Should I request an IMR?

[Steelerpride51]

Greetings,
I am wondering if I should request an IMR or let this thing ride out to the PEB. I WANT to be found unfit for duty. I have 20 yrs in so I am less concerned with the DOD rating, I just want to be found unfit. My assumption is if unfit even at a 0% DOD rating, I will receive the standard 50% for 20 yrs and get concurrent with VA. I have an Aortic Root Aneurysm, The NARSUM states it "appears" that it does not meet Retention standards and refer to PEB. All my other conditions meet medical retention standards, which I am fine with. But the doc (Online reviews for this doc were hilarious) that wrote my NARSUM seemed to tear apart the inconsistencies of the MTF and the VA, highlighting everything I haven't been seen with or profiled for. Is it standard for the NARSUM narrative to be written in a manner of minimizing your health issues? I am going to post some of the language here and hope someone that has experienced this can tell me if they think the PEB will find me unfit or fit. Also if you were in this position would you request an IMR etc. Thanks for your time God Bless.


1. Soldier Identification. MSG is a 37 year old 25U/ Signal Support Systems Specialist in US Army referred into IDES for Aortic root dilatation.

4. DA 3947 Block 11 a diagnoses. The following diagnoses do NOT meet medical retention standards per AR 40-501:
1. Aortic root dilatation (VA DX: Aortic aneurysm, ascending, thoracic or abdominal). Origin November 2023. EPTS: No. Permanent Service Aggravation: N/A. IAW 3-15c.

5. Medical Retention Determination Point (MRDP) Statement. The soldier is within one year of being diagnosed with aortic root dilatation and it
appears to not meet AR 40-501, 3-15c. He has reached MRDP.

I will Omit the profile review and discussion for brevity.

e. Prognosis Statement. His condition is not likely to improve enough to permit return to full duty within the next 12 months. SM will require long-term treatment and monitoring beyond the next 12 months. It is unlikely that his condition would improve significantly within the next 3 years to allow SM to be able to successfully perform job duties. f. Impact on Duty Performance. has deployment limitations due to this condition and requires monitoring every 6-12 months. He also has limitations on certain aspects of ACFT per cardiologist. He passed ACFT in February 2023. The VA exam states condition does not impact his ability to work. Commander's statement dated 11 March _2024 states: SM is unable to endure any added stress and currently has an Aortic root dilatation ... The SM is working a limited duty to prevent any undue stress to his he, also the medical professionals have requested that the SM does not work no more than 8 hours during the duty day and is not allowed be in an austere environment until cleared by unit medical Officer ... The SM is unable to conduct physical fitness and most limit his stress levels to due to Aortic root dilatation ... currently has a Aortic Root Dilatation and has multiple limitation that would provide him to deploy. g. Selection of Applicable AR 40-501, Chapter 3 provision. This does not meet medical retention standards IAW AR 40-501 3-15c.
8. Mental Competency Statement, when applicable. The Soldier is deemed mentally competent for pay purposes, is capable of understanding the nature of, and cooperating in, PEB proceedings, and is not considered dangerous to himself or others.
10. Quality Assurance Check.
a. Apparent Inconsistencies. Inconsistencies between Veterans Administration and Medical Treatment Facility: -The VA exam made multiple new diagnoses that are not found in the military treatment record.
Also for the sake of brevity I will end it here. But the doc digs in on how the VA diagnoses basically all of my claims without a MTF history.

 

[Provis]

Greetings,
I am wondering if I should request an IMR or let this thing ride out to the PEB. I WANT to be found unfit for duty. I have 20 yrs in so I am less concerned with the DOD rating, I just want to be found unfit. My assumption is if unfit even at a 0% DOD rating, I will receive the standard 50% for 20 yrs and get concurrent with VA. I have an Aortic Root Aneurysm, The NARSUM states it "appears" that it does not meet Retention standards and refer to PEB. All my other conditions meet medical retention standards, which I am fine with. But the doc (Online reviews for this doc were hilarious) that wrote my NARSUM seemed to tear apart the inconsistencies of the MTF and the VA, highlighting everything I haven't been seen with or profiled for. Is it standard for the NARSUM narrative to be written in a manner of minimizing your health issues? I am going to post some of the language here and hope someone that has experienced this can tell me if they think the PEB will find me unfit or fit. Also if you were in this position would you request an IMR etc. Thanks for your time God Bless.


