ptsd MEB PEB CHRONIC HIP PAIN/PTSD

[USDevilDawgMC]

Good morning everyone,

New to the forums here, thanks for having me.  I'm currently going through the MEB/PEB process (active duty Marine Corps) and have a few questions. 

I am having to do a NARSUM for both mental health and my hip injuries.  Everything seems to be going smoothly so far, but my psychiatrist, who diagnosed me with both GAD and PTSD, is only putting PTSD on the NARSUM, while stating that he does not agree with the GAD diagnosis.  Is this going to effect my overall rating on the DoD side?  I understand that there can't be two different mental health ratings for the VA portion, and whichever is rated higher is the one that they go with, but am not sure if this is the same for the DoD side.  If this is something that could effect my rating, however, I plan on sitting down with me PEBLO and requesting an IMR and/or writing a rebuttal.  I'm also curious as to how much I may be rated for this.  On the NARSUM it states that I have a GAF of 46/I have moderate symptoms/and my future prognosis is listed as "fair".

The next question is about my chronic hip pain.  In 2009 I cracked a femoral neck bone and had to have 3 screws inserted.  In 2013 I reinjured the same hip and had to have arthroscopic surgery to replace a torn labrum and shave some bone.  I am still having chronic pain afterwards, however, and the doctor says that I have frozen hip and there is a possible chance that I am in the 15% category that is a clinical failure (the surgery did not work).  Will the DoD take into account both of my surgeries and the fact that I have had complications with the hip for long periods of time?

If anyone could offer me any advice I would greatly appreciate it, and if any more information is needed please just ask and I will try to fill in those blanks so it makes more sense. 

-Matt

 

[Andyman73]

DevilDawg,

Goodonion(good on ya) for jumping on this before your EAS!  It will pay dividends for you for sure!  First off, welcome to Hadit, founded by the wonderful Tbird, for Vets to help Vets deal with the VA grinder.

As for your hip, the easier one for me to answer, with my tiny little bit of knowledge and experience.  The VA(not DoD) rates most joint/bone type claims based on Range of Motion(ROM).  This means that the reduced range is what gets you your rating, for the most part.  You can look on this website, under the main heading of Forums, scroll down to the CFR section and click on the rating tables and scroll to the hip joint section. 

There aren't any 5% ratings, the VA works in whole 10s(10, 20, 30 etc).  But they use their own special fuzzy math for combining ratings.  So if they told you maybe 15%, then odds are 20% or more.  If you already know your reduced ROM, it would be fairly easy to figure out.  As for the failed surgery and the screws, this will play a big part in your outcome.  If the military Dr. diagnosed you(DX) with frozen hip(no ROM, or extremely limited ROM), you could be looking at 50% or more. 

If you don't already have, make a complete copy of your medical record!!!  Nothing in your possession can disappear, if you have a hard copy of it.  This includes any and all labs, x-rays and radiology reports and so on.

Now back to your first question, which is less known to my brain housing group.  The VA has moved away from GAF scores, for ratings, even if they still used them for informational purposes only.  Have you had your exit physical health questionaire session yet?  If not, make sure to tell/mark off everything!  If you have sleep issues, trouble sleeping, nightmares, night sweats, so on, make it known.  It's nearly guarenteed if you have PTSD, you have sleep issues too.  Kinda goes hand in hand with PTSD and many other types of MH illnesses.

The "Sleep Disturbances" claim would be secondary to PTSD, and can be filed right away as well. 

I hope this helps you.  I've only been on this website for less than a year and have gone from 40-80% during that time.  It won't be easy or quick, for the most part, but some miracles happen and Vets get the right rating very quickly. 

There are many Vets on here that have forgotten more than I know, who will give you better direction.

Semper Fi.

Andyman

[USDevilDawgMC]

Thanks for the reply Andyman,

I did see the VA about some other other conditions as well already.  I don't get much sleep at all and was diagnosed with sleep apnea after a sleep study not long ago.  They are ordering me a machine so hopefully that will help me out.  

The hip and PTSD are my DoD conditions going to the board and for the VA I have those two, sleep apnea, neck condition, shoulder condition, both wrists, a foot injury, osteoarthritis in the hips, and a back injury.  

I already got a copy of my entire medical records but some issues are still ongoing so I get those when I can.

-Matt

[Andyman73]

DevilDawg,

You're welcome.  Having your complete medical record puts you ahead of the curve, already, even before you transition from AD to Veteran status.

Thank you for your service.

I understand the sleep thing.  I've been DXd for nearly 2 years now, with SA.  And have been using my CPAP ever since.  I no longer snore like a grizzly, sitting on an idling Harley riding, on a moving freight train, pulled by a pair of Big Boy steam engines.  But still sleep like crap.  My bp has come down some and my acid reflux/heartburn went away, but still, I sleep like crap.

