Surgery during MEB process

I am currently in a geographically separated unit, on AGR orders with the Air Force Reserve and see civilian doctors. I’ve been in the AF DES process since 31 Oct 2018. I’m being evaluated for multiple lumbar issues to include severe degenerative disc disease, spinal stenosis, multiple bilateral bulged and herniated discs to include paralysis of the associated nerves bilaterally. Along with PTSD, all from my convoy days. I’ve had 2 back surgeries conducted by Neurosurgeons and my Orthopedic Surgeon believes I could see a 60-70% relief from a 3rd. My L5-S1 is fused and they want to fuse the joint above, L4-L5. I am currently required to complete a regiment of Evidence Based Treatment from my current mental health provider prior to moving forward in the MEB process. This will be completed at the earliest Aug 2019.

I received a phone call from my PEBLO and while on the phone I informed her that I had scheduled the surgery. I briefly herd her speak to a co-worker and when she came back on the phone she said that I wasn’t authorized to have the surgery. She gave be a couple different answers as to why and couldn’t tell me what AFI she was referencing. She had to reach out to AFPC for the answer. She then emailed me back with AFI 36-3212, 1.5 Delay of Processing. Basically said that I couldn’t request the surgery due to it delaying my process. I find this odd due to my current treatment plan for mental health completing in Aug 2019 and my ETS 31 Oct 2019. I’m going to have to extend my contract either way. My commander has stated (not in writing though) that he believes that my medical issues preclude me from conducting my duties to their fullest and that is the reason why he declined me to stay on AGR orders. When I asked for that in writing he changed his tune and stated that his decision was performance based. This information is relevant due to me realizing that I'm not staying in after this decision and with 14 years of active service my only hope for an active retirement is via medical retirement.

My question is has anyone experienced this type of situation? Would it be advantageous for me to go through the rest of the MEB and IPEB with the knowledge that I require another operation? I’m torn because I’m in a considerable amount of pain, sleep is suffering, my demeanor is poor due to constant pain and I notice myself not being kind to my family at times. The possibility of relief is appealing and is driving me toward possibly wanting to request authorization. I'm not saying that I cant live with the pain for the time being but looking at rough calculations based off of the historical data of the DES process taking somewhere around 230 days total (https://www.afpc.af.mil/Portals/70/...ite - 05SEP2018.pdf?ver=2018-09-05-163112-397), I estimate a decision being made sometime in early 2020. Honestly, I don’t want to deal with the pain that I'm in daily until then. Thanks for any and all advice.
 

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Do you have an "In the Line of Duty" (ILOD) attached to your back issue? Also, why exactly are you on the AGR orders? You can email me directly at sbarq1@yahoo.com if you would like. I'm in a very similar situation and have been since mid 2014.
 
I'm not sure if I have an ILOD attached to my back. I'll have to ask the question. I was AD for 11 years then transferred to Air Force Reserve Recruiting where I planned on finishing my time. Now after 14 years if this doesn't work out in my favor I'm looking at having to become a Traditional Reservist and missing out on my AD retirement.
 
blackrubi05 said:
I'm not sure if I have an ILOD attached to my back. I'll have to ask the question. I was AD for 11 years then transferred to Air Force Reserve Recruiting where I planned on finishing my time. Now after 14 years if this doesn't work out in my favor I'm looking at having to become a Traditional Reservist and missing out on my AD retirement.
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I see that you are possibly throwing a wrench into the system considering you have passed the "treatment" phase and are in the middle of the med board. I would suggest that your doctor state that this surgery is medically necessary and time sensitive only if you absolutely need it at this time. You are walking a slippery slope though. Piss off anyone in the system and they could possibly block you from even being able to go traditional in the future. Nevertheless, with proper medical paperwork you would be covered through the VA should you wind up being forced out. National Guard and Reservist have to have paperwork stating our injuries were either in the line of duty or not. If we injure ourselves at home "off duty" we could be hung out to dry and forced out medically without any compensation prior to 20 good years of service. Good luck bro
 
Man.. there is a lot going on here. I am going to break this up into a couple focus areas to make it easier to read.

AGR Orders - They don't have to keep you on AGR orders during your DES process, but they do have to keep you on Title 10 orders during the DES process. The days should flow down from HHQ and get approved in 120 day chunks. DO NOT, I repeat, DO NOT let them kick you off orders with nothing in place. DODI 1332.38 plain states that you must be "afforded" orders during your disability processing. The same people that deal with MEDCON orders (AFI 36-2910) are the ones managing my orders for my DES. It is separate from your PEBLO so talk with your unit medical to find out who the MEDCON POC is if they are going to take you off of AGR orders.

