why does it matter if I am seen at an Air Force Base and not a Navy clinic?

HI everyone,

I don't know if anyone would have the answer to this or if you might know where I could get some sort of answers but I have been seeing at the Air Force Base for my mental health issues and my docs there put me on LIMDU and recommended me for MED BOARD. When I went to Portsmouth LIMDU office I was told my doctor, myself, and my paperwork was all sorts of messed up. the man that said all this kept saying things that really made me upset because on my first limdu my doctor did put me on limdu. He really didn't give me any answers and it has been bothering me for a while now. I have talked to one of my doctors about this and he pretty much said we will make some calls and see if we can get you an appointment ASAP at the hospital. I guess my question is why does it matter if my doctors work at an Air Force base and I have been seeing them for almost a year and now since I am LIMDU in the eyes of the Air Force why the Navy doesn't recognize it. Just wondering and again if anyone knows something that I don't, I will take any help!

thank you

Kristen

 

[oddpedestrian]

The Air Force sends the information to your Navy medical command to submit the MEB since they are *technically* not in your chain of command it has to work that way. The Air Force did all my paperwork for the Army and initially getting it started there were a few hiccups but since my physician was a full bird my Army PCM jump through hoops to expedite everything and transferred all his air force submissions to army ones.

 

[Jason Perry]

I guess my question is why does it matter if my doctors work at an Air Force base and I have been seeing them for almost a year and now since I am LIMDU in the eyes of the Air Force why the Navy doesn't recognize it. Just wondering and again if anyone knows something that I don't, I will take any help!

Here is the quote from the Navy Manual of the Medical Department that explains this:

"(5) Other Service and TRICARE Provider Involvement in Navy and Marine MEBs (a) Paperwork on the cases of all Navy and Marine members undergoing any MEB action must be processed through a Navy MTF, even if an MTF of another branch of the Armed Forces initiated the MEB or if TRICARE network providers were engaged in the preparation of the MEBR. "

However, see this link: Guide to TriService Terms.

The Air Force sends the information to your Navy medical command to submit the MEB since they are *technically* not in your chain of command it has to work that way. The Air Force did all my paperwork for the Army and initially getting it started there were a few hiccups but since my physician was a full bird my Army PCM jump through hoops to expedite everything and transferred all his air force submissions to army ones.

It is not really a "chain of command" issue. The services have different regulations about MEB's and Tri-Service MEB's. Much depends on the completeness and accuracy of the MEB and the service, but, it is certainly possible to have an MEB conducted by another service for consideration by the parent services PEB.
I have had Navy PEB cases that were conducted with Army MEBs. It is unusual, but, possible.

 

[chaplaincharlie]

The Navy has implement this requirement because they are much tougher on MEBs than the other services. When you have process control, you have significant outcome control.

 

[Coffeeaddixt]

The Navy has implement this requirement because they are much tougher on MEBs than the other services. When you have process control, you have significant outcome control.

What do you mean by much tougher on MEB’s than the other services? You mean they are stingier (so to speak) to dole out ratings?

 

[chaplaincharlie]

The USN leans toward finding conditions fitting more than its sister services. On this forum you can find several post about sailors who were found fit, but their detaielr could not find them a job due to their physical limitations. That makes no sense to me, but there is hundreds of years of tradition uninterrupted by progress at stake.

 

[tony292]

Each branch has its own retention standards. I was seen at an Air Froce base, but I’m Army. My neurologist told me at the time that if I was Air Force he would initiate my MeB, but he couldn’t because I was Army.

all the doctors from all branches can see and read each other’s tests results and ALTHA notes. But they cannot initiate MEBs for other branches.

 

[Jason Perry]

all the doctors from all branches can see and read each other’s tests results and ALTHA notes. But they cannot initiate MEBs for other branches.

