New diagnosis that changes everything while waiting percentages

T

turk77

PEB Forum Regular Member
Registered Member
Hello,

First of all I want to thank you in advance. I am currently waiting for my percentages (unfitting conditions is non union fractures in both feet) and I found out that I have Hyperparathyroidism which explain my bone (bone loss), kidney stone issues, muscle and joint pain and non union fractures. if I knew this and claimed it I would get 100% but now I am just getting probably %10 from Army and whatever from VA. What should I do? Should I wait till my 199 come back and go for formal PEB as my JAG recommend or is there any other way to fix this issue? Thanks again. Today is the day 91 for percentage waiting period.

Also I am concerned about timing. Will this change make me wait another year?

Thank you

Turk
 
turk77 said:
Hello,

First of all I want to thank you in advance. I am currently waiting for my percentages (unfitting conditions is non union fractures in both feet) and I found out that I have Hyperparathyroidism which explain my bone (bone loss), kidney stone issues, muscle and joint pain and non union fractures. if I knew this and claimed it I would get 100% but now I am just getting probably %10 from Army and whatever from VA. What should I do? Should I wait till my 199 come back and go for formal PEB as my JAG recommend or is there any other way to fix this issue? Thanks again. Today is the day 91 for percentage waiting period.

Also I am concerned about timing. Will this change make me wait another year?

Thank you

Turk
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You will probably end up having to wait until your 199 comes, but you could attempt to contact the PEB through your PEBLO, or lawyer, and let them know your claim is not fully developed, and a new much more serious diagnosis has come out since your file went to the VA. They could then send it back to the MEB to document the new diagnosis. If nothing else, it will alert the PEB that you will be appealing, and not to bother putting a 199 together since you were diagnosed incorrectly. It may work, or it may not, but worth a try at least.

As far as waiting, yes this is going to add time to your case. How much depends on how far back into the process your packet has to go.

Joe
 
Thanks Joe. I tried to talk my JAG lawyer but couldn't reach her so emailed her as soon as I found out about it I will let you guys know what they recommend. On the other hand paralegal at JAG office told me to wait for 199 and appeal to that. Sad thing I found out about this issue during informal PEB and I talked to my PEBLO and one of the MEB doctor together and they told me that it is not unfitting conditions and it is not serious which was total bs and of course they told me you can claim it while you are getting out. And today someone in WTU told me the truth. It is just sad that people are just trying to get rid off you in MEB and presenting all conditions affecting your job.
 
turk77 said:
Thanks Joe. I tried to talk my JAG lawyer but couldn't reach her so emailed her as soon as I found out about it I will let you guys know what they recommend. On the other hand paralegal at JAG office told me to wait for 199 and appeal to that. Sad thing I found out about this issue during informal PEB and I talked to my PEBLO and one of the MEB doctor together and they told me that it is not unfitting conditions and it is not serious which was total bs and of course they told me you can claim it while you are getting out. And today someone in WTU told me the truth. It is just sad that people are just trying to get rid off you in MEB and presenting all conditions affecting your job.
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7900 Hyperthyroidism
Thyroid enlargement, tachycardia (more than 100 beats per minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or astrointestinal symptoms 100

Emotional instability, tachycardia, fatigability, and increased pulse pressure or blood pressure
60
Tachycardia, tremor, and increased pulse pressure or blood pressure 30

Tachycardia, which may be intermittent, and tremor, or; continuous medication required for control 10

Note (1): If disease of the heart is the predominant finding, evaluate as hyperthyroid heart disease (DC 7008) if doing so would result in a higher evaluation than using the criteria above.

Note (2): If ophthalmopathy is the sole finding, evaluate as field vision, impairment of (DC 6080); diplopia (DC 6090); or impairment of central visual acuity (DC 6061-6079).

http://www.ecfr.gov/cgi-bin/retriev...ty=HTML&h=L&r=SECTION&n=38y1.0.1.1.5.2.109.61
 
Well it is hyperparathyroidism:

Code 7904: Hyperparathyroidism occurs when the parathyroid gland produces too many hormones. There are two kinds of hyperparathyroidism: primary and secondary. Primary is a result of the glands themselves malfunctioning. This kind has very few symptoms but can include symptoms like depression, fatigue, bone pain, and muscle soreness. Secondary is a result of low Vitamin D levels. Symptoms include bone conditions like osteomalacia.

