Welcome kljunior.
The NARSUM is covered in AR 40-400 and here is the detail:
7–9. Preparing medical evaluation board narrative summaries
The recommended format for an MEB narrative summary is provided below.
a. Baseline documentation.
At the beginning of the MEB, the following will be recorded:
(1) The signatory physician’s specialty.
(2) The clinical department/service.
(3) The MTF and its location.
(4) Reason for doing the MEB (for example, physician-directed, command-directed).
(5) Soldier’s eligibility for MEB.
(6) Military history.
(a)
Date of entry into Service.
(b)
Estimated termination of Service.
(c)
Administrative actions ongoing, pending, or completed (for example, courts-martial, selective early retirement,
bars, retirement or separation dates).
(7) Chief complaint stated in Soldier’s own words.
(8) History of present illness. Exact details, including pertinent dates regarding injuries, how incurred, and a
statement of the final LD determination, if available.
(9) Past medical history.
(a)
Past injuries and illnesses.
(b)
Prior disability ratings (for example, given by the VA).
(c)
Past hospitalizations and relevant outpatient treatment, including documentation of diagnosis and therapy,
pertinent dates, and location should be listed.
(d)
Illnesses, conditions, and prodromal symptoms, existing prior to service conditions.
b. Physical examination.
A complete physical examination must be recorded in the MEB. Selected specialty-related
considerations and guidelines follow.
(1) Cardiology.
(a) Results of special studies to support and quantify the cardiac impairment should be noted (for example, treadmill
and thallium stress tests, angiography, and other special studies).
(b)
It is imperative that the Functional Therapeutic Classification of the cardiac condition be included. Either the
New York or Canadian classification system may be used.
(2) Gastroenterology. Soldiers with fecal incontinence should have recorded findings of rectal examination (for
example, digital exam, manometric studies as indicated and radiographic studies). The degree and frequency of the
incontinence should be noted, as well as the incapacitation caused by the condition.
(3) Neurosurgery.
(a) In vertebral disc problems, radicular findings on physical examination should be supported by laboratory studies
such as computerized axial tomography scan, MRI, or electromyography. In cases where surgery has been performed,
both pre- and post-operative deep tendon reflexes should be documented.
(b)
In head injuries, neuropsychiatric assessment should be accomplished. Results of any clinically indicated
neuropsychological testing should be included.
AR 40–400 • 6 February 2008 55
(4)
Ophthalmology. If retention standards are not met for reasons related to vision, visual fields must be included in
the physical examination and verified by an ophthalmologist. Specialist examination should include uncorrected and
corrected central visual acuity. Snellen’s test or its equivalent will be used and, if indicated, measurements of the
Goldman Perimeter chart will be included.
(5) Orthopedics.
(a) Range of motion measurements must be documented for injuries to the extremities. The results of the measurement
should be validated and the method of measurement and validation should be stated.
(b)
In cases involving back pain, the use of Waddell’s signs should be included in assessing the severity and
character of the pain. (See app A.)
(6) Psychiatry.
(a) Particular attention should be paid to documenting all prior psychiatric care. Supportive data should be obtained
for verification of the patient’s verbal history.
(b)
Psychometric assessment should be carried out if such assessment will help quantify the severity of certain
conditions and allow a reference point for future evaluation.
(c)
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (or current edition) will be
used for diagnostic terminology (app A). The Multiaxial System of Assessment will be used to include Axes I-V. The
degree of social and industrial impairment must be determined and documented, and correlated to the Soldier’s clinical
manifestations for each Axis I and Axis II diagnosis. In addition, relationship of the impairment to military and civilian
performance is required.
(d)
Every effort must be made to distinguish symptoms and impairment resulting from personality disorder or
maladaptive traits from impairments based on other psychiatric conditions.
(7) Pulmonary. When an MEB is held for restrictive or obstructive pulmonary disease, documentation will be
provided of pulmonary function testing carried out when Soldier is on and off therapeutic medication. There must be
three pulmonary function tests done off medication, two of which must be in agreement within the 5 percent level, and
three done on medication, two of which must agree within the 5 percent level.
(8) Urology.
(a) Cases involving neurogenic bladder must have studies done that document the condition.
(b)
All cases involving incontinence must have studies done that document the condition.
(c)
Cases involving incontinence/neurogenic bladder should have documentation regarding severity as indicated by
the number of times self-catheterization is required, the number and type of pads required in a day, or the soilage
frequency.
c. Laboratory studies.
Studies that support and quantify the diagnosis(es) should be included as should any studies
that conflict with the diagnosis(es).
d. Present condition and current functional status.
The current clinical condition of the Soldier should be noted
i n c l u d i n g r e q u i r e d m e d i c a t i o n s a n d a n y n o n - m e d i c a t i o n t r e a t m e n t r e g i m e n t s ( f o r e x a m p l e , p h y s i c a l t h e r a p y ) i n
progress.
(1) The Soldier’s functional status as to the ability to perform his/her required duty should be indicated.
(2) The Soldier’s civilian equivalent performance should be indicated.
(3) A statement should be given regarding the prognosis for functional status after completion of treatment, if
chronic treatment is not necessary.
(4) A statement should be given regarding the prognosis for functional status in cases requiring chronic treatment.
(5) The stability of the current clinical condition and functional status should be addressed.
e. Conclusions.
(1) An informed opinion should be stated as to the Soldier’s ability to meet current retention standards.
(2) If a Soldier does not meet retention standards, the specific reasons why should be stated.
f. Diagnosis(es).
The diagnostic terminology used by the MEB should correlate, if at all possible, with that of the
VASRD. Because the PEBs are required to assess a Soldier’s status based on the VASRD, a clearer understanding of
that status is facilitated when the same terminology is used by the MEBs and the PEBs. All MEB diagnoses will be
given an International Classification of Diseases-Ninth Revision-Clinical Modification (ICD-9-CM) code.
g. Profile (if required by Service regulation).
(1) The physical profile of the Soldier should agree with the severity of the medical impairment as expressed in the
narrative summary.
(2) The physical profile of the DD Form 2808 should agree with that of the physical profile form, as well as that
noted in the MEB cover sheet.
56 AR
I think you should show this reg to your PEBLO and insist that all current medical conditions (see 9.a above) be reflected in the NARSUM regardless of whether they are the boarding action issues. It is worth a shot. Have you had Xray confirmation of degenerative arthritis? If not you need to have this done also.
Good luck,
DMcK