1. Soldier Identification. MSG is a 37 year old 25U/ Signal Support Systems Specialist in US Army referred into IDES for Aortic root dilatation.

4. DA 3947 Block 11 a diagnoses. The following diagnoses do NOT meet medical retention standards per AR 40-501:
1. Aortic root dilatation (VA DX: Aortic aneurysm, ascending, thoracic or abdominal). Origin November 2023. EPTS: No. Permanent Service Aggravation: N/A. IAW 3-15c.

5. Medical Retention Determination Point (MRDP) Statement. The soldier is within one year of being diagnosed with aortic root dilatation and it
appears to not meet AR 40-501, 3-15c. He has reached MRDP.

I will Omit the profile review and discussion for brevity.

e. Prognosis Statement. His condition is not likely to improve enough to permit return to full duty within the next 12 months. SM will require long-term treatment and monitoring beyond the next 12 months. It is unlikely that his condition would improve significantly within the next 3 years to allow SM to be able to successfully perform job duties. f. Impact on Duty Performance. has deployment limitations due to this condition and requires monitoring every 6-12 months. He also has limitations on certain aspects of ACFT per cardiologist. He passed ACFT in February 2023. The VA exam states condition does not impact his ability to work. Commander's statement dated 11 March _2024 states: SM is unable to endure any added stress and currently has an Aortic root dilatation ... The SM is working a limited duty to prevent any undue stress to his he, also the medical professionals have requested that the SM does not work no more than 8 hours during the duty day and is not allowed be in an austere environment until cleared by unit medical Officer ... The SM is unable to conduct physical fitness and most limit his stress levels to due to Aortic root dilatation ... currently has a Aortic Root Dilatation and has multiple limitation that would provide him to deploy. g. Selection of Applicable AR 40-501, Chapter 3 provision. This does not meet medical retention standards IAW AR 40-501 3-15c.
8. Mental Competency Statement, when applicable. The Soldier is deemed mentally competent for pay purposes, is capable of understanding the nature of, and cooperating in, PEB proceedings, and is not considered dangerous to himself or others.
10. Quality Assurance Check.
a. Apparent Inconsistencies. Inconsistencies between Veterans Administration and Medical Treatment Facility: -The VA exam made multiple new diagnoses that are not found in the military treatment record.
Also for the sake of brevity I will end it here. But the doc digs in on how the VA diagnoses basically all of my claims without a MTF history.

Have you discussed this with legal yet. Everytime there is a decision whether, appeal, IMR or rebuttal its wise to confer with your free legal before making a decision. Your peblo can request an extension if there is a delay due to legal being busy and not being able to assist you within the given window.

 

[thanks4urhelp]

Is it standard for the NARSUM narrative to be written in a manner of minimizing your health issues?

In my experience, yes. My referring provider's NARSUM stated the following:

MRI Lumbar and thoracic spine [REDACTED DATE] revealed T6-T8 degenerative changes with mild spinal canal narrowing at T6-T7
and dorsal epidural lipomatosis in the upper/mid thoracic spine. Of note, these findings do not explain pain involving multiple
segments of upper and lower back.

The VA diagnosed me with the issues that explain the pain involving multiple segments. My psychologist who just retired informed me that a SM boarding out is seen as a mission failure for them (them being referring provider/PCM), and seeding doubt where they can maximizes the chances of things turning around. Though a quality doctor wouldn't care about that and would just want the best for the SM.