If there are kidney stones, weakness, loss of calcium in the bones, and gastrointestinal symptoms: vomiting, constipation, weight loss, nausea, anorexia, or a peptic ulcer, it is rated 100%. If there are gastrointestinal symptoms and weakness, it’s rated 60%. If constant medication is required to control the condition, it is rated 10%.

If surgery was performed to fix this condition, then the condition can be rated under this code or under any code for a remaining symptom or complication, whichever gives the highest rating. Only one rating can be given.


So according to my symptoms I should be getting 100%
 
turk77 said:
Well it is hyperparathyroidism:

Code 7904: Hyperparathyroidism occurs when the parathyroid gland produces too many hormones. There are two kinds of hyperparathyroidism: primary and secondary. Primary is a result of the glands themselves malfunctioning. This kind has very few symptoms but can include symptoms like depression, fatigue, bone pain, and muscle soreness. Secondary is a result of low Vitamin D levels. Symptoms include bone conditions like osteomalacia.

If there are kidney stones, weakness, loss of calcium in the bones, and gastrointestinal symptoms: vomiting, constipation, weight loss, nausea, anorexia, or a peptic ulcer, it is rated 100%. If there are gastrointestinal symptoms and weakness, it’s rated 60%. If constant medication is required to control the condition, it is rated 10%.

If surgery was performed to fix this condition, then the condition can be rated under this code or under any code for a remaining symptom or complication, whichever gives the highest rating. Only one rating can be given.


So according to my symptoms I should be getting 100%
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Not to shoot holes in what you are saying, but your last sentence you wrote indicates that "according"? Have you been diagnosed with Hyperparathyroidism or not? They have tested you for this, and put it to paper? It will be very important to have this to get the rating.
 
I have been diagnosed with Hyperparathyroidism multiple times. Depression, vit D efficiency not responding treatment, constant constipation and nausea, chronic kidney stone due to excessive calcium in urine, osteopenia ( bone loss). They are all documented in my notes several times. Since I am a medic I make sure everything is documented right. Fort Carson Evans could not find out away to treat it after 6 months of trials and I am seeing University of Colorado hospital which can not do anything neither other than making me try meds which is not working. So pretty much I am screwed.

The problem I am having is does it worth to fight and wait another year for this? Because I have BS in Engineering and I do not think I will have hard time to get a decent job. BUT what if this condition gets worse in couple years and make me not able to walk which I am having real difficult time with not healing fractures.
 
turk77 said:
I have been diagnosed with Hyperparathyroidism multiple times. Depression, vit D efficiency not responding treatment, constant constipation and nausea, chronic kidney stone due to excessive calcium in urine, osteopenia ( bone loss). They are all documented in my notes several times. Since I am a medic I make sure everything is documented right. Fort Carson Evans could not find out away to treat it after 6 months of trials and I am seeing University of Colorado hospital which can not do anything neither other than making me try meds which is not working. So pretty much I am screwed.

The problem I am having is does it worth to fight and wait another year for this? Because I have BS in Engineering and I do not think I will have hard time to get a decent job. BUT what if this condition gets worse in couple years and make me not able to walk which I am having real difficult time with not healing fractures.
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Your time really comes down to what you decide. When it comes to that, consider what you will potentially gain.

Wait and Retire with 100% (this is actually 75% because that is the max DOD will pay) Advantages:

Blue ID Card
Tricare Insurance for you and family
Post access
retired pay equal to 75% of your base high three (remember VA compensation pay offsets this dollar for dollar)
If combat related, you can get some or all of the lost pay restored via CRSC (CRSC is based on years of service, not disability percent)

Leave now, and claim with VA. Advantages:

No wait, get out now
Ability to apply for the new diagnosis, and get rated 100%. If done in the first 365 days of discharge, it back dates to discharge date.
You get severance pay

Things to consider:
Is my condition combat rated, or related?
How much can CRSC restore if I max out?
Is it worth waiting?
Do I have strong evidence that the Army did not get the diagnosis right?
At the end of the day, does the potential extra income, out weigh the time lost to appealing?

