Chronic Pain and VA ROM

acarr8

acarr8

PEB Forum Regular Member
Registered Member
Hello all

So I had my C&P exam for several issues that have come up. One of them was for my chronic back pain resulting from an injury last August. My VA exam was scheduled for a total of 6 hours. I spent less than 30 minutes with the provider. She didn't even have me move out of a regular chair, she asked me a few questions and sat at her computer typing and filling out paperwork. She asked if my back pain was constant or comes and goes, I said its constant and unbearable.
She then told me I could leave. I asked about ROM, she said that she already had obtained an idea on how much my ROM is. I asked about the tool she is supposed to use, she told me it wasn't necessary.
So not knowing much, I left.
Come to find out from my PEBLO, this is optional?!?
My VA findings in the report were that my ROM is normal. I can attest that it is not normal, I can't tie my own boot! I can't pull my own pants on most days.
I talked to MEB Legal, wrote a rebuttal etc.
How do I get a new VA exam for ROM?
I was told I could pay someone to do ROM and submit paperwork back to VA for their rating purposes. Im sorry I don't have $350.00, I have 4 kids and a disabled husband to feed.
Any other recourse's?
 
There are several recourses, I would start with physical therapy at BAMC. I am not sure if you are currently being treated by them, if you are great, if you are not, request a referral from your PCM.

When you get to see the physical therapist, request that they do a range of motion exam with a goniometer, this instrument is listed as a indispensable tool in 38 CFR Book C.

There are a couple of options for you at this point, you can write a rebuttal to the examination, based upon your statement that you were not measured for range of motion per the standard as listed in 38 CFR Book C, Schedule of Ratings for Disabilities.

The section option is that you can request a reexamination, either through the facility that performed your examination or through your VA MSC.

Now here is where things may get tricky for you, as a 68C graduate you know just enough about the medical process to make yourself dangerous, however you may have not gained the skills of diplomacy when it comes to communicating to medical providers.

You could easily find yourself in the same predicament as before, in which the provider challenged your statements as not being truthful.

It is tough for me to write this, but in order for me to advocate for you, I also have to look at what you may be facing.

Now to switch gears, I wanted to ask you a couple of questions...

Are you assuming that VR&E has approved you to attend classes in approximately one month? I think you may be setting yourself up for disappointment If you are not able to begin in January.

The reason I asked there are a few basic standards to be found eligible for VR&E, the first is that you have an employment handicap as determined by your vocational rehabilitation counselor (this is easy, you cannot work as a nurse), the second two which I fear the VRC will not be able to demonstrate yet is that you have a current disability rating of at least 10% (you do not because you are still enlisted), or you have received a memorandum rating of at least 20%. With the C&P evaluation just being completed, VR&E may not be able to get the memorandum rating as well as develop and approve your VR&E plan.

I do not want to sound like a downer, but to me, the reality of the situation is that quite a bit needs to be accomplished and in the months of December and January, there are very few productive work days to accomplish this.
 
gsfowler said:
There are several recourses, I would start with physical therapy at BAMC. I am not sure if you are currently being treated by them, if you are great, if you are not, request a referral from your PCM.

When you get to see the physical therapist, request that they do a range of motion exam with a goniometer, this instrument is listed as a indispensable tool in 38 CFR Book C.

There are a couple of options for you at this point, you can write a rebuttal to the examination, based upon your statement that you were not measured for range of motion per the standard as listed in 38 CFR Book C, Schedule of Ratings for Disabilities.

The section option is that you can request a reexamination, either through the facility that performed your examination or through your VA MSC.

Now here is where things may get tricky for you, as a 68C graduate you know just enough about the medical process to make yourself dangerous, however you may have not gained the skills of diplomacy when it comes to communicating to medical providers.

You could easily find yourself in the same predicament as before, in which the provider challenged your statements as not being truthful.

It is tough for me to write this, but in order for me to advocate for you, I also have to look at what you may be facing.

Now to switch gears, I wanted to ask you a couple of questions...

Are you assuming that VR&E has approved you to attend classes in approximately one month? I think you may be setting yourself up for disappointment If you are not able to begin in January.

The reason I asked there are a few basic standards to be found eligible for VR&E, the first is that you have an employment handicap as determined by your vocational rehabilitation counselor (this is easy, you cannot work as a nurse), the second two which I fear the VRC will not be able to demonstrate yet is that you have a current disability rating of at least 10% (you do not because you are still enlisted), or you have received a memorandum rating of at least 20%. With the C&P evaluation just being completed, VR&E may not be able to get the memorandum rating as well as develop and approve your VR&E plan.

