR or appeal board use logic in seeing this VA doctor just cut and pasted numbers? The VA doctor did say both my Cervical ROM and Lower Back ROM were abnormal and a functional limitation even with the numbers she got, but clearly that was understated. The VA doctor also understated my Lower back pain as Mild and Cervical pain as Mild/Moderate. It was like she wasn't even listening to me or reading my doctor reports. There was a language barrier that worried me. She was from India and she was hard to understand and she probably didn't understand me well either. Why is the VA hiring foreign doctors for such a critical role?

I am sending the below from my primary doctor to the MEB Appeal Board in hopes they use it:

ROM is abnormal and outside the normal ranges and contributes to functional loss. The Veteran has difficulty in routine tasks such as driving, sitting for longer than 20 minutes at a computer or desk, performing tasks of daily living, extreme pain with changing overhead light bulbs or any activity looking up and raising his arms above his neck such as at the grocery store or in the kitchen.

The Veteran exhibited pain in the following ranges:

Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation


The Veteran has radicular pain as follows:

Paresthesias and/or dysesthesias-

Right Upper Extremity: Severe

Left Upper Extremity: Moderate


Numbness-

Right Upper Extremity: Moderate

Left Upper Extremity: Moderate


Involvement of the C5/C6 nerve roots (upper radicular group)

Both are involved.


Indicate severity of radiculopathy and side affected:

Right Side: Severe

Left Side: Moderate


These conditions greatly impact the Veteran’s ability to work.


The Veteran was observed during repetitive use.

The Veteran is able to perform repetitive use testing with at least 3 repetitions, but he has loss of ROM and function during these tasks. The Veteran experiences increased pain and fatigue. After the examination the Veteran suffers from the activity. This is consistent with his prior examinations.

The Veteran has been seen during his flare ups and he is unable to tolerate the pain even with prescribed pain medication.


What my doctor wrote for my Lower Back:


ROM is abnormal and outside the normal ranges and contributes to functional loss. The Veteran has difficulty in routine tasks such as driving, picking up objects, running, walking, sitting for longer than 30 minutes at a computer or desk, performing tasks of daily living.

The Veteran exhibited pain in the following ranges:

Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation


The Veteran has radicular pain as follows:

Intermittent Pain (usually dull)

Right Lower Extremity: Mild

Left Lower Extremity: Mild


Paresthesias and/or dysesthesias-

Right Lower Extremity: Moderate

Left Lower Extremity: Moderate


Numbness-

Right Lower Extremity: Mild

Left Lower Extremity: Mild


Involvement of the L4/L5/S1/S2/S3 nerve roots (sciatic nerve)

Both are involved.


Indicate severity of radiculopathy and side affected:

Right Side: Moderate-Severe

Left Side: Moderate


These conditions impact the Veteran’s ability to work.


The Veteran was observed during repetitive use.

The Veteran is able to perform repetitive use testing with at least 3 repetitions, but he has loss of ROM and function during these tasks. The Veteran experiences increased pain and discomfort. After the examination the Veteran suffers from the activity. This is consistent with his prior examinations.

The Veteran has been seen during his flare ups and is able to reduce some of the pain by lying down flat and taking prescribed pain medication. The Veteran is unable to sit or stand straight up and log rolls out of bed.

Question? I am trying to reach 30% to retire. Given the above I wonder what else I can do to state my case for the PEB?

Can the VA rate me on something found to 'Meet Retention Standards'? Will the VA use just the NARSUM and VA doctor notes for my rating?

The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?

I am sorry this is so long. But any insight would be appreciated.
 
Question? I am trying to reach 30% to retire. Given the above I wonder what else I can do to state my case for the PEB?

Don't know if it's the same for radiculopathy from the cervical spine, but in my case at the MEB I appealed with the help of my assigned JAG lawyer to have the lumbar radiculopathy for EACH leg listed. They are SEPARATE RATABLE CONDITIONS, so in my case, even if the Army had gotten away with low-balling my spinal injury at 10%, having the radiculopathy listed at Conditions Not Meeting Retention Standards put me in a position at the PEB stage to get at least the 30% needed for military retirement. (10% for the spine, 10% for right leg, 10% for left leg = 30% combined).

