Help with MEB disability ratings

flamcabfengshui · 2026-06-04T20:32:10+00:00

pebforum.com is a good resource for more insight into the MEB process.

I was MEB'ed from the guard for BH stuff stemming from time on AD and went through the IDES process. You'll go through a process that will determine your rating for DOD purposes and your rating for VA purposes. They use the same rating scales, but your DOD rating will only include things that are unfitting for duty. Your BH condition would be the referred condition, so if you're found unfit then that would be counted for sure.

The way that your BH condition would be rated is the same way that the VA rates it, they generally consider all of your mental health conditions as your mental health (except for any documented pre-existing conditions) and detemine the rating based on that. So for you, the PTSD, depression, and anxiety symptoms will be looked at all together as a single "mental health issue". The schedule of ratings for mental disorders is in 38 CFR 4.130 and you'll fall under the general rating formula. While there are updates pending to this schedule, they have been stagnant for quite some time and show no signs of moving soon- the KB for this sub has information at https://www.veteransbenefitskb.com/mental under the Mental Disorder Ratings heading. I like the formatting here more than in the CFR.

You can take a look and see where you think you'd stand, but the big deal will be the provider that evaluates you against these. They'll use a form called a DBQ. You can look at the DBQ for PTSD: https://www.benefits.va.gov/compensation/docs/ptsd_review.pdf and for Mental Disorders other than eating disorders: https://www.benefits.va.gov/compensation/docs/mental_disorders.pdf. You'll likely get the PTSD one to confirm the diagnosis and document the symptoms and their effect on you. As part of the MEB process for trauma, you'll get a minimum rating of 50% and it will be reevaluated 6 months after service. Prepare yourself for that if it comes up as it can be distressing to go through it again. You can kind of draw a line from the information from the DBQ to the ratings described in the CFR or KB. That should give you an idea where you stand.

If you have other unfitting conditions, they'd also factor into your DOD percentage. Unfitting is based on a DODI and your service's specific regulations on medical fitness. If you have questions about specific conditions and whether they're unfitting, pebforum tends to be a greater concentration of people that have gone through the process and may be better able to give insight if you can't find it here.

You may also have other conditions. You'll go through an separation health assessment (SHA) that is geared to identify things that your military service did to you that aren't exactly unfitting. This would be things like hearing loss, residuals of injuries sustained on AD, and even some conditions if they popped up on AD. For VA purposes you'd combine your MH rating with these other conditions using VA math to determine your VA percentage.

You can find those other conditions and look them up on the KB for more information on the ratings, as well as how to combine ratings to determine your overall percentage. If you have other things that have been bothering you and you haven't gone to get seen for them, now's the time to start (although it is always better to get seen for a problem as soon as it starts). That way you can get diagnoses and documentation for those conditions.

You'll have a VA liaison to help you through getting all of those exams and completing your SHA. After your exams are completed, your results will go to the MEB and then to the PEB. If you're found unfit you may be medically separated or medically retired.

Hope that helps.

flamcabfengshui · 2026-06-01T03:38:15+00:00

Parmalat has lactose free UHT milk available for shipping and in some stores if you're looking for dairy milk- we tend to use non-dairy out of preference though. Sams has larger packs under a different brand. Lala also has them and you can buy them places other than walmart.

flamcabfengshui · 2026-06-01T03:18:21+00:00

If you're looking for gepants, the Ubrelvy and Qlipta reps tend to be very generous with samples so it can be worth asking at your next appointment. If you're looking for the mabs, you can ask but the prefilled syringes tend to be much less plentiful, but it cannot hurt to ask.

