PEB Results - No Action Taken

As stated in other post, I have been dealing with various neurological issues for nearly 2 years now. I have been under the care of a local neurologist for quite some time who has already diagnosed me with small fiber neuropathy which is worsening and is leaning towards a diagnosis of MS due to many central nervous system issues that are caused by MS. He also diagnosed me with probable partial complex seizures after an abnormal EEG and some symptoms I reported. All that said, I underwent a Medical Evaluation Board a few months ago for (I don't have it in front of me so this isn't word for word):

1. Neuropathy that is affecting autonomic and all four limbs.
2. Sleep Apnea.
3. Other neurological issues causing (another word for seizures) controlled by anti-seizure medication.

I underwent my C&P exams at the VA and they went ahead and said I do have MS and I do have a seizure disorder.

The PEB returned my package today saying they were unable to adjudicate the package as it lacked a definitive diagnosis. It sounded like I would be returned to duty and once I got a "definitive diagnosis" another MEB could be done and another referral to PEB could be made.

What are my options here? Does this even sound right. I clearly have something wrong with me that is neurological in nature and that is affecting my ability to do my job. My other issue is I have to get out NLT 31 July due to being twice passed over and it would be much better getting out with some kind of medical discharge or retirement than merely separating with severance. Any advice or someone with similar experience. I will be meeting with the PEBLO on Monday next week to discuss.
 
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This sounds a bit fishy. I wonder if the PEB is trying to separate you without benefits because of the your upcoming NLT date.

What branch of service are you in?

I am going to tag @Jason Perry to see if he can provide any insight. At this point I highly recommend hiring a competent PEB attorney.
 
I agree with finding a PEB attorney. I know they review your entire medical record as well as the NARSUM. They may be putting more emphasis on your record vice the C&P exams, and thats why they are ignoring the diagnosis as well.
 
ScottAir1 said:
The PEB returned my package today saying they were unable to adjudicate the package as it lacked a definitive diagnosis.
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Would be helpful to know what the "Return memo" stated. Sometimes, they will request further information. Othertimes, they will pose questions with a suspense to the MEB directing/requesting more information.

ScottAir1 said:
My other issue is I have to get out NLT 31 July due to being twice passed over and it would be much better getting out with some kind of medical discharge or retirement than merely separating with severance.
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Fortunately, you have some time to address your issues before your admin separation.


ScottAir1 said:
I will be meeting with the PEBLO on Monday next week to discuss.
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Likely, you will (or should) get more clarifying information at that point. Seems to make sense to see what the PEBLO says and then you can update here with more information. Absent additional information, it is a lot of "guess work" as to what is actually happening.
 
Jason Perry said:
Likely, you will (or should) get more clarifying information at that point. Seems to make sense to see what the PEBLO says and then you can update here with more information. Absent additional information, it is a lot of "guess work" as to what is actually happening.
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Jason --

First of all, sorry for the delay. I've been disgusted by the whole thing and getting anywhere seems to be like spinning tires in the mud. To clarify my original post, I was being boarded for the following:

1. Other Idiopathic Peripheral Autonomic Neuropathy.
2. Obstructive Sleep Apnea.
3. Fasciculations/neuro symptoms treated with seizure medication.

The findings and recommended disposition from the PEB was "this case returned without action" and the remarks section was:

"The Board is unable to adjudicate this case at this time, since the service member (SM) is still undergoing active evaluation and has not yet been determined to have medical condition which can be used to determine prognosis. Additionally, the SM's commander indicates the SM is able to complete the requirements of his AFSC. Therefore, the MEB package is returned without action. The case should be resubmitted once the SM has a diagnosis with a reasonable and clear prognosis. Upon reaching a diagnosis, the SM may be returned to duty with coordination of Medical Standards (AFPC/DP2NP), if he is fully world-wide qualified and without duty limitations. If the SM still has limitations or is not world-wide qualified, another MEB will be required."

I asked the PEBLO if this was something I could appeal and they said no.
 
Jason Perry said:
Likely, you will (or should) get more clarifying information at that point. Seems to make sense to see what the PEBLO says and then you can update here with more information. Absent additional information, it is a lot of "guess work" as to what is actually happening.
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Jason --

First of all, sorry for the delay. I've been disgusted by the whole thing and getting anywhere seems to be like spinning tires in the mud. To clarify my original post, I was being boarded for the following:

1. Other Idiopathic Peripheral Autonomic Neuropathy.
2. Obstructive Sleep Apnea.
3. Fasciculations/neuro symptoms treated with seizure medication.

