I'm AD AF with about 6 years TIS. I was anticipating a med board and the process has just started. I got a call from my PEBLO Apr 3 that basically said the process was starting and I'd have to notify her of any leave and couldn't go TDY. Apr 6 My profile was changed from temporary to a code 37. That same week my supervisor was called into the first sergeants office to answer some questions about me. Later that day the shirt, my supervisor and I went into my commander's office where he told me he'd be writing a statement recommending my retention. It wasn't really a discussion about what was going on with me so much as the commander telling me about the MEB process in general. April 14 I followed up with the PEBLO and she told me my package had been sent to AFPC for the RILO Apr 11. She didn't offer it but I requested copies of what was sent up to AFPC.
I looked at the paperwork after leaving her office and this is what was submitted:
Commander's memo to MEB/PEB
1. Does members medical condition allow him/her to perform all in-garrison duties?
Yes. SSgt X does great work for our unit.
2. Detail any duty-related restrictions, limitations, work-around, or schedule modifications that are in effect and for how long they have been in effect. If member is currently assigned to desk or admin duties was the medical condition a factor in selecting this duty?
None
3. Describe the specific duties the member is unable to perform because of his/her medical condition.
N/a
4. Other than medical appointments, approximately how many days of work have the member missed over the past 90 days due to this condition? How many days were 1. Appointments? 2. Formal quarters or con leave? 3. Other days off due to condition?
0
5. You are encouraged to speak with the PCM regarding the member's medical condition. Have you spoken with the PCM and do you agree with the PCM's assessment of the member's condition? If not, why?
I have not recently but have in the past and am comfortable not talking with the PCM. I did speak with SSgt X's supervisor and our first sergeant who had spoken with the provider recently and my responses are based reflect that discussion.
6. How will member's condition affect his/her ability to serve in primary AFSC in future assignments?
I am not certain that it will affect her ability to serve in the future. However, her primary duties will require her to be on call for X, and other, duties which could be impacted if she isn't available 24/7.
7. How will the member's condition affect his or her ability to perform their primary afsc duties in an OCONUS deployed environment?
I am not certain that it will affect her ability to perform duties in an OCONUS deployed environment. However, her primary duties will require her to be on call for X, and other, duties which could be impacted if she isn't available 24/7.
8. How does the member's medical condition impact your units ability to perform your in-garrison/deployed mission?
It doesn't impact our unit's ability at all! SSgt X is a top-notch NCO who performs her duties with no issues.
Commander Recommendation:
Retain
Unless medical condition worsens,or another assignment changes her ability to perform, the best outcome for SSgt X, the unit and our Air Force would be to continue her service. She is a good NCO who is an asset to our unit!
Now for the dr's write-up:
Referral source and chief complaint: PCM; depression with psychotic features
History of present illness: Mbr first presented to outpatient mental health Feb 2016 after being referred by her ob/gyn for treatment of depression during her pregnancy at 17 weeks. The patient also reported sxs c/w generalized anxiety and reported worries about prior trauma. At the time, she was given psycho education including progressive muscle relaxation and treatment with biofeedback.
Patient eventually seen in BHOP in Oct 2016. Patient reported nightmares about previous sexual trauma, night sweats, and sharp pains in her hands and feet that she attributed to feeling "extra stressed" per the BHOP provider. The patient was also noted to have fears that her sons will be molested and panic symptoms.
The patient returned to follow up with BHOP two weeks later and this provider was contacted for psychiatric consultation. At the time, the patient described auditory hallucinations that were occurring over the prior week and visual hallucinations- cars that are parked appear to be moving, sense of detachment from reality. The patient denied any suicidal ideation at the time but due to the severity of her sxs she was started on cymbalata and clonazepam and close follow-up with MH was arranged.
The patient was seen for MH intake by psychology on Oct 31 2016 and reported an increase in symptoms that included the psychotic-like symptoms mentioned above. She was noted to have been suffering from anxiety and depression symptoms since the birth of her first son but the symptoms increased after her second child was born (3 months prior to intake). The patient also endorsed suicidal ideation. As a result of increased symptoms she was admitted to an outpatient program and a provisional diagnosis of PTSD was given.
