Can An Army PCM Refuse a Request to See Medical Specialist?

1LT Private RallyPoint Member — Thu, 02 Jan 2020 12:16:59 -0500

So I am experiencing pain in my foot (associated with a popping noise when fully flexed), of which I have been experiencing for 9 months now. My PCM recently prescribed Physical Therapy for me. However, I have several issues about PT and him refusing my request to see a Podiatrist. In the same 9 months I saw a Physical Therapist for my Knee Pain, my foot and knee pain occurred during the same time. However, my first Physical Therapist found my foot pain irrelevant.

Physical Therapy never made my knee pain better, often I would leave Physical Therapy limping as my pain would be severely worse after Physical Therapy, after just getting tired and arguing with my Physical Therapist about Physical Therapy not working, I checked myself into the ER as my last round of exercises left me unable to walk without a severe limp and intense pain.

(I understand that some of you may mention muscle soreness. As soldiers we experience muscle soreness all the time, this was pain that I never felt before and I attempted PT for 9 months, with no improvement.)

At the ER they were surprised that in 9 months I was never referred to Orthopedics and never received further diagnostic examination for my knee pain. They referred me to Orthopedics and after one visit I received a steroid shot that almost overnight greatly lessened the pain in my knee. While I still experience some pain, it is now a go and comes type of pain, instead of a constant pain. I can walk without fear that my knee is going to give out due to pain.

In all, I was hoping for a similar experience with my foot after seeing a Podiatrist, but my PCM has refused my request. I believe it is because I am in the process of a MEDBOARD, he is acting in the best interests of the Army above mine.

My question is, can my PCM refuse my request to see a Podiatrist?

NOTE: A PCM does not have to be a Medical Doctor, a Nurse Practitioner or Physician Assistant can be a PCM in the military. Note I been in the Army for close to a decade now.

Response by SrA John Monette made Jan 2 at 2020 12:28 PM

SrA John Monette — Thu, 02 Jan 2020 12:28:17 -0500

i wouldn't think the could refuse your request to see a specialist. can you go to a civilian podiatrist instead?

Response by Kim Bolen RN CCM ACM made Jan 2 at 2020 12:29 PM

Kim Bolen RN CCM ACM — Thu, 02 Jan 2020 12:29:11 -0500

Yes, he can refuse, from what you are describing here, podiatry is not where you need to go. Orthopedics maybe a better option then they can refer to a foot and ankle specialist. Although, I have no doubt that the MEDBOARD process is in play here and everywhere.

Response by MSgt Michael Smith made Jan 2 at 2020 12:38 PM

MSgt Michael Smith — Thu, 02 Jan 2020 12:38:46 -0500

Yes he or she can. But you can keep on asking and asking and going to the Doctor. Eventually you are going to probably get Med-boarded, and then you have to deal with proving it to the VA. Get lots of documentation. What you are describing is VERY common in military medicine.

Response by MAJ Byron Oyler made Jan 2 at 2020 1:35 PM

MAJ Byron Oyler — Thu, 02 Jan 2020 13:35:14 -0500

Your PCM is in all likelihood not refusing you to see a podiatrist, in their professional opinion they cannot justify the consult. There are professional standards that are expected to be met before they can do a consult and at your facility for what you are presenting, PT maybe one of those standards. Do as your PCM asks and you will have better grounds to get that podiatry consult, especially if you need to seek a second opinion. Doing your own thing when requesting a second opinion probably will not go well for you and as a seasoned military RN, go see PT for your foot as your PCM requests.

Response by CSM Darieus ZaGara made Jan 2 at 2020 2:02 PM

CSM Darieus ZaGara — Thu, 02 Jan 2020 14:02:42 -0500

Based i. Other comments I will add only this. I would explain what the ER did, and respectfully ask your PCM to indulge you and allow you to seek a second opinion from another Doctor on staff. Oh, and don’t contact the DAV, they have no dealings with active duty. Thank you for your service.

Response by 1LT Private RallyPoint Member made Jan 2 at 2020 2:57 PM

1LT Private RallyPoint Member — Thu, 02 Jan 2020 14:57:35 -0500

NOTE: In the Army a PCM does not have to be a Medical Doctor, a Nurse Practitioner or Physician Assistant can be a PCM in the Army. Also I been in the Army for close to a decade now.

Response by SFC Private RallyPoint Member made Jan 2 at 2020 5:08 PM

SFC Private RallyPoint Member — Thu, 02 Jan 2020 17:08:08 -0500

Yes they can, in order for you to see a specialist your PCM is required to place a consult. Your PCM may simply not be able to justify the referral. Just because "they" at the ER believe you should see a podiatrist off of one visit, does not mean you should. The job of the ER is to treat immediate injuries, not sustained care.

However, PCMs are not always correct. If you believe that your PCM is wrong, you are entitled to request a second opinion.

Since you are in the Med Board and this could be a potentially disqualifying condition, this is something you could easily bring up with your PEBLO and MEB physician to be evaluated and treated for.

Response by CPL Gary Pifer made Jan 2 at 2020 5:55 PM

CPL Gary Pifer — Thu, 02 Jan 2020 17:55:37 -0500

Start learning US Code Law.. Army and VA regs on disability and MEB PEB... Knowledge.. If they refuse... pay for an exam yourself and have the Doctor opine within a Nexus letter. Now is the time to LEARN and take ACTION. Everything is found online.

Response by SFC Private RallyPoint Member made Jan 2 at 2020 9:29 PM

SFC Private RallyPoint Member — Thu, 02 Jan 2020 21:29:44 -0500

I had the same issue before with my right knee. I called TRICARE and changed my PCM. Got the referral to Orthopedic and long and behold I had a meniscus tear and some shredded ligaments in my knee. My surgery was in August and I’m still in physical therapy as of today.

You know your body better than anyone else. You always have an option to change your PCM if you feel you’re not receiving adequate care. The longer you wait the more severe the long term damage can be. I hope this helps. Good luck to you...

Response by CPT Private RallyPoint Member made Jan 3 at 2020 12:06 PM

CPT Private RallyPoint Member — Fri, 03 Jan 2020 12:06:32 -0500

I'm a Nurse Practitioner on the civilian side. For injuries like this, the standard of care is usually x-ray and symptom management, and a referral to physical therapy. MRIs are expensive, and insurance usually won't approve them or other more expensive diagnostics or treatments until you have SUCCESSFULLY completed physical therapy and are still having issues. The reasons are simple, physical therapy is cheaper and resolves a large majority of musculoskeletal pain. If there was nothing visible on the x-ray and you haven't completed PT, then there is currently no indication for anything further. Do the PT, if you are still having issues, go in and ask for further testing or a referral.