The findings and recommended disposition from the PEB was "this case returned without action" and the remarks section was:

"The Board is unable to adjudicate this case at this time, since the service member (SM) is still undergoing active evaluation and has not yet been determined to have medical condition which can be used to determine prognosis. Additionally, the SM's commander indicates the SM is able to complete the requirements of his AFSC. Therefore, the MEB package is returned without action. The case should be resubmitted once the SM has a diagnosis with a reasonable and clear prognosis. Upon reaching a diagnosis, the SM may be returned to duty with coordination of Medical Standards (AFPC/DP2NP), if he is fully world-wide qualified and without duty limitations. If the SM still has limitations or is not world-wide qualified, another MEB will be required."

I asked the PEBLO if this was something I could appeal and they said no.

I've been thinking about which direction I should go from here. I know MS is heard to diagnose but that is what my neurologist has been suspecting. He has not been able to rule it out or in at this point.
 
@ScottAir1
How long have you been in the USAF?

Two things are working against you being medically retired:
1) Diagnosis. The C&P finding don't constitute a diagnosis of MS. The VA uses the uses the diagnosis most closely fitting your conditions. Make some calls and find an MS guru and request a referral to see him/her. Once a neurologist has given you a diagnosis you can go back to he board.

2) Work with your commander to clearly delineate why you are not able to perform all the task of your job.

Additionally, how many years do you have toward retirement?
 
chaplaincharlie said:
@ScottAir1
How long have you been in the USAF?

Two things are working against you being medically retired:
1) Diagnosis. The C&P finding don't constitute a diagnosis of MS. The VA uses the uses the diagnosis most closely fitting your conditions. Make some calls and find an MS guru and request a referral to see him/her. Once a neurologist has given you a diagnosis you can go back to he board.

2) Work with your commander to clearly delineate why you are not able to perform all the task of your job.

Additionally, how many years do you have toward retirement?
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I have 10 years towards retirement plus an additional 3 years in the reserves prior to AD. I am told I am seeing the best neurologist in the area. He is Mayo trained and seems to me to know his stuff but this has also been a long process. I've been seeing him for almost a year. We are, however, getting ready to do a lumbar puncture for an MS panel and see if a diagnosis can be nailed down that way.

Honestly, my commander reported I was able to do my job because he was hopeful I would be promoted and try to stay in. Now that that is not an option, I told him his next commander's letter needed to say I sucked.
 
ScottAir1 said:
Honestly, my commander reported I was able to do my job because he was hopeful I would be promoted and try to stay in. Now that that is not an option, I told him his next commander's letter needed to say I sucked.
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Best wishes as you go forward with the lumbar puncture. Hopefully you will get an answer. Neurological disorders are difficult to diagnose.

You may want to start listing all the accommodations that are made at work as well as lost time. This will help your CC
write a good "do not retain" type letter.

Best wishes
Mike
 
chaplaincharlie said:
Best wishes as you go forward with the lumbar puncture. Hopefully you will get an answer. Neurological disorders are difficult to diagnose.

You may want to start listing all the accommodations that are made at work as well as lost time. This will help your CC
write a good "do not retain" type letter.

Best wishes
Mike
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Thanks. We are already working on that.
 
Glad to hear you are working a plan. It sounds like your A plan was to stay in, so this plan should be quite different! Best wishes. Mike
 
I was extended for 6 months on a medical hold through 31 January 2017. As you can see in my signature, I've had some additional testing and started seeing a new neurologist. The new neurologist does not feel my symptoms are indicative of MS. He has tentatively diagnosed me with Myasthenia Gravis. He will be sending me to the Mayo for a definitive diagnosis. I have wondered about this from my Google research but never brought it up with my former neurologist because I figured, "What do I know?" Anyway, this will make 3, maybe 4 auto-immune things I have going on now. I have the Small Fiber Neuropathy which was the first to show up. Then the type 2 Diabetes. And now the MG, if that is indeed the case. I may have seizure activity going on too but we have yet to nail that down. I will be doing a sleep deprived EEG next month. My PEBLO said all this will probably get me rolled over into an additional 6 months of medical hold while they try to get it all worked out. The Med Group Commander also has eyes on my case and says the AF will not let me go until it is worked out. Anyone had any experience with MG that can advise me on everything I need to be concerned about? Thanks.