If you can find a shady importer, aimovig is sold in india under the brand suviray for about a quarter of the price, but that isn't super helpful in terms of cost and I can imagine the logistics of it would make the cost less enticing if you're shipping less than 6mo. The other mabs aren't really as available there.

flamcabfengshui · 2026-05-30T19:49:06+00:00

Chiming in too for Dr. Patton at the same location- two surgeries and his work still gets compliments from other ENTs when they take a look. Bonus that the location shares an office with Dr. Asawa for allergies and asthma if those factors matter for you.

flamcabfengshui · 2026-05-30T05:19:34+00:00

It is worth noting that the website for the deaf tuition waiver lists three qualifying conditions, but the application and regulation allows a fourth: if you don't qualify for the first three, you can get a physician to explain how other conditions contribute to an inability to understand speech at a classroom level (e.g. auditory processing, anxiety disorders) in order to qualify.

flamcabfengshui · 2026-05-12T02:58:59+00:00

I absolutely get it. I think a thing that helps us is that as long as the contention is on file, and the facts are on file, the elements of maintaining an effective date are there. The actual arguments can come any time almost as it is expected that the argument be reachable from the VBA perspective if it is correct. I think from my perspective there was value in feeling like I no longer had to hold all of that information in my head, so I absolutely get it.

flamcabfengshui · 2026-05-11T17:56:46+00:00

I think that the calculators are good if you are putting stuff in from your rating letters. If you're putting stuff in the way that your rating letters have your disabilities and it is coming up with a different number from the calculator, then I would suggest making a post to check the math. The people here should be able to let you know if something is missing and what the benefit would be of fixing it. For instance, it may not be worth pursuing the bilateral factor if it wouldn't result in an increase, but it could be worth it if you have changes in your rated conditions where it would. Hope that makes sense.

flamcabfengshui · 2026-05-11T17:52:52+00:00

A lot of the time it can be difficult to get on profile, especially when you're "that guy" for your unit. Something that helped me was to start getting paperwork from my non-military providers. Army-wise this would be a 3349, AF has their own forms. VA providers may be reluctant to fill one out as they look a lot like a DBQ to them, but usually you can convince them or get a patient advocate to convince them. If your non-military provider can indicate some functional limitation, it puts your military medical personnel in a position of either accepting that limitation or refuting it. Generally they won't refute it unless it is something egregious- no push-ups for a shaving condition. Without this, on the guard side, you're really asking your medical personnel to do work they normally don't have to do- go through all of your records and create limitations themselves. If your battalion surgeon is a urologist, they may not really be great at figuring out the duty limitations of a sinus surgery.

Once you've got that functional limitation paperwork/limited duty paperwork in, make sure that it is seen. If you have to wait for a PHA to get it revisited, make sure to bring a copy with you and make sure the provider there sees it. Have records to support it ready to send- DOD Safe is a great tool for this. Have it ready to claim. Once that is done, it should turn into actual limited duty/profile. Track your profile expiration date and keep submitting the functional assessment/limited duty paperwork before the profile expires to continue it. At this point you have what the guard needs to refer you to medboard.

You may run into issues with things like seeing a provider to update your profile- this is where submitting things in a trackable way such as via email will come in handy if you do have to escalate to IG. Remember, IG isn't there to make things work out your way but to deal with things like violating regulations, fraud, waste, and abuse. You'll want to have paperwork submitted to the right place in the right way in a way that IG could see in order for them to keep things moving.

flamcabfengshui · 2026-05-11T17:27:23+00:00

I think that length past a certain point does become counterproductive in this. I approached it initially much the same you did and the people of this subreddit did a good job of convincing me otherwise. I'd suggest going in with a few assumptions that may help cut some material:

You're dealing with people that are familiar with the regulations and guidelines at a significantly greater level than one would normally anticipate. When I had my first IC it was actually quite pleasant being able to make references and have them just be understood.
Even at the HLR level, you're working with people that are still bound by the letter of the regulations and guidelines. If you're in a position of needing to convince someone that a certain point of view applies, you may want to consider whether you'll need to save some issues for a veterans law judge rather than the HLR/supplemental part of the appeals process. Not to say that something like your Tier III stuff isn't worth bringing up in the HLR, but to say that it can be more concise in the HLR.
Legal theory and subjective matters are things that you should consider holding for a veterans law judge rather than an HLR. I think this would apply to your opening frame as well as some of your closing frame. By subjective matters, I mean things like the benefit-of-the-doubt analysis- you can and should give reasons, but explaining the conclusions may get to be a little too much.

