Unprovoked PE with lifelong anticoagulation recommended

Marks

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Sorry to hear about the DoD rating clearly something is not right. Have you heard anything about proposed VA ratings being changed after a year or having to re do C and P exams after a year?
 

trini123

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I heard that before. I guess it all depends on you seperation date. Like the ratings can't be in 2019 and you separate 2022, you may have to ask your VA rep.
 

RS_0624

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I was given a P2 profile and returned to duty. Anticoagulation therapy doesn’t preclude you from service in the Army apparently. I was told this is relatively new guidance. Since the new oral anticoagulants don’t require INR testing, they don’t pose a risk. I’ll require waivers to deploy in the future. That’s all.
This seems crazy to me that the Army would keep you with being on lifetime anticoagulants. I’ve had one DVT (lower leg), with one recurrence of severe pain and swelling after a two week break from three months of anticoagulant treatment. I am currently in another trial period of being off the anticoagulant meds to see if I can function without any recurrence. My hematology doctor told me that if I have any additional issues (severe pain, swelling, another DVT), or if my upcoming blood tests come back with any kind of genetic issues that they will start the MEB process. He said I will be considered high risk of recurrence, non-deployable and put on anticoagulant meds for life. I’m curious if this same thing will happen to me, referring to the P2 profile. Does anyone else have any experience or information they can share on this issue?
Thanks
 

Marks

PEB Forum Regular Member
Registered Member
Please be advised, I too was place on a profile and returned to duty initially however, if a determination is made for life long anticoagulants the MEB is re-initiated and you will be found unfit.
 

RS_0624

Member
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Please be advised, I too was place on a profile and returned to duty initially however, if a determination is made for life long anticoagulants the MEB is re-initiated and you will be found unfit.
@Marks thanks for they info. If you don’t mind me asking - what were your particular circumstances that lead to you being medically retired?
 

pharmphresh12

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Hey all,

I was just scheduled for my initial MEB appointment (30 July) for life-long Anticoagulation (Eliquis). All evidence has been directed that I will be found unfit. It's news to me that you could possibly be found fit for taking a medication that precludes you from deploying. I was denied a waiver to deploy to Kosovo last month, which prompted the physician to initiate a MEB. I will continue to update on my status. Who knows if this is the new guidelines or if this was just an anomaly.
 

trini123

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Some folks from the Army and Airforce spoke about being found FIT and returned to duty while on anticoagulants.
 

pharmphresh12

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Some folks from the Army and Airforce spoke about being found FIT and returned to duty while on anticoagulants.
Ahhh gotcha. I am wondering what determines if they are found FIT or not. Residual symptoms probably play a role. It would seem odd to keep someone that is nondeployable.
 

Rijmus

PEB Forum Regular Member
Registered Member
I am going to have another crack with a different physician at seeking a MEB. I have a PHA scheduled for tomorrow at 10. We'll see what they say. I was found fit by a profile reviewing physician. I was initially written a P3 but upon review was changed to a P2 without referral to the MEB. I feel this was done with a poor understanding of AR 40-501 that explicitly states "Thromboembolic Disease. When response to therapy is unsatisfactory, or requiring prolonged/indefinite systemic anticoagulation. If found fit for duty by a PEB, Soldiers will be restricted to assignment locations where adequate medical care is available and will not deploy to an environment where there is a high risk for traumatic injury (for example, combat zone)." The justification used to downgrade my profile to a P2 was that my condition was responding to therapy. However, I am prescribed anticoagulants indefinitely and thereby meet the requirement for referral to the MEB. My original hematologist also wrote in her notes that lifelong anticoagulants are recommended for first occurrence unprovoked PE but not required and that I opted to take them lifelong. I'm not sure of the reasoning behind this strange phrasing but it may explain the P2 profile. If it is necessary, I will seek a second opinion from another hematologist.
 

trini123

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Good luck. My doctor initially was not going to refer me, but he ask what were my wishes and i told him to refer me. I got my FPEB next week.
 