Harsh verbiage in the NARSUM isn't something to be fearful of though. The first two statements in your prognosis statement is extremely helpful for an unfit determination though.

a. Apparent Inconsistencies. Inconsistencies between Veterans Administration and Medical Treatment Facility: -The VA exam made multiple new diagnoses that are not found in the military treatment record.

This also doesn't matter. This is a nothing burger. New diagnoses are made all the time, and that's because the SM is not expected to be a medical professional. You claim issues you foresee being problematic or disabling, it's up to the doctors, nurses, and specialists in the VA network to justify those claims or deny them outright. I understand it may look frightening, but this is just a velvet dagger from the NARSUM writer trying to paint you as a benefits chaser.

It would be wise to discuss this idea with your lawyer and state the concern you have from the passive aggressive NARSUM comments, it very well may be worth an IMR since you could potentially have more conditions added to your DoD consideration. The worst that could happen is you get denied and you proceed from there, delaying the process slightly. Unless you're on fire to get out (not anxious, I mean like every day is torture) I would suggest advocating for giving it a go especially if you're concerned that you'd be found fit.

 

[Steelerpride51]

In my experience, yes. My referring provider's NARSUM stated the following:

The VA diagnosed me with the issues that explain the pain involving multiple segments. My psychologist who just retired informed me that a SM boarding out is seen as a mission failure for them (them being referring provider/PCM), and seeding doubt where they can maximizes the chances of things turning around. Though a quality doctor wouldn't care about that and would just want the best for the SM.

Harsh verbiage in the NARSUM isn't something to be fearful of though. The first two statements in your prognosis statement is extremely helpful for an unfit determination though.


This also doesn't matter. This is a nothing burger. New diagnoses are made all the time, and that's because the SM is not expected to be a medical professional. You claim issues you foresee being problematic or disabling, it's up to the doctors, nurses, and specialists in the VA network to justify those claims or deny them outright. I understand it may look frightening, but this is just a velvet dagger from the NARSUM writer trying to paint you as a benefits chaser.

It would be wise to discuss this idea with your lawyer and state the concern you have from the passive aggressive NARSUM comments, it very well may be worth an IMR since you could potentially have more conditions added to your DoD consideration. The worst that could happen is you get denied and you proceed from there, delaying the process slightly. Unless you're on fire to get out (not anxious, I mean like every day is torture) I would suggest advocating for giving it a go especially if you're concerned that you'd be found fit.

Thank you for sharing your experiences and insight. I didn’t share a lot of what she wrote but yes, benefits chaser is a good description of her tone. I basically claimed everything with the VA that has bothered me regardless if I have been seen or not because most people I talked to suggested get evaluated for it and also try to get a diagnosis for it while I’m still active so if I need to update the claim I will have new medical evidence and it could be back paid as necessary. All of my minor issues I have not gone to the doctor for. Eg ingrown toenails. I can’t wait 3 months to see a PCM and just let them get infected. I get them removed at a salon. But the narsum doc is like no diagnosis never been seen etc.

I do want to get out and found unfit. I’m just curious if the concensus is that the language is strong enough to be found unfit or if the board will look at this and say he fit for duty.

 

[JoelPettit]

@Steelerpride51

When it comes to IMR's and MEB Rebuttals, legal is the first place to go. Pretty much any input from Soldiers in the IDES process and backfire if the narrative and evidence isn't crafted according to a well thought out strategy. The last thing you want to do is make the process harder or give the IPEB or FPEB something with which to question your motives or credibility. The PEB members see a lot of good and bad cases, but, sadly, the memories of the bad ones stick with them longer, and they sometimes let a few bad apples spoil the bunch.

I hope this helps.

S/f,

Joel

Disclosure: I was a Marine JAG, Active Duty and Reserve IPEB & FPEB attorney, federal government civilian FPEB & TDRL-focused attorney at the Navy PEB, and now a private attorney focused solely on IDES cases. This post is meant as procedural insight only and should not be construed as legal advice related to a specific case or a legal analysis of facts thereof.