Psoriasis / Psoriatic Arthritis / Humira MEB; RAF Lakenheath

Bwit43

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Good day forum,

I wanted to post my timeline and keep it updated as I feel like I am getting to the point where it may be beneficial to other people and I check on new posts for information multiple times a day.

My background is: 10 years Active Duty Air Force, currently at RAF Lakenheath, England. I was diagnosed with Psoriasis in 2012 while deployed and have basically been off and on topical steroids ever since. I was officially diagnosed with Psoriatic Arthritis in 2016 after multiple physical therapy referrals and numerous Naproxen prescriptions. This took my new dermatologist after PCS'ing to England referring me off-base to a Rheumatologist instead of getting passed around the clinic. After a 2017 deployment, the topical ointments basically stopped working and I was getting 2-3 hours a sleep a night due to primarily back/hip pain. This lead to March of 2019 when my Derm said I would start Humira (was putting it off as long as I could) or start an MEB because my conditions were uncontrollable with just topical steroids and ibuprofen for pain. Initially, my PCM and Derm said I could be returned to duty with a limitation code, but after talking to the VA MSC and PEBLO, it seems the realistic shot of being found fit is extremely slim. Ultimately, I would like to be found fit for duty, but am expecting to be unfit and pushing for the highest ratings that my conditions should warrant. I claimed a few additional items with a total of 15 off the top of my head. I just read through my VA exams today and will probably be following up with some concerns with the exams (the podiatry/podiatrist was the worst doctor I dealt with there). They also sent me to the Washington D.C. VA Medical Center as the doctors doing the exams in England did not have their contracts renewed.

Here is the timeline with the projected goal dates I was given on a handout. I am honestly trying not to rush any of this process and the closer we can get to the summer for a potential separation the better. I'll be sure to continue updating it as everything progresses and hopefully helps people out in the future.

Timeline.JPG
 

Bwit43

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Hoping someone can give me some words of wisdom,

I've been reviewing my C&P Exams that were returned 1NOV19 and have some concerns on what the examiners put in them...

The first major one is under treatment for Psoriasis, they put:

C&P Exam Humira Snippet.JPG
My medical notes from my Derm and specially Rheum state I will be on the medication long-term. I believe the C&P should have been annotated Constant (since I have been on it constantly since March 2019) and the 6 weeks or more is going to result in a 30% instead of 60% rating. I am curious if I am over-worrying about the marking or if I should start pushing/preparing something now. I haven't signed anything from my PCM yet, so maybe that will show something different.

The other major issue is they stated I had zero psoriatic arthritis in any of my joints besides my lower back and right hip. Whereas I've had tests/ultrasounds done by my Rheum that states otherwise. I believe they saw in the notes, her primary concerns were the near debilitating pain in my back/hips and assumed there was nothing else wrong. I scheduled a follow-up with my Rheum Tuesday as she is a British doctor who has a limited amount of experience in the military system to see if she can provide further notes or explanations on pain in my ankles/toes/fingers/hands. I am sure I can get additional or more specific notes from her, but unsure if I can include them at this point in the package or if they would hold any weight at all.

Just looking for some outsiders opinions if there is anything I can or should do now to prep for.
 

eerf123

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Do you think they are basing it strictly on the time period? If that’s the case then you wouldn’t meet the 60 percent criteria until Mar 2020.
 

eerf123

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Looking at the DBQ it does state “ total duration of medication use in past 12 months” which seems to indicate they are basing it on strictly time.
That’s how I think they are defining constant/near constant. I just wonder what the cutoff is to meet this criteria; 6 months or more; 8 months? You would think this would be objectively defined somewhere. It seems a waste of everyone’s time to not rate you 60% since for sure you will be entitled to it in the very near future.
 

Bwit43

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Yeah, that’s what I’ve been thinking since I started the process. Especially since the one marked is 6 weeks or more but not constant and by the definition I am on it constant. I’m just hoping to get everything settled without having to wait after I potentially get out and re-attack the issue.
 

chaplaincharlie

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If you get 30%, but continue on the medication, you can ask for a VARR.
 

eerf123

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I also wonder if they perhaps are labeling the Humira treatment as not constant or near constant because the injections are only one every two weeks. This doesn't seem plausible though since every two weeks is the standard maintenance dose and that would at least qualify it as near constant.

I realize you have already had your exams but is there a way to just ask the VA examiner this specific question?
 

