Type 1 Diabetic, IPEB Help

Jason, thanks for the feedback. I have a couple of other questions and was hoping for some last bits of information. Could I or can't i still appeal and not on the grounds that i'm disagreeing with their decision of me being rated at 40% or my regulation of activities but more the fact that i'm still able to perform my job. I have a desk job which is all administrative, i sit behind a computer most of the time. I have done so since being diagnosed a year ago without missing time from work aside from scheduled Dr. appointments. I know there are individuals who have other conditions, which are not unfitting by AF standards I suppose but still get coded. Being coded allows them to stay in and only be sent to certain locations with what medical facilities are needed to suit their condition. So isn't that something I could bring up to argue my side? I understand the AF think's that if you cannot deploy then are of no use, but i have been in for 15 years and don't understand why i couldn't be coded now and be allowed or remain active for my last 5 years and be just be coded. That would by my only grounds for a appeal, not to disagree with their rating or findings other than I believe i can still do my job with no limitations. You will see below my Commander even said i had no duty or physical limitations. But the board says it is a medical risk to my health and imposes significant requirements on the military to maintain and protect my health.

Also you mentioned the LAS. I have heard of this before but how could i apply for this since i'm already being boarded? I'm not sure if this is the same thing as i mentioned above or not. If not how would go about finding more about this. If it is the same as i mentioned above, would this simply be something i would ask or recommend at my appeal.

Lastly, i just wanted to pass along to everyone the comments that came back on my findings from the PEB.

"The service members (SM) medical condition is not compatible with the long-term rigors of military service. The SM has Diabetes Mellitus Type I and is followed by an endocrinologist with significant control on insulin and regulated diet. His most recent A1C was 6.0%. The commander notes that SM has no duty or physical limitations or restrictions. However, the Board notes diabetes is a disease that has no cure and requires constant attention to diet, exercise, blood sugar levels, insulin dosage, and is very difficult to control under deployed conditions. Military life is fraught with many demands that are physical, somewhat unpredictable, and not always amenable to the detailed attention required for managing diabetes. The Board opines the service member's (SM) medical condition represents a decided medical risk to his health and imposes significant requirements on the military to maintain and protect his health. The Informal Physical Evaluation Board finds the SM unfit and recommends permanent retirement with a disability rating of 40% IAW the Veterans Administration Schedule for Rating Disabilities guidelines."

Thanks and sorry for the long post, just thought others might find it helpful to see what kind of results they might expect. Also my PEBLO mentioned that she never see's comment's come back like this as they did on mine. She didn't know why but said they are usually brief and to the point an they don't usually go into detail as to why they find they way they do. IDK what any of that means but just throwing it out there.

Thanks
Tim
 
Tim, that is amazing you were rated 40% and your a1c is 6.0% WOW! Congrads.... however I just got my IPEB and as a Type 1 DM, I was given a 20% rating and offered servance pay I have been in 17 years. I am appealing the decision to prossibely being found fit to finish my 20 years. Any advice would be great!
Thanks
JBrown7
 
Jason,

I am new to this form but see that you are very knowledgible on the MEB/PEB processes. My first question is should I fight the Army finding of unfit with a 20% and hope my appeal comes back with a fit finding to continue until 20 yrs? I have 17 yrs in now.
My second question is the IPEB found me unfit at 20% my a1c has been around 7.5% past year, I also got a 80% disable rating from VA with this finding. Is it more likely they will find me fit to stay or unfit and raise the rating to 40% and retire me? Waiting for your reply or anyone who may have some insight!

Thanks in advance

JBrown7
 
JBrown7,
I'm sorry to hear that your IPEB came back with 20%. That is what i thought mine was going to come back with as well. I would very much like to appeal mine as well to be found fit but i'm so scared to give up a retirement that so many others are having to appeal and fight to get. I was also rated at 70% from the VA. I don't think what the VA rated you at will have any affect on the IPEB's decision. They are only rating you on unfitting conditions where the VA is rating you on any and all conditions. I would most certainly appeal to have your rating moved to 40% so you can get your retirement. I am at 15yrs now and hate leaving or retiring before i was ready and being so close to retirement so i know where you are coming from. But at this point it seem not very likely to be found fit. I'm
not saying it isn't possible I just don't know how to go about doing that nor have I been successful in finding anyone who was able to appeal be found fit.