DES timeline - The 230 days you mention is from entering the DES until separation. You are already a good ways into the process. You only have to complete the MEB, IPEB, and get the VA rating. Based on what I have read from others, you are looking at maybe 120 days depending on if the VA tried to hose you or not.

Surgery - The 1.5 paragraph mentioned is:

1.5. Delay of Processing. Medical Treatment Facilities (MTFs) will not delay disability processing for nondisabling conditions such as elective surgery. If a member needs emergency surgery, treatment, or hospital care, consider a delay in retirement or discharge only when it could cause a change in the disability disposition or rating.

Just as sbarq1 said, get your doctor to say it is a medical necessity on a memo that you can give to your PEBLO. Make sure it says he does not view this surgery as elective and that delaying could impact your health. You can also write a personal memo stating that you feel this surgery could impact the disability disposition or rating.

LOD - with you being on AGR orders and previous on AD, an LOD might not have been given to you. As a member of the reserves you are afforded an LOD anytime you push it, but they really only give them out to DSGs and TRs that are on mobility orders or title 10 orders. If you didn't get an LOD, don't panic, just make sure your medical records are up to snuff and cover everything wrong with you. If you haven't received an LOD by now, it is probably too late anyway. An LOD that deals with disability separation would have to be routed to HHQ and would take 5-6 months at least to complete.

To answer your question, in my opinion, you need to pursue your health and work on getting fixed. If you doctor wants to do this and is pushing for it, I would go through the process to try to get your surgery approved and delay your processing. The advantageous side of waiting would be you are obviously in a lot of pain and that pain could correlate to a potential higher rating if you haven't already done your C&P exam. If the surgery really helps with the pain and mobility, it could have the potential of reducing your rating, but it would be worth it in my opinion.

Hope this helps!

Brad
 
Brad....I am in the IDES system now and asked to be returned to orders until I was returned to duty, separated, or medically retired and told that didn't "apply" to me and my situation. Are they correct or am I being hosed by those that say I can't? I'm national guard being processed for ILOD injuries
Thanks
 
Tell me about your Pre-IDES process. How did you get your LOD? What was the gap between medcon and DES entry?
 
I was injured working on equipment in country on title 10 orders in 2014. Finished the deployment injured, came home and was operated on a couple of months after return while on Medcon orders. The first surgery failed early the next year while still on Medcon. Had a heart episode and wound up with 3 stents and a total of 3 heart caths all on Medcon for initial shoulder injury. Broke my finger while on these same medcon orders. It got infected with staph and underwent a total of 9 right hand surgeries trying to save the finger. In the middle of all that, had my 3rd left shoulder surgery for rotator cuff and bicep injuries. I need a total shoulder replacement and now the right shoulder is in need of surgery. Once all the therapy for all of the issues were done, I came off of Medcon in early april 2018 and have been on Incap since then waiting on the IDES system to finalize everything. I just finished all of my C&P exams the middle of May and awaiting a verdict from the Med board and VA. I've been cut the length of my finger and palm 9 times and had two tendons removed from my forearm and top of right hand to repair the movement of the one finger.
 

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sbarq1 said:
I was injured working on equipment in country on title 10 orders in 2014. Finished the deployment injured, came home and was operated on a couple of months after return while on Medcon orders. The first surgery failed early the next year while still on Medcon. Had a heart episode and wound up with 3 stents and a total of 3 heart caths all on Medcon for initial shoulder injury. Broke my finger while on these same medcon orders. It got infected with staph and underwent a total of 9 right hand surgeries trying to save the finger. In the middle of all that, had my 3rd left shoulder surgery for rotator cuff and bicep injuries. I need a total shoulder replacement and now the right shoulder is in need of surgery. Once all the therapy for all of the issues were done, I came off of Medcon in early april 2018 and have been on Incap since then waiting on the IDES system to finalize everything. I just finished all of my C&P exams the middle of May and awaiting a verdict from the Med board and VA. I've been cut the length of my finger and palm 9 times and had two tendons removed from my forearm and top of right hand to repair the movement of the one finger.
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Gerald... That is an absolute cluster man. Glad you are still alive. My first question is, did your LOD come back as ILOD? How in the hell did they kick you off MEDCON with all of that going on? This just seems so stupid. You have a couple avenues you can tackle, but my guess is you have already tried them.

