Hello, I got diagnosed with narcolepsy with Cataplaxey in early 2016 and I just started my MEB process in APR of this year. Initially I wanted to stay in the service but after looking at VSRD classifications and history of VA appeals - I see that it's not likely (looking at the VSRD criteria I fall in the 80% range). My concern now is to make sure that I get rated correctly, the issue is both my NARSUM and Command Impact Statement were written with the intent to be found fit for duty. What's the best way approach this situation? I have an appointment with someone on my PCM team (my actual PCM just PCS'd) later this month to discuss the issue, but I'd also appreciate some input from you guys as well. I know my PEBLO mentioned something about being able to request the case get looked at by another doctor if I disagree with the information on the NARSUM, but is that necessary? Can I just have my PCM update the NARSUM? Fortunately I'm still early on in the process so I believe this is something that is resolvable.
Guidance on MEB (IDES) Process [USAF]
- Thread starter Idiosyncrasy
- Start date
First question is, has your stuff even been off the base yet to be reviewed?
Yes, if your NARSUM and your commander's letter were both written from a perspective for you to stay in the service, it might not fully capture all of your symptoms. But you have a few chances to get that fixed.
You will be rated under 8108 Narcolepsy (Rate as for epilepsy, petit mal.)
Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.
Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).
General Rating Formula for Major and Minor Epileptic Seizures:
Averaging at least 1 major seizure per month over the last year 100
Averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly 80
Averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week 60 At least 1 major seizure in the last 6 months or 2 in the last year;or averaging at least 5 to 8 minor seizures weekly
40 At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months 20 A confirmed diagnosis of epilepsy with a history of seizures 10
So it is very important that your NARSUM and your Commander's Letter both reflect the number of episodes you are having.
If your stuff hasn't left the base for the MEB part of the MEB process you are golden, as you can get these things amended.
If They have left the base and you are in the IPEB part of the MEB process, its fixable as well.
As far as what your commander said, yes that is called an IMR (Impartial Medical Review) that will occur before your package goes up to the IPEB for decision. You can also appeal the IPEB decision at a formal board.
Biggest question right now is where you are on the spectrum.
Yes, if your NARSUM and your commander's letter were both written from a perspective for you to stay in the service, it might not fully capture all of your symptoms. But you have a few chances to get that fixed.
You will be rated under 8108 Narcolepsy (Rate as for epilepsy, petit mal.)
Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.
Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).
General Rating Formula for Major and Minor Epileptic Seizures:
Averaging at least 1 major seizure per month over the last year 100
Averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly 80
Averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week 60 At least 1 major seizure in the last 6 months or 2 in the last year;or averaging at least 5 to 8 minor seizures weekly
40 At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months 20 A confirmed diagnosis of epilepsy with a history of seizures 10
So it is very important that your NARSUM and your Commander's Letter both reflect the number of episodes you are having.
If your stuff hasn't left the base for the MEB part of the MEB process you are golden, as you can get these things amended.
If They have left the base and you are in the IPEB part of the MEB process, its fixable as well.
As far as what your commander said, yes that is called an IMR (Impartial Medical Review) that will occur before your package goes up to the IPEB for decision. You can also appeal the IPEB decision at a formal board.
Biggest question right now is where you are on the spectrum.
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Thanks for the reply! As of right now the only thing I know is the case has been reviewed by the D.A.W.G. (an on base facility) and they recommended a full MEB. I don't specifically know where I am (as I said before my PCM just PCS'd, so I'm kind of in limbo right now) I'll speak with my PEBLO today to get specifics on the situation. Also, The VA found some things that may have to be added to the NARSUM as well so I wouldn't be surprised if it ends back up on base.
Ok. Knowing that the DAWG has recommended a full MEB narrows down the timeline a little.
Do you know if your PEBLO has been directed to do a full MEB by HQ AFPC/DPFD? Have you signed a DES Counseling Acknowledge Sheet? A VA 21-526EZ?
I'm going to assume when you say "The VA" you mean the VA MSC (Military Services Coordinator). If you have met with him I'm willing to bet that you have done the VA 21-526EZ.
