Sheppard AFB - MEB Timeline (PTSD, Psoriasis)

commcubine

PEB Forum Regular Member
Registered Member
Hi everyone, I'm still pretty early in the process but here's my timeline so far - figured it might be therapeutic to keep it updated as it moves along. For background, I've got 11 years AD, I got diagnosed with psoriasis in 2015 (2 years after joining). Caught strep in Oct 23, which triggered severe worsening of my psoriasis (50% exposed area coverage) and onset of psoriatic arthritis. Started biologics in December, which triggered the MEB. Mental health jumped onto the case to add in PTSD as a disqualifying condition, which was finally diagnosed in January after MH spent months covering all their bases. I'm hoping for medical retirement/100% VA with a pretty strong case for both. I've got quite a few heavyweight conditions to pull in a strong VA rating plus A LOT of smaller conditions.

15 Dec - Disqualifying condition documented (psoriasis WITH biological treatment)
17 Dec - PCM places AMRO referral
17 Jan 24 - AMRO board approves code 37
23 Jan 24 - CC impact statement submitted to PEBLO ("Do not retain")
30 Jan 24 - NARSUM from both PCM and Mental Health sent to PEBLO ("Do not retain" from both)
1 Feb 24 - Case sent to AFPC for fitness determination
...
 
Have you done any VA appointments as part of IDES?
Not yet! That will be after AFPC determines "return to duty with code" or "full MEB required". PEBLO told me that I should have a determination by end of next week from AFPC. Then I'll start working with the VA PEBLO.
 
Okay so you are going up for your IRILO. You’ve got some waiting ahead of you but it sounds like you’ve got no issues as far as knowing if you are separating. I had a “return to duty” from my PCM, Mental Health, and CC and I still got unfit. With them pushing for you to be out I’m sure they will concur at AFPC.

Tips from someone that overthought and read everything I could find on the process:

- Start thinking of all your conditions you can claim now with the VA. Your assigned MSC will go over everything in your records, but your C&P appointments they will check anything you put on your form that you will fill out to start your claim. Put down anything and everything. Look up “missed VA claims” or something similar to see if you have anything you might not be thinking of. A good C&P doc will also note anything they notice that you aren’t claiming and the VA will offer you the opportunity to add them to your claim.
- Don’t memorize the Rating Schedule <<LINK) for your conditions, but be familiar with what they look for in their process. Your condition of psoriasis is visual so they will rate it based on that, but think of the how it affects you on your worst day. Same for every other condition you claim. Don’t talk about how it’s good cause you aren’t dealing today. Stuff like sinusitis gets rated based on how many flare ups a year you have and how bad they are. So your worst day should be the focus of your C&P when answering questions.
- Stop when you are uncomfortable for ROM tests. You should not push yourself on your ROM tests. You aren’t trying to prove anything to anyone by being tough at these appointments. If you feel discomfort at 10% then stop moving at 10%.
- Turn everything in quickly. Don’t be the slow link in your process. The process will slow you down enough on its own.
- Mental health C&P will probably be virtual and the ratings for MH are for all mental health conditions, not separate for some physical conditions (think flat feet and plantar fasciitis, both are conditions of the feet but both have their own section in the rating schedule and are rated separately.) again, your worst day is what should be brought to the forefront. If you are on medication and it’s working, tell them how bad it was before you got on and if you stop how bad it’ll be. Highlight how it interferes with all aspects of your life where it does, not just work. Home life, social life, personal care (not wanting to get up to even shower, etc).

Good luck in your journey and I look forward to your updates and to see that 100% P&T in your future.
 
Okay so you are going up for your IRILO. You’ve got some waiting ahead of you but it sounds like you’ve got no issues as far as knowing if you are separating. I had a “return to duty” from my PCM, Mental Health, and CC and I still got unfit. With them pushing for you to be out I’m sure they will concur at AFPC.