The only thing that i believe saved me was the VA. No where in my records did any of my doctors say i had any restriction of any activities. It was only when i was assessed by the VA during my board process that the VA asked me a few questions, to which i replied i had to check my sugar before any activities and make sure i was eating before performing activities. I was told the IPEB didn't look at the VA report but they must because in the report i got back they referred to the Dr's note, stating i had restrictions. Which is the only reason they rated me at 40%. I had even talked to my Dr's about adding that i had restrictions but they wouldn't do it, saying they were sure i would be found fit.

On one last note, i was supposed to go in yesterday to give my final decision on either accepting their offer or appeal, but when i went in my PEBLO was asking if i had any other questions. I told her i was diagnosed with OSA after my board and after being assessed by the VA. So she is calling to see if i can have that added to my case now before i get out or retire. She said it may be possible to pull my case since OSA is a boardable condition as well. She said i would probably be found fit on that but it would get it added to my case and the VA before i get out. In the end it isn't going to help much if any at all other then maybe buying me a little more time. Anyone have any experience in this or know what this will do to my case if anything?

JBrown7, let me know if you need anything or i can help in anyway. Good luck and don't give up yet.
 
JBrown7,

The 40% rating revolves around the requirement to regulate both recreational and occupational activities. Did your MEB discuss this impact one way or another? Often they don't and that can lead to a 20% finding becuase they failed to include discussions on the requirement to regulate activities.

Mike
 
JimBrown7 and emsm,

Whats up fellas? Fellow newly diagnosed T1D here. Got my diagnoses Jan 2011 after mobing here and receiving my immunizations (including the anthrax for those of you with the same suspicion). I am currently in the appeal stage of my PEB. My IPEB came back 20%. Been hell here on Ft. Bliss screwing around with this, haha. Been Med Boarding for about 10 n a half months. I'm sure you guys feel the pain. I've been doing some outreach to find others in my same predicament. Nice to find this forum. I've been having issues covering the "restricted activities" criteria under the 40% of the 7913 VA Code. Well, getting them to adhere to it actually is the issue. My counsel said it doesn't look promising for me. I would suggest doing extensive research about T1D and understanding it, the terms, whats happens and suggested causes. Understanding the difference between traditional congenital juvenile diabetes and ours which is pretty much a medical phenomenon. I've used the restrictive argument that when your BG is <70 or >250, we are not to operate machinery, drive, handle firarms, and etc. That affects alot of ares in our lives. I've been trying to study precedented cases using the Board of Veterans' Appeals: Board of Veterans' Appeals Decisions Search
The BVA case law is not controlling on the VA or Army, but it can be "persuasive." Also, The Court of Veterans Appeals, CAVC, is controlling: USCAVC - United States Court of Appeals for Veterans Claims. The problem with the CAVC is that these cases are from so long ago. The CAVC has like 10 years to respond to your case. Alot of issues finding precedence in recent cases like yours, emsm,. It helps those of us who they try to shaft. I've also been trying to reach fellow service members that have been affected in this way trying to raise a stink to congress to get others from getting the shaft. Don't know if you guys have been to this facebook page: "Anthrax Vaccine Caused Type 1 Diabetes, US Military Should Own UP"
or this other website PROTECTOURGUARDIANS.ORG. Also have some family members and friends in the medical field who would agree with immunizations to key player in cause. Just hold faith and do not let them screw you with 20%. There are many reason as to why we need healthcare especially if you cannot get our own privatized in the future. Quarterly ENDO. visits, future complications needing immediate attention (neurological disorders, arteriosclerosis and heart disease, increased risk for cancer, limb extremity issues, intestinal problems). If or when you go to the PEB for an Appeal Hearing, bring out all the big guns you can. Do as much extensive research around Type 1 Diabetes as you can and reference other successful cases. Also, be very descriptive on certain restriction that we all have as well as your onslaught (Like, I had 45 lb weight loss, the normal symptoms, severe burning in abdomen, fading in and out, A1C in E.R was 14%). Make sure this is alllll document in AHLTA notes or whatever doctor you have keeps a log that gets submitted. My hearing date is 1 FEB. I'll keep in touch to let you know how it goes. Godbless and good luck.

