MedCon/MedBoard/IRILO/VA Questions

[beckay93]

Hello all,

I am a wife of a service member who was in a severe MVA in 2019. He is currently in the Air Force reserves (did 5 yrs of Marine Corps AD prior), however, due to being injured while on his AD orders for training, he is considered on Medcon and receives AD benefits. Regarding Medcon, the orders have typically been re-upped every 3-6 months, with us basically playing the waiting game to see if his orders will be extended or not.

This whole process has been a nightmare as I am basically the coordinator and advocate for everything with no clear direction or help with anything, so if I do not understand/say something inaccurate, please elaborate for me. Or please point me in the right direction for posting.

He received 2 LODs, one of his for "Grade I splenic laceration, Gustillo Grade 1H distal Right femur intra-articular fracture, Closed Right proximal tibia fracture"
and his second was for "Adjustment disorder with mixed anxiety and depressed mood: ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD"

As of the beginning of this month, his IRILO status is pending with AFRC (IRILO Senior Med Review).

1. Does anyone have any information on timelines for this? And if so, could someone please tell me what the next steps are/how long this will take?

He completed his mental health portion at the VA and they rated 50% for PTSD and is soon to complete his other portions. However I have a couple of questions with this.

2. Although he completed his mental health portion, he was JUST diagnosed with Major depressive disorder. Should I send it to the WWP that is helping us with the VA claim to request challenging this percentage?

3. Right now, the R leg residuals are being claimed with an emphasis on the knee only. The WWP person helping us stated this, but I have heard horror stories about trying to wait again, especially with COVID19. Can anyone tell me if this is the most optimal way to go?

"Your claim is for residuals of right leg fracture. The C&P exam paperwork doesn't specify the ankle and hips because they weren't exclusively claimed. Make sure the examiner knows about all of the affected areas. Once the VA has the medical opinion, they can define what injuries "residuals" actually means. If all areas are not considered, we can submit a new claim at a later date."

Thank you all so much.

 

[chaplaincharlie]

All MH issues generally receive a single rating. So if his MH has not decline, additional diagnoses are irrelevant.If his MH is worse, you could ask the VA for a re-rate. If the VA diagnosis is less than a year old, you can appeal the 50%.

 

[beckay93]

Okay that helps! Thank you!

 

[Guardguy11]

1. Does anyone have any information on timelines for this? And if so, could someone please tell me what the next steps are/how long this will take?

Guard / Reserve timelines are case by case and honestly have no rhyme or reason why they take so long. Complex cases obviously take longer, but the reserves really suck as this. Basically, you are in a holding pattern. MEDCON is designed to get the service member active duty time to heal and return to service while using Tricare to pay for all of the stuff. Medical has to get to a point that feel things have stabilized enough for them to make a long term diagnosis.

How you can tell which way they are leaning is his profile. Is his profile a Code 31 or Code 37? If his current AF 469 profile is code 31, you still have a way to go in your journey. It basically means that his medical staff thinks that his condition will improve within 365 days. If his profile is Code 37, then you are waiting on AFPC to review his LOD and give approval to push him into the Integrated Disability Evaluation System (IDES). IDES often gets confused with MEB, but the MEB portion is local and at this point is just a rubber stamp.

2. Although he completed his mental health portion, he was JUST diagnosed with Major depressive disorder. Should I send it to the WWP that is helping us with the VA claim to request challenging this percentage?

This is part of the reason that you are not seeing any traction. It appears his case is getting worse and his medical team needs to see where it stabilizes. If it gets to the point that the military says he can't be fixed in 365 days, they will push him to a Code 37 profile. Definitely send all relevant information to the person helping with your VA but realize that you can't get any VA compensation until he is off orders. Also, the IDES process has a function where he will be rated by the VA as part of his separation if it comes to that.

3. Right now, the R leg residuals are being claimed with an emphasis on the knee only. The WWP person helping us stated this, but I have heard horror stories about trying to wait again, especially with COVID19. Can anyone tell me if this is the most optimal way to go?

Mobility issues are really tough. They are the most difficult things to get a significant rating on. You need to understand that there are two areas of review right now, the DOD & the VA. The DOD only cares about issues that affect his ability to perform his military service. Any issue that the DOD says is "unfitting" is claimed for his DOD rating. The VA on the other hand will allow you to claim every single thing in your entire military medical record. The complete package. The only concern I would focus on for your husband is to ensure that if his R leg issue is unfitting for service, that it is stated as so when he proceeds through the IDES process.

"Your claim is for residuals of right leg fracture. The C&P exam paperwork doesn't specify the ankle and hips because they weren't exclusively claimed. Make sure the examiner knows about all of the affected areas. Once the VA has the medical opinion, they can define what injuries "residuals" actually means. If all areas are not considered, we can submit a new claim at a later date."

This is interesting. If he has already performed his C&P exam, that would lead me to believe that you are well established within the IDES process. Meaning that AFRC has said his condition(s) are unfitting for service. Based on what I am reading, it sounds like your MSC didn't claim these issues correctly and as such, they didn't fully look over these issues. He doesn't necessarily have to go back to the C&P exam. He can have a local doctor perform the same movement exams and then submit it as evidence for a VA request for rating increase.

The concern I have is if these issues are unfitting for service that your DOD rating will be affected by not having this information. Your MSC should be able to guide you into an appeal. Unfortunately, it is going to get increasingly difficult to get information added to your case in the IPEB process. You may have to reject your IPEB rating if it doesn't meet your expectations and then go into the FPEB to formally fight the ratings with the new information from your doctor stating these conditions are unfitting and related to the accident.

God bless you for fighting for your husband through this. Most people don't have an advocate and it is hell. Please keep the questions coming.