Tips from someone that overthought and read everything I could find on the process:

- Start thinking of all your conditions you can claim now with the VA. Your assigned MSC will go over everything in your records, but your C&P appointments they will check anything you put on your form that you will fill out to start your claim. Put down anything and everything. Look up “missed VA claims” or something similar to see if you have anything you might not be thinking of. A good C&P doc will also note anything they notice that you aren’t claiming and the VA will offer you the opportunity to add them to your claim.
- Don’t memorize the Rating Schedule <<LINK) for your conditions, but be familiar with what they look for in their process. Your condition of psoriasis is visual so they will rate it based on that, but think of the how it affects you on your worst day. Same for every other condition you claim. Don’t talk about how it’s good cause you aren’t dealing today. Stuff like sinusitis gets rated based on how many flare ups a year you have and how bad they are. So your worst day should be the focus of your C&P when answering questions.
- Stop when you are uncomfortable for ROM tests. You should not push yourself on your ROM tests. You aren’t trying to prove anything to anyone by being tough at these appointments. If you feel discomfort at 10% then stop moving at 10%.
- Turn everything in quickly. Don’t be the slow link in your process. The process will slow you down enough on its own.
- Mental health C&P will probably be virtual and the ratings for MH are for all mental health conditions, not separate for some physical conditions (think flat feet and plantar fasciitis, both are conditions of the feet but both have their own section in the rating schedule and are rated separately.) again, your worst day is what should be brought to the forefront. If you are on medication and it’s working, tell them how bad it was before you got on and if you stop how bad it’ll be. Highlight how it interferes with all aspects of your life where it does, not just work. Home life, social life, personal care (not wanting to get up to even shower, etc).

Good luck in your journey and I look forward to your updates and to see that 100% P&T in your future.
Wow this was incredibly thorough and gave me some new things to think about. I'm a very thorough and persistent person by nature so I've been working tirelessly to get all my conditions documented. I have a list made, broken down by how well documented they are, how likely they are to earn high ratings, if they're service-connected, etc. I've done the VA calculator using both pessimistic and optimistic estimates of how I'll be rated for my conditions - even being catastrophically pessimistic, I was able to just barely get to 100%.

I will say that my psoriasis is responding well to the Humira so I'm worried that it won't be as observable in the C&P exam - but from what you're saying, it sounds like I just need to paint a full picture of how bad my psoriasis is without medication. I have pictures from before the Humira as well. I also didn't know the VA would actually give me the opportunity to add more to my claims - I assumed that if you don't mention it yourself, you're SOL. But like I said, I've been very thorough and everything I plan to claim has a clear documented history. I also know I have to explain my worst days and avoid positive language about my health during the exams. For MH, you're saying that all my conditions will be rated as one condition? So PTSD, PDD, and anxiety disorder will be rated together? Anyway, this answer was extremely helpful, thanks so much for the advice.
 
So PTSD, PDD, and anxiety disorder will be rated together? Anyway, this answer was extremely helpful, thanks so much for the advice.
Exactly. Your social and occupational function will determine the percent. Attached is a doc with some of the things the MH C&P doc will be looking for during your exam. My mental health doc really messed up my DBQ making it seem like all my diagnosis were exaggerated. For example, my PCL-5 for PTSD with Mental Health was a score of 53 and the C&P doc said I didn’t have PTSD symptoms at all.

You will be able to see your DBQs uploaded to TricareOnline once they are past the QA check with whoever your C&P contract company is. Then you can get a better representation of what your rating could be comparing them to the Rating Schedule.
 

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Exactly. Your social and occupational function will determine the percent. Attached is a doc with some of the things the MH C&P doc will be looking for during your exam. My mental health doc really messed up my DBQ making it seem like all my diagnosis were exaggerated. For example, my PCL-5 for PTSD with Mental Health was a score of 53 and the C&P doc said I didn’t have PTSD symptoms at all.

You will be able to see your DBQs uploaded to TricareOnline once they are past the QA check with whoever your C&P contract company is. Then you can get a better representation of what your rating could be comparing them to the Rating Schedule.
This is extremely helpful, knowing what they're going to ask about on the exam. For physical stuff like psoriasis, would you say the rule still applies about medication being effective? i.e. my meds are working really well so my psoriasis patches are not very visible anymore. Is this bad for me or do they care more about what my symptoms are like when I'm unmedicated? I guess I'm still a little worried on where the line is drawn between playing the truth to my favor (having my worst day) and VA fraud.
 