I am not sure that the bolded is technically accurate. If an Army doc is assigned to an AF Clinic or Hospital, they could initiate for any branch member, I think (assuming they are properly credentialed, which almost all would be...no point in having an AF doc assigned to a Navy Hospital, but restricted from making admin determinations that are common; I suppose it could take endorsement from a branch common physician, but this doesn't make much sense in practice). The key is not the "service" that an organization that the clinic or hospital is under, or the military branch of the commander of the hospital. It is more technically correct to say that each member will fall under their own branch's standards as set by their Service Secretary, regardless of what medical activity the member is seen at.

Now, this is not to say that any of the docs or personnel will understand the difference and take the time to figure out what branch-specific criteria apply to the member of another branch who shows up for care. I think the best way to look at it though is that whatever branch you are in, your own branch criteria should apply (regardless of the branch of the physician or hospital commander).

 

[tony292]

I am not sure that the bolded is technically accurate. If an Army doc is assigned to an AF Clinic or Hospital, they could initiate for any branch member, I think (assuming they are properly credentialed, which almost all would be...no point in having an AF doc assigned to a Navy Hospital, but restricted from making admin determinations that are common; I suppose it could take endorsement from a branch common physician, but this doesn't make much sense in practice). The key is not the "service" that an organization that the clinic or hospital is under, or the military branch of the commander of the hospital. It is more technically correct to say that each member will fall under their own branch's standards as set by their Service Secretary, regardless of what medical activity the member is seen at.

Now, this is not to say that any of the docs or personnel will understand the difference and take the time to figure out what branch-specific criteria apply to the member of another branch who shows up for care. I think the best way to look at it though is that whatever branch you are in, your own branch criteria should apply (regardless of the branch of the physician or hospital commander).

Jason, I don’t technically know the answers’s it stands today. In my case this is what I was told by the AF COL, cheif of neurology at wright Patterson AFB in 2014. Maybe at that time, army and AF could not initiate mebs against each other, and perhaps now they have that capability. All I know is that is what I was told then. My knowledge may no longer be up to date.

there were zero Army docs at WPAFB at the time. I saw plenty of AF docs but not a single Army doc. I believe they may technically be able to “press the MEB button” for any patient, but the AF neurologist doesn’t know Army retention standards, how to issue an Army profile, or Army procedures.... Just the act of issue of a simple profile
Is different between Army and AF.... AF has the whole “DAWG” thing and Army does not.. maybe he said he “can’t” MEB me because he doesn’t know the process for MEBing anyone outside his branch... I don’t know. I just know if it is possible, it’s also highly unlikely.... I also remember it was either 2013 or 2014 that was the first year I was able to go to get a PHA from an AF doctor and had a technique/process that we could go through to get that PHA over to the Army side.... so they were in the very early stages of working together back then. Perhaps in 2021, it’s fully and automatically integrated... like I said my info might be dated.

 

[tony292]

Honestly for the original Poster, you’re best bet is to go see a Navy doctor. Find the nearest Navy base and go TDY if you have to, but understand that each military branch may be different when it comes to issuing profiles/Limdu status. Don’t expect anything across the services to be automatic... or easy...

I was seen by AF doctors and civilian docs under tricare for 3 years before finally I had to go out of state (I was in ROTC at the time) to the nearest Army base to get a fit for duty exam that then triggered a MEB. I was very sick and actually purposely trying to go hide out as far away from Army doctors as I could at the time... it took my O6 commander sending me a written order to go to the nearest Army base for a fit for duty exam... I wasn’t trying to hide until 20, I was absolutely trying to hide until I received an accurate diagnosis for what turned out to be a very rare and extremely difficult diagnosis.

 

[Jason Perry]

Jason, I don’t technically know the answers’s it stands today. In my case this is what I was told by the AF COL, cheif of neurology at wright Patterson AFB in 2014. Maybe at that time, army and AF could not initiate mebs against each other, and perhaps now they have that capability. All I know is that is what I was told then. My knowledge may no longer be up to date.

there were zero Army docs at WPAFB at the time. I saw plenty of AF docs but not a single Army doc. I believe they may technically be able to “press the MEB button” for any patient, but the AF neurologist doesn’t know Army retention standards, how to issue an Army profile, or Army procedures.... Just the act of issue of a simple profile
Is different between Army and AF.... AF has the whole “DAWG” thing and Army does not.. maybe he said he “can’t” MEB me because he doesn’t know the process for MEBing anyone outside his branch... I don’t know. I just know if it is possible, it’s also highly unlikely.... I also remember it was either 2013 or 2014 that was the first year I was able to go to get a PHA from an AF doctor and had a technique/process that we could go through to get that PHA over to the Army side.... so they were in the very early stages of working together back then. Perhaps in 2021, it’s fully and automatically integrated... like I said my info might be dated.