Once you gain Veteran status, you will want to order your C-file, which contains all info related specifically to your VA claims.  Most of the info may be accessible via Blue Button download on MyhealtheVet.  But not all of it will be, so that is why you will need your C-file.  As I understand it, you get one free copy.  However, if you order updates, say every 6 months, or once a year, but only starting on the last day of record on your C-file, covering the new period.  That should keep you in the free copy range.

I must reiterate, joining this 'net family is one of the most important choices you will ever have made in your life.  With the info and guidance available here, you will be successful with any and all honest claims for compensation.

Semper Fi.

Andyman

[USDevilDawgMC]

So I was able to look up the ROM that the VA put down for my hip.  This is what they are stating.

Flexion (0-125 degrees) - 0 - 120 degrees

Extension (0-30 degrees) - 0 -25 degrees

Abduction (0-45 degrees) - 0 - 30 degrees

Adduction (0-25 degrees) - 0 - 20 degrees

External Rotation (0-60 degrees) - 0 - 45 degrees

Internal Rotation (0-40 degrees) - 0 - 30 degrees

Any idea on what I am looking at based off of these numbers?  I also feel as though these numbers don't represent a frozen hip like my surgeon is telling me I have.  Is it normal for these VA C&P examiners to just rush people through the process and put whatever number they feel like on paper?

It also states that adduction is limited such that I cannot cross my legs, that it contributes to functional loss, that pain was noted on examination, there is objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue (which is listed as mild), and there is pain noted with flexion, abduction, adduction, external rotation, and internal rotation.

Thanks in advance for any feedback and advice on this information! 

-Matt

Edited December 4, 2015 by USDevilDawgMC

[Andyman73]

Matt,

Now that you have that, you can compare it to the CFR rating chart and give a good guesstimate.

 

	Rating
5250   Hip, ankylosis of:
Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated	390
Intermediate	70
Favorable, in flexion at an angle between 20° and 40°, and slight adduction or abduction	60
5251   Thigh, limitation of extension of:
Extension limited to 5°	10
5252   Thigh, limitation of flexion of:
Flexion limited to 10°	40
Flexion limited to 20°	30
Flexion limited to 30°	20
Flexion limited to 45°	10
5253   Thigh, impairment of:
Limitation of abduction of, motion lost beyond 10°	20
Limitation of adduction of, cannot cross legs	10
Limitation of rotation of, cannot toe-out more than 15°, affected leg	10
5254   Hip, flail joint	80
5255   Femur, impairment of:
Fracture of shaft or anatomical neck of:
With nonunion, with loose motion (spiral or oblique fracture)	80
With nonunion, without loose motion, weightbearing preserved with aid of brace	60
Fracture of surgical neck of, with false joint	60
Malunion of:
With marked knee or hip disability	30
With moderate knee or hip disability	20
With slight knee or hip disability	10

³Entitled to special monthly compensation.

Yes, yes they do have a very nasty habit of ignoring what's right in front of them, and what the Vets tell them, and mark off what ever they want during the C&P exams.  50% or more of appeals and NODs are based on examiners marking the wrong boxes during exams.  Every so often they forget what they're doing and get it right.

I've developed pain in my pelvic girdle over the last few years.  Mostly I thought it was just an extension of my low back pain.  I had a C&P exam for it a month ago, and the ROM numbers were reduced across the board, for both.  But the examiner gave me the "less likely than not" opinion that it is secondary to my feet, ankles, knees, and low back.  Ok, but I did fall down a flight of stairs, which started those previously mentioned SCDs.  When the examiner was moving my legs to check the ROM for pain limits,...wow, it hurt way more than I could have imagined, and he wasn't trying to hurt me.  I couldn't get up off the exam table, much less sit up, without his help.

When I get a chance I will post my numbers here, so you can get an idea.  And I'll let you know what the RO decides as for SC, or not, and at what level.

Semper Fi.

Andyman

[Navy04]

USDEVIL,

I totally understand that this whole MEB/PEB, IDES as they call it now, can be a Stressful Process. You are in better shape then you think. I went thru this as well, and was Medically Retired from the Navy in 2013. I was very scared, cause I too did not know how this process works. It looks like the process is moving along. As far as your Psych Doc, that is how it goes. I was only Medically Retired for Crohns Disease and PTSD, yet the VA granted a ton of SCs at high %s as I had a lot of medical issues. The Navy decided just to go with those 2 conditions and not I am Permanently Retired from the Navy and VA, and I collect SSDI, and I am only 33. Good luck, and keep us posted as you go thru the different steps. My whole process from start to Retired was about a year. I hear that the process is a lot smoother now, and also you need to realize, that most DOD folks, do not have a lot of Experience with the MEB/PEB process, and there is always high turn over. God Bless