Potential PEB for EoE (Dupixent) & MH — Navy E-6

I was recently blindsided by my UMO and could use some insight into what the next few months look like. I’ve been in for 8 years (E-6), and I’m currently at a crossroads between LIMDU and a potential Med Board.

The Situation:
Mental Health: Recently placed on LIMDU for MH. My latest scores were PHQ-9 (18) and GAD-7 (13), with chronic SI documented. I have a psychiatry follow-up in two weeks.

EoE (Eosinophilic Esophagitis): I’ve had a waiver for years, but symptoms recently worsened (chest pain/food blocking). My GI specialist just started me on Dupixent (an immunomodulator).

The Conflict: My UMO stated that long-term use of an immunomodulator like Dupixent is NPQ and that a PEB will be considered.


My Questions for the Group:


1. Timing: Does the Navy typically wait for a "stability" period on new meds (like Dupixent) before officially triggering the PEB, or is the prescription itself enough to start the referral?


2. Timeline: From the moment a PEB is "considered," what is the realistic timeline? Could I be out in 6 months, or is the process currently backed up?


3. Ratings: Has anyone gone through a PEB specifically for EoE while on a biologic? If so, what was your DOD/VA rating? (I’ve heard it ranges from 10% to 80% depending on strictures/dilations).


4. Combined Claims: Since I’m already on LIMDU for MH, will they likely combine the MH and EoE into one Integrated Disability Evaluation System (IDES) case?

I’m worried about providing for my family and the sudden shift in my career path. Any input on what to expect at the 6-month mark would be huge.

 

[Provis]

I was recently blindsided by my UMO and could use some insight into what the next few months look like. I’ve been in for 8 years (E-6), and I’m currently at a crossroads between LIMDU and a potential Med Board.

The Situation:
Mental Health: Recently placed on LIMDU for MH. My latest scores were PHQ-9 (18) and GAD-7 (13), with chronic SI documented. I have a psychiatry follow-up in two weeks.

EoE (Eosinophilic Esophagitis): I’ve had a waiver for years, but symptoms recently worsened (chest pain/food blocking). My GI specialist just started me on Dupixent (an immunomodulator).

The Conflict: My UMO stated that long-term use of an immunomodulator like Dupixent is NPQ and that a PEB will be considered.


My Questions for the Group:


1. Timing: Does the Navy typically wait for a "stability" period on new meds (like Dupixent) before officially triggering the PEB, or is the prescription itself enough to start the referral?


2. Timeline: From the moment a PEB is "considered," what is the realistic timeline? Could I be out in 6 months, or is the process currently backed up?


3. Ratings: Has anyone gone through a PEB specifically for EoE while on a biologic? If so, what was your DOD/VA rating? (I’ve heard it ranges from 10% to 80% depending on strictures/dilations).


4. Combined Claims: Since I’m already on LIMDU for MH, will they likely combine the MH and EoE into one Integrated Disability Evaluation System (IDES) case?

I’m worried about providing for my family and the sudden shift in my career path. Any input on what to expect at the 6-month mark would be huge.

#1. Navy leans fit. If the medication is the issue then most likely they aren't going to do anything until they see if that med works. What if the disqualifying medication doesnt' do the trick and you move on to another med that isn't DQ?

#2. Expect a long timeline. Nothing is fast and the Navy is particularly slow.

#3. You have to look at how the VA rates the condition. The medication itself isn't a condition that is rated. So look at EoE ratings for VA and can see what that condition is rated at for each level of symptoms.

#4. All conditions are considered. If MH is a condition that prevents you from doing your job than it too can be an unfit condition. Unfitting conditions are the ones where their VA rating is used. Also when more than one unfitting condition the combination uses VA math. 2 conditions rated 50% by the VA and found unfitting by the iPEB or FPEB = 80% DOD. That's 50% for the first one. Then 50% of the remaining 50% left that is healthy. That equals 25%. All final ratings are rounded up at 5% or higher. So 25% for the 2nd condition is 30%. So 50% + 30% equals 80% DOD. Also, the max for compensation purposes is 75% so an 80% DOD would result in 75% of your HIGH 3 pay. Though for most to include enlisted like you any chapter 61 pension is reduced to zero since any VA compensation received will offset a chapter 61 pension. So the goal is to have 30% or higher DOD% with PDRL to secure a medical retirement. The key is to medically retire to get Tricare for you and your family. That is the main prize.

Remember that you don't get a say in a lot of it. If the Navy is willing to work with your medical profile restrictions they can find you fit for almost anything. The Navy is the hardest to be found unfit as they try to keep everyone in if possible. Whether it's work restrictions or placing you in a different job so that you can continue to contribute.