Bwit43

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Reading other posts/forums, I am going to see what percentage it all comes back at and go from there at this point.

Additionally, I wanted to provide an update to my timeline...

Ended up reviewing the MEB/Medical Summary on 8 November and was given until 12 November to request an IMR, submit a Letter of Exception, or any other concerns I may have had. Ended up signing it today (12 November) and waiving the IMR as they seemed to cover everything correctly for the referred conditions. I chose not to submit a letter, just going to see what the board has to say. I think we are going to appeal to the FPEB if it comes back unfit as a last ditch effort and may even appeal the FPEB if it still is unfit.

I did follow-up with my Rheumatologist today and she is going to put in some comments that refute some concerns I had from the C&P exams. I also updated the projected days for each step with the new 180-day timeline.

Capture.JPG
 

Brokin1104

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Reading other posts/forums, I am going to see what percentage it all comes back at and go from there at this point.

Additionally, I wanted to provide an update to my timeline...

Ended up reviewing the MEB/Medical Summary on 8 November and was given until 12 November to request an IMR, submit a Letter of Exception, or any other concerns I may have had. Ended up signing it today (12 November) and waiving the IMR as they seemed to cover everything correctly for the referred conditions. I chose not to submit a letter, just going to see what the board has to say. I think we are going to appeal to the FPEB if it comes back unfit as a last ditch effort and may even appeal the FPEB if it still is unfit.

I did follow-up with my Rheumatologist today and she is going to put in some comments that refute some concerns I had from the C&P exams. I also updated the projected days for each step with the new 180-day timeline.

View attachment 4761
I thought I was the only one who saw the new 180 day timeline.
 

w1a9c8k5

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Wanted to follow this post since I have been diagnosed with Psoriatic Arthritis for a couple years now. Been trying to stay off the MEB radar, but in 2018 I was at the DAWG and they returned me to duty with a limitation code.

Currently been taking Mobic (meloxicam), but its not really taking care of all the joint pain I've been having. Rheumy said in 6 months we would try another run of prednisone to see if that knocked out the joint pain and if so we'd start another medication. Was on Meloxicam for 3-4 months and saw no change in symptoms so I'm guessing we'll try something new.

Thanks for posting your updates. it'll help me in the future if I have to go through this as well.
 

eerf123

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How long did the DAWG take to adjudicate your case? I'm under DAWG review myself for PSA and am curious about the timeline.
 

Bwit43

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Called my PEBLO yesterday and apparently the IPEB met last Friday (15 Nov 19) and found me unfit and it is heading to the VA for ratings. I am thinking mid-December or right before Christmas I will get the ratings back from the VA. Right now I am drafting recommendation letters for some of my leadership to sign and reaching out to prior supervisor's/leaders for more ammunition. Think I am going to try and reach out to the Office of Airmen's Council either early next week or after Thanksgiving. Pretty sure I will appeal to the FPEB if only to delay the process. Was pondering hiring my own representation for the FPEB, but think it will be just a waste of money as it seems pretty certain for another unfit finding. I may look to hire someone for the VA Rating Reconsideration, depending what they come back with.

Was really surprise/disappointed the IPEB made their decision so quickly.

Timeline.JPG
 

Brokin1104

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Called my PEBLO yesterday and apparently the IPEB met last Friday (15 Nov 19) and found me unfit and it is heading to the VA for ratings. I am thinking mid-December or right before Christmas I will get the ratings back from the VA. Right now I am drafting recommendation letters for some of my leadership to sign and reaching out to prior supervisor's/leaders for more ammunition. Think I am going to try and reach out to the Office of Airmen's Council either early next week or after Thanksgiving. Pretty sure I will appeal to the FPEB if only to delay the process. Was pondering hiring my own representation for the FPEB, but think it will be just a waste of money as it seems pretty certain for another unfit finding. I may look to hire someone for the VA Rating Reconsideration, depending what they come back with.

Was really surprise/disappointed the IPEB made their decision so quickly.

View attachment 4848
Congrats you’re one step closer to the end. I’m shocked by their quickness as well. Our packages were sent up at the same time and mine still hasn’t been touched.
 

Bwit43

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I checked my ebenefits & VA.gov claims status this morning. They added an additional claim on the 15NOV19 (the day IPEB found me unfit) and says they finished reviewing it on 23NOV19 and sent it back.

