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

National Symposium for the Needs of Young Veterans

Lots of Veteran's advocacy groups going to this. I'm looking forward to it and hope it brings strong positive results.

National Symposium for the Needs of Young Veterans' official Web site. This first-of-its kind event will be hosted by AMVETS on Oct. 18-21 at the Hyatt Regency O'Hare (please use special event code 26168 for the best rate) in Chicago.

One of the greatest and yet largely unrecognized challenges facing America is how we will provide for the needs of future veterans—especially those younger people who are serving in Iraq, Afghanistan and other parts of the world today. It’s an issue we must address now if our nation is to keep its promise to those who defend us.

Homepage:
http://www.veteransnationalsymposium.org/home.htm


- Ragin' Ranger Out

Military medical malpractice

Why can't service members sue their military doctor for medical malpractice? The Feres Doctrine, which protects military doctors from malpractice claims is explained in the following links. The courts turned their backs on American Service Members more than half a century ago. Will the American people keep their backs turned, or will they push Congress to enact legislation to hold military doctors to the standards of their separate profession within the profession of arms? Legislation get kicked around every now and then but nothing has come of it yet.

• The Feres Doctrine Decision

- Ragin' Ranger Out

State Programs for vets

Some states offer special programs for Veterans and Active Duty members who have been on Active Duty during conflict regardless of being deployed over seas. It is worth checking out state programs through state government websites.
In Mass. Veterans and Active Duty Service Members may qualify for what is called the "Welcome Home Bonus." Check it out at www.mass.gov/veterans do a search on "bonuses" in the search window (top right corner). There are phone numbers on the site you can call if you're having trouble with the site.
Some states offer educational and vocational programs to varying degrees.
There is one thing that nearly every single agency has in common - they won't come looking for individual vets to offer their help - these agencies don't have the budget for massive advertising, and some gov't agencies are notoriously lazy (but that could be called common knowledge). Vets have to go find them. Some are easier to work with than others.
www.Firstgov.gov is a decent site to check out for explanations of various government programs.


- Ragin' Ranger Out

PTSD Post Traumatic Stress Disorder Battle Fatigue Combat Stress

It's all the same, really. And what sucks the most about it is just how hard it is to prove that PTSD keeps soldiers and vets from having normal lives. It's different for everyone. But no matter what, it sucks for the patient and the patient's family.

The worst scars from battle are the ones invisible on the surface - they penetrate the deepest and they heal slowest.

Vets who are having trouble proving their claim for PTSD should probably consider if they suffer from other possible behavioral health problems that may augment or enhance their symptoms. Anxiety and depression are very common among vets. Both are treatable and both are commonly acknowledged as service connected by VA.

- Ragin' Ranger Out

Guide to my helpful links

The Links below will open in a new window.
To open Links on the SideBar in a new window hold "CTRL" as you [click].

Lots of acronyms in the Helpful Links section on my sidebar.
What do they all mean?
VOTE VETS -- This is an organization committed to Veterans Issues - whatever they may be.
VA -- Dept of Veteran's Affairs. Major gov't bureaucracy that has many benefits available to veterans. For every benefit they provide there always seems to be 10 reasons why *you* won't qualify for it.
DAV -- Disabled American Veterans. One of many Veterans Advocacy groups that helps cut through the 10 reasons VA wants to block benefits. This group is very helpful on the Active Duty side for Service Members going through the MEB process.
VFW -- Veterans of Foreign Wars. Another Veteran's Advocacy group with similar goals to DAV
IAVA -- Iraq and Afghanistan Veterans of America. A group fighting to help make changes in the military now, also deals with military medical issues and VA as well
Vet Pac -- Group of Vietnam Vets that don't want to see another generation of Vets suffer from ANY mistreatment by ANY entity after leaving the service.
Web MD -- This is a great resource to help patients be more proactive in their own care. It can help patients understand medical jargon more clearly. This site sometimes has more up-to-date information than the information provided with prescriptions of some medications.
U.S. Code Title 10 -- This is the "LAW OF THE LAND." Laws are often cited in official military documents, this is where much of it comes from. Just a great reference.
FirstGov.gov -- This site offers a guide to many government programs. Sure the gov't put it together to try to explain itself, but it can be helpful.

- Ragin' Ranger Out

Dependant vs. Active Duty Medical Care

Last week I went to see a doctor at the local army hospital. My wife is still in the army and I have the special privilege of being provided military "health care." (OK, I know sarcasm doesn't always read well -- army health care is an oxymoron, and is more a sentence than a privilege)
Anyway, I see this doctor, who I've never seen before, just to get refills for the medicines I take for back pain. The contracted, civilian doctor took time to ask me many questions about my back pain. I told him chiropractic treatment would relieve the pain for a day but the pain quickly returned. I'd had X-rays taken and knew I had some degeneration and bone spurs -- very common for any soldier, especially those who wear Kevlar helmets often, like I did. But my X-rays were a year old and this new doctor wanted to update my records and try to see if further degeneration had occurred. Having to physically life my wife out of bed for 3 years has aggravated my back pain significantly. This doctor referred me immediately for an MRI and physical therapy. He was quite surprised that I had not been recommended for these tests and treatments already.

I was very happy to have a PT referral and to have an MRI scheduled.

BUT NOW I'M PISSED!

Other active duty soldiers (including my wife) going through the MEB process at this same hospital are treated like shit at what has been named the "Deployment Health Clinic." Some soldiers, once an MEB starts, transfer to the Medical Hold Company. Med Hold is a good thing for the army because it helps personnel managers track soldier status and unit fighting strength more accurately.
At our hospital all soldiers assigned to Med Hold are also assigned to the Deployment Health Clinic (DHC). The DHC is in a sad state of affairs. My wife's treatment from providers at that clinic has been deplorable. But her story is, unfortunately, not unique.

I felt the red carpet was rolled out for me at my appointment. I received outstanding medical care from a professional staff. I did not discuss much of my military history, just some medical concerns, with this doctor, I would assume he treats every single patient he sees in the same manner he treated me: with respect and acknowledgement of my personal assessment of my prior treatments and future concerns.

So for now we continue to fight administrative battles inside the hospital regarding this piss-poor treatment of injured soldiers. Some of the most handicapped soldiers are assigned to Med Hold and DHC and they deserve much better than to be dismissed as weak-minded or just complaining.
But it's also time to turn up the intensity of complaints. The public needs to know how America's injured warriors are treated.

- Ragin' Ranger Out