It's CRITICAL to get every condition you can listed at Not Meeting Retention Standards at the MEB stage, as those are the ONLY conditions that are normally considered for military ratings and benefits at the PEB stage.

Another KEY path for you to consider is having a DBQ (Disability Benefits Questionnaire) filled out by your OWN doctor. The form(s) can be downloaded from the VA website, for each type of condition. They mirror the VA C&P exams. I suggest you have your doctor fill them out, but HAND THEM BACK TO YOU< NOT e-file with the VA. That way you not only have an opportunity to see what the DBQ says, but are able to present it during the PEB stage as NEW EVIDENCE to counter any errors in the C&P exams, NARSUM, and/or disability ratings. By using the DBQ as new evidence at the PEB appeal / VARR stage I was able to effectively counter grossly low-balled C&P exam, doubling the ratings I finally received on appeal.


Can the VA rate me on something found to 'Meet Retention Standards'? Will the VA use just the NARSUM and VA doctor notes for my rating?


The VA rates you (during the PEB stage) on EVERY ratable condition that is SERVICE CONNECTED. BUT the PEB only considers those ratings for conditions that were deemed as Not Meeting Retention Standards at the MEB stage, again, the MEB stage is CRITICAL to success at the PEB.

Technically the VA is supposed to consider ALL evidence during the ratings process, but who knows what they actually do. The good news, REALLY GOOD NEWS, is that if the DBQ and C&P exams disagree, the VA is supposed to use whichever report FAVORS the Veteran (provides the higher rating). But if you put in the DBQ prior to their first rating, and they ignore it, who's to say. Then if you use it AGAIN at the VARR to appeal, they may well say "we've already considered it, denied". That's why it's better to sit on the DBQ until you can slap them in the head with it at the PEB appeal / VARR.


The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?

I believe you mean CRSC (Combat Related Special Compensation). The standard is it has to be "combat related". Meaning as a result of combat OR during simulations of combat (combat field training) OR instrumentalities of war (caused by equipment specifically military in nature designed for combat, such as being injured while operating an armored vehicle, body armor causing a spinal injury, or a M-16 malfunction) OR military extreme hazardous duty (such as military diving, parachuting, etc...).

Just being deployed does NOT meet that CRSC standard. Someone who is hurt at the base gym or in an office even while deployed will most likely be denied. If in doubt, make the best case you can, and submit it when the time comes.

Hope this helps...
 
First let me say this site is very helpful. The INCAP, MEB, PEB, etc process is confusing and convoluted.

I am a Field Grade Officer with 17.5 years of Guard time and 12 years Active. The below listed issues occurred while on Active Duty. I have LODs for my Cervical Spine and Lower Back, both occurring in Iraq while flying. I also had skin cancer in Iraq, Hemorrhoids (Led to surgery), Sinus Issues (Led to surgery) and PTSD...

Question? I am trying to reach 30% to retire. Given the above I wonder what else I can do to state my case for the PEB?

Can the VA rate me on something found to 'Meet Retention Standards'? Will the VA use just the NARSUM and VA doctor notes for my rating?

The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?

I am sorry this is so long. But any insight would be appreciated.
Welcome to the PEB Forum! :)

No worries, a lengthy post provides clarity about your specific situation leading up to the particular questions; at least in my opinion. As such, I offer the below feedback to your specific inquiry:

Q1. This is a big deal right?
A1. Indeed, yes; never default acceptance to any injustices when in the DoD IDES MEB/PEB process!

Q2. Will the IMR or appeal board use logic in seeing this VA doctor just cut and pasted numbers?
A2. Within the MEB phase, the IMR physician will review all available medical evidence and medical documentation in order to determine the appropriate status (e.g., "medically acceptable/meet retention standards" or "medically not acceptable/fails retention standards") of all identified medical conditions.