I do not want to sound like a downer, but to me, the reality of the situation is that quite a bit needs to be accomplished and in the months of December and January, there are very few productive work days to accomplish this.
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Going through IDES, this makes me automatically eligible for VR&E services. I know at this point with the holidays etc., that I more than likely will have to skip the Jan term. I am looking into online schooling due to me just sitting in an office all day doing nothing but counting the flies on the wall.
I did about 8 months of physical therapy for my back, and am scheduled to see if FRP (28DEC) is appropriate since I have lost just about most of my physical functioning (I.E. tying my boots, pulling pants on, cooking and caring for my family). I am currently in physical therapy for my neck, which is 3 times a week.
My PCM was switched on OCT 16 2015 to the one I started having problems with. I had a civilian contractor, who was the best doctor ever, then it was switched to an active duty MAJ. She was the one causing problems. The previous PCM is now my husbands PCM and he doesn't know why he was moved, but he is pissed that she is my PCM. Ombudsman says that she used to be a WTU/B provider until she started fudging over active service members. He also reports that she is a habitual liar, whom is now being reported to the higher ups for repercussions against service members who have reported her. He talked to her several times regarding my case and she kept going off on a rant about how I joined the service to just get insurance for my two special needs children and that I didn't want to serve my country. While I did join to make sure that two of my children had the medical coverage they needed, that is not the only reason. Plus, my husband was active duty at the time I joined the service. (He is now 90% disabled vet.)


I did state in my rebuttal that no tool was used nor at any point was a flexion extension test completed. I was told that only the PEB can request another exam. Is this true?
 
First off going through the IDES doe not make you automatically eligible...nothing is ever automatic. Here is the qualification based upon the regulation.

A Servicemember may apply and qualify for automatic entitlement under provisions of the NDAA. Entitlement is based on the receipt of VAF 28-1900, receipt of qualifying documentation, and attendance at the initial evaluation with the VRC. VA will accept documentation of referral to a military PEB as acceptable qualifying documentation. It is important to note that documentation to a PEB should be available for each Servicemember who is currently enrolled in the Integrated Disability Evaluation System (IDES).

Because you have not been referred to the PEB yet, the VR&E counselor will request a memorandum rating, showing that you will receive a 20% or greater evaluation. Based upon your current C&P, you may be discharged with 0% (range of motion) or 10% (pain). It is likely that you will be found unfit.

This doe not mean that you will not be referred to a PEB, I think that is imminent.

It is time to adjust fire, you are fighting for benefits for your children, diplomacy is going to be key here. You should also consider your own personal counsel, I recommend @Jason Perry he is the founder of this forum and I feel confident you will benefit greatly by having your own personal attorney.

Being separated with 0, 10 or 20% and severance would be very tough on you and you family, you need somebody to fight for 30% if at all possible.
 
gsfowler said:
First off going through the IDES doe not make you automatically eligible...nothing is ever automatic. Here is the qualification based upon the regulation.

A Servicemember may apply and qualify for automatic entitlement under provisions of the NDAA. Entitlement is based on the receipt of VAF 28-1900, receipt of qualifying documentation, and attendance at the initial evaluation with the VRC. VA will accept documentation of referral to a military PEB as acceptable qualifying documentation. It is important to note that documentation to a PEB should be available for each Servicemember who is currently enrolled in the Integrated Disability Evaluation System (IDES).

Because you have not been referred to the PEB yet, the VR&E counselor will request a memorandum rating, showing that you will receive a 20% or greater evaluation. Based upon your current C&P, you may be discharged with 0% (range of motion) or 10% (pain). It is likely that you will be found unfit.

This doe not mean that you will not be referred to a PEB, I think that is imminent.

It is time to adjust fire, you are fighting for benefits for your children, diplomacy is going to be key here. You should also consider your own personal counsel, I recommend @Jason Perry he is the founder of this forum and I feel confident you will benefit greatly by having your own personal attorney.

Being separated with 0, 10 or 20% and severance would be very tough on you and you family, you need somebody to fight for 30% if at all possible.
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I have been found unfit for duty as of 14Dec. I am awaiting rating right now.
 
Do you have a copy of the C&P evaluation yet? It would be interesting to see the documentation on the DBQ.
 
gsfowler said:
Do you have a copy of the C&P evaluation yet? It would be interesting to see the documentation on the DBQ.
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I am currently scanning it in, should be up within the hour. I am also scanning in the IMR and rebuttal from the MEB counsel. Along with the commanders statement (which I was told to fill out, even though I had no idea what it was for. My platoon sgt forced me to fill it out the way it was filled out).
 
One thing I am a little bit concerned about is how fast you are moving through the process, 90 days from MEB referral to an unfit notification is way ahead of the current curve. Hopefully your file will be hung up in ratings for a bit to allow you to adjust and regroup your efforts.
 
gsfowler said:
One thing I am a little bit concerned about is how fast you are moving through the process, 90 days from MEB referral to an unfit notification is way ahead of the current curve. Hopefully your file will be hung up in ratings for a bit to allow you to adjust and regroup your efforts.
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Attached are the rebuttal and the IMR.
 

Attachments

Here is the C&P exam from the VA
 

Attachments

acarr8 said:
Here is the C&P exam from the VA
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When I read the DBQ, it reaks of pencil whipping, there are not many objective observations and it reads like a narrative summary.

When I read the IMR and Commanders Statement, it does not quite add up. The Commander is recommending retaining you and does not find your condition(s) to interfere with the Unit's mission.