I've really wanted to draw this process out and its feeling like I am getting the most historically fast IDES process in history. Figure I will call my PEBLO this week to see if she has heard anything else. Are there any secrets to get the ratings earlier than waiting for the IPEB to come back?
 

Bwit43

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Yeah, think I’m going to appeal to the FPEB no matter what really. It has definitely started to get mentally taxing and motivation is definitely slipping. If the percentage comes back good (which I am not expecting) I will be real tempted to punch the ticket and bounce.

I find this whole process rather asinine. With such a perceived focus on mental heath and “resilience” (just another of the 100s of buzzword the USAF throws around) we leave people in the complete dark weeks on end.
 

Bwit43

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So...

I received my disposition from my PEBLO today. I was officially offered 40% DOD and 60% VA and PDRL.

My ratings came back: Psoriasis 30%; Psoriatic Arthritis (Back/hip) 10%; Left Knee 10%; Right Knee 10%; Right Thumb 10%; Tinnitus 10%; Iritis 0%

It's in-between what I wanted to get and the worst case scenario they would have given me. I am working with the Office of Airman's Council now and very likely going to request an FPEB even though the odds are extremely abysmal for a return-to-duty. In the meantime, I am going to make sure I have the followup visits I've had with my rheumatologist after my C&P exams to show that I actually do have psoriatic arthritis in other joints that the C&P examiner basically blew off. Additionally, working to argue a case to bump my psoriasis rating up to 60% as my prescription runs through March 2020 (which would be 12 months of constant use) and most likely, with terminal leave, will still technically be in the Air Force then. Here is hoping for a FPEB date that is a few weeks away.

Timeline.JPG
 

eerf123

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So...

I received my disposition from my PEBLO today. I was officially offered 40% DOD and 60% VA and PDRL.

My ratings came back: Psoriasis 30%; Psoriatic Arthritis (Back/hip) 10%; Left Knee 10%; Right Knee 10%; Right Thumb 10%; Tinnitus 10%; Iritis 0%

It's in-between what I wanted to get and the worst case scenario they would have given me. I am working with the Office of Airman's Council now and very likely going to request an FPEB even though the odds are extremely abysmal for a return-to-duty. In the meantime, I am going to make sure I have the followup visits I've had with my rheumatologist after my C&P exams to show that I actually do have psoriatic arthritis in other joints that the C&P examiner basically blew off. Additionally, working to argue a case to bump my psoriasis rating up to 60% as my prescription runs through March 2020 (which would be 12 months of constant use) and most likely, with terminal leave, will still technically be in the Air Force then. Here is hoping for a FPEB date that is a few weeks away.

View attachment 4870
So...

I received my disposition from my PEBLO today. I was officially offered 40% DOD and 60% VA and PDRL.

My ratings came back: Psoriasis 30%; Psoriatic Arthritis (Back/hip) 10%; Left Knee 10%; Right Knee 10%; Right Thumb 10%; Tinnitus 10%; Iritis 0%

It's in-between what I wanted to get and the worst case scenario they would have given me. I am working with the Office of Airman's Council now and very likely going to request an FPEB even though the odds are extremely abysmal for a return-to-duty. In the meantime, I am going to make sure I have the followup visits I've had with my rheumatologist after my C&P exams to show that I actually do have psoriatic arthritis in other joints that the C&P examiner basically blew off. Additionally, working to argue a case to bump my psoriasis rating up to 60% as my prescription runs through March 2020 (which would be 12 months of constant use) and most likely, with terminal leave, will still technically be in the Air Force then. Here is hoping for a FPEB date that is a few weeks away.

View attachment 4870
Yeah if they didn’t rate rate you on joints you have issues with then that should be a good reason to appeal to the FPEB. I think the 30 to 60 percent bump for the PSA should be pretty easy as well; either at the FPEB or via a VARR after all your appeals are exhausted. This may preclude you from fighting for a fit rating though. It wouldn’t seem prudent to lobby for the additional claims and also ask to be returned to duty.
 

Bwit43

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Yeah, I think at this point going to focus on trying to increase the percentages and have given up on the chance of a return to duty.
 

deepdiver1

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I just got diagnosed with psa last week so I will be going through this as well. I appreciate the effort you've put forth for educating everyone about your experience! So what evidence was used for your thumb to receive 10%? Did your rheum put any emphasis on your thumb over your other hand joints? Thanks again and good luck!
 
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