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Re: Not yet sure what is going on
justice #111216 05/15/08 11:18 PM
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I agree with Jill. Like they used to blame ulcers on stress until they found out that they are actually caused by a bacteria. Oops!

I hope that both you and Jill get an accurate diagnosis and help with your pain soon.

Brenda



Brenda

undifferentiated spondyloarthropy, HLA-B27+, iritis, Vit D3: 6000 IU/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, impaired glucose tolerance, sleep apnea.
Re: Not yet sure what is going on
justice #111793 05/21/08 06:42 PM
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Well I got some kind of result (even though its crap) they are saying severance pay at 10%. I totally don't agree with the results! What do you think I sould do?


Brian W Greathead
Re: Not yet sure what is going on
justice #112810 05/29/08 05:36 PM
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This is what the doc was trying to say after the psych eval, does anyone have any suggestions on how to handle this.
DIAGNOSIS:

Axis I: (300.11) conversion disorder, with mixed presentation. As manifested by onset of sensory motor deficits, muscle spasm, and tremor suggestive of a neurological medical problem following a back injury at work, association with psychological factors related to his back injury, no clinical evidence of intentional production of symptoms, symptoms that are not fully explain by presence of a general medical condition, and symptoms that cause clinically significant distress and impairment in occupational functioning.

Axis II: No diagnosis
Axis III: No diagnosis
Axis IV: occupational and family stress
Axis V: Global Assessment of Functioning
Current: 51-60 Moderate symptoms, moderate difficulty in social and occupational functioning.


Approximate date of origin: Winter of 2007
Incurred while entitled to base pay: Yes
Existed prior to service: No
Permanently aggravated by service: N/A
Impairment for further military duty: Marked, especially sea duty
Impairment for social and industrial adaptability: Definite


CURRENT FUNCTIONAL STATUS:

IMPACT ON DUTY: This service member’s ability to perform his assigned military duties is negatively impacted by his psychiatric condition

STABILITY: His condition has been progressively worsening over the past 12 months.

PROGNOSIS: Indeterminate, the service member has not been receiving any type of mental health treatment for his condition.

COMPLIANCE: This service member appears compliant with his established somatic treatment protocols. He has not been treated by mental health services in any capacity.

GEOGRAPHICAL ASSIGNMENT CONSIDERATIONS: Due to his psychiatric condition, this service member is not fit for worldwide deployment, and his ability to adequately perform his assigned military duties in negatively impacted in any duty assignment.

COMPETENCE: He is competent to manage his fiscal, administrative and logistical affairs.

SAFETY: He does not appear to pose a risk of imminent dangerousness to self or others.

CONCLUSIONS: This service member is medically disqualified for continued Coast Guard Service in accordance with COMDT Instruction M6000.1C, “Medical Manual”, Chapter 5, Section (B)(12)(a)

RECOMMENDATION:

CLINICAL DISPOSITION: The service member should continue with somatic treatment of his physical complaints with primary care as scheduled. He should be engaged with mental health services to address the underlying intrapersonal conflicts leading to his disabling medical problem.
ADMINISTRATIVE DISPOSITION: This service member should be processed in accordance with Physical Disability Evaluation System, COMDTINST M1850.2

HISTORY OF PRESENT ILLNESS: This service member was in his usual state of uncompromised health until approximately one year ago, when he injured his back at work during small boat operations. Review of his available medical records indicate that he had " a history of recurrent episodes of back problems through his teenage years," but nothing that medically prevented his initial accession into the Coast Guard.

Immediately following his injury, this service member began to experience pain in his back. Over time, this pain progress up his spine into his neck and shoulder, as well as down his spine into the back of his legs and his quadriceps. He described a progressive course of pain, muscle spasm, numbness and tingling which eventually included tremors of his hands. He reports now that he has swelling of his lower extremities after walking short distances, left greater than right. Further he stated that he used to swim competitively, but now even entering the pool makes his lower extremities “numb.”

The service member has undergone extensive physiologic workup to address his somatic complaints. No medical explanation has yet been found to adequately explain his clinical symptoms. The patient indicated that, all things being equal, he would prefer to stay on active duty with the Coast Guard and that he likes his job. However, in light of his subjectively experienced physical limitations he does not believe that he is medically able to complete his assigned military duties.

SOCIAL/DEVELOPMENTAL HISTORY: This patient was on May 27, 1986 in Pepperell, Massachusetts. He is the second of 4 sons, born to an intact married Union that remains together to this day. He described it emotionally supportive environment growing up, free of any overt abuses or neglects. He is a high school graduate, finishing on time with no skipped a repeated academic years in 2004. He entered the United States Coast Guard shortly after high school graduation. He is single, never married and has no children.