pharmphresh12

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I am going to have another crack with a different physician at seeking a MEB. I have a PHA scheduled for tomorrow at 10. We'll see what they say. I was found fit by a profile reviewing physician. I was initially written a P3 but upon review was changed to a P2 without referral to the MEB. I feel this was done with a poor understanding of AR 40-501 that explicitly states "Thromboembolic Disease. When response to therapy is unsatisfactory, or requiring prolonged/indefinite systemic anticoagulation. If found fit for duty by a PEB, Soldiers will be restricted to assignment locations where adequate medical care is available and will not deploy to an environment where there is a high risk for traumatic injury (for example, combat zone)." The justification used to downgrade my profile to a P2 was that my condition was responding to therapy. However, I am prescribed anticoagulants indefinitely and thereby meet the requirement for referral to the MEB. My original hematologist also wrote in her notes that lifelong anticoagulants are recommended for first occurrence unprovoked PE but not required and that I opted to take them lifelong. I'm not sure of the reasoning behind this strange phrasing but it may explain the P2 profile. If it is necessary, I will seek a second opinion from another hematologist.
I’m actually encouraged by this. My P3 was signed off on the very same day. My PEBLO, MSC and NARSUM doc all say unequivocally that I will be found UNFIT. I tried to obtain a waiver to deploy to Kosovo and no one would touch it.
 

Rijmus

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Registered Member
After my PHA I was written a P4 profile and referred once again to the IDES process. My new provider conferred with the IDES director on whether this case would constitute referral to the IDES. It would appear that this time around I will be given a fair assessment. Truthfully, I would be surprised if found fit by the PEB but stranger things have happened. It seems like the majority of people are found unfit if the case makes it that far.
 

pharmphresh12

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After my PHA I was written a P4 profile and referred once again to the IDES process. My new provider conferred with the IDES director on whether this case would constitute referral to the IDES. It would appear that this time around I will be given a fair assessment. Truthfully, I would be surprised if found fit by the PEB but stranger things have happened. It seems like the majority of people are found unfit if the case makes it that far.
I’m glad they’re taking a second look. I had a legal brief today and the lawyer said that it would be nearly impossible to find someone fit for indefinite anticoagulation. He said this especially true since the non deployable memo came out last year. I would be super surprised if you were found fit as well. I’ll be sure to continue to update.
 

Rijmus

PEB Forum Regular Member
Registered Member
Please be advised, I too was place on a profile and returned to duty initially however, if a determination is made for life long anticoagulants the MEB is re-initiated and you will be found unfit.
I'm curious, were you prescribed oral anticoagulants? There was a write up in my first MEB referral regarding a "changing of opinion" regarding the safety of the new oral anticoagulants. It basically read that I was able to deploy with a waiver. However, "with a waiver suggests that," until a waiver is granted, I am non-deployable. Also, I was evaluated under the previous edition of AR 40-501. The new one removes some of the ambiguity by stating indefinite anticoagulants are automatic referral to MEB. I tried reviewing the DODIs and DODD's as well as the Army policy published 11/8/18 and it seems like they may classify me in the special category of "Deployable with limitations." That is literally my nightmare. An inability to deploy is an inability to progress in my career and will guarantee I am passed over for my next promotion.
 

pharmphresh12

Active Member
PEB Forum Veteran
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I'm curious, were you prescribed oral anticoagulants? There was a write up in my first MEB referral regarding a "changing of opinion" regarding the safety of the new oral anticoagulants. It basically read that I was able to deploy with a waiver. However, "with a waiver suggests that," until a waiver is granted, I am non-deployable. Also, I was evaluated under the previous edition of AR 40-501. The new one removes some of the ambiguity by stating indefinite anticoagulants are automatic referral to MEB. I tried reviewing the DODIs and DODD's as well as the Army policy published 11/8/18 and it seems like they may classify me in the special category of "Deployable with limitations." That is literally my nightmare. An inability to deploy is an inability to progress in my career and will guarantee I am passed over for my next promotion.
I’m worried about the portion in the reg that states: “if found fit for duty by a PEB, then the SM will not be deployed to a combat zone.”
I’m under the impression that if you’re not world wide deployable, then you don’t promote. CPT to MAJ is getting more difficult and I’m not sure if I would be able to promote without that ability. I also don’t want to be that leader that can’t deploy or do PT with my unit.
 

trini123

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I understand where you are coming from as far as not being able to deploy. My non medical assessment (NMA) that came from my commanding officer was worded to the extent that...Sailors are needed to deploy and be worldwide assignable and i was unable to do that, so it was in the best interest of the Navy that i be found UNFIT and be medically retire. Your personal statement you also state you wishes to be found UNFIT.
 

Rijmus

PEB Forum Regular Member
Registered Member
I’m in the exact same spot. I’m pre-command. I ask myself, what kind of commander can I be if I can’t deploy. I have literally been praying that I am found unfit.
 
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