Jordan
 
So long as the case has not been overruled, it does not matter how old a case is. If it is "good law" the date does not matter.
 
Quick thought,

I've read and understand people's push for having an Endo. stating in a letter about you needed to restrict recreational activities to help ensure the 40%. My Endo will not state it this way. My appointments DO reflect, however, that I keep talking about everytime\I try to exercise, I keep dropping severely into hypoglycemia those specific nights and days. Would any of you presume that I may be able to sway the PEB on these notes and that each Endo expresses care differently and she just has a "glass half full" attitude for me? She continuously keeps adding that I will be able to manage better with ever so often basal rate change. Any thoughts? I've repeatedly tried to get her to state restrictions specificly, but it's not looking good.
 
JodanAL,
I experienced the same problem with my Endo. She would not state that I had any restrictions saying I would be retained and nothing to worry about. It wasn't until I was going through my eval with the VA as part of the MEB that I told the Dr doing my exam about my limitations and she documented it. I truly believe that that is the only thing that helped me because no where else in my records did it state I had any restrictions. So you have to push for that statement and tell every Dr you meet with and hope at least one of them documents it. I even had a commanders letter stating I had no restrictions but because of that one note from my VA dr I got 40%.
Let me know if you have any other questions or if I can help in any way.
Tim
 
JordanAL said:
Quick thought,

I've read and understand people's push for having an Endo. stating in a letter about you needed to restrict recreational activities to help ensure the 40%. My Endo will not state it this way. My appointments DO reflect, however, that I keep talking about everytime\I try to exercise, I keep dropping severely into hypoglycemia those specific nights and days. Would any of you presume that I may be able to sway the PEB on these notes and that each Endo expresses care differently and she just has a "glass half full" attitude for me? She continuously keeps adding that I will be able to manage better with ever so often basal rate change. Any thoughts? I've repeatedly tried to get her to state restrictions specificly, but it's not looking good.
Click to expand...

B.S.!!!! The doctor is wrong for not discussing the regulation of activities. The MEB is required to include all data from the applicable VA exam worksheets. The worksheet for diabetes can be found here:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm13.pdf

This worksheet states:

Describe what regulation of activities, if any, is needed due to diabetes (e.g., avoiding strenuous activity to prevent hypoglycemic reactions).

You need to demand the doc include all the required information from this worksheet. Not to do so can screw you out of a lifetime of due disability benefits.

If the DOC still won’t, demand an impartial medical review (IMR) of your MEB and raise this specific issue. If the IMR fails to address the issues, appeal the MEB and raise this issue in your MEB appeal.

Make sure your MEB discusses both recreational and occupational activities as needed by the requirements of the Camacho case.

They system will screw you if you let it.