After three weeks the patients care was elevated to inpatient status due to continued suicidal ideation. Following six weeks inpatient it was recommended she do an additional two weeks outpatient due to the severity of her PTSD symptoms and comorbid depression.
There then seems to be a page missing from the report....
There are some social factors mentioned, military history, physical exam which just took info from a recent drs visit I had to address shoulder pain so that's the only thing mentioned in there instead of it being a full physical.
Mental status examination:
Pt typically presents well-groomed, cooperative and alert and oriented X4 (following hospitalization). Her psychomotor activity appears somewhat decreased. She appears to be guarded with her well with his mental health providers. Her speech is normal. Her typical mood is severely depressed. Since Nov 2016 her self-reported PHQ scores have remained in the severely depressed range. Her affect is typically flat and congruent with her mood. Her thought processes are linear, logical, and goal directed. With her most recent visit, as of the writing endorsing suicidal ideation without intent. There was report of previous psychotic features as described in the narrative. Judgment and insight are in question due to factors mentioned in the narrative. Cognition is within normal limits.
Psychological testing:
Not done
Consultations:
None
Lab data (just showing abnormal factors):
Hemoglobin: low
Hematocrit: low
RDW CV blood: high
MPV blood: high
Duty restriction report:
As noted above, PT will likely remain nobility restricted. Her career field does not arm in garrison but she would not meet arming/use of force criteria.
Prognosis & recommendation:
Pt is competent for pay and records, and is at increased risk for suicide completion based on her diagnosis and other risk factors. She is currently on the high interest log and is followed weekly in the mental health clinic. She has required a frequency and intensity level of treatment that exceeds the capability of the military. Her function is not compatible with rigors of military service.
Questions:
1. Is it normal for a RILO to take over three weeks?
2. Is it normal not to receive your full medical narrative? The way mine reads there is at least one page missing.
3. How is it viewed when the commander's write-up is so brief and doesn't match the medical narrative?
4. The PEBLO mentioned the RILO process may take longer because of a new initiative called Invisible Wounds that separately reviews PTSD cases. Has anyone heard of this?
5. My mental health diagnoses are Major depressive disorder recurrent with (and now without) psychotic features, PTSD and generalized anxiety disorder. I also have physical issues that are still in the process of being diagnosed, how does this work during the MEB?
Thanks for reading the long post and for any advice in this intimidating process!
I looked at the paperwork after leaving her office and this is what was submitted:
Commander's memo to MEB/PEB
1. Does members medical condition allow him/her to perform all in-garrison duties?
Yes. SSgt X does great work for our unit.
2. Detail any duty-related restrictions, limitations, work-around, or schedule modifications that are in effect and for how long they have been in effect. If member is currently assigned to desk or admin duties was the medical condition a factor in selecting this duty?
None
3. Describe the specific duties the member is unable to perform because of his/her medical condition.
N/a
4. Other than medical appointments, approximately how many days of work have the member missed over the past 90 days due to this condition? How many days were 1. Appointments? 2. Formal quarters or con leave? 3. Other days off due to condition?
0
5. You are encouraged to speak with the PCM regarding the member's medical condition. Have you spoken with the PCM and do you agree with the PCM's assessment of the member's condition? If not, why?
I have not recently but have in the past and am comfortable not talking with the PCM. I did speak with SSgt X's supervisor and our first sergeant who had spoken with the provider recently and my responses are based reflect that discussion.
6. How will member's condition affect his/her ability to serve in primary AFSC in future assignments?
I am not certain that it will affect her ability to serve in the future. However, her primary duties will require her to be on call for X, and other, duties which could be impacted if she isn't available 24/7.
7. How will the member's condition affect his or her ability to perform their primary afsc duties in an OCONUS deployed environment?
I am not certain that it will affect her ability to perform duties in an OCONUS deployed environment. However, her primary duties will require her to be on call for X, and other, duties which could be impacted if she isn't available 24/7.
8. How does the member's medical condition impact your units ability to perform your in-garrison/deployed mission?
It doesn't impact our unit's ability at all! SSgt X is a top-notch NCO who performs her duties with no issues.
