Tag Archives: Veteran’s Affairs

Appealing the Indecision

Moderatix note: This post will be United States Military centric, as that is the perspective I offer, and the broken system within which I currently exist and attempt to navigate.  Other voices are welcome and experiences appreciated within the context of the conversation, since I can not pretend to know every thing about every military experience from every branch in every country.

The MedBoard has handed down its decision and you have been given ten calendar days (this is very specific, calendar days, not business days) to vie for any appeal if you are unhappy with or believe that the findings were not in your best interest.

Here’s the catch.

One of the doctors who wrote a recommendation for your review board has to agree to write a rebuttal to the review board on your behalf.

If the military and DoD as a whole are pressuring doctors to give lower diagnoses to prevent higher disability ratings, how many doctors do you think are going to come rallying on your behalf?  I’ll wait while you count them.

If a doctor has already written a recommendation to the Medical Review Board chances are they aren’t exactly champing at the bit to write a recommendation that goes against their original finding.  They also have to submit new diagnostic criteria to show why they think that your case has merit for review.  It takes time to do this, and the doctor has to be willing to fit you in to their schedules in order to accommodate this.

In my case, my filing doctor had done all he could do.  He had written the strongest case that he could, but the case depended on the letters written by the specialists, including the rheumatologist.  The rheumatologist was my turncoat.  He, together with the chiropractor, had suggested my diagnosis, and had proceeded to treat me accordingly until my review board needed letters written.

I received my MedBoard findings on a Friday.  If you are keeping count at home, Friday counts as calendar day one.  Saturday and Sunday are days two and three, and on Monday I was scrambling to get my filing doctor to find time to see me.  This required me to make a walk in appointment, which left me waiting all day for a cancellation, only to be told that he could do nothing to help me.  Day four wasted.  Day five came (mind you, I was missing work but still getting calls about it, plus still receiving my regular treatments), and I could not get an appointment with the rheumatologist.  I called, went to the office, sat in the waiting room, left messages on days six and seven.  Nothing.  Finally, on day eight (the last day for me to do anything at all, because my day ten was a Sunday, and my response would be entered Monday), I waited until I saw the rheumatologist, and literally chased him down, in tears, and begged.  Sighing (yes, he sighed, audibly), he let me into his office to hear me out.  He told me point blank that no one had ever said that I had fibromyalgia (what the fuck were they treating me for, and what the fuck was that at the top of my medical record?, I thought to myself), and that there was no way to prove that I did.  For all he knew, I could have CFS, Lupus, PTSD, chronic depression, or anything at all, and since it could be anything, his finding had to be that it was nothing, and he was unwilling to devote any more work to my case.


If your doctors are unwilling to help you then you have no recourse at all.  None.  You have to have a doctor backing you to file an appeal.  I can not tell you the feeling of helplessness and loss I felt as I went to the liason’s office (which, I am not even sure why there is a liason, because mine only handled paperwork, and did nothing to help me except tell me I had 30 days to prepare to be out) to sign the paperwork that ended my military career with a MedBoard finding that I not only objected to, but that was wrong.  Wrong, and incorrect according to what every doctor who had written otherwise had told me up until this whole mess started.  All of a sudden they were not on my side, and I had no advocate.  It was me against them.

If you get a doctor who is willing to back you then the evidence is presented to the board again.  The board has the right to call you to appear before them in person to review your case at this point, which for some is a major deterrent.  This decision, IIRC, is final (there may be one more appeal opportunity, but it is a lather, rinse, repeat process, with that one being final).  That part is fuzzy to me…probably because the process from this point was so upsetting…

I had an opportunity to make a choice to remain in under what is called PERMLIMDU, or Permanent Limited Duty Status, which in the Navy means that you remain in for the remainder of your obligation under a specific set of guidelines, doing a job within those guidelines, retaining all of your benefits and allowances, but not being able to or allowed perform certain duties.  You have to have approval from the Command, your direct CoC, and at least one of your treating physicians for this to happen, and for a few reasons I hope to cover in another post, I was to ashamed to take this option.  So, I signed the paperwork, and with 30 days left began my transition from Sailor to Veteran.