This is extremely helpful, knowing what they're going to ask about on the exam. For physical stuff like psoriasis, would you say the rule still applies about medication being effective? i.e. my meds are working really well so my psoriasis patches are not very visible anymore. Is this bad for me or do they care more about what my symptoms are like when I'm unmedicated? I guess I'm still a little worried on where the line is drawn between playing the truth to my favor (having my worst day) and VA fraud.
I am not sure as I didn't have any conditions that would be something visible. From what I am reading from the rating schedule (38 CFR § 4.118 - Schedule of ratings—skin. Seciotn 7816) the requirements for a 100% rating for Psoriasis that is service connected would be:

Generalized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following:
  • Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA (psoralen with long-wave ultraviolet-A light), UVB (ultraviolet-B light) treatments, biologics, or electron beam therapy required over the past 12 month period; or
  • No current treatment due to a documented history of treatment failure with 2 or more treatment regimens

So depending on if you have the systemic manifestations, it sounds like your Humira usage actually helps you case since it is something you have to take "constant or near-constantly"
 
I am not sure as I didn't have any conditions that would be something visible. From what I am reading from the rating schedule (38 CFR § 4.118 - Schedule of ratings—skin. Seciotn 7816) the requirements for a 100% rating for Psoriasis that is service connected would be:

Generalized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following:
  • Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA (psoralen with long-wave ultraviolet-A light), UVB (ultraviolet-B light) treatments, biologics, or electron beam therapy required over the past 12 month period; or
  • No current treatment due to a documented history of treatment failure with 2 or more treatment regimens

So depending on if you have the systemic manifestations, it sounds like your Humira usage actually helps you case since it is something you have to take "constant or near-constantly"
That is definitely good news for me then, especially since I'm not depending entirely on psoriasis to get me to 100%. I meet the criteria for 60% on psoriasis (no systemic manifestations but does require near-constant systemic therapy) and 70% on PTSD alone (so hopefully higher with the other MH conditions). Plus a ton of other conditions.
 
15 Dec - Disqualifying condition documented (psoriasis WITH biological treatment)
17 Dec - PCM places AMRO referral
17 Jan 24 - AMRO board approves code 37
23 Jan 24 - CC impact statement submitted to PEBLO ("Do not retain")
30 Jan 24 - NARSUM from both PCM and Mental Health sent to PEBLO ("Do not retain" from both)
1 Feb 24 - Case sent to AFPC for fitness determination
14 Feb 24 - FL4 approved, full MEB required
15 Feb 24 - Emailed by VA MSC to initiate records review
20 Feb 24 - First phone appt w/ MSC, claims submitted

My MSC said I will receive an email tomorrow with my first C&P exam date/s.
 
15 Dec - Disqualifying condition documented (psoriasis WITH biological treatment)
17 Dec - PCM places AMRO referral
17 Jan 24 - AMRO board approves code 37
23 Jan 24 - CC impact statement submitted to PEBLO ("Do not retain")
30 Jan 24 - NARSUM from both PCM and Mental Health sent to PEBLO ("Do not retain" from both)
1 Feb 24 - Case sent to AFPC for fitness determination
14 Feb 24 - FL4 approved, full MEB required
15 Feb 24 - Emailed by VA MSC to initiate records review
20 Feb 24 - First phone appt w/ MSC, claims submitted

My MSC said I will receive an email tomorrow with my first C&P exam date/s.
1 Mar 24 - 1st C&P (general medical - 5 hrs)
4 Mar 24 - 2nd C&P (audio - 1 hr)
14 Mar 24 - 3rd C&P (mental - 2 hrs)

These should be my only exams hopefully!
 
That's impressively fast. It may take a few weeks after your last C&P appointment before your documents show up online, so don't be discouraged. I found that the mental health portion typically takes the longest to upload due to the QC process.
 
That's impressively fast. It may take a few weeks after your last C&P appointment before your documents show up online, so don't be discouraged. I found that the mental health portion typically takes the longest to upload due to the QC process.
Yeah, I was surprised at how quick they got scheduled. Also, it seems like everyone says that the documents get uploaded to TOL. I thought TOL was discontinued. Sheppard is fully moved over to MHS genesis so is that where the docs will be? Would you say 30 days after my last appt might be a reasonable expectation to see them uploaded?
 
