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I’ve had 2 back surgeries in 2 1/2 months and my issue is not getting better. I have scar tissue surrounding my L4-L5 nerve root and the neurosurgeon won’t operate to remove it because of the risk involved. I can’t stand for long periods or even sit up without being in excruciating pain. What should I do if my PCM is refusing to send my case to a MEB if I’ve exhausted all treatment options?
Veterans Affairs (VA)
Discharge
Medical Board
Disability
Posted 3 y ago
Responses: 6
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Do you have a perm profile with 3, 4? If you do, you're supposed to be referred to MEB/PEB.
You may want to peruse AR 40-502 and AR 635-40.
You may want to peruse AR 40-502 and AR 635-40.
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Under Tricare you are entitled a second opinion. Entitled, not just authorized - it is your right as a patient to demand a second opinion and receive one. It's a lot easier than requesting a PCM change because PCMs are usually aligned to your unit. You can also request a second opinion for the neurosurgical consult. It's very possible that no neurosurgeon will operate due to the risk, but you have a right to hear that from a second surgeon as well.
To initiate a P3 most providers will require that you've pursued all avenues of treatment. It sounds like you've had enough time to attempt all of that.
Now, what to do if you've had your second opinions and it hasn't resolved your case. First, bring your case to your Brigade Sugeon and then to your Division Surgeon. The BDE surgeon has authority over your PCM and can review the case. The Division Surgeon is the Provider who must sign off on all P3 profiles. If that doesn't work, go to the Ombudsman of your local hospital. There is no IG for medical care, the Ombudsman is the one who reaches out and makes things happen when they aren't happening like they should. You can also use the Patient Advocate at your hospital as well, and I would suggest you consult them before the ombudsman, but they have limited authority.
If all that fails you can file a Congressional complaint. But, before you file that you need to make sure you've closed the loop on everything there is. There can't be any legitimate reason left for your PCM to delay your MEB. If the Congressional office calls your PCM and your PCM hasn't initiated your MEB because they still need to send you to Pain Management before they initiate the MEB, then that was your one shot and it's gone. So make sure it's your very last resort
To initiate a P3 most providers will require that you've pursued all avenues of treatment. It sounds like you've had enough time to attempt all of that.
Now, what to do if you've had your second opinions and it hasn't resolved your case. First, bring your case to your Brigade Sugeon and then to your Division Surgeon. The BDE surgeon has authority over your PCM and can review the case. The Division Surgeon is the Provider who must sign off on all P3 profiles. If that doesn't work, go to the Ombudsman of your local hospital. There is no IG for medical care, the Ombudsman is the one who reaches out and makes things happen when they aren't happening like they should. You can also use the Patient Advocate at your hospital as well, and I would suggest you consult them before the ombudsman, but they have limited authority.
If all that fails you can file a Congressional complaint. But, before you file that you need to make sure you've closed the loop on everything there is. There can't be any legitimate reason left for your PCM to delay your MEB. If the Congressional office calls your PCM and your PCM hasn't initiated your MEB because they still need to send you to Pain Management before they initiate the MEB, then that was your one shot and it's gone. So make sure it's your very last resort
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SSG (Join to see)
Thanks.
Injury occurred in June 2020. Did 3 months of PT. Was prescribed all types of medications to try and stop the nerve pain which didn’t work. Then sent to pain management and had to get back injections which didn’t work. I PCSed in January and was sent to a neurosurgeon and told I should have had surgery 3 months after the injury. Have had 2 surgeries in 2 1/2 months with no relief. Doctor told me yesterday that I don’t meet the requirements for a MEB and have to start the process all over again. I’m waiting for a call from some colonel on Monday to talk to because I’ve literally exhausted all treatment options and I’m not exactly sure what PT is gonna do if I can’t sit or stand for long periods of time. AND I’m expected back at work 1 Dec
Injury occurred in June 2020. Did 3 months of PT. Was prescribed all types of medications to try and stop the nerve pain which didn’t work. Then sent to pain management and had to get back injections which didn’t work. I PCSed in January and was sent to a neurosurgeon and told I should have had surgery 3 months after the injury. Have had 2 surgeries in 2 1/2 months with no relief. Doctor told me yesterday that I don’t meet the requirements for a MEB and have to start the process all over again. I’m waiting for a call from some colonel on Monday to talk to because I’ve literally exhausted all treatment options and I’m not exactly sure what PT is gonna do if I can’t sit or stand for long periods of time. AND I’m expected back at work 1 Dec
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SFC (Join to see)
SSG (Join to see) Army medicine requires exhausting all treatment options first before initiating a MEB. Some Division Surgeons won't sign off on a P3 unti you've been to PT and Pain Management two or three times. But you still have the right to a second opinion so start there.
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Request a different PCM and get your command involved in requesting a different PCM. There are so many that bull shit about back pain and those asses may very well be making it more difficult for you. The fact that you cannot sit is a hallmark sign of someone with real back pain. Get an officer in your chain of command that supports you to help you get a PCM change, field grade or higher is better because they will outrank many of the docs performing patient care and they cannot tell them to fuck off.
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