How can I initiate an MEB if my PCM won’t?

2021-10-15T17:04:19-04:00

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?

Response by SFC Kelly Fuerhoff made Oct 15 at 2021 6:24 PM

2021-10-15T18:24:25-04:00

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.

Response by SFC Jake Middaugh made Oct 15 at 2021 8:55 PM

2021-10-15T20:55:59-04:00

There are two ways to begin the MEB process:
1) When you have a P3/4 Profile. Obtaining a permanent profile requires that you have the same profile that has been continued 3x for a total of 1yr.
Or
2) Your Commander can initiate an MEB

Response by MAJ Byron Oyler made Oct 16 at 2021 1:44 AM

2021-10-16T01:44:09-04:00

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.

Response by SFC Private RallyPoint Member made Oct 16 at 2021 7:24 AM

2021-10-16T07:24:47-04:00

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

Response by SGT Private RallyPoint Member made Oct 16 at 2021 9:58 AM

2021-10-16T09:58:33-04:00

Sounds like my back without having the surgery. Hurts when standing, sitting and at times when laying down. You then discover what seems the most comfortable thing to lie down on is an X-ray table. The only safe exercise going forward will be swimming and while swimming suck that abdominal muscle in to support your back. Physical therapy for pain control. Stay off pain killers and muscle relaxers if possible. If you take pain killers there is the chance of addiction and doing more damage to your back because since the pain is gone you act like you don't have an issue. So you end up causing more damage.
The best therapy is aquatic therapy in a heated pool. It does wonders. I get to start back next week and can't wait.

I have a questions for you. Has this condition caused a decreased feeling in your feet. Has your PCM diagnosed you has having neuropathy in your feet? If not make sure they check your feet out. I have nerve root impingement at L4-L5 causing neuropathy in both feet which has resulted in multiple falls causing fractures in both legs, a ruptured ACL, a torn meniscus and 2 fractures in the left arm. All because my feet can't fell the ground in my shoes which is why when walking thise short distances I do so barefoot. I have yet to experience a fall while barefoot.

Response by SSgt Christophe Murphy made Oct 16 at 2021 8:22 PM

2021-10-16T20:22:03-04:00

Short answer you can’t. The patient doesn’t initiate a med board the provider does.

The good news is that you are more than welcome to get a second opinion. Get a new provider and pursue it.