PHYSICAL EXAMINATION: limited to the mental status examination

O: MSE: Appearance: Well-developed, well-nourished, Caucasian male wearing a well-maintained, clean Coast Guard uniform, consistent with his social and occupational norm. He was sitting comfortably in an examination office in the Department of Psychiatry, Madigan AMC. He was neat, clean and well groomed with good attention to his personal hygiene. He was alert and oriented to person, place, time and circumstances of this assessment. Behavior: He was calm, cooperative and interactive with the examiner. Speech was normal to rate, prosody, tone and volume. Eye contact was appropriate. Mood was described as “O.K.” with a mood-incongruent, guarded affect (limited range and reactivity). Tp were linear, logical and goal directed, organized with good capacity for abstract thought. Tc was stated to be free of any suicidal or homicidal thought, intent or plan. He denied any hallucinations, delusional thoughts, inability to distinguish reality from fantasy, expansiveness, racing thoughts or any other clinical evidence of psychosis or manic illness. Judgment was fair, given his willingness to participate in this assessment. Insight was broad. HCF was grossly normal. Estimated intelligence level was average. Impulse control: good at the time of assessment


Brian W Greathead
Re: Not yet sure what is going on
bgreathead27 #112846 05/29/08 11:19 PM
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Hi Brian,

I am a military spouse (husband is a Navy chaplain). I have a background in clinical psych (worked as a therapist for about 6 years), and I was interested in a few things. First, who referred you for a psych eval? From what I understand through my husband, when someone gets sent for an eval, there needs to be a diagnosis. I don't know if this is consistent with the Coast Guard system since I hear more about Marines and Navy, but it seems that my husband and the docs talk a lot before sending someone in for an evaluation. Was it a psychiatrist who diagnosed or a psychologist? It can change how someone is seen in the diagnostic process. Also, I would imagine that there was some discussion between the person who referred for the eval and the person who did the eval; that could have influenced how you were seen. Have you been sent to a rheumatologist at all? It took a long time for me to get my diagnosis, and I had several Navy docs (who I liked personally but knew were completely clueless and grasping...but not required to get a diagnosis since I was a spouse) come up with absolutely meaningless diagnoses (my favorite was fever of unknown origin). Conversion disorder does exist, but it is not very common. Have you read about it in the DSM-IV? The more you can document against the diagnostic criteria, the better you can argue the current assessment. On a side note- why was there not an Axis III diagnosis?? (medical issues)

Laura

Re: Not yet sure what is going on
MomtoRhi #112893 05/30/08 11:26 AM
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Brian,
You definitely want to appeal to the FPEB. You will want to get any additional medical information you can to explain to the fomal board why you felt you were not given the proper rating. You will have an appointed CG attorney during this process. I agree with MomtoRhi (Laura), you should be sent to a rheumy doc also. I fought several flare-ups until finally a civilian optomologist had my blood tested for HLA-B27, which was positive. Then the Navy rheumy and CG docs finally agreed I had AS. Good luck fellow coastie.
Ray

Re: Not yet sure what is going on
RayH #112895 05/30/08 11:31 AM
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Brain,
Have you been over on the PEB forum yet? If not here is the link,
http://www.pebforum.com/
There is a lot of good people there that have excellent words of wisdom about going through the MEB process. It is moderated by Jason, a retired JAG.
Ray

Re: Not yet sure what is going on
RayH #112954 05/30/08 03:47 PM
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Ray/Laura,
After being in the medical board for around 6 months, the formal board requested a psych eval with a Psychiatrist because there was no dianosis found to explain what was going on. I have not seen a rheumatologist at all that pretty much the only doc I haven't seen. I just yesterday had the blood test for HLA-B27, so in alaska I will hear in about 2 weeks. I have been reading up on the disorder but to me it seems like a catch all for not knowing what is going on with me. The symtoms fit but the backgroud is way off. Ray I'm still waiting for the fullpackage to get here so I have to wait to talk to CG legal. I even have a friend in the VA to haelp me with my case so I'm off to a good step right? Again I apprieciate the help its been a long 16 months of this crap.


Brian W Greathead
Re: Not yet sure what is going on
bgreathead27 #112976 05/30/08 09:19 PM
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Brian,
Hang in there. I know from personal experience, the MEB can be a long, painful, and drawn out process. Hopefully the docs can get something figured out.

Ray

Re: Not yet sure what is going on
bgreathead27 #113045 05/31/08 12:52 PM
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Hi Brian,

It is important to remember that the diagnoses in the DSM are only categories created to understand clusters of symptoms. Conversion disorder is one of those often used for a "we don't know what else to diagnose because the patient doesn't fit anywhere else but does have symptoms". It can be a damaging diagnosis because it says little about what is truly happening (and offers no clear treatment). Keep documenting, pushing for skilled specialists, and taking care of yourself. All it will take is one knowledgeable person who is connected to your case to get it moving in the right (and helpful to you) direction. Also, I imagine that it creates less accountability of care if "they" can put you in a mental health category than a medical one. As much as it would be bad news in many ways, I hope you get a positive result for the HLA-B27 blood test to start getting the proper treatment. Hang in there!

Laura

Re: Not yet sure what is going on
MomtoRhi #114093 06/09/08 04:47 PM
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good morning,
Well it sucks to say but my HLA-B27 test came back negative. I also finally got the package with the findings in it. I'm waiting to talk to a lawyer about it. I'm also planning to take some leave so hope fully nothing will interup that. Who knows whats going to happen, but I do know thats its going to be an up hill battle to get any change.


Brian W Greathead
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