I am sure there are many more, but those are what come to mind. Did the Army list Hyperparathyroidism as a DX on your NARSUM? If not, why?

Joe
 
Hyperparathyroidism is not in the Narsum cause we find out about it after I accept the NARSUM and I did not know I could change it during Informal PEB. Cause after I sign paperwork for Narsum in 3 days I got my temporary 199 and was told that need to wait for percentages. A day after PCM made the diagnosis and when I talked to PEBLO and MEB doctor they told me I can claimed while I am getting out which I was OK with it till I found out that this health problem cause a lot of serious conditions and had already started.

So when I found out one of my patient got %100 for this. It got me thinking if I should fight for it. You are right about a lot of things to consider and I had fractures during field training and it is Combat related( V1:no, V3:yes, V4:no).

As you said a lot to consider.... and there is not a right answer. Thank you for your help JOE.


Turk
 
When the time comes (199 is presented) you can request a formal PEB and request that the condition be found unfitting (AR 40-501 Chapter 3-11 h.) provide the medical evidence necessary.

The standards for unfitness are residuals or complications of surgical correction (such as renal disease or bony deformities) preclude the performance of military duty.

The kicker that I see when reading this, it that I get the understanding from you there has been no attempt at treating the hyperparathyrodism. The reason I get this understanding is that you wrote "I found out that I have Hyperparathyroidism which explain my bone (bone loss), kidney stone issues, muscle and joint pain and non union fractures. if I knew this and claimed it I would get 100%".

This would lead me to believe the PEB will cancel the board and request that you get treatment, or find the condition to MEET retention standards. (The standard for fitness is that you failed surgery and the conditions preclude the performance of military duty).

If I am incorrect in my assumptions, please correct me. I may be incorrect because I read a conflicting statement that you have been diagnosed multiple times, this statement would lead me to believe that you had not "found out that you had hyperthyroidism" during the last 90 days while your case has been with the VA DRAS waiting to get rated.

From my experience with healthcare, the typical treatment you receive for hyperparathyroidism is partial or complete glandular removal (over 90% of cases are successful)
 
I had 2 fractures ( metatarsal 2nd toes) and tried everything for fractures but they did not heal. Left one healed a little but left a residual, Ortho Doc said we won`t perform surgery on this fractures you need to find a way to fix the calcium issue. So my PCM told me that I have secondary hyperparatyroidism non-renal which happens because of not having enough Vitamin D. So they put me on Vit D 50 000 twice per week and 3 months later same results came back. English is not my mother language therefore I think I expressed my self wrong when I said diagnosed couple times. I have seen PCM multiple times for the issue and diagnosis was hyperparatyroidism.

Also they did the tyroid/paratyroid scanning with some nuclear meds and I was told that my glands are not swollen and they will not perform surgery.

I have tried 2 different medication from University hospital and the results were same. SO basically they do not know why my vitamin D is low and paratyroid hormone is high. Basically they told me I will be on medication to just easy the symptoms.

And honestly I was not this worried at the beginning and was tired of waiting and when my MEB doctor told me it wont be consider as unfitting ( because I had not have any treatment back then) I was like" well I can claim that later while I am getting out. But symptoms are just keep getting worse. Constant muscle and joint pains, chronic kidney stones(14 mm ones).

I was still not going to mention about this during PEB and accept whatever they gave me till I found out what is really going on. And honestly I am not looking for high percentage. I am just worried what if in the future I get really sick and not be able work at all and not able to get medical attention through VA.

And before this Non healing fractures I was always scoring higher 300 at pt test and was accepted to OCS.
 
I find it odd that you and your MSC, as well as the MEB Physician who did your NARSUM did not pick up on the hyperparathyroidism.

I think right about now would be a good time to start scanning your AHLTA notes and look for all of the instances when hyperparathyroidism is mentioned (or possibly just diseases of the thyroid).

Prep up and get ready to request a Formal PEB.

If it were me, I would retain a good, quality lawyer such as Jason Perry. I truly do not think the Office of the Soldiers Counsel (JAG MEB) will put the correct time into this to get the condition added in and found unfitting from the Army. If you are not trying to get the condition to be found unfitting by the Army and get rated for it, you can just file with the VA once you separate. They will back date the condition to your date of discharge if you file within 12 months.
 