Yeah, I was surprised at how quick they got scheduled. Also, it seems like everyone says that the documents get uploaded to TOL. I thought TOL was discontinued. Sheppard is fully moved over to MHS genesis so is that where the docs will be? Would you say 30 days after my last appt might be a reasonable expectation to see them uploaded?
Yeah Genesis took over but for some reason they still upload the dbqs to TOL so you can somewhat gauge your ratings. Mine took about a month for all of them to be uploaded, some were faster than others though.
 
I'm just a step behind you
MY case was with AMRO since Sep 2023
Irilo began Feb 1st
Narsum and CIS (both DNR) submitted to PEBLO on Feb 15
Waiting to hear if they want to iniate a full MEB or return to duty.

I was reffered for chronic low back pain/injuries. Buldging discs, DDD, arthiritis. Ive had multiple lower back injuries on the job. 1 got me admitted in the hospital and put me out of work for a month. I've been non deployable and havent took a PT test in over a year.

At this point I'm not sure what to expect.
 
I'm just a step behind you
MY case was with AMRO since Sep 2023
Irilo began Feb 1st
Narsum and CIS (both DNR) submitted to PEBLO on Feb 15
Waiting to hear if they want to iniate a full MEB or return to duty.

I was reffered for chronic low back pain/injuries. Buldging discs, DDD, arthiritis. Ive had multiple lower back injuries on the job. 1 got me admitted in the hospital and put me out of work for a month. I've been non deployable and havent took a PT test in over a year.

At this point I'm not sure what to expect.

Are you wanting to be found fit or unfit? If it was submitted to PEBLO on Feb 15, you should get a decision back soon if they did their job. AFPC moves quick on the decision once it's submitted to them. Be persistent with your PEBLO and your MSC (your VA PEBLO basically) if it goes full MEB. If you have other evidence, submit it through VA.gov (if you can, I could not) or your MSC. I recommend getting peer letters validating your disability. It's not a requirement and they won't tell you to do it but if you're looking to get disability, I recommend doing everything you can to make your case.
 
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Also, fun thing I noticed. My first C&P is tomorrow but I can already see my NARSUMs and everything on TOL. I was told I wouldn't get to see those until the PEB approves separation/retirement. Anyway, I noticed that the medical records package on there only went up to February 2023. I called my MSC to have him check if he had any of my records from the past year and he said no. He had to go on Genesis and pull those - thank goodness I caught it before my C&Ps started. I guess because a lot of the process is still done through TOL, there is potential for mistakes because of Genesis being a separate system.
 
Are you wanting to be found fit or unfit? If it was submitted to PEBLO on Feb 15, you should get a decision back soon if they did their job. AFPC moves quick on the decision once it's submitted to them. Be persistent with your PEBLO and your MSC (your VA PEBLO basically) if it goes full MEB. If you have other evidence, submit it through VA.gov (if you can, I could not) or your MSC. I recommend getting peer letters validating your disability. It's not a requirement and they won't tell you to do it but if you're looking to get disability, I recommend doing everything you can to make your case.
Yeah I'm still waiting on my PEBLO to let me know what AFPC has decided to do with me. I havent thought about the VA stuff yet. I dont think i have an MSC and if I do i have no clue who that is. Noone has spoke to me about the VA stuff so im kind of lost playing the waiting game.
 
Yeah I'm still waiting on my PEBLO to let me know what AFPC has decided to do with me. I havent thought about the VA stuff yet. I dont think i have an MSC and if I do i have no clue who that is. Noone has spoke to me about the VA stuff so im kind of lost playing the waiting game.
You won't have an MSC until AFPC sends back an FL4 (unfit) decision. Call your PEBLO and ask. AFPC turnaround should be around 10 days.
 
My MH provider told me today that she received my packet for signature. Can anyone clarify what this means? The last step I completed was my final C&P on 14 Mar. If my provider has my packet, does that mean the VA has already finished reviewing my records or that I'm nearly done with the MEB stage?
 
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