During the transition there are long classes to take to help prepare you for civilian life, in which a lot of people from many offices come to talk to you about your insurance options, how to write a resume, how to get care from the VA hospitals, and how to tell time like a civilian (I still haven’t mastered that one, it isn’t “10 PM”, it’s 2200, dammit!).  One is a representative from the DAV (Disabled American Veterans), and I remember her presentation well, because I was the only person there with a MedSep.  She made me laugh out loud, earning me a dirty look and a lecture.  She was explaining to us about our exit exams, and that we needed to document everything that was wrong with us, to hold the military accountable for our condition and for reporting to the VA.  There are things that we can document that do not matter, like shin splints and a few others I can’t remember, and she was trying to tell us that if we documented it all together as fibromyalgia that the doctors had to give us a disability rating for all of them combined.  This was what made me laugh, and she made me tell her what was so funny.  I told her that it was great advice as long as she could direct us to a doctor who was willing to support that, because so far I hadn’t found one, and that I would love to meet one.  She spent about five more minutes reassuring me that she knew for a fact that if I said it was true then the doctors would back me up.  I am not sure we were in the same military.

The military’s determination to get doctors to downplay the conditions of service members, particularly those with invisible or difficult to diagnose conditions, leaves a veteran in a particularly vulnerable position, with no one on hir side.  There is no advocate.  There is no one to speak for you if your doctors are unwilling to back you up or fight for your care.  This dumps all the work and responsibility of getting the diagnosis and care squarely in the lap of the veteran, who is soon to be dealing with transitioning into a world that is long foreign.  Some veterans never make the transition successfully (about one in four homeless today are US Veterans, which is startling if you consider that veterans only make up about 11% of the population, and active duty military less than 1%).  If this kind of treatment continues I believe that we are going to see these numbers surge, as more and more people return from combat with invisible injuries such as PTSD.  I hear that the military is going to start taking these things “more seriously“.  Good on them.  I don’t think it’s enough soon enough.  Too many people have fallen through the cracks…and too many more are still.

And what about all the people who weren’t “in combat”.  Cuz, ya know, women can’t be in combat, so how can they possibly have combat related injuries?  Or people who didn’t have combat related jobs?  Are their lives somehow less valuable?

The short answer?  Yes.  Because that is the first thing you learn at boot.  You don’t matter.  You are nothing but a number.

The long answer?  Coming soon.

Shifting the Responsibility for Disability in Uniform

Moderatix note: This post will be United States Military centric, as that is the perspective I offer, and the broken system within which I currently exist and attempt to navigate.  Other voices are welcome and experiences appreciated within the context of the conversation, since I can not pretend to know every thing about every military experience from every branch in every country.

Disability issues overlap many facets of life, and one of our goals here at FWD is to bring as many of those to light as possible.  One voice I want to offer here is that of the disabled U.S. Veteran.  Specifically in feminist circles I feel that the disabled veteran is a voice that is seldom heard, and while hir voice may be part of a very small percentage, sie is facing a unique set of challenges.

One of those challenges is getting a diagnosis and care in the first place.  A person gives hir time and life to the military for one of a variety of reasons and find hirself trained for any number of jobs.  Sie can travel the world, see exciting places, or be sent off to fight in wars.  In the blink of an eye hir world is turned upside down.  Suddenly life isn’t what it was before.  Hir body/mind/soul are not what they once were, and coming to terms with that is no easy task.  If sie is one of the ones who has survived combat injuries or someone who became sick or injured while doing hir job in a Stateside base, sie does what sie has been taught to do…sie makes a routine appointment at the local Military Treatment Facility (MTF) to see her Primary Care Manager (PCM).

Hir PCM might evaluate hir, refer hir out for tests with specialists, or set hir on a merry-go-round of treatments.  When the ride stops sie may or may not have any answers, and there may or may not be a Medical Review Board pending to tell hir the terms of the future of hir career.

This is where things get interesting.  By interesting, I mean kind of fucked up.  One, any or all of those specialists might have diagnosed hir.  Those doctors start treating hir accordingly, because while TRICARE (military medical insurance) has its flaws, it kicks a lot of arse, and sie gets the care sie needs, mentally and physically (until her PCM deploys, but that is another post altogether, just you wait!), all under the umbrella of hir diagnosis.  But then the Medical Review comes up, and all of hir doctors have to write these recommendations, and suddenly things change in terms of hir care.  In hir appointments hir doctors start getting vague about care plans, and start talking around the actual words for hir condition…sie might suddenly feel dismissed or as if hir questions are not being answered.