Q3. Why is the VA hiring foreign doctors for such a critical role?
A3a. Good question, and it was definitely asked when I was voluntarily admitted to the local VAMC MH facility.
A3b. One opinionated answer by a MH inpatient staff personnel was that the DoVA pay scale for PhD physicians/medical doctors isn't competitive enough to entice American citizens who are probably knee-deep in school loan(s) repayments. But, that same DoVA pay scale for PhD physicians/medical doctors is very enticing to foreign doctors since employment income wages seem to be much lower in their native country.

Q4. Given the above I wonder what else I can do to state my case for the PEB?
A4. Remain "positively proactive" and continue to push (e.g., appeal) the issues when in the MEB phase.

Q5. Can the VA rate me on something found to 'Meet Retention Standards'?
A5. The DoVA D-RAS shall evaluate all PEB-referred "unfit for duty" medical conditions for the DoD (military branch of service ) to include all medical conditions/contentions as listed on the DoVA Form completed by the MSC.

Q6. Will the VA use just the NARSUM and VA doctor notes for my rating?
A6. No, the DoVA D-RAS shall review all available medical evidence, medical documentation, and military branch specific documentation in order to evaluate a military service-connection decision then adjudicate the applicable VA disability rating percentage IAW the 38 CFR VASRD criteria.

Q7. The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?
A7. Combat Related Special Compensation (CRSC) is a program that was created for disability and non-disability military retirees with combat-related disabilities. To qualify for CRSC, you must:
  • be entitled to and/or receiving military retired pay
  • be rated at least 10 percent by the Department of Veteran’s Affairs (DoVA)
  • waive your DoVA pay from your military retired pay
  • file a CRSC application with your military Branch of Service
Moreover, there exist additional appeal opportunities (if warranted) when your DoD IDES case file has been determined to have at least one PEB-referred "unfit for duty" medical condition. So, don't be too concerned if you don't achieve your personal goal(s) when in the MEB phase of the DoD IDES process. Take care! :cool:

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

Best Wishes!
 
Question? I am trying to reach 30% to retire. Given the above I wonder what else I can do to state my case for the PEB?

Don't know if it's the same for radiculopathy from the cervical spine, but in my case at the MEB I appealed with the help of my assigned JAG lawyer to have the lumbar radiculopathy for EACH leg listed. They are SEPARATE RATABLE CONDITIONS, so in my case, even if the Army had gotten away with low-balling my spinal injury at 10%, having the radiculopathy listed at Conditions Not Meeting Retention Standards put me in a position at the PEB stage to get at least the 30% needed for military retirement. (10% for the spine, 10% for right leg, 10% for left leg = 30% combined).

Good to know. Yes my JAG Lawyer said right off the bat lets get the Lower Back and Legs listed. Again I have no idea why they switched my Permanent Profile from L3 to L2. I hope with the information from my primary doctor and the new ROM numbers my lower back will be switched to non-retainable. I have radiculopathy in both my legs as well as my neck, shoulders and arms.

It's CRITICAL to get every condition you can listed at Not Meeting Retention Standards at the MEB stage, as those are the ONLY conditions that are normally considered for military ratings and benefits at the PEB stage.

Another KEY path for you to consider is having a DBQ (Disability Benefits Questionnaire) filled out by your OWN doctor. The form(s) can be downloaded from the VA website, for each type of condition. They mirror the VA C&P exams. I suggest you have your doctor fill them out, but HAND THEM BACK TO YOU< NOT e-file with the VA. That way you not only have an opportunity to see what the DBQ says, but are able to present it during the PEB stage as NEW EVIDENCE to counter any errors in the C&P exams, NARSUM, and/or disability ratings. By using the DBQ as new evidence at the PEB appeal / VARR stage I was able to effectively counter grossly low-balled C&P exam, doubling the ratings I finally received on appeal.

I will do this, thanks!



The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?