One key thing is all of this is that "words" and "titles" matter. Make sure to know who you are talking about because a small difference in the process really does change what you can get accomplished.
Do you know if your PEBLO has been directed to do a full MEB by HQ AFPC/DPFD? Have you signed a DES Counseling Acknowledge Sheet? A VA 21-526EZ?
I'm going to assume when you say "The VA" you mean the VA MSC (Military Services Coordinator). If you have met with him I'm willing to bet that you have done the VA 21-526EZ.
One key thing is all of this is that "words" and "titles" matter. Make sure to know who you are talking about because a small difference in the process really does change what you can get accomplished.
Yes, I have filled out a form A VA 21-526EZ. When I said "the VA" It was in regards to specialist they referred me to see to evaluate my claims. I also believe my PEBLO was directed to do a full MEB however I am not 100% on that. I also believe that I signed DES Counseling Acknowledge Sheet, once again, not 100% sure.
The specialist they referred you to help you file your claim is your MSC. You'll see him one more time after your proposed ratings come back.
Ok, so that narrow the range down a little further. If you have done the VA 21-56EZ it means that the DAWG's recommendation to do a full MEB was concurred by AFPC and AFPC has directed your PEBLO to coordinate a full MEB. ((See little by little we are peeling back the onion))
As you have done the VA 21-56EZ it means your NARSUM and your Commander's Letter are both on file and would have been sent to AFPC for them to make the determination directing the full MEB. This is not a bad thing, however, as your doctors will can write an addendum to the to the MEB NARSUM. This is where your military treatment team and review the VA C&P exam reports and decide if they agree or not. If they do not agree, they can add verbiage.
In my case my PCM outright said their diagnosis was wrong, and the VA changed it.
You can also submit a letter in your MEB packet. You can also get your commander to write a letter on your behalf which acknowledges your symptoms.
Perfect! Thank you for all the information! This is the farthest I've gone in the process (I'm still waiting for my results from the VA specialist to come back) I'll be sure to ask my PCM team to write an addendum. Also, I'll be sure to put an emphasis on quantifying everything from now on (ie. I have x episodes of narcolepsy week, and x episodes of cataplexy a week). I have an appointment with both my PCM team and Neurologist later this month, I'll be sure to discuss everything with them
as well.
as well.
I've done a few exams, but I haven't gotten any results back from them yet. (I would still consider the process ongoing)
Edit: I'd also like to mention I havent done exams at any VA facilities, I've been referred to outside doctors for everything. (I dont know how relevant that information is to tour question.)
It does make a difference. Just answering the questions have narrowed down where you are in your IDES process.
If you Google "IDES Timeline" it will pull up the same image from a lot of place.
You are currently in the Medical Evolution Board Phase. Your claim has been developed (that was sitting down with the VA MSC and filling out the VA 21-56EZ.
Your next milestone marker will be your VA C&P exams.
After that (usually 5 days) the VA will send those results back to your VA MSC who will pass them to your PEBLO who will pass them to both you and your providers. Your providers can then write an Addendum to the MEB NARSUM. That is where your new PCM could state he doesn't agree with the original diagnosis, and feels you suffer from whatever. This helps because you wanted to stay in, but now you won't, so his verbiage will really help.
Your commander can also write an Addendum to his commanders' statement.
And of course, you are allowed to submit a personal letter to the IPEB if you want.
If you Google "IDES Timeline" it will pull up the same image from a lot of place.
You are currently in the Medical Evolution Board Phase. Your claim has been developed (that was sitting down with the VA MSC and filling out the VA 21-56EZ.
Your next milestone marker will be your VA C&P exams.
After that (usually 5 days) the VA will send those results back to your VA MSC who will pass them to your PEBLO who will pass them to both you and your providers. Your providers can then write an Addendum to the MEB NARSUM. That is where your new PCM could state he doesn't agree with the original diagnosis, and feels you suffer from whatever. This helps because you wanted to stay in, but now you won't, so his verbiage will really help.
Your commander can also write an Addendum to his commanders' statement.
And of course, you are allowed to submit a personal letter to the IPEB if you want.