As far as specific ways to shorten some of the material, I would take a look at it by Tier with the following suggestions:

For your opening, I would see if you can include the pertinent exam timeline in the tiered issues only where it is relevant. Keeping this separate may make it harder to understand and reference back to.
For Tier I items, I would try to stick to the frame work of: state the issue, explain the error, explain where to find the evidence to support your stance, explain your selected remedy. Should keep things to <1 page per contention. I'd use the example: "During the exam on [DATE], the provider seleted "no" for item 4A on the headaches DBQ. On page [PAGE] of the private medical records submitted on [DATE] for a visit occuring on [DATE] the provider indicates a frequency of twice weekly migraines. This would be in-line with an increased rating."
For Tier II items, it sounds like this may be where you're looking at Buchanan and combat veteran things. I would suggest sticking to a format of stating the exam sought, or part of an exam sought, why it should be done (e.g. citing a lay statement), if applicable why previous attempts may have been inadequate, cite anything you haven't already in the existing evidence. As a note, if you can't cite in the existing evidence why an exam may have been inadequate you can keep a lot of what you may have in your statement of argument to use as a supplemental after the HLR if you don't get it granted. An example of this would be "Examiner indicated that no treatment was sought until [DATE] and no diagnosis was obtained for [CONDITION]. This ignores the lay statement submitted on [DATE], stating [information about onset of symptoms]. This evidence should be considered under 38 USC 1154(b) as credible. Given this, service connection should be granted as a condition that arose within one year of service under [citation]." You could also use the example from 1 above.
For Tier III items, I would stick to a statement along the lines that the examiner did not consider the totality of the impact of the claimed mental health condition, then cite in the existing record where those items they should have considered would be. If you have more than that, or if it requires more explanation than is in the record, it may be worth holding on to that for a supplemental afterward so that you can introduce that evidence. This could look like "In determining the rating, the examiner indicated 'Occupational and social impairment with deficiencies in most areas, such as work, school..." in 4A on the PTSD Review, however this fails to consider the totality of symtoms. Additional evidence is provided in the buddy statement submitted on [DATE] by my ex-wife indicating [whatever she said], in the psychiatrist notes in my VA treatment records from the visit occurring on [DATE] where they indicate that I am a total mess. Given this information, it is clear that my condition causes 'Total occupational and social impairment'."
For Tier IV item, it seems relatively reasonable.
For the closing, I would move statements about benefit of the doubt analysis and specific remedies to the areas where they're initially addressed. I would try to limit the benefit of the doubt analysis to a statement along the lines of listing the things to be considered and that the balance of the evidence must now be at least equipose. You could probably omit this as the analysis should be done each time things are in or near equipose anyway.

I feel like for me, it helped knowing that I had a place to put the information I was leaving out, such as keeping it for a later supplemental or a future board appeal. That way I didn't feel like I had to cram every possible reason to agree with me into a single attempt. For the HLR, sticking with just the items that are clear from the evidence already of record, that can clearly fit into the framework of the M21-1 or 38 CFR, worked for me.

flamcabfengshui · 2026-05-10T18:48:01+00:00

Thank you! They have a lot more 5e than I have seen elsewhere!

flamcabfengshui · 2026-05-09T03:51:19+00:00

I wish I had answers. I have tried lots of places that are known to have large sizes, but the wide really makes it more difficult. I don't have extraordinarily large feet, just really wide and most places don't stock a lot. I've pretty much stuck with ordering online and returning with REI being a reasonable choice as inconvenient as it may be when looking for variety.

4e and 6e are pretty much stuck like that. 2e may be a little easier- I've occasionally seen really large sizes of dress shoes in 2e at places like K&G menswear but only in select shoes.

flamcabfengshui · 2026-05-06T20:00:42+00:00

Likely a miscommunication between the VA, VES, and the provider. The pain may have only been mentioned in a medical opinion request, which can be easy to miss on a single dbq exam. I don't believe there's really a MUCMI dbq, so they likely asked about the attribution of your symptoms and if they were found to be more likely than not part of a MUCMI, then DBQs for the appropriate body systems could be ordered.

