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THE BIGGEST OF THANKS!
#102404 09/12/07 02:19 AM
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To maparker!

He provided me with in invaluable amount of help with my board. He took out a lot of his time to review my case and prepare letters at all pro bono. The board wanted to separate me at 20%, but with his help I got back on TDRL at 40% and have to work on appealing the VA for the correct rating.

Re: THE BIGGEST OF THANKS!
#102405 09/12/07 02:46 AM
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Alright!


AS/PsA DX in 1988

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Re: THE BIGGEST OF THANKS!
#102406 09/13/07 02:46 AM
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Hmmm...sounds like assistance like that could be beneficial with my re-evaluation since now need to appeal it. wink


Sal
Re: THE BIGGEST OF THANKS!
#102407 09/13/07 05:03 PM
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With his permission, I have posted below the letter I sent to the Navy PEB on Sir Sly's behalf in prepartion for his formal board. Upon reading the contents, the medical advisor for the board determined that he should remain on the TDRL at a 40% rating. This letter has many of the same points I have made before to various entities.

Sir Sly had a couple of things going in his favor. First he was being evaluated by the Navy PEB which is probabaly the least of the evils amongst the Service PEB's. More importantly, the medical advisor got it. She understands that AS is more than a back condition; it is a systemic, body-wide autoimmune disease with numerous medical considerations.

Incomplete MEBs are a foundational issue with improper PEB ratings. Trash in will lead to trash out. This is just a true for VA ratings. If your VA C&P exam did not cover the issues in the physician worksheets, your are heading in the wrong direction.

Finally, I prepared a detail brief on rating AS per the VASRD. It has many Army specific issues but includes information that is applicable to VA as weel as AF and Navy PEB's.

I briefed a different version to the VA and I believe thay will be taking action in short order to help ensure the VA rate AS correctly in the future. I should know more by the end of the month so stand by.

If you would like a copy of this brief, please send me an email at ma.parker@yahoo.com. It will be useful for both VA and military appeals. We already used it for mapmaker's VA appeal. He should get his decision soon.


Regards,

Mike


SUBJECT, Incomplete Medical Evaluation Board for Sir Sly,(USMC)

Sir,

Sir Sly's Medical Evaluation Board (MEB) is incomplete. As such, his fitness and disability ratings cannot be properly assessed. Request Sir Sly's formal disability evaluation board be held in abeyance until he receives a complete and proper MEB IAW the requirement of the VASRD, DoDI 1332.38, DoDI 1332.39 and SECNAVIST 1840_E. Specific issues with his MEB are addressed below:

DoDI 1332.38 E3.P1.2.3 requires all current medical conditions to be addressed in the original MEB. DoDI 1332.38 E3.P1.2.5 requires all medical conditions to be addressed in TDRL periodic reexaminations as well. This was not done in Sir Sly's case. In addition, his MEB laboratory tests demonstrated an positive ANA test. A positive ANA test is not associated with Ankylosing Spondylitis but it is associated with lupus, other autoimmune conditions and cancer, all of which are known side effects of Humira, the drug Sir Sly uses to control his Ankylosing Spondylitis. Also, as described below, Sir Sly has recently experienced hand and finger pain and inflammation, a sign of drug induced lupus. This issue must be thoroughly vetted before the degree and stability of his condition can be properly addressed.

Ankylosing Spondylitis is an autoimmune, inflammatory arthritic condition. It is rated in the VASRD under Diagnostic Code DC 5009, arthritis, other types. DC 5009 conditions are rated under the criteria of DC 5002 which begins with rating criteria for the active disease process. Sir Sly's Ankylosing Spondylitis is in an active phase which is why he must take the immunosuppressive drug Humira on a continuous basis. DC 5002 then directs the rater to rate the chronic residuals under the appropriate diagnostic codes. Ankylosing Spondylitis can affect numerous body parts. Therefore, a body wide assessment for residual damage must be done in order to rate the condition properly. DC 5240(Ankylosing Spondylitis) is the appropriate chronic residual diagnostic code for rating residual damage to the spine. X-rays must be taken of the areas affected by Ankylosing Spondylitis as degenerative changes are a part of the overall rating criteria. Only Sir Sly's back and hips have been recently X-rayed.