As we read earlier this year, it isn’t a coincidence that military doctors are getting dodgier than Sarah Palin in an interview.  There seems to be pressure to not diagnose active duty personnel while active duty, and it isn’t just PTSD.  This service member might have received treatment for months leading up to hir review board only to have hir diagnosis revoked for the board so that the military could discharge hir with a lower rating.

It’s not too hard to understand why this happens.  The rating system breaks down a little like this:

A medical team of medical officers somewhere in Officer Land and look at your whole military medical record, and all these nifty letters written by the doctors who have seen you, along with some reports from your Chain of Command (CoC).  Based on all of this information they determine whether or not to separate you from the military.  They also give you a percentage rating of how disabled they think you are before discharging your from the military (there is also something called Permanent Limited Duty, which I can talk about sometime in another post).  It goes 0%-100% (the percentage is ultimately the amount of money they give you and “how disabled” they think you are).  Unless they give you at least a 10% rating you get nothing.  There is a list somewhere of what constitutes what percentages, and the military’s is different from the VA’s and each branch seems to interpret it differently.  Anything between 10 and 20% will grant you a one time award (I love that they use the word “award”, like somehow you have won a prize) based on your pay over the number of years you spent active duty (minus taxes, but including any bonuses you earned).   Most medical review boards fall in this range.  The magic number seems to be 30%, which gives you a monthly stipend based on the same numbers.  This math works all the way up to 100%.  After 80%, however, you receive what is called a Medical Retirement, which, regardless of how many years you have served, you retain your full benefits (insurance, commissary, exchange and medical) as if you had retired after 20 years of service.  That, I think is the rub.  It’s money.

When I had my review, it went a lot like that as well.  I could have been Sgt. X (well, Petty Officer X) in the rheumatologist’s office w/ a tape recorder.  The same guy who had written in my record that he was treating me for fibromyalgia had written in my medical review that there was no way to know for sure, that I could in fact have fibro, but that I could also have CFS, or PTSD, or just be really depressed, so there was no real answer.  His best advice was for a medical discharge and a referral to the VA for follow up care.  He also suddenly became angry because I didn’t want to be on Cymbalta, because I didn’t feel the need to be on another anti-depressant when ADs weren’t helping my pain (Lyrica wasn’t out yet, and Cymbalta was a new-ish treatment).  When a doctor tells me “I guess you don’t want to get better”, without listening to my concerns I know I have lost a battle.

After my review board findings came back (10% if you are nosy), my doctors seemed to have a shift in my care.  I was receiving less pain management care (well, less pharmaceutical) and the focus was more on mental health.  My review board found that I was too depressed to continue with active duty service, oh, and Trichotillomania sounded weird, I guess, so they tossed that on there, even though no one gave a fuck about it before.  Pretty much all of my care was to be managed through Mental Health (which, should be noted, is in no way a slam on mental health.  In my case, it was not the treatment I needed, even though for some people it is what they need), which made my physical needs very difficult to acquire while I was still active duty.  Yes, I was depressed, but I was depressed because I was in so much pain that I was having a hard time dealing with life and a child, and because no one was listening to me.  I was not in pain because I was depressed.  No one seemed to be interested in the sequence of events.  Before my review board findings I had a PCM, a neurologist, a rheumatologist, a chiropractor, an internal specialist, and a pain management specialist all convinced that all signs point to fibromyalgia.  Afterward you could have dropped a pin in room of crickets for the voices that came to my defense.

After my discharge I began the process of filing the VA claim.  It is pretty much the exact same process, minus the stuff from the CoC.  Oh, and it takes longer.  Hmmm.  I wonder why that is.

I firmly believe in my heart that military doctors (and doctors employed by the military) are being pressured to push us out the door and to let the VA sort us out because it is easier on the budget.  The Armed Forces Committee seems content to thank soldiers by one-lining them out of the fiscal year’s planning, and it pisses me off.  When I was given my board findings and told to sign off on it I was able to glance at the list of others who had been reviewed with my own.  I remember seeing at least a dozen names with finding for PTSD or other things that are “invisible”, all with a 10% or lower finding.  Brothers and sisters who have served their country, and this is the thanks we get when shit didn’t go as planned.  I know that this is happening to many service members, military wide.  I know that this is happening because our disabilities are invisible and easy to dismiss.  Veterans are slipping through the cracks, and Congress and the DoD is not only letting it happen, but damn well encouraging it.

This is the first in what will hopefully be a series of posts on navigating disability in the military health care system.