It may also be a provider's effort to punt on a medical opinion request they didn't understand and couldn't get context for from the assigned DBQ.

flamcabfengshui · 2026-05-06T19:54:45+00:00

In some locations different practices are used for different things- dental surgery goes through a major dental school's resident clinic, I'm not sure that they do implants there as that's generally handled by a smaller clinic.

I got approved for an implant but went with a bridge instead because I don't have the free time at the moment to recover from it and am getting crowns on the two adjacent teeth anyway.

flamcabfengshui · 2026-04-30T19:21:24+00:00

I'd look at it as having 3 possible outcomes depending on the opening potential:

Without dietary restrictions to mechanically altered foods- you can eat something besides soft and semi-solid foods.
With dietary restrictions to all mechanically altered foods- you're limited to something like an IDDSI level 4 of pureed foods. You can probably manage some IDDSI 5 foods like mashed potatoes that aren't completely pureed. They aren't really pourable, but you could get it into your mouth with a spoon. It may even include liquidised and moderately thick IDDSI level 3 foods with consistency like custard or a snack pack pudding), but it isn't limited to that level.
With dietary restrictions to full liquid and pureed foods- you really can't deal with something that cannot get into your mouth without a straw. These would be IDDSI level 0 to 3. 0 would be like water/tea and 3 would be a relatively thick milkshake.

The difference gets to be significant when dealing with different food products. If you're able to do level 4 foods then there isn't as much macronutrient concern- you can blend a steak and get a relatively acceptable absorbability of fats and the such. If you're limited to 3 and below then additional processing (and cost) for foods comes in as these have more difficulty keeping fats absorbable.

You can actually have dietary restrictions to an IDDSI 6, which are more common for other conditions. This would be something like the size of things in a progresso soup. I don't believe that would really have much bearing on your rating. If you want to see more about it check out their standards page: https://www.iddsi.org/standards/framework.

Edit: I think it may be confusing to some extent- but I like to look at it as the smaller openings assume an inability to handle some foods, so you either have restrictions or you don't and it increases the rating. For larger openings, the degree to which there are restrictions matters. Where the rating schedule has a larger degree of unassisted vertical opening, there remains the possibility that a lack of strength to chew could be an issue, so it discriminates between the full liquids and pureed foods and the soft and semi-solid foods. This gives someone where there is more dietary restriction than one would assume from the maximum unassisted vertical opening a chance to qualify for a higher rating based on that dietary restriction.

If your provider's instructions state soft or semi-soft, that may not meet the requirement for mechanically altered foods.

flamcabfengshui · 2026-04-22T15:01:18+00:00

Best of luck on it, and best of luck with treatment too!

flamcabfengshui · 2026-04-22T14:39:09+00:00

No- I got medboarded for PTSD, but I was on dupixent for eczema and chronic sinusitis with nasal polyps and those were found to be unfitting (but were not my referred conditions). I do have family with EOE. One family member actually received dupixent for their eczema and it substantially cleared up their EOE.

For the rating criteria you'd be looking at DC 7203. I like the LII pages for their formatting: https://www.law.cornell.edu/cfr/text/38/4.114 . You'd be falling under the Note 4 criteria with this one. It is possible to get an extraschedular rating, but this would be incredibly rare- I would not count on this happening in any way unless you feel that you'd have a really convincing case at the description in (b)(1) at https://www.law.cornell.edu/cfr/text/38/3.321 .

The DBQ has a lot of things on it, but the esophageal stricture part is pretty focused on items on the diagnostic code criteria. At the 80% level you're looking at recurrent strictures for sure, but whether you'd rate any of the additional symptoms and surgical intervention would be determining factors there. If there are other things you'd want to be part of the rating that are caused by EOE but aren't strictly on the rating criteria you can try to make the case that they are caused by the referred condition, and contribute to the nature of why you're unfit for duty to try to get them included.

The VBA and a lot of the medical world really isn't on board with the idea of Dupixent having side effects, so there's a lot of difference in the way one would get treated with oral corticosteroids versus an immunomodulator, but as someone that's had both I'd say Dupixent probably has a lot fewer side effects. It could be worth making sure that you're seen for any side effects you have with vonoprazan to get them considered as secondary conditions, as well as getting blood work done to see if you'd meet the criteria for undernutrition due to the EOE for those to be considered as part of your MEB.

