Type 1 Diabetic, IPEB Help

E

emsm

PEB Forum Regular Member
Hello, I wish i would have found this site sooner, I was diagnosed as Type 1 in Jan this year, and now they are putting together my package to be sent off for the IPEB. I have over 14yrs active service (E-7) with no other unfitting conditions and PT scores are good. My diabetes are controlled with Novolog with each meal and Lantus at night. I believe all my Dr. reports right now say i have no problems. From what i'm seeing, i should have made sure they said i had restriction of activities to try and get rated at 40%. I do not want to be separated, but from the looks of things that seems to be the way most ppl are being pushed from these boards. I wouldn't mind if i was being retired but after 14yrs to be given 20% and see you later isn't so good. What should i do from here, I don't want out but then i don't want 20% either? I don't know how to go about getting documentation from my doctors to say that I have restrictions. Or should i try to fight to stay in? Is trying to fight to stay in even a worthwhile cause with Type 1? Or should i push for the restriction of activities and try for 40%?

Thank you in advance for all your help! You guys are doing an amazing job at helping people here.
Tim
 
Also, i don't know if it makes a difference or not, but i had just returned from a deployment from Iraq in Nov 2010, then diagnosed in Jan 2011
 
The regulation of activities must be in terms of both occupational and recreational activities. If found unfit you could also consider retention depite being found unfit. This program is called COAD inthe Army and I believe Permanent LIMDU in the Navy/USMC.

Perhaps you can wait until the IPEB results come back. If found fit, good to go (at least for now). If found unfit at 20%, request a formal and insist the regulation of activities be documented prior to your formal board. The MEB was required to document the regulation of activities.

Are you uner the IDES or legacy DES? What branch of service?

Mike
 
I am active duty AF. I think my only option at this point is like you said for me to wait for the results and if I have to go before the formal board I can make sure my records show the regulation of activities for occupational as well as recreational.
Also I think I am u der the legacy system. I spoke to my liaison today and they told me because of my career field I had to be processed under the old system rather then what she called the fast track which is how they process most people now.
 
I can't help you in the AF, but I know the Navy will not unfit Diabeties that is controlled by pills and regulation of activities. If the member is a surface sailor there are even occasions where they will allow injections to slide. I have a sailor who has to have injections, but unfortunately had to have a finger amputated before they knew what was going on, so I suspect he will be discahrged due to complications assosiated with diabeties.
 
Processing under the IDES is based on location rather than by MOS. Where are you located and what is your career field? The IDES has the VA assessing all your medical conditions as part of your MEB. Who did your MEB? Were all conditions covered? Were you allowed to add conditions not referred to the DES? Did you get a chance to request an impartial medical review of your MEB?

If under the IDES, the PEB will find you fit or unfit? If found unfit, they will pass the file to the VA who will rate all conditions. The PEB will then apply to VA rating to the unfitting conditions.

If under the legacy system, the PEB will rate the conditions they deem unfitting.

Mike
 
I met with my liaison again this morning. Now I'm being told it's not because of my career field, it is strictly because I am type 1 diabetic that I have to go through this process. Since i do have to take injections, she showed me where if i were type 2 and taking pills i could through the fast track and have a better chance. That is where she was confused before saying it was because of my job. It all comes down to me being type 1. I am located in FL, and I am a electromagnetic spectrum manager. I have met with the VA already and they assessed me on all my conditions. Don't know how or what they will rate me, i won't know that until i know the results of the board and they present me with the findings. The board is only going look at my unfitting condition, diabetes, the VA will hopefully rate me on everything else which isn't much anyway. I have not had the chance to request an impartial review yet, they should call me next week to review what they are sending to the board. If i don't agree with what that says, then i can request the impartial review.

I just wish i had known all this earlier i would have had my doctors write about the regulation of activities. And i'm still trying to get them to give me a referral for a sleep study. The Dr. at the VA told me she thinks i have sleep apnea as well and could be causing my levels to be harder to regulate. But of course the AF Dr's are not wanting to refer me that easy. So I’m still working on that and trying to get seen to find out if do have it or not.

I have a Dr appt next with my specialist off base and i will bring up that im having a harder time doing things like running or other activities without going too low. I am in the process of moving, and just moving boxes around I’ve noticed that it causes me to drop pretty low pretty fast. I really have to be careful what i do and how much insulin i take compared to when I’m not doing anything, the difference is significant. It's wasn't like this when i was first diagnosed back in Jan and i thought i was good but it is getting harder to manage along with any activities i do.