BCMR - Go to the portal, go to MyPers, search for BCMR, file a complaint. For the data I would use Dodi 1241.01 para 2(a). As far as I can tell from reading your story, you meet this criteria to the letter. The problem with this Dodi in my experience is that AFI 36-2910 doesn't have a mechanism to help people who fall into the grey area between restorative care and full DES. The pre-IDES process takes too long and forces the member to get kicked off orders or suddenly get a case of PTSD and get counseling once a week for 6 months while ANG/SG gets their crap together.

Appealing Denied MEDCON - 36-2910 does have a paragraph (5.9) that discusses how to appeal a denied MEDCON request. While it doesn't explicitly say denied extension, I believe that is within the scope of this appeal process.

Reapply for MEDCON now that you are in the IDES - 36-2910 para 5.11.1.2 states that members who are not on MEDCON orders at the time of entry [into IDES] may apply for MEDCON, subject to para 5.2, while processing through IDES. If you end up getting approved for this... absolutely do a BCMR and get back paid for all of your time off of orders. This one seems like a no brainer. Schedule some physical therapy for your hand, make it a weekly appointment, and WHAM, you are now in "restorative care".

Write a congressional inquiry - Every senator has a different process. Find yours and contact their minion. Tell them you would like to write a congressional inquiry as to why you were removed from the MEDCON program when you clearly meet every aspect of the DODI saying they should have you on orders.

I hope one of these options helps you man. Out of a lot of people I see on this site, you definitely are getting hosed bad. I will do everything I can to help you get some justice.

Brad
 
Guardguy11 said:
Gerald... That is an absolute cluster man. Glad you are still alive. My first question is, did your LOD come back as ILOD? How in the hell did they kick you off MEDCON with all of that going on? This just seems so stupid. You have a couple avenues you can tackle, but my guess is you have already tried them.

BCMR - Go to the portal, go to MyPers, search for BCMR, file a complaint. For the data I would use Dodi 1241.01 para 2(a). As far as I can tell from reading your story, you meet this criteria to the letter. The problem with this Dodi in my experience is that AFI 36-2910 doesn't have a mechanism to help people who fall into the grey area between restorative care and full DES. The pre-IDES process takes too long and forces the member to get kicked off orders or suddenly get a case of PTSD and get counseling once a week for 6 months while ANG/SG gets their crap together.

Appealing Denied MEDCON - 36-2910 does have a paragraph (5.9) that discusses how to appeal a denied MEDCON request. While it doesn't explicitly say denied extension, I believe that is within the scope of this appeal process.

Reapply for MEDCON now that you are in the IDES - 36-2910 para 5.11.1.2 states that members who are not on MEDCON orders at the time of entry [into IDES] may apply for MEDCON, subject to para 5.2, while processing through IDES. If you end up getting approved for this... absolutely do a BCMR and get back paid for all of your time off of orders. This one seems like a no brainer. Schedule some physical therapy for your hand, make it a weekly appointment, and WHAM, you are now in "restorative care".

Write a congressional inquiry - Every senator has a different process. Find yours and contact their minion. Tell them you would like to write a congressional inquiry as to why you were removed from the MEDCON program when you clearly meet every aspect of the DODI saying they should have you on orders.

I hope one of these options helps you man. Out of a lot of people I see on this site, you definitely are getting hosed bad. I will do everything I can to help you get some justice.

Brad
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Brad.....I'm afraid that this is why they denied me the Medcon Orders....I don't have an "active treatment plan". I only see the doctor every 6 months for followup and I'm sure that if I did have some type of issue requiring some more PT that it would throw a wrench possibly into the IDES system by stopping it until stable enough to finish and rate me....maybe not. I'm just gun shy at this point to try to do anything for fear of more bs.
5.2. Eligibility. MEDCON eligibility requires an LOD determination and a finding by a credentialed military medical provider that the member has an unresolved health condition requiring treatment that renders the member unable to meet retention or mobility standards IAW AFI 48-123. (T-1)
 
Ask your PEBLO what happens if you start physical therapy. Just let him know that it won't interfere with or delay your disability processing.

Can't hurt to ask
 
sbarq1 said:
Do you have an "In the Line of Duty" (ILOD) attached to your back issue? Also, why exactly are you on the AGR orders? You can email me directly at sbarq1@yahoo.com if you would like. I'm in a very similar situation and have been since mid 2014.
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My ailments do have an ILOD attached to them due to me incurring the injuries while on Active Duty and I have never been a Traditional Reservist.
 
