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.
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.