Lastly, if they put you in IDES I strongly recommend hiring a dedicated private IDES attorney from the very start. That should give you the best chance to get the results you want. I can provide references if needed. There are only a handful that specialize in IDES and those are the only ones worth paying for.

 

[Cteam47]

#1. Navy leans fit. If the medication is the issue then most likely they aren't going to do anything until they see if that med works. What if the disqualifying medication doesnt' do the trick and you move on to another med that isn't DQ?

#2. Expect a long timeline. Nothing is fast and the Navy is particularly slow.

#3. You have to look at how the VA rates the condition. The medication itself isn't a condition that is rated. So look at EoE ratings for VA and can see what that condition is rated at for each level of symptoms.

#4. All conditions are considered. If MH is a condition that prevents you from doing your job than it too can be an unfit condition. Unfitting conditions are the ones where their VA rating is used. Also when more than one unfitting condition the combination uses VA math. 2 conditions rated 50% by the VA and found unfitting by the iPEB or FPEB = 80% DOD. That's 50% for the first one. Then 50% of the remaining 50% left that is healthy. That equals 25%. All final ratings are rounded up at 5% or higher. So 25% for the 2nd condition is 30%. So 50% + 30% equals 80% DOD. Also, the max for compensation purposes is 75% so an 80% DOD would result in 75% of your HIGH 3 pay. Though for most to include enlisted like you any chapter 61 pension is reduced to zero since any VA compensation received will offset a chapter 61 pension. So the goal is to have 30% or higher DOD% with PDRL to secure a medical retirement. The key is to medically retire to get Tricare for you and your family. That is the main prize.

Remember that you don't get a say in a lot of it. If the Navy is willing to work with your medical profile restrictions they can find you fit for almost anything. The Navy is the hardest to be found unfit as they try to keep everyone in if possible. Whether it's work restrictions or placing you in a different job so that you can continue to contribute.

Lastly, if they put you in IDES I strongly recommend hiring a dedicated private IDES attorney from the very start. That should give you the best chance to get the results you want. I can provide references if needed. There are only a handful that specialize in IDES and those are the only ones worth paying for.

Thank you for this in-depth response.

It sounds like the medication is the disqualifying factor and from my UMO via clinical notes “There needs to be consideration for PEB if continued on Dupixent for EoE”. The condition itself likely falls between 30-50% VA. I follow up with GI in another month, I think the medication is working but I guess another scope will truly show if it’s working. The fear of the unknown is wrecking my mind right now. I joined for job security and now it’s like I’m walking a thin line between being unemployed or not.

I would be interested in an attorney if I got that far. Though someone at medical claimed you only need a lawyer if you truly need it or you’re trying to game the system.

I wish there was more out there about Dupixent and EOE for service members so I’ll continue to post regular updates here.

 

[Provis]

Thank you for this in-depth response.

It sounds like the medication is the disqualifying factor and from my UMO via clinical notes “There needs to be consideration for PEB if continued on Dupixent for EoE”. The condition itself likely falls between 30-50% VA. I follow up with GI in another month, I think the medication is working but I guess another scope will truly show if it’s working. The fear of the unknown is wrecking my mind right now. I joined for job security and now it’s like I’m walking a thin line between being unemployed or not.

I would be interested in an attorney if I got that far. Though someone at medical claimed you only need a lawyer if you truly need it or you’re trying to game the system.

I wish there was more out there about Dupixent and EOE for service members so I’ll continue to post regular updates here.

My only advice is never trust the system. 20+ years ago I was told to trust the system in LDES and I got royally screwed. Also, the results create a financial impact for the rest of your life. You should be trying to get the best result for yourself!!! Everyone needs an attorney. There is a reason they have JAG there for you and that's to protect their behind... The main issue is that they are free and can't possibly give everyone the same amount of time and attention as a dedicated private attorney.

 

[Cteam47]

My only advice is never trust the system. 20+ years ago I was told to trust the system in LDES and I got royally screwed. Also, the results create a financial impact for the rest of your life. You should be trying to get the best result for yourself!!! Everyone needs an attorney. There is a reason they have JAG there for you and that's to protect their behind... The main issue is that they are free and can't possibly give everyone the same amount of time and attention as a dedicated private attorney.

Thank you my pcm is considering a men but wants to see how my condition reacts to the medication. I feel some symptoms are the same and some have improved slightly. We’ll see hope these next few months go. I’m already LIMDU for mh so I wonder how multiple Limdu triggering conditions will affect that decision…