Guardguy11 said:
Man.. there is a lot going on here. I am going to break this up into a couple focus areas to make it easier to read.

AGR Orders - They don't have to keep you on AGR orders during your DES process, but they do have to keep you on Title 10 orders during the DES process. The days should flow down from HHQ and get approved in 120 day chunks. DO NOT, I repeat, DO NOT let them kick you off orders with nothing in place. DODI 1332.38 plain states that you must be "afforded" orders during your disability processing. The same people that deal with MEDCON orders (AFI 36-2910) are the ones managing my orders for my DES. It is separate from your PEBLO so talk with your unit medical to find out who the MEDCON POC is if they are going to take you off of AGR orders.

DES timeline - The 230 days you mention is from entering the DES until separation. You are already a good ways into the process. You only have to complete the MEB, IPEB, and get the VA rating. Based on what I have read from others, you are looking at maybe 120 days depending on if the VA tried to hose you or not.

Surgery - The 1.5 paragraph mentioned is:

1.5. Delay of Processing. Medical Treatment Facilities (MTFs) will not delay disability processing for nondisabling conditions such as elective surgery. If a member needs emergency surgery, treatment, or hospital care, consider a delay in retirement or discharge only when it could cause a change in the disability disposition or rating.

Just as sbarq1 said, get your doctor to say it is a medical necessity on a memo that you can give to your PEBLO. Make sure it says he does not view this surgery as elective and that delaying could impact your health. You can also write a personal memo stating that you feel this surgery could impact the disability disposition or rating.

LOD - with you being on AGR orders and previous on AD, an LOD might not have been given to you. As a member of the reserves you are afforded an LOD anytime you push it, but they really only give them out to DSGs and TRs that are on mobility orders or title 10 orders. If you didn't get an LOD, don't panic, just make sure your medical records are up to snuff and cover everything wrong with you. If you haven't received an LOD by now, it is probably too late anyway. An LOD that deals with disability separation would have to be routed to HHQ and would take 5-6 months at least to complete.

To answer your question, in my opinion, you need to pursue your health and work on getting fixed. If you doctor wants to do this and is pushing for it, I would go through the process to try to get your surgery approved and delay your processing. The advantageous side of waiting would be you are obviously in a lot of pain and that pain could correlate to a potential higher rating if you haven't already done your C&P exam. If the surgery really helps with the pain and mobility, it could have the potential of reducing your rating, but it would be worth it in my opinion.

Hope this helps!

Brad
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Brad,

Thank you for the explanation. I have already spoke to my command, Recruiting, and they are on board with extending my AGR orders to keep me on status as long as the DES takes. I have some real good leaders advocating for me. I will keep in mind the reg that you referenced and the other information concerning that.

The benefit of seeing civilian providers is that if I tell them that I need a memo from them stating that the surgery is necessary they'll do it. They don't look at health care the same way the military does with cost effectiveness first.

I confirmed with my PEBLO that I have ILOD for my ailments due to me never have been on TR status. I transferred directly from Active Duty Recruiting to Reserve Recruiting and prior to all that was Active Duty Ground Trans. No TR time here so no reason to worry about ILOD not being applied.

I appreciate the advice. I have to make the decision if I feel it will be better for me at this time to hold off on the surgery. I know that if I get it the proposed recovery time is 12-18 months so I'm sure that would delay my process even further. Thanks again.
 
blackrubi05 said:
Brad,

Thank you for the explanation. I have already spoke to my command, Recruiting, and they are on board with extending my AGR orders to keep me on status as long as the DES takes. I have some real good leaders advocating for me. I will keep in mind the reg that you referenced and the other information concerning that.

The benefit of seeing civilian providers is that if I tell them that I need a memo from them stating that the surgery is necessary they'll do it. They don't look at health care the same way the military does with cost effectiveness first.

I confirmed with my PEBLO that I have ILOD for my ailments due to me never have been on TR status. I transferred directly from Active Duty Recruiting to Reserve Recruiting and prior to all that was Active Duty Ground Trans. No TR time here so no reason to worry about ILOD not being applied.

I appreciate the advice. I have to make the decision if I feel it will be better for me at this time to hold off on the surgery. I know that if I get it the proposed recovery time is 12-18 months so I'm sure that would delay my process even further. Thanks again.
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Good deal and I apologize I wasn't trying to hijack your thread...I was in two different spots on here and got mixed up bro. I've got a great command and unit...My problems are with the ones administering these programs. They seem to have a serious disconnect on the members that are injured and their families. It's easy to screw someone when you don't have to look them in the eye or tell their families they have to suffer.
 