I am actually clear that what I wrote is "legally correct." My language in the response was being a small bit kind to your valid points as to what often happens. But, Tri-Service MEBs are a "thing," and if fought out, should resolve along the lines I stated.
All of that said, there is a fair amount of sunlight (actually a lot) between what the law says and what actually happens, and what you wrote jibes with much of what can/does shake out.

Nothing especially different in 2021 vice many years ago on this issue. Just that there are many examples over many years of services not following regulations.

Honestly for the original Poster, you’re best bet is to go see a Navy doctor. Find the nearest Navy base and go TDY if you have to, but understand that each military branch may be different when it comes to issuing profiles/Limdu status. Don’t expect anything across the services to be automatic... or easy...

I also concur here. (Whatever the branch, if you are in a multi-service environment, makes sense to get reviewed by your own service's providers to increase chances of proper processing. Not needed, but might be to your benefit.

Also, a "PEB War Story" (okay, there is no such thing, but hang in with me for a second). When I was the Chief, Soldiers' Counsel at the Ft. Sam FPEB, I was invited to a conference to present on PEB issues. The audience consisted of newly appointed MEB approving authorities (usually, Deputy Commanders of MTFs). Most were 05's and were career Army and Air Force physicians. I gave a class on common issues with cases, the standards, the common administrative deficiencies, etc. The bulk of the class, when asked to raise hands on several questions, admitted they had little to no previous training on the issues, did not know the common regulations, and did not understand the process. That was about 17 years ago. I don't suspect it has changed much.

 

[tony292]

Jason,

Thank you for being kind to me. As always I will defer to you. I have no “legal” opinion any more than I could have a “medical opinion”. After all, I’m neither a doctor nor a lawyer. What I think we agree on is that while technically something may be very possible, (MEB initiation across the branches), it’s not happening in many cases because of what you stated, many doctors don’t know a whole lot about the processes. And what they do know, is they know their own service. If I were an Air Force neurologist, I’d know the Air Force retention standards inside and out, top to bottom A to Z. What I wouldn’t know are the Army standards for neurology. Although I would be absolutely sure that something as severe as say ALS would be unfitting and cause for a MEB across all branches, as an Air Force doctor I would know nothing about AR 40-501 chapter 3.... and even if I did have that knowledge, I might not know the Army process.. the Army for example has no DAWG.... so how do I as an Air Force Neurologist submit something to the Army DAWG “equivalent”???? I agree that it’s most likely very possible to initiate MEBs across the board, and possibly profiles too... but in 2013/2014 we just got the ability for an active duty Army recruiter to go to an Air force MTF, get a PHA, and submit that through a process that would convert it to an Army PHA... I remember because I was there in recruiting and got my PHA converted and the Army actually could
See it... that wasn’t possible in 2012.... believe me I tried!!! Prior to that, we had to go get PHAs through the same process as Army Reserves or National Guard.... 2013/2014 was the first time we could process something across the services as simple as a PHA!!!! And even then, it wasn’t automatic!! There was a process for transferring it over...as I recall my fuzzy memory tells me it took a few days to a week to transfer over... So think about that for a minute.... that was a simple PHA!! How simple is a PHA vs the complexity of IDES? So as I said before, maybe my information is dated... maybe the Air Force and Army medical information systems are now 100% seamless in 2021.... but as a former Army Signal officer... I’m skeptical of seamless integration...

look at it from a different perspective. It could very well be legally correct to say that any doctor from any branch can initiate a MEB on any servicemember... that can be true. But it doesn’t mean that it’s either possible or likely with the limitations and constraints based on knowledge, training and medical IT systems.