DoDI 1332.38 encourages the use of DVA worksheets to ensure all needed information to rate conditions properly is elicited during the physical exam. For Ankylosing Spondylitis, this would include, at a minimum, the DVA worksheets for:

Immune disorders Examination,
(http://www.vba.va.gov/bln/21/Benefits/exams/disexm32.htm)

Spine Examination,
(http://www.vba.va.gov/bln/21/Benefits/exams/disexm53.htm)

Shoulder, Elbow, Wrist, Hip, Knee, and Ankle Examination,
(http://www.vba.va.gov/bln/21/Benefits/exams/disexm34.htm)


The chronic residuals from Ankylosing Spondylitis, such as DC 5240, are based on range of motion criteria. In addition to the range of motion measurements, the provisions of paragraphs 4.40, 4.45 and 4.59 of the VASRD must be assessed as well to establish the overall rating. These issues were not addressed fully in Sir Sly's case and they must be addressed in order to rate him properly.

Sir Sly's MEB physical was completed in April 2007. Over the past 2-3 months, he has had exacerbations of his conditions involving his hands for which he has sought treatment for at the rheumatology department of Walter Reed. It is imperative that this new issue be fully vetted as an exacerbation of his active Ankylosing Spondylitis as well as for any residual damage. Without proper vetting of this flare up, he cannot be properly rated.

It order to be properly rated under range of motion based criteria, a range of motion test must be conducted. Sir Sly did not have a range of motion test performed on the joints affected by his Ankylosing Spondylitis during his lastest MEB physical. Such a test must be done (to include back pain Waddell's signs), in Compliance with the range of motion testing requirements of the VASRD, DoDI 1332.38, DoDI 132.39 and SECNAVINST 1840.E. Without such an examination, he cannot be properly rated.


Sincerely,

Michael A. Parker
LTC, USA (Retired)

Re: THE BIGGEST OF THANKS!
#102408 09/13/07 07:09 PM
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Mike you really need to get a job that would allow you to represent these folks! What a great understanding of the law you have. If only the DAV/VFW/AL/VSO etc had the same level of knowledge..


AS/PsA DX in 1988

Retired on disability
in 2005 at age 44
Re: THE BIGGEST OF THANKS!
#102409 09/25/07 05:32 PM
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I ditto Ken.

But I can also say thanks to Mike, my entire claim is on re-work with service connected now established for the Ankylosing Spondylitis.

I will post with the complete details in the near future. For those of you who know me on here, it has indeed been a long time coming (four years). But I too have Mike, as well as Jeffry, to thank for their help. God Bless!

Re: THE BIGGEST OF THANKS!
#102410 10/08/07 08:06 PM
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To maparker

I have recently been told I have Ankylosing Spondylitis and I am in the Army is there any advise you can give me THANK YOU!


stetson78
Re: THE BIGGEST OF THANKS!
#102411 10/08/07 08:10 PM
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Mike is going to need allot of info from you Stetson78. Get copies of everything.

Will also need the History/background on it. It is possible to do 20 years in the Military with one of the diseases that are related to AS. If you want to stay in the Army you will need to fight to do so. If you are not well enough to serve, then you should be retired, not discharged.


AS/PsA DX in 1988

Retired on disability
in 2005 at age 44
Re: THE BIGGEST OF THANKS!
#102412 10/08/07 10:47 PM
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Thank you Kenneth, The doctor told me that I had AS starting in my hip and going up my spine at first they thought it was sciatica but after the blood test, it came back positive for HLA-B27 and that I am going to get med boarded. I have only been in the Army little over 3 years and I guess I am ready to get out I just hope the Army will take care of on my pension since i have a family and all.


stetson78
Re: THE BIGGEST OF THANKS!
#102413 10/09/07 01:26 AM
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Stetson,

Consider yourself lucky that you found this site before you began your MEB board.

Step one is to make sure your MEB board is done correctly or it will be trash in/trash out.

As you can see from above, there are at least 3 or 4 VA physician worksheets that need to be used to ensure you are raated correctly.

We have time. Keep us informed as you progress through.

Where are you currently stationed?