Forgot to mention in all of this that I have not conducted the VA C&P exams and my case isn’t at the PEB for adjudication. I am still in the MEB process until I complete this treatment for PTSD. That will be Aug-Oct 2019. I'll request a 6 month extension on my orders and have been assured that I'll be granted that. I may end up waiting to get the operation until after a decision has been made. I'm already on a profile and working light duty. I hate not having a purpose currently but at the same time I want to do what is going to be best for my case and career.
 
sbarq1 said:
Good deal and I apologize I wasn't trying to hijack your thread...I was in two different spots on here and got mixed up bro. I've got a great command and unit...My problems are with the ones administering these programs. They seem to have a serious disconnect on the members that are injured and their families. It's easy to screw someone when you don't have to look them in the eye or tell their families they have to suffer.
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Highjack away man. No worries. All the info is valuable. Good luck.
 
blackrubi05 said:
Forgot to mention in all of this that I have not conducted the VA C&P exams and my case isn’t at the PEB for adjudication. I am still in the MEB process until I complete this treatment for PTSD. That will be Aug-Oct 2019. I'll request a 6 month extension on my orders and have been assured that I'll be granted that. I may end up waiting to get the operation until after a decision has been made. I'm already on a profile and working light duty. I hate not having a purpose currently but at the same time I want to do what is going to be best for my case and career.
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It will behoove you to keep that mindset going forward. At some point, even the best command team in the world will drop you and start pressing towards the future, as they should. The US mission still needs to be done, but now your mission is to get better. Every decision you make from here on out should be towards that goal. You're lucky you are on AGR orders because in the TR / DSG world, you would have to be on MEDCON and it a booger to get orders beyond 1 year unless you are in the full DES. They won't let you get out of the Pre-IDES process until they are sure you are going to get kicked out so it really screws a lot of people. SBARQ is a prime example of the "it puts the lotion on the skin" attitude of the Air Force once you fall into the gray area.

Either way, I am glad you have the information you need to make a successful decision. As a point of correction, the DODI for saying someone has to be on orders during DES is 1241.01 (Reserve Component pay entitlements) not 1332.38 (military separation & retirement).

Keep us posted as you go through your journey. I will be interested to see how your timeline shakes out.

Brad
 
blackrubi05 said:
Brad,

Thank you for the explanation. I have already spoke to my command, Recruiting, and they are on board with extending my AGR orders to keep me on status as long as the DES takes. I have some real good leaders advocating for me. I will keep in mind the reg that you referenced and the other information concerning that.

The benefit of seeing civilian providers is that if I tell them that I need a memo from them stating that the surgery is necessary they'll do it. They don't look at health care the same way the military does with cost effectiveness first.

I confirmed with my PEBLO that I have ILOD for my ailments due to me never have been on TR status. I transferred directly from Active Duty Recruiting to Reserve Recruiting and prior to all that was Active Duty Ground Trans. No TR time here so no reason to worry about ILOD not being applied.

I appreciate the advice. I have to make the decision if I feel it will be better for me at this time to hold off on the surgery. I know that if I get it the proposed recovery time is 12-18 months so I'm sure that would delay my process even further. Thanks again.
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Don't let that proposed recovery time stop your decision. The calculus for this decision really boils down to a single question; Does the health concerns about waiting for the surgery out weigh the prospect of being completely done with the IDES process and moving into the next season of life without delay? One thing a nurse friend of mine said is that you can't die from pain. I know that sounds cold, but you won't die, and as long as you take it easy it shouldn't get worse unless it is degenerative in nature. If you can manage the pain, it might be worth it just to wait for the surgery and be done with the VA and separation stuff, but I would lean on getting it done before. Primarily because you would be on orders and if something goes wrong, you can get it covered easier. After you get out you can still get it worked because it would be service connected, but it would just take more time.

Just my 2-cents.

Brad
 
I also want to share my experience with surgical intervention. I used to have problems due to difficulty breathing and constantly suffering from a runny nose. Shortly before the pandemic started, I discovered that the cause of my breathing problems was a curved nasal septum. I turned to https://www.drbustillo.com to make an operation and change the situation. Now I'm doing great, and I regret that I didn't do it earlier. I dreamed of a military career, but because of the problems with breathing, I thought it was impossible for me.
 
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