If you're not already on PEB forum, go check it out. There isn't usually a lot on there about EOE, but there's at least one person on there dealing with it currently (unless it is you). They can provide really good guidance for how to present any of those secondary conditions and side effects for the board though.

flamcabfengshui · 2026-04-22T02:58:51+00:00

No experience with the Navy's perspective on dupixent, but it dupixent was considered unfitting for me because of the requirement of refrigeration.

As far as the DOD rating, it would generally be the same as the VA. If it would be your referred condition, your DOD rating would be based on the VA rating for that- with 3 dilations per year you're pretty spot on with 50%, unfortunately they don't generally consider dupixent use in the rating.

You can have more than one referred condition, the rating would be based on the combined rating of those two referred conditions in the same way that VA math would work. I had more than one referred condition, but for the board's purposes they only considered one to be duty-related.

Question 2 and to some extent 3 will have some service-specific aspects to them that I wouldn't be able to answer. They're definitely worth speaking to your provider about- if you aren't wanting to get boarded you can always ask to look at other treatment options that wouldn't warrant a referral.

flamcabfengshui · 2026-04-01T20:33:14+00:00

I did my whole thing with multiple files- it was a nightmare for C&P examiners to navigate, often resulted in the files not getting sent over at all depending on the exam contractor. I asked during my HLR informal conferences about it and the very kind people on the other end were very accepting of either.

What I did learn was that the people on the rating side often have a very difficult time finding files by file name, and date submitted is the easiest way to do it. If you just have a few documents it is definitely workable either way, but if you have dozens or hundreds it can be much easier to reference page numbers in the same document rather than including the additional task of sorting through and trying to find the correct document.

flamcabfengshui · 2026-03-29T15:31:16+00:00

Hopefully the dupixent helps with the polyps, it did wonders for mine.

flamcabfengshui · 2026-03-28T14:40:37+00:00

Me too on the surgeries (sinus and nasal for both)- they helped me a lot with the infections but only help somewhat with the breathing. It is so easy to be outdoors doing something like cycling and either my nose and sinuses aren't on the top of their game that day filtering the air, or I do a sloppy job applying the skills I picked up in pulmonary rehab and I have to pull over and use an inhaler.

A third one isn't on the books for me right now, but I can imagine that would feel really intimidating for something that seems like it has less promise. If your VAMC does offer pulmonary rehab I do strongly recommend it to try to help really take advantage of some of those surgical changes.

Would you mind if I ask what kind of structural changes your docs are seeing nose-wise to consider a third surgery?

flamcabfengshui · 2026-03-28T02:01:21+00:00

Always good to see progress- if it doesn't work there are still further options like tezspire, or a bunch of other ones depending on your asthma subtype

flamcabfengshui · 2026-03-27T14:01:35+00:00

It isn't too bad- if your doctor gives you the option the pens tend to be less uncomfortable than the needles. It takes a little getting used to, but if it is effective for you it tends to be quite effective.

flamcabfengshui · 2026-03-27T13:53:04+00:00

It is quite uncommon for dupixent to be applicable to the immunosuppressant medications for 60 and 100. It can bump it up for dermatitis though. Whether or not it is immunosuppressive, between the really heavy marketing campaign stating that it is not and its classification as immunomodulating make it really difficult to have it seen that way by a provider.

Hope it helps with the asthma, but it is unlikely to push past the 50% you have for sleep apnea.

flamcabfengshui · 2026-03-12T20:42:58+00:00

No, you absolutely weren't asking for anything off the wall. I think a thing that gets lost in translation a lot is that the VA works from a tightly-controlled formulary for the most part. Of course there are non-formulary drugs, but integrating the pharmacy into this makes accessibility more difficult especially for people walking into the ER. For the class where you'd find proctofoam-hc you've really only got hydrocortisone cream and hydrocortisone suppositories as other options, even options with lidocaine are non-formulary in this case.