Thanks for all the help and information thus far. I'll keep posting as i know more.
 
The AF IPEB is going to come back with 20%. As Mike Parker said, the key is to match the exact wording in the VARSD with your condition to receive 40% at the Formal PEB.

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated
100

Requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated
60

Requiring insulin, restricted diet, and regulation of activities
40

Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet
20

Manageable by restricted diet only
10

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes.



One young man I worked with came to me after he was diagnosed with DM1 and after the AF IPEB rated him at 20%. I told him him the exact same thing and that he needed to get his Doctor(s) E.G. Endocrinologist, to write a statement about how his activities are restricted due to DM1. I then told him to hire Jason to represent him at the Formal PEB which he did. He also did his homework and contacted some others on this forum who have gone through the same exact thing. He became very pro active in his case and at the FPEB he was rated at 40%.

You need to talk to him, he can help you out...send him or me a PM..
BROKENLOAD

Here's another good guy to contact...

rreed454


-duck
 
Apparently from your last post you are still in the MEB process. If you don't get rated at 40% you're screwed...

1. You need to make them refer you to a sleep apnea Doctor. They have no choice but to refer you.

2. You need to do the impartial review when your MEB comes back.

3. You need to make sure that you have a good statement from your DM Doc showing how screwed up you are AND that you are being tested for SA in your MEB rebuttal statement to the IPEB.

4. Hire Jason now...
 
Thank you Ruptured Duck and Mike for the information. Ruptured Duck, you are correct, i am still in the MEB process. My package has not even been sent off yet. I still have to sit down with my commander to help him write my letter for the board. I have a appointment to meet with him tomorrow to do that.

I am pushing the sleep apnea referral, I don't know why my Dr is making a big deal out of being referred but i have another appointment with her coming up where i will bring this up again. She wanted me to get a letter from my VA Dr. who recommended i get the sleep study done. I agree my primary care manager shouldn't have any problems referring me, but for whatever reason she does. So i'll keep pushing that issue as well.

From my understanding the impartial review is done if i don't agree with what the package says as far as my condition correct? I mean if it says i have type 1 diabetes i can't disagree with that of course, but can i do a impartial review on the grounds that i believe I do have restrictions and that the restrictions should be added. And I was told today that whomever reviews the case only reviews it to make sure it is accurate. Would me questioning the restrictions of activities not being included qualify for a impartial review?

By the time my package gets sent off and the IPEB comes back with a finding (which will be 20% most likely) i can have letters from my Dr's showing how bad i am for when i appeal my case. I don't know if i have enough time now to get those letters saying i have restrictions. The current letters they have all say i'm controlled and doing well with no restrictions.

How do i go about contacting Jason or hiring him?

You have been a huge help already thank you!!
 
Hello,
Speak to your endocrinologist and let him/her know that you do have restrictions. He/she can always ammend the Narrative Summary. The fact that you are in the MEB process is good news.. you still have time to get this done!! Also, understand that the Impartial Provider Review is not in case you disagree with the doctor's narrative summary, for that purpose you have the rebuttal process. The Impartial Provider Review is a second set of eyes to ensure that all your injuries/illnesses were properly addressed. Whether you agree or disagree with your MEB results, it is always a good thing to do to have an Impartial provider review. Of course, you only have 7 days to get that review from the day you were counselled regarding your MEB results!! But seriously, go back to your doctor and speak to him/her, they can be very understanding. Let me know how it goes...
Brian
 
Your MEB is required to cover all your medical condition with full clinical data (DoDI 1332.38) to include the applicable data from the applicable VA AMIE worksheets (14 OCT 2008 DoD DTM). If your MEB is not to that standard you need to request an impartial medical review. In your request specifically point out the deficiencies and ask the review to specifically address these concerns. Trash in = trash out. An incomplete MEB will lead to bad PEB results.

You can find the VA AMIE worksheets here: Index of Disability Examination Worksheets (U.S. Department of Veterans Affairs)

Pay attention to the worksheet for diabetes and make sure you MEB fully addresses these areas.

Know your conditions and how they are rated per the VASRD. Insist the MEB include all medical conditions to include the VA AMIE worksheet info.