Blessings!
 
Scott, sorry to hear of your troubles.
I went through many of the same tests (MRIs, CTs, EEGs and on and on) and have a lot of the same symptoms as you. After a year of testing and I was finally diagnosed with POTS syndrome/Autonomic Neuropathy. You may want to ask your neuro or PCM about being tested for it if you have not done so thus far. Feel free to PM if yo have any questions.
 
Baylenkm said:
Scott, sorry to hear of your troubles.
I went through many of the same tests (MRIs, CTs, EEGs and on and on) and have a lot of the same symptoms as you. After a year of testing and I was finally diagnosed with POTS syndrome/Autonomic Neuropathy. You may want to ask your neuro or PCM about being tested for it if you have not done so thus far. Feel free to PM if yo have any questions.
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Thanks. The small fiber neuropathy is, I think, considered autonomic. I'm having a sleep deprived EEG in the morning for my on again off again maybe I have a seizure disorder going on too. I've had 2 abnormal 20 minute EEGs but all my 72 hour EEGs have been normal. I have a new neurologist now and he wants to do the sleep deprived one which will be in about 8 hours...if I don't fall asleep :) Personally, I think I'm falling apart.
 
The journey continues. My RILO is due for my sleep apnea. My PCM has referred me for another sleep study. PEBLO says I'll need a score of 16 or higher for it to help me when my case goes back before the PEB. I think my score may have been 12 last time. But I have added some more weight since then. We'll see.
 
Does anyone out there have an example of a prognosis letter from a civilian physician? The PEBLO has asked me to get one from my cardiologist as to my prognosis following my recent open heart bypass surgery. I will see him soon. I want him to stay away from words like "good" or "excellent". I am going to provide him with copies of my sleep studies/sleep apnea info as well as my diabetes so he can tie all that together with his prognosis. I would like to have an example of things to include of those like me who want to be permanently retired. I've been on a medical hold pending separation while the Air Force tries to determine what is going on with me neurologically speaking. I was referred for an MEB last year which was kicked back without action as it appeared to the PEB folks I was still under care and no definitive diagnosis had been made. We may be nearing a definitive diagnosis but I now have an unexpected development to add to the mix. In early October 2016 I started having chest discomfort and chest pain on exertion then with no exertion at all. I underwent a heart catheterization on 26 Nov anticipating a stint or two based upon my failed stress test earlier that week. Instead, I found myself undergoing triple bypass open heart surgery on Nov 28th, at the much too early age of 45. I have now been extended up to 8 more months to 31 August 2017.
 
I feel your pain. It took me 3 years to get diagnosed with MG. I went to Mayo Clinic in rochester MN and Walter reed. Neither of them were worth a damn and would/could not diagnose me nor help me in any way. I was eventually diagnosed by a neuro opthalmologist. I am seronegative and mayo neurons don't believe in such a thing.

I sincerely hope that you get a quick diagnosis and medically retired. MG sucks and I struggle with it daily. Go ahead and get started on SSDI applications.
 
tony292 said:
I feel your pain. It took me 3 years to get diagnosed with MG. I went to Mayo Clinic in rochester MN and Walter reed. Neither of them were worth a damn and would/could not diagnose me nor help me in any way. I was eventually diagnosed by a neuro opthalmologist. I am seronegative and mayo neurons don't believe in such a thing.

I sincerely hope that you get a quick diagnosis and medically retired. MG sucks and I struggle with it daily. Go ahead and get started on SSDI applications.
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The neurologist I'm seeing now says he will send me to Mayo in Jacksonville for a definitive diagnosis. Apparently they have some fancy needle up there or something that's the size of a muscle cell that they insert into the muscle cell and do with it whatever it is they do and you either have it or you don't. I have been doing semi-well with the Mestinon and can notice if I miss a dose my eye muscles start to get tired more quickly. Still don't know if it's affecting my breathing but I did take a while longer to come off of the vent after my open heart surgery back in November.
 
They are probably talking about single fiber emg. The good news is that simply having MG is worth 30%.
 
UPDATE: I Received the results of my PEB today. Permanent medical retirement at 75% for the AF and 100% for the VA. God is good!!!
 
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