MEB NARSUM Appeals

When writing an appeal to an MEB NARSUM it can be very difficult to not get personal in writing style. It is important to remember that the people reading the appeal probably don't care about your personal life and don't care for your opinion of some doctor. I haven't heard many service members compliment doctors, it is a rarity. (I will compliment my doctor -- he did a wonderful job re-attaching my arms so that they stay in the socket -- I am very pleased with what he did).
It is important to not stoop to a level of "attack mode," but to very carefully and professionally point out errors with what the doctor "may have missed," in describing your condition.

Open nice and politely by saying something like: "After reviewing my MEB and NARSUM I am concerned that my condition is not fully described in a manner that will allow the reviewing doctors to have an accurate understanding of my condition."
Then list all the things that you saw that are wrong and describe, professionally, why it's wrong. "According to AR 40-501," is a great way to start describing why your condition is not properly documented. Attach updated records that support your claims. Make this easy for the reviewers: "my NARSUM states that I have ___, however, according to AR 40-501 my condition should be documented as _____. The attached records from a visit with Dr. ___ describe why this should be changed.

An EXTREME for instance: If a patient had their left arm amputated and the doctor wrote "patient has limited functionality of upper extremity." The very first step is to locate the paragraph in AR 40-501 that references amputations and explain that because the arm is gone, a better description is: "quote from regulation." Though it may be tempting to write something like: "This doctor is totally incompetent and grossly misdiagnosed my amputated arm condition as mere 'loss of functionality in upper extremity,' he obviously does not care how my disability rating reflects my condition."

Yes, the second statement sounds awesome in the court of public opinion and with your buddies in the barracks, but the MEB bureaucrats will label you a whiner and your appeal will be taken less seriously.

Another great problem in military medicine is the 2nd opinion debate. What constitutes a second opinion and where is a second opinion guaranteed? I'm still trying to find a definition of both cases and when I do I will post it, but right now I don't know.
However, if your PCM tries to say that you had a second opinion and you don't think you did, think about the credentials of the providers you did see.

AN EXTREME For example: If your PCM is a proctologist (ass doctor) by specialty and is counting his opinion about a brain tumor as your first opinion and the opinion of your orthopedic doctor as a second opinion, you may be able to build a case for why neither of these counts as an opinion.
A brain tumor patient should probably see a brain-tumor doctor, an ass doctor, as a PCM, should first write a referral for the patient to see a brain-tumor doctor -- that should count as opinion #1. If the patient is not satisfied by the recommendation to have their knee scoped to cure the brain tumor, the PCM (ass doctor) should write a referral for a second opinion by another brain-tumor doctor - this time a case manager should intervene and double check that the brain-tumor doctor has the specialized training and qualifications necessary to diagnose and treat the condition and act in the best interest of the patient.
PCMs can certainly count as a first opinion in many cases but for some serious and complicated cases the opinions of specially trained experts are essential to providing the best care possible.

In closing the appeal a good way to sign off is to just say words to the effect of "I feel that my above recommendations are needed to describe my condition. I have attached the following documents that support my claims: list of records that you have that were either lost or are from outside providers, or were created after the dictation was written." Then, if needed: "I respectfully request the opportunity to see another specialist for a second evaluation and opinion of my condition," or "I am still pending further tests and evaluations that may change the nature of diagnoses in my MEB."

It is important to sound confident and professional. Don't stoop to their level.
Also keep in mind that anything not listed on your MEB will probably be denied by the VA. You can still appeal the VA, but its a time consuming process and a pain in the ass.

This next paragraph can be confusing, I had trouble writing it, to much regulatory bull shit involved in government money. Every case is different and I suggest talking to a veteran's advocacy group before getting anxious about money situations but the bottom line is simple: if the gov't can find a way to not pay the will find it.

This is a warning shot, this can and has happened:
NOT having conditions listed on your MEB can also work in your favor with the VA. The VA withholds the total value of any money a vet received from severance pay -- some gov't jibber-jabber codes payments intended to go to vets from the VA as "already paid" by DoD (DFAS), and instead of VA money going to vets it goes to DoD. What the gov't is saying is that the severance pay was just an advance on a vet's disability payments by the VA. To get severance from the DoD and then get disability from VA would be considered "double-dipping) So, if a vet has been discharged at less than 30% disabled (by their active component), but due to a laundry list of conditions, all VA compensation for those conditions will be withheld until the severance is "paid back." If a vet is discharged for less than 30% with only one condition they can claim their additional conditions with the VA and not have that compensation withheld. Cases over 30% are even more complex, I'm not going to try to explain it -- go to the VA site to get confused, sorry.

- Ragin' Ranger Out