Case got rejected? Help!

My case was referred for both Enthesothapy of the Right hip and for my Migraines, however, today My VA Peblo told me it got rejected because of enadequate treatment for Neurological symptoms. I have had treatment for my migraines since 22 May 2014. Over a year now and have been prescribed numerous/Various amounts of medication all documented I my ALTA notes. The migraine was added as an addendum to my original referral, My hip injury. My VA Peblo told me that my case would get canceled until further treatment was excercised. This has to be wrong tho... My second LIMDU has already expired in March and now I'm being told my migraines aren't rateable?

What do I do now? Please help.

 

[USAFRet92010]

Migraines and Headaches are ratable items. Check out CFR 38 Part 4 for rating guidelines.

 

[lee.michael.f92]

Migraines and Headaches are ratable items. Check out CFR 38 Part 4 for rating guidelines.

Thank you for the reply. I have read the CFR and VASRD and understand that Migraines are ratable conditions... My issue is that they rejected my case even though I have had treatment for over a year now. I just don't know what my next course of action is? Do I talk to Jag? Do I need to see a case manager? Should I talk to patient advocacy?

 

[scoutCC]

Well, the year is a guideline. It is more accurately described as maximum medical benefit. They can't really judge you unfit if there is a good chance a different treatment plan will make you fit. Remember, being unfit is a negative finding, they are saying there is no way the military can work with your condition. So after that second LIMDU the doc couldn't waive you to keep trying different options, the MTF commander or MEB folks can.

What they want to see is the doc talking about the different preventive meds you've tried and why they are out of options for further treatment with those. They also want to see the different abortive meds you've tried and why they are out of options for further treatment with those.

Example:
Tried topomax and it reduced migraine frequency, but side effects couldn't be tolerated
Tried anti-depressant, no effect
Tried blood pressure med, moderate effect, currently at highest dose that can be safely tried

Tried imitrex, was no effective at aborting migraines
Tried relpax, is able to abort migraines, but not until second dose on many occasions, and the symptoms while waiting for meds interferes with work.

There are lots of treatment options, some won't work, some won't be right for you due to drug interaction, etc., and some will work, but just not well enough to make you fit to serve. They need to give you the benefit of the doubt that you can serve until every option is exhausted. Sometimes this is you being more aggressive with treatment providers about trying new things, sometimes this is simply a matter of the provider documenting things better.

Your next course of action is to keep exploring options until the provider submits you for a MEB again because nothing is working well enough.

 

[lee.michael.f92]

Well, the year is a guideline. It is more accurately described as maximum medical benefit. They can't really judge you unfit if there is a good chance a different treatment plan will make you fit. Remember, being unfit is a negative finding, they are saying there is no way the military can work with your condition. So after that second LIMDU the doc couldn't waive you to keep trying different options, the MTF commander or MEB folks can.

What they want to see is the doc talking about the different preventive meds you've tried and why they are out of options for further treatment with those. They also want to see the different abortive meds you've tried and why they are out of options for further treatment with those.

Example:
Tried topomax and it reduced migraine frequency, but side effects couldn't be tolerated
Tried anti-depressant, no effect
Tried blood pressure med, moderate effect, currently at highest dose that can be safely tried

Tried imitrex, was no effective at aborting migraines
Tried relpax, is able to abort migraines, but not until second dose on many occasions, and the symptoms while waiting for meds interferes with work.

There are lots of treatment options, some won't work, some won't be right for you due to drug interaction, etc., and some will work, but just not well enough to make you fit to serve. They need to give you the benefit of the doubt that you can serve until every option is exhausted. Sometimes this is you being more aggressive with treatment providers about trying new things, sometimes this is simply a matter of the provider documenting things better.

Your next course of action is to keep exploring options until the provider submits you for a MEB again because nothing is working well enough.

Thank you for the reply! I understand that that there is a "year" guidline, however that being said, I have had treatment well over a year. Some of my ALTHA notes date migraines and headaches back to 2012.
I have also tried various treatments, i.e. Gangoline Nerve block injections, Topomax, Imitrex, Gabapeptin, Ibuprofen, Maxalt, Tylenol, Magnesium, Melatonin and other list of medication. I believe the only thing I haven't tried is Botox.

My biggest stickler is that I was referred, originally, for my Hip injury, for being on my 2nd LIMDU and they are ONLY rejecting/ trying to suspend my package for my migraine which was added with an addendum. Even though I have had addequate treatment. My biggest question is why wouldn't they just rate me for one condition, My Hip, and not my migraine; stating that my migraine is not rateable due to insufficient treatment or inadequate treatment. --This to me would make sense, but rejecting the whole package because of my migraine treatment isn't finished.

Is there is a way to just take the Migraines out and resend my package for just my Hip condition?

 

[scoutCC]

There isn't an honest way to do it and certainly nothing I would recommend. They need to consider every condition, and they need to consider it in the context of its suitability for you to continue to serve. If that data isn't available, the right answer is to get that data not just hand waive things through and pretend its not a problem. I'm pretty sure if you wanted to pretend its not there and magically fixed itself, they'd be happy to hand waive it through, but that will cause problems down the road when it comes time for proper compensation.