Based on what you said above, the more that is properly documented in your MEB, the greater the chance of you being found unfit but rated properly. If you want to stay in, recommend you investigate the Air Forces continuation on active duty program. It is well worth your time to make it to 20 years.

Mike
 
Ruptured Duck said:
Apparently from your last post you are still in the MEB process. If you don't get rated at 40% you're screwed...

1. You need to make them refer you to a sleep apnea Doctor. They have no choice but to refer you.

2. You need to do the impartial review when your MEB comes back.

3. You need to make sure that you have a good statement from your DM Doc showing how screwed up you are AND that you are being tested for SA in your MEB rebuttal statement to the IPEB.

4. Hire Jason now...
Click to expand...


I requested a sleep apnea referral because I have been on ambien since January, wake up gasping every couple weeks and have leg twitching that also wakes me up. The civilian rheumatologist said he thought I had it but I was "too young" to worry about it. And my PCM keeps saying oh well dicuss it next visit. And then said no.
 
I would like to make it to 20 but i don't know if that will happen or not seeing as how others are being rated. I don't know what the likely hood of the board returning me to duty is. If not then of course i am and will continue to push for the 40%. I will make sure that it is in my records that i'm being treated for sleep apnea. Also, I will make sure my records have the VA AMIE worksheets.

Thanks to all who have posted i do appreciate it. And again i will keep you updated on how it goes as i know more.
 
From my understanding the impartial review is done if i don't agree with what the package says as far as my condition correct?
Click to expand...

Impartial review is just that...impartial review by another Doctor.
 
I would like to make it to 20 but i don't know if that will happen or not seeing as how others are being rated.
Click to expand...
I'm sorry to say it but in my opinion 20 is not going to happen being a DM type 1 in the Air Force. You have to make the right decision now and go for it.

They are going to medically discharge you no matter what you do.

You are now a liability to the Air Force that they will do everything to minimize including making sure your condition is under rated at 20%.

You have to decide if you want to be retired at 40% and fight for it or screw around with this and be separated at 20%...

You have to start fighting today...now...to get what you want.
 
I am in the same boat and had to fight for my 40% with the Navy PEB. Your Dr must say "you must regulate your activities and avoid any strenuous occupational and recreational activities in order to prevent further hypoglycemic episodes." which is all absolutely true. No one with type-1 has physiological function of their pancreas to control b/s therefore any and all activity must be regulated and monitored because of the loss of pancreatic function. The reason you were not going low as often when you were first diagnosed is because your pancreas still had limited function. Your pancreas monitors your bodies blood sugar and when it goes high it produces insulin and when it goes low it communicates to the liver to secrete glucugon(stored sugar) into your system to bring it back up. As your Beta cells in your pancreas are furthered destroyed by antibodies you loose the communication between your pancreas and liver and your body can no longer bring your blood sugar up on its own hence the dangerous lows. contact me for any questions and I can help you.
 
Just wanted to post some updates. It's been awhile but I just received my findings from my PEB today. They rated me at 40% permanent retirement. I should feel lucky as most of whom I've seen on here have been having to appeal to get a rating of 40%. But I was really hoping to be able to stay active and finish my time. I knew it wasnt likely they would return me to duty right away. So now I have to make a decision on what to do. Should I feel lucky I got the 40% and move on or should I appeal to try and get what I really want and fight to stay on active duty? I don't want to risk losing the 40%.
Any feedback is appreciated. I just wanted to let everyone know the outcome of my board. I have 10 days now before I have to give my decision so I have lots of thinking to do and a lot to consider.
Thanks
Tim
 
Congratulations on getting the 40% finding! As for whether to push for a fit finding, I think you have hit the nail on the head. Doing so would tend to create the risk of you getting an unfit finding with a lower rating. The regulation of activities is the key to a 40% finding. Almost intrinsic to a fit finding and return to duty is an argument that your diabetes does not impact you much and you can do most or all of the "activities" required. So, if you make that argument, I think it creates a large risk that they find you do not have significant regulation of activities- but they may still find you unfit. The outcome would likely be separation with 20%.

You could put in a request for LAS. However, I think this is not risk free either as this means that another set of eyes will review your case and those eyes (up at SAFPC, really it is, at least initially, a Special Assistant who is a Colonel at Lackland), could end up changing your findings.

So, you have to weigh the risks against the outcome you presently have. It is a tough decision. Best of luck!
 
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