Even though you are assigned to Troop Command, with the initial duty as the CSM driver (appropriate TDA for your rank and MOS) you state your profile limits you from performing this task. I find it odd the commander completed the performance and functional statement just three days after you were referred for a MEB (and only a week or so of you being under her command).

By reading everything, I fear that the PEB will come back with a fit finding and subsequently the command will attempt to separate you for not meeting the standards or AR 600-9.

Another option is that they will come back with a fit finding, you will continue to get treated for your C-spine and potentially get referred to another MEB.
 
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gsfowler said:
When I read the DBQ, it reaks of pencil whipping, there are not many objective observations and it reads like a narrative summary.

When I read the IMR and Commanders Statement, it does not quite add up. The Commander is recommending retaining you and does not find your condition(s) to interfere with the Unit's mission.

Even though you are assigned to Troop Command, with the initial duty as the CSM driver (appropriate TDA for your rank and MOS) you state your profile limits you from performing this task. I find it odd the commander completed the performance and functional statement just three days after you were referred for a MEB (and only a week or so of you being under her command).

By reading everything, I fear that the PEB will come back with a fit finding and subsequently the command will attempt to separate you for not meeting the standards or AR 600-9.

Another option is that they will come back with a fit finding, you will continue to get treated for your C-spine and potentially get referred to another MEB.
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I wrote on it where I disagreed or found it to be untrue.
I was already found unfit for duty.
I am no longer in that particular commanders company, when I graduated nursing school I went from Delta company to Alpha company. The Delta company commander just signed the form, my platoon sgt made me sit in his office and fillout the form to his specifications, not the commander at all. My peblo asked for my new command to fillout that paperwork but that request was submitted 7Nov15, she has yet to respond.

What do you think my recourses are? I haven't been in the "real" army that long but what I have seen and how I have been treated makes me think I will get nowhere.

Thanks again!
 
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The PEB makes the ultimate fit/unfit decision and based upon what has been presented to them.

They would potentially find you fit for duty, since the C&P came back essentially within normal limits and the commander's statement reflects retention.

I think it is very important to have physical therapy get you some accurate range of motion numbers to see what your potential best outcome can be.
 
I just read your C&P report. I did not see anything that would support a finding of unfit and very little in support of compensation.
 
How do I add things to the C & P? I got my xray results this morning stating that I have DDD of the cervical and thoracic spine? Pending MRI 13 JAN now, they moved it up to expedite the process.
How do I request another examination?
 
You cannot add to the C&P, it is an evaluation that is made by a Physician. You can talk to your VA MSC and see if they are willing to amend your claim and request a C&P evaluation for your C-spine, however right now is not the time to get the evaluation as you may need further treatment (unstable condition).

I'd try to stall your current case for a bit pending the outcome of you MRI. If you are in need of medical treatment that will take greater than six months to complete, you can request transfer to a WTU.

As it currently sits with you C&P, you are likely to be found fit for duty.
 
Im totally confused. I received my unfit memo on the 14th of December? Is there another determination that will say Im fit for duty??
 
acarr8 said:
Im totally confused. I received my unfit memo on the 14th of December? Is there another determination that will say Im fit for duty??
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Yes, you unfit memo is from the MEB. Based upon the narrative summary that is written, the MEB decides whether or not they feel you meet retention standards per AR 40-501. They do form DA 3947 and forward your case to the DoVA DRAS (VA rating team) which will determine you rating based upon the C&P evaluation and any other medical documentation that you have.

Once they finish with the rating, your file is sent to the PEB, which then determines whether you will return to duty, receive severance or medical retirement.

That is why the process is called MEB/PEB.
 
gsfowler said:
Yes, you unfit memo is from the MEB. Based upon the narrative summary that is written, the MEB decides whether or not they feel you meet retention standards per AR 40-501. They do form DA 3947 and forward your case to the DoVA DRAS (VA rating team) which will determine you rating based upon the C&P evaluation and any other medical documentation that you have.

Once they finish with the rating, your file is sent to the PEB, which then determines whether you will return to duty, receive severance or medical retirement.

That is why the process is called MEB/PEB.
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Just to update an oversight of information via an U.S. Army perspective only...

Indeed, the IPEB decision will include written justification supporting a "Fit for duty" or "Unfit for duty" finding for each of the military service member's medical conditions, and if their condition(s) is(are) combat-related and/or incurred in a combat zone.

Moreover, the IPEB shall determine other pertinent information (e.g., EPTS, LOD, compliance with recommended medical treatment & permanent and/or stable conditions) for any "unfit for duty" medical conditions.

To that extent, if the IPEB determines that a military service member is "unfit for duty" then the PEB will forward their IDES case file to the DoVA D-RAS (e.g., VA Rating Board) for proposed ratings of the military service member's "referred" PEB-determined unfitting conditions and VA "claimed" contentions/conditions (as listed on the VA Form 21-0819).

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
Most of claims are based on one time episodes without any extensive medical treatments or diagnoses. I'm afraid that you will at most get 10-20% from the VA if you're found unfit.
 
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