Some more things to add:

How many years have you been in the Army?

Is there a family history of hyperparathyroidism?

Have you been tested for genetic markers that are consistent with hyperparathyroidism?

Was the diagnosis of hyperparathyroidism made because of your symptoms, or have they checked the hormone levels of PTH and found them abnormally high?

I have a friend (Dr Jim Norman) who is the world's leader in parathyroid disease, please look at his website http://www.parathyroid.com

Dr Norman has an incredible app for smart devices http://calciumpro.com that can assist you with the diagnosis of parathyroid disease
 
Some answer for Gsfowler

How many years have you been in the Army? 3 years

Is there a family history of hyperparathyroidism? No. Actually they do not have any serious condition.

Have you been tested for genetic markers that are consistent with hyperparathyroidism? No. First time I heard about this. Is there a special name for this test?

Was the diagnosis of hyperparathyroidism made because of your symptoms, or have they checked the hormone levels of PTH and found them abnormally high?
Due to chronic kidney stones my urologist wanted to check tyroid and parathyroid hormones and parathyroid hormone was pretty high. And then we did DEXA scan and scan on parathyroid to see if something was wrong. And of course Dexa scan show that I have very weak bones. Nothing on the parathyroid scan. So we thought it is secondary and after checking the Vitamin D levels( which was very low with calcium level between 9.9 - 9.6) I was on Vit D for 3 months trial. At the end parathyroid was higher and Vit D was same. And I was referred to see endocrine. My endocrine Doctor is doing same thing; giving me more vitamin, which does not make sense. Since the parathyroid scan was negative she does not want surgery..

I was on that web page literally everyday after diagnosis and I called them to have second opinion they believe it is secondary too since my calcium levels are not over 10`s.
 
My interpretation of AR 40-501 is that the condition will not be found unfitting, you do not have residuals from surgery.

You can get rated for this by the VA (unless they decide the condition is not related to military service).
 
All medical conditions are required to be covered by the MEB with full clinical data. What is listed on your DA 3947? What is listed on your DA 199? You mentioned a temporary PEB decision. What is that?

If I were you, I would write a letter to both the MEB and PEB explains the situation and how the new diagnosis relates to your other medical conditions. Specifically state you need the new diagnosis to be covered by the MEB and PEB and how to proceed.

Remember, a condition can be found unfitting even if it meets retention standards under AR 40-501.

If you are going to be rated at 30% or more by DOD and placed on the TDRL, perhaps, this is an issue that can addressed upon TDRL review.

Mike
 
maparker said:
All medical conditions are required to be covered by the MEB with full clinical data. What is listed on your DA 3947? What is listed on your DA 199? You mentioned a temporary PEB decision. What is that?

If I were you, I would write a letter to both the MEB and PEB explains the situation and how the new diagnosis relates to your other medical conditions. Specifically state you need the new diagnosis to be covered by the MEB and PEB and how to proceed.

Remember, a condition can be found unfitting even if it meets retention standards under AR 40-501.

If you are going to be rated at 30% or more by DOD and placed on the TDRL, perhaps, this is an issue that can addressed upon TDRL review.

Mike
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@maparker what referance are you refering to that all medical conditions are required to be covered by the MEB . I got into the IDES program with just two conditions. But when looking to file the claim I found a lot more .
 
So I wanted to update the topic with results. I just received my 199 today. I had %30 (permanent) Army and %90 VA which is way better than I expected. I was thinking I will get only %10 for non fiting condition but my left feet got %20 and right foot %10 with bilateral percentage I got 30.8 which was rounded to 30. And I will be filling additional claim before I signed out from Army for hyperparathyroidism which will bump my VA ratings to %100. So long story short if I did not have retirement and I appealed to PEB for hyperparathyroidism, It would be unfitting condition with approx. %100 both sides with the paperwork I have from PCM and one of the best endocrinologist in the country stating I wont be getting any better without removing the parathyroids which I would deny to get surgery done at the age of 28. I would like to Thank you to all and each of you. If you have any questions please let me know.
 
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