Mike
 
Well, my Formal hearing is in 35 hours. My endo sent a memorandum discussing my case intrinsically to my attorney. two excerpts read: "SGT (last name) is required to regulate glucose management to accomodate physical activity. Type 1 does not necessarily infer restrictions on recreational or occupational activities;however, activities must be appropriately timed and insulin dosing and diet must be adjusted to accomodate exercise. Physical activity imparts risk of hypoglycemia if appropriate adjustments are not implemented. Also, inappropriately timed physical activity may worsen long-term diabetes-related complications." Next section talks about no brainer restrictions on cleanly enviornment and access to power and refrigeration and geographically restricted. Section after that I am hoping helps me out after the slaughtering I took in previous section. SGT (last name) has good glucose control, however has a history of diabetic ketoacidosis, and he is often plagued by hypoglycemia that occurs overnight and with physical activity. As with all T1D's, normalization or near normalization of glucose is goal and therefore hypoglycemia is an expected and likely risk with therapy." Give it to me straight doc....I'm fudged aren't I? lol I kept trying to get a better distinct wording but this is the best I could get out of her. I'm hoping I can work something of it with my near 100 page report I got and good puppy eyes. Wish me luck. Feb 1st is right around the corner.
 
I assume your IPEB rating was 20%. Was this a VA rating under the IDES? Is this a TDRL case?

I don't think what the endo said was too far off but I would certainly like to see a more direct statement that you must regulate both recreational and occupational activities. Per the Camacho case, the need to regulate both occupational AND recreational activities is needed for the 40% rating. One is not enough.

The MEB was required to incude all the data from the applicable VA exam worksheet. Here is the link to the VA worksheets.

Index of Disability Examination Worksheets (U.S. Department of Veterans Affairs)

See the worksheet on diabetes. If you MEB does not include all the data, to include the requirement to discuss regulation of activities, I would request a suspension of the case until all required data is included. If your attorney won't make this request, you can. You have that right. Trash in will lead to trash out and silence on the issue will allow the trash to be processed at your expense.

Mike
 
Thanks mike,

Yes, I had received 20% on my IPEB. I'm not sure about the IDES thing, I know I'm under the legacy system so I am assuming VA rating? I will get that Diabetes worksheet and review it with my attorney and if I don't get warm and fuzzies I'll do whatever I can. lol Really sucks to find out you've been preparing for the PEB for 9 months and you've been doing it all the wrong way. A few things we got today made my case a little better. Hearing tomorrow at 1300. Thanks guys once again, Godbless.
 
Hey mike and others, just getting back with you guys for an example not to follow. Although, if I went through the IDES system and evaluated by a VA physician I'm sure I wouldn't have been screwed. But alas, I was a legacy that was recommended by an Endocrinologist. My Formal PEB hearing was FEB 1. After I got done, they expressed how impressed they where with my research on Type 1 and talked with me for about 4 hours. After we closed, turned out my MTF here in Fort Bliss did not send my NARSUM, Appeals, and response to appeals. It took them three weeks for them to send those Docs up and then another week for them to make their final decision. They kept me at 20% because my Endocrinologist wrote in a piece that being a diabetic does not infer restrictions although there is a distinct factor in adjusting and monitoring insulin for activities. Ie. Regulation, but not restricted. So since I still go to the gym and try to continue exercise...I get shafted. I am being medically separated with 20%. My attorney said that it would be pointless trying to do another appeal of the final decision since I would not have any other supporting documents. So i signed my Formal 199 with "do not concur with results with no appeal attatched" and wrote my congressman and both senators addressing some problems I have with this system. Oh well, I hope others don't wind up like me. Good luck to alll.
 
Sorry to hear of the lousy results. I hate to disagree with your attorney, but legal argument can be submitted. Not sure it would have changed anything at the PEB/APDA level, but it is a feasible course of action. That said, I am glad to hear you did not concur. That makes later appeals easier (generally...what sometimes happens is that later appeals are rejected if the member has agreed or waived their rights). So, you did a good thing there. I would think that a good VA rating of 40%, with a VA exam supporting the need for "regulation of activities" would help you a great deal in later appeals.

From reading what you wrote, it sounds like the PEB confused regulation of activities ("avoidance of strenuous occupational and recreational activities" from the Comacho case) with some idea that you are not allowed to do much...it is STRENUOUS activities that are to be avoided, not all exercise.
 