Have you received anthrax shots?

You should also read the VDBC section I posted on this board as it will give you an idea of some of the issues you will be facing with the MEBs and the PEBs. Forewarned is forearmed!

Mike

Re: THE BIGGEST OF THANKS!
#102414 10/09/07 01:59 PM
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Dear Mike

Thanx for getting back to me. I am stationed at Hunter Army Airfield in Savannah,Ga and I did get the anthrax shot back in 2005 and 2006.One thing I don't like is the doctor that said I have this don't seem to be doing his research on AS,he said he don't think AS is a serious matter which of course he is wrong.What advise do you have for me on this if any.And again thank you for getting back to me so quick.


stetson78
Re: THE BIGGEST OF THANKS!
#102415 10/26/07 05:57 PM
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Thank you so much for this information. I have had a MEB and now the package is ready to go to the PEB or so i thought.

A little background info on me. I am active duty with 19 1/2 years of active service. I have been diagnosed with AS with Xray evidence showing the early stages of Arthritis in my spine, ankles, knees, hips, shoulders and a few of my fingers. I also have bursitis and impingment in both shoulders as well.

I printed the three DVA worksheets and took them with me to review the package that was going to be sent out today. I discovered that the physical therapist here as Keesler AFB did not follow ANY of the worksheets. She did not document any of the pain, she merely pushed my arms (and other joints) through the pain to get a range of motion. My arms were lifted for me over my head as i cringed in pain... giving me a full range of motion with no mention to the pain that i was in.

I talked to the PEBLO here at Keesler AFB about my concerns and she told me that she could not discuss it with me because she was not there in the room. She was absolutely no help.

I (on my own) went back to my Primary Care Provider and showed him the worksheets and the limited results of her ROM test, he agreed that what she provided did not come close to the worksheet. He is requesting a second opinion from a nuetral (i.e. civilian) provider.

I am new to this forum, i found this forum a few hours before my appointment to review my package and i was going to let the PEBLO send it forward...with alot of missing information that would have most likely resulted in an inadequate rating.

Is there anything else that i should be watching out for? What advice do you wish you would have received BEFORE the package went out?

Once again thank you for the help you have already provided.

Joe Willams

Re: THE BIGGEST OF THANKS!
#102416 10/29/07 11:06 AM
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It sounds like you are on the right track. Having them use all of the VA worksheets related to this disease is very important.

If found unfit, it will be important that they rate you per the 5002 VA rating criteria.

Mike

Re: THE BIGGEST OF THANKS!
#102417 11/01/07 02:22 PM
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WOW most of the people dealing with this process on the MEB side makes this system seems like a huge "Charlie Foxtrot" (as we used to call it when i was in the Army).

I asked for a second opinion for my range of motion test (mentioned in previous post) and it was signed off complete because they already did a range of motion test and "I did not need another test".

My PEBLO here at Keesler AFB is telling me that "they dont need the DVA worksheets" and "they dont need to follow DoDI 1332.38 because they have a email that was sent to her and the physical therapist doing the range of motion test". She then said that "IF they need anything else they will call and ask for it".

What can I do or who should I be complaing too? This PEBLO certanily does not appear to be looking out for my interest.

Any suggestions?

Re: THE BIGGEST OF THANKS!
#102418 11/07/07 11:52 AM
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First line of defense is to write a rebuttal to attach to your MEB board explaining what you believe to be in error or missing. Try to tie your points to regulatory and policy requirements.

Mike

Re: THE BIGGEST OF THANKS!
#102419 11/14/07 06:13 AM
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I personally whould request a copy of the email that states they are exempt from following DoDI 1332.38 because unless I've become retarded overnight the directive for them is to follow the 38 CFR and unless they have a Congressional approved allowance to deviate from those gidelines then inform them that with all due respect they need to stop blowing smoke up you third point of contact.

Re: THE BIGGEST OF THANKS!
#102420 12/23/07 06:34 AM
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Slight error,

The DEPARTMENT OF THE NAVY (DON) DISABILITY EVALUATION MANUAL is SECNAV INSTRUCTION 1850.4E


"A ship in the harbor is "SAFE"; but that is not what ships are built for."
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