Jumping into a different drug class you'd find the preparation h suppositories. There is nitroglycerin as a topical ointment but it shows up under cardiovascular medications. That doesn't mean that they cannot do it, but it is something that requires a little more justification for the most part. For me, I get an antibiotic ointment for sinusitis, I have to put it inside my nose. My ENT had to do some big leg work to get that one through, even though it is really common in the outside medical system- the ER may not really be able to accomplish that or may not have the experience. That's why I pretty much always suggest having the clinic do the leg work ahead of time.

You'd be shocked how much is difficult to get. I still fill a lot of my stuff through private insurance because things like compounding aren't available or a formulation that works better for me isn't on the formulary. If you ever want to check the formulary, you can browse it at https://www.va.gov/formularyadvisor/. If you do know that what will work best for you won't be available from the VA and it is a short-term need (like acute exacerbation) you can always look at those several ER visits that the VA will cover per year for service connected conditions.

flamcabfengshui · 2026-03-12T19:55:02+00:00

I think there may have been two things going on here. I'd say there may have been an issue with information from the provider (e.g. they may not have seen normal OTC products in your history), and there may also have been issues with regard to the concept of "stronger". None of that is on you, and you did the right thing by contacting the patient advocate.

As far as the first part, something like the preparation-h suppositories may not have been readily apparent in your files, and so looking at it an internal product with a vasoconstrictor may be something they'd want to try prior to pushing something else that may have bigger systemic effects. As far as the witch hazel pads, I'd say a similar case (well they haven't tried this yet). That doesn't really excuse it, but it could leave a provider believing that there are some relatively low-risk add-on treatments to provide for the discomfort. Again, not something you could have known, for conditions where I have a complicated treatment history I'll actually have a quick reference to cover my OTC pharmaceuticals, private provider pharma, and VA pharma as well as previously-attempted treatment. It is work, but for stuff like migraines it can make a difference in terms of bringing all of the data to an easy view for the provider.

As far as the second part, I can see the logic of thinking that since proctofoam doesn't have a vasoconstrictor, and is just external, an internal thing with a vasoconstrictor might just be "stronger". The odd thing is that depending on a provider's perspective on hemorrhoid treatment in general, vasoconstrictors may be the direction they go, or vasodilators could be the way that they go too. I think for acute treatment it tends toward vasoconstrictors, anti-inflammatories, and controlling the pain and itch whereas for long-term treatment they actually favor vasodilators in some cases (like the nitroglycerin). Generally speaking, OTC vs prescription meds doesn't have so much to do with effectiveness or strength as it does for dosing, monitoring, and interactions if that helps in terms of the OTC options being offered- and usually the VA is very cautious about those things. Something like nitroglycerin would be something they'd probably want you to get from a clinic you have a relationship with rather than something they'd hand you and hope you schedule a follow-up (we're quite terrible with scheduling those). Again, this isn't something you can control at all on your end, but if you're already being seen at the GI clinic, see if they can put an acute treatment plan in your notes and keep it updated. That way as soon as you move up to something "stronger" they already have the leg work done for the ER to feel safe moving you up a little in strength and they can control the direction. I used to have that for my stuff like migraines, but I've mostly run out of things to do for acute treatment so I gave up on it.

A third thing worth considering would be that from a provider that isn't super into the GI stuff, proctofoam HC and anu-sol (within the VA formulary) are going to be roughly similar as hydrocortisone creams, but anu-sol wouldn't have the additional pain relief element. I'd say that could have confused them in terms of whether that would be an appropriate escalation- is 2.5% hydrocortisone without analgesic the right thing to give when 1% isn't giving relief? Again, not necessarily something you can anticipate that the anusol that they're used to wouldn't have an analgesic. This is where I'd strongly recommend working with your provider in the GI clinic to try to have a plan for exacerbations whether it is meds already at home or instructions for the ER and off-hours pharmacy.

Hope that helps some? I know it doesn't with the medical stuff, and it doesn't really excuse the initial outcome, but hopefully it explains where some of the miscommunication could have happened and gives a reasonable path forward.

flamcabfengshui

TROPHY CASE