When I've seen them kick something back for inadequate treatment, usually they were decently specific. I.e. make sure the guy goes to ortho and consider surgery, or go to physical therapy, etc. To me it sounds like they just need a better write up or considered for possible causes of the migraines, i.e. head MRI or CAT scan. My gut says, with 3 years of treatment and them not having the data they need, you haven't seen a specialist and just need to be seen my neuro. Is it only the PCM who has been treating you, or maybe neuro wasn't involved in the write up? Generally I consider the MEB kicking something back for further development a good thing, it means someone is pointing out you need real care instead of the typical military medicine half arse approach.

 

[lee.michael.f92]

There isn't an honest way to do it and certainly nothing I would recommend. They need to consider every condition, and they need to consider it in the context of its suitability for you to continue to serve. If that data isn't available, the right answer is to get that data not just hand waive things through and pretend its not a problem. I'm pretty sure if you wanted to pretend its not there and magically fixed itself, they'd be happy to hand waive it through, but that will cause problems down the road when it comes time for proper compensation.

When I've seen them kick something back for inadequate treatment, usually they were decently specific. I.e. make sure the guy goes to ortho and consider surgery, or go to physical therapy, etc. To me it sounds like they just need a better write up or considered for possible causes of the migraines, i.e. head MRI or CAT scan. My gut says, with 3 years of treatment and them not having the data they need, you haven't seen a specialist and just need to be seen my neuro. Is it only the PCM who has been treating you, or maybe neuro wasn't involved in the write up? Generally I consider the MEB kicking something back for further development a good thing, it means someone is pointing out you need real care instead of the typical military medicine half arse approach.

I have been seeing neurology for over a year now and i have been seen by the specialist/ Dr. on every visit with MRI's and CAT Scans done. He even wrote my addendum stating that my migraines are frequent and prostrating 2-3 times a week and that the condition is unfitting per his review.

I really do appreciate your input though, and I would like to firmly believe that them telling me to get more treatment is only helping me and my case even more.

My other question is they say I may need a 3rd period of LIMDU. Who would initiate this? Neurology? Me? I'm so lost.

 

[scoutCC]

Probably neurology is a good idea, so they can do a LIMDU based on migraines. Could be PCM, and make sure the LIMDU addresses both conditions. I don't know LIMDUs very well, but assume they are like Army profiles where they specify what activities are a bad idea, not just a simple statement of no ship duty.

 

[lee.michael.f92]

Probably neurology is a good idea, so they can do a LIMDU based on migraines. Could be PCM, and make sure the LIMDU addresses both conditions. I don't know LIMDUs very well, but assume they are like Army profiles where they specify what activities are a bad idea, not just a simple statement of no ship duty.

I know you probably wouldnt know this but what if HQMC denies my 3rd period of LIMDU?

 

[scoutCC]

U.S. Navy Manual of the Medical Departments, chapter 18, section 18-10 seems like a good read. A real LIMDU is only done by a MEB, the two previous LIMDUs are more accurately described as temporary LIMDUs. The MEB action should be regarded as already authorizing an additional LIMDU period.

 

[lee.michael.f92]

U.S. Navy Manual of the Medical Departments, chapter 18, section 18-10 seems like a good read. A real LIMDU is only done by a MEB, the two previous LIMDUs are more accurately described as temporary LIMDUs. The MEB action should be regarded as already authorizing an additional LIMDU period.

If my case gets suspended... "if", can my Neurologist/ Dr. Specialist request that the PEB continue if they feel my conditions are severe enough to where a PEB must be conducted? Also I heard that if a 3rd LIMDU is denied then my case must be forwarded to the PEB as all my conditions are unfitting regardless of the time that have seen a specialist (even thought I've seen them over a year).

So back to the real question... Can my Specialist send me back up for a board?

 

[wallflood]

A year isnt that long for migraines although Ill be honest, I dont know what the cutoff if for minimum time for MEB.

But I can say Ive had migrainous headaches (post traumatic) far longer than you and have tried many more medications than you as well. A nexus letter statiing 2-3 times a week is good but youll probably need more time.

And at this point I doubt theyll consider a MEB without ALL conditions. They arent going to rate anyone on just 1 specific condition. Theyll want everything on your service and medical records. You dont pick and chose.

I think scout may be right that they just need more time before they decide your conditions are ratable or fitting vs unfitting.

Have you sought legal counsel with the MEB-ROC????

 

[vaneeya]

The member would need to know that once his package is forwarded to IPEB, he
will be discharged when he is discharged. He will not be given medical hold
or kept in the service pending the recovery from any surgery.

 

[lee.michael.f92]

The member would need to know that once his package is forwarded to IPEB, he
will be discharged when he is discharged. He will not be given medical hold
or kept in the service pending the recovery from any surgery.

That is interesting because my package got kicked back for only my Migraines and says I need 4-6 more months of seeing a specialist. Is there anyway I can take off my Conditioned referred for Migraines and resubmit it with just my first referred condition, my Hip issues?

I am not trying to wait another 4-6 months in service as my conditions are only getting worse.

I am going to talk to the JAG tomorrow as well as a medical Case Manager.