I believe you mean CRSC (Combat Related Special Compensation). The standard is it has to be "combat related". Meaning as a result of combat OR during simulations of combat (combat field training) OR instrumentalities of war (caused by equipment specifically military in nature designed for combat, such as being injured while operating an armored vehicle, body armor causing a spinal injury, or a M-16 malfunction) OR military extreme hazardous duty (such as military diving, parachuting, etc...).

Just being deployed does NOT meet that CRSC standard. Someone who is hurt at the base gym or in an office even while deployed will most likely be denied. If in doubt, make the best case you can, and submit it when the time comes.

I hurt my neck and lower back flying apaches in combat. PTSD came from that as well. Hemorrhoids as well.
 
Thanks for the fast and detailed response.

The 25 meter target is getting the NARSUM updated and accurate to send to the PEB.

Question 1: I don't think any of my conditions outside my lower back and cervical spine would rate as unfitting so I am not going to spend valuable time on them unless you think any of them are worth listing in appeal and fighting for? They are all Service Connected.

I am concerned about this IMR and NARSUM Appeal process. The VA Evaluation was a joke and turned out to really hurt my case. I am not trusting anyone.

The issues with my cervical spine have ruined my life these past few years. I am considering trying another fusion, spinal doctor says 30% chance it will help. Could make it worse too. I however was told if I do anything else I will not get through the MEB process. I am not in a good place physically. My neck hurts like hell just typing this email.

The lower back conditions are bad in their own right, but aren't as hard to fight through. Hard to not use your neck.

Question 2: Do the ROM I have from the Physical Therapist weigh into my non-retainable/retainable (unfit/fit) argument? Does ROM play into the percentage of retirement like radiculopathy?

Question 3: Will the IMR and Appeal Board take what I give them and use because it is a medical doctor report or is it up to them if it's used? I ask this because clearly I have documentation that contradicts the VA doctor. The attorney didn't sound as if they had to use it. They could say sorry the VA doctor was awesome.

Question 4: Is there a risk to appealing the NARSUM? PEB? I am hoping they fix my NARSUM and my PEB is good the first go round.

Question 5:
Scenario 1: If I don't get 30% from the PEB but still UNFIT and I am at 17.5 years guard and 12 Active what does the REG say? After a certain time they can't pay me just severance correct?
Scenario 2: I am found FIT by PEB cause they are crazy. I know I can't serve so I just resign?
Yes I am looking at the worst case. I will be happy to see 30% or more and a thank you.
 
64Driver
I met with my PCM and the MEB physician today. We went over my case. Basically cervical radiculapthy, cervical disc disorder, cervical spondylosis, and anterior and posterior spondylotic spurring degenerative retrolisteses. I was told my chronic hip bursitis is not unfitting..hmmm. I will be beginning the MEB process in about two weeks. I would be happy to see 30% as well, considering I only have 8 years and 5 months active federal service. I have been told not to take the severance and I would refuse to do so. Where are you located? I am at Fort Lee, VA.
 
@64driver

You can ask for a VA Rating Reconsideration (VARR) using the ROM numbers from your other providers and a statement that the C&P examiner failed to measure ROM with a goniometer.
 
64Driver
I met with my PCM and the MEB physician today. We went over my case. Basically cervical radiculapthy, cervical disc disorder, cervical spondylosis, and anterior and posterior spondylotic spurring degenerative retrolisteses. I was told my chronic hip bursitis is not unfitting..hmmm. I will be beginning the MEB process in about two weeks. I would be happy to see 30% as well, considering I only have 8 years and 5 months active federal service. I have been told not to take the severance and I would refuse to do so. Where are you located? I am at Fort Lee, VA.

I had a fusion on C5-C6 but it didn't help much.
 
My IMR call today was pointless. Dr didn't ask me anything except what I had listed for review. Nothing specific. Maybe I am not understanding this process. Dr said they are just reviewing the medical documents for accuracy.

I have my primary doctor filling out the VA DBQ. This is an in depth document! Great idea.
 