Commander Recommendation:
Retain
Unless medical condition worsens,or another assignment changes her ability to perform, the best outcome for SSgt X, the unit and our Air Force would be to continue her service. She is a good NCO who is an asset to our unit!
Now for the dr's write-up:
Referral source and chief complaint: PCM; depression with psychotic features
History of present illness: Mbr first presented to outpatient mental health Feb 2016 after being referred by her ob/gyn for treatment of depression during her pregnancy at 17 weeks. The patient also reported sxs c/w generalized anxiety and reported worries about prior trauma. At the time, she was given psycho education including progressive muscle relaxation and treatment with biofeedback.
Patient eventually seen in BHOP in Oct 2016. Patient reported nightmares about previous sexual trauma, night sweats, and sharp pains in her hands and feet that she attributed to feeling "extra stressed" per the BHOP provider. The patient was also noted to have fears that her sons will be molested and panic symptoms.
The patient returned to follow up with BHOP two weeks later and this provider was contacted for psychiatric consultation. At the time, the patient described auditory hallucinations that were occurring over the prior week and visual hallucinations- cars that are parked appear to be moving, sense of detachment from reality. The patient denied any suicidal ideation at the time but due to the severity of her sxs she was started on cymbalata and clonazepam and close follow-up with MH was arranged.
The patient was seen for MH intake by psychology on Oct 31 2016 and reported an increase in symptoms that included the psychotic-like symptoms mentioned above. She was noted to have been suffering from anxiety and depression symptoms since the birth of her first son but the symptoms increased after her second child was born (3 months prior to intake). The patient also endorsed suicidal ideation. As a result of increased symptoms she was admitted to an outpatient program and a provisional diagnosis of PTSD was given.
After three weeks the patients care was elevated to inpatient status due to continued suicidal ideation. Following six weeks inpatient it was recommended she do an additional two weeks outpatient due to the severity of her PTSD symptoms and comorbid depression.
There then seems to be a page missing from the report....
There are some social factors mentioned, military history, physical exam which just took info from a recent drs visit I had to address shoulder pain so that's the only thing mentioned in there instead of it being a full physical.
Mental status examination:
Pt typically presents well-groomed, cooperative and alert and oriented X4 (following hospitalization). Her psychomotor activity appears somewhat decreased. She appears to be guarded with her well with his mental health providers. Her speech is normal. Her typical mood is severely depressed. Since Nov 2016 her self-reported PHQ scores have remained in the severely depressed range. Her affect is typically flat and congruent with her mood. Her thought processes are linear, logical, and goal directed. With her most recent visit, as of the writing endorsing suicidal ideation without intent. There was report of previous psychotic features as described in the narrative. Judgment and insight are in question due to factors mentioned in the narrative. Cognition is within normal limits.
Psychological testing:
Not done
Consultations:
None
Lab data (just showing abnormal factors):
Hemoglobin: low
Hematocrit: low
RDW CV blood: high
MPV blood: high
Duty restriction report:
As noted above, PT will likely remain nobility restricted. Her career field does not arm in garrison but she would not meet arming/use of force criteria.
Prognosis & recommendation:
Pt is competent for pay and records, and is at increased risk for suicide completion based on her diagnosis and other risk factors. She is currently on the high interest log and is followed weekly in the mental health clinic. She has required a frequency and intensity level of treatment that exceeds the capability of the military. Her function is not compatible with rigors of military service.
Questions:
1. Is it normal for a RILO to take over three weeks?
2. Is it normal not to receive your full medical narrative? The way mine reads there is at least one page missing.
3. How is it viewed when the commander's write-up is so brief and doesn't match the medical narrative?
4. The PEBLO mentioned the RILO process may take longer because of a new initiative called Invisible Wounds that separately reviews PTSD cases. Has anyone heard of this?
5. My mental health diagnoses are Major depressive disorder recurrent with (and now without) psychotic features, PTSD and generalized anxiety disorder. I also have physical issues that are still in the process of being diagnosed, how does this work during the MEB?
Thanks for reading the long post and for any advice in this intimidating process!