I actually discussed exactly that with them. I told them how much my activity has dropped. I'm in a SF unit and spent alot of my off time training and spent many miles rucking. I told them my gym time went from 2 hrs 5 days a week to 30 mins 4 days a week. I tried to hike the mountain and almost had to call the rescue lol. They loved my presentation per what they told me. I'm sure they may have forgotten it after waiting three and a half weeks for those forgotten documents the hospital left out. But I've detailed everything to my congressman and wrote him permission to get the recorded audio and a number of other things. I'm going to try my damn-dest to get this crap changed. Also made a big stink for future SM's if they have to deal with this.
 
JordanAL said:
JimBrown7 and emsm,

Whats up fellas? Fellow newly diagnosed T1D here. Got my diagnoses Jan 2011 after mobing here and receiving my immunizations (including the anthrax for those of you with the same suspicion). I am currently in the appeal stage of my PEB. My IPEB came back 20%. Been hell here on Ft. Bliss screwing around with this, haha. Been Med Boarding for about 10 n a half months. I'm sure you guys feel the pain. I've been doing some outreach to find others in my same predicament. Nice to find this forum. I've been having issues covering the "restricted activities" criteria under the 40% of the 7913 VA Code. Well, getting them to adhere to it actually is the issue. My counsel said it doesn't look promising for me. I would suggest doing extensive research about T1D and understanding it, the terms, whats happens and suggested causes. Understanding the difference between traditional congenital juvenile diabetes and ours which is pretty much a medical phenomenon. I've used the restrictive argument that when your BG is <70 or >250, we are not to operate machinery, drive, handle firarms, and etc. That affects alot of ares in our lives. I've been trying to study precedented cases using the Board of Veterans' Appeals: Board of Veterans' Appeals Decisions Search
The BVA case law is not controlling on the VA or Army, but it can be "persuasive." Also, The Court of Veterans Appeals, CAVC, is controlling: USCAVC - United States Court of Appeals for Veterans Claims. The problem with the CAVC is that these cases are from so long ago. The CAVC has like 10 years to respond to your case. Alot of issues finding precedence in recent cases like yours, emsm,. It helps those of us who they try to shaft. I've also been trying to reach fellow service members that have been affected in this way trying to raise a stink to congress to get others from getting the shaft. Don't know if you guys have been to this facebook page: "Anthrax Vaccine Caused Type 1 Diabetes, US Military Should Own UP"
or this other website PROTECTOURGUARDIANS.ORG. Also have some family members and friends in the medical field who would agree with immunizations to key player in cause. Just hold faith and do not let them screw you with 20%. There are many reason as to why we need healthcare especially if you cannot get our own privatized in the future. Quarterly ENDO. visits, future complications needing immediate attention (neurological disorders, arteriosclerosis and heart disease, increased risk for cancer, limb extremity issues, intestinal problems). If or when you go to the PEB for an Appeal Hearing, bring out all the big guns you can. Do as much extensive research around Type 1 Diabetes as you can and reference other successful cases. Also, be very descriptive on certain restriction that we all have as well as your onslaught (Like, I had 45 lb weight loss, the normal symptoms, severe burning in abdomen, fading in and out, A1C in E.R was 14%). Make sure this is alllll document in AHLTA notes or whatever doctor you have keeps a log that gets submitted. My hearing date is 1 FEB. I'll keep in touch to let you know how it goes. Godbless and good luck.

Jordan
Click to expand...
I have the exact same symptoms, lost 50lbs, burning in my stomach, and A1C of 18.3, now my feet are messed up. Email me if you can and compare findings maybe there is something linking our cases together. I had 5 anthrax shots, and I had a reaction on the small pox also. TSgt DeRoucehy ANG NV Active
 
So if you don't have regulation of activities but everything else would you still get 100%
 
I would say no because it builds up. You've got to get the "Regulation of Activities." Hell, We all pretty much qualify for at least 60%. Go to the E.R. once or twice, massive weight loss, blah blah blah. If you don't get it in there, The PEB will royally screw you like me. You'll get separated at 20%.
 
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