So I am about to send up my NARSUM appeal letter and medical info. I have really strong DBQs written for my Cervical issues and Lumbar issues. These DBQs are considerably different than what the VA doctor wrote. I am hoping these DBQs are given the appropriate weight as they are accurate. The VA dr did me no favors in my eval and failed to score me accurately.

Has anyone had luck with the DBQs?
 
Question? I am trying to reach 30% to retire. Given the above I wonder what else I can do to state my case for the PEB?

Don't know if it's the same for radiculopathy from the cervical spine, but in my case at the MEB I appealed with the help of my assigned JAG lawyer to have the lumbar radiculopathy for EACH leg listed. They are SEPARATE RATABLE CONDITIONS, so in my case, even if the Army had gotten away with low-balling my spinal injury at 10%, having the radiculopathy listed at Conditions Not Meeting Retention Standards put me in a position at the PEB stage to get at least the 30% needed for military retirement. (10% for the spine, 10% for right leg, 10% for left leg = 30% combined).

It's CRITICAL to get every condition you can listed at Not Meeting Retention Standards at the MEB stage, as those are the ONLY conditions that are normally considered for military ratings and benefits at the PEB stage.

Another KEY path for you to consider is having a DBQ (Disability Benefits Questionnaire) filled out by your OWN doctor. The form(s) can be downloaded from the VA website, for each type of condition. They mirror the VA C&P exams. I suggest you have your doctor fill them out, but HAND THEM BACK TO YOU< NOT e-file with the VA. That way you not only have an opportunity to see what the DBQ says, but are able to present it during the PEB stage as NEW EVIDENCE to counter any errors in the C&P exams, NARSUM, and/or disability ratings. By using the DBQ as new evidence at the PEB appeal / VARR stage I was able to effectively counter grossly low-balled C&P exam, doubling the ratings I finally received on appeal.


Can the VA rate me on something found to 'Meet Retention Standards'? Will the VA use just the NARSUM and VA doctor notes for my rating?


The VA rates you (during the PEB stage) on EVERY ratable condition that is SERVICE CONNECTED. BUT the PEB only considers those ratings for conditions that were deemed as Not Meeting Retention Standards at the MEB stage, again, the MEB stage is CRITICAL to success at the PEB.

Technically the VA is supposed to consider ALL evidence during the ratings process, but who knows what they actually do. The good news, REALLY GOOD NEWS, is that if the DBQ and C&P exams disagree, the VA is supposed to use whichever report FAVORS the Veteran (provides the higher rating). But if you put in the DBQ prior to their first rating, and they ignore it, who's to say. Then if you use it AGAIN at the VARR to appeal, they may well say "we've already considered it, denied". That's why it's better to sit on the DBQ until you can slap them in the head with it at the PEB appeal / VARR.


The CRCS should be an option to me should I reach 30% for the issues occurring while in Iraq correct?

I believe you mean CRSC (Combat Related Special Compensation). The standard is it has to be "combat related". Meaning as a result of combat OR during simulations of combat (combat field training) OR instrumentalities of war (caused by equipment specifically military in nature designed for combat, such as being injured while operating an armored vehicle, body armor causing a spinal injury, or a M-16 malfunction) OR military extreme hazardous duty (such as military diving, parachuting, etc...).

Just being deployed does NOT meet that CRSC standard. Someone who is hurt at the base gym or in an office even while deployed will most likely be denied. If in doubt, make the best case you can, and submit it when the time comes.

Hope this helps...
My Cervical Issues and Lumbar issues occurred while flying Apaches in Iraq. I guess that would meet the standard.
 
So I am about to send up my NARSUM appeal letter and medical info. I have really strong DBQs written for my Cervical issues and Lumbar issues. These DBQs are considerably different than what the VA doctor wrote. I am hoping these DBQs are given the appropriate weight as they are accurate. The VA dr did me no favors in my eval and failed to score me accurately.

Has anyone had luck with the DBQs?
I was in the same position, the VA C&P exam was a joke, in my case the DBQ was critical in having the VA ratings brought to a fair level. I think it should do the same for you. Good Luck.
 
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