Military Series: Medical Evaluation Board (MEB)

As someone who's been medically retired, I've gained first-hand knowledge of the complex process. I often get asked about the ordeal, so here's an inside look for those interested. My Medical Evaluation Board resulted from residual symptoms via the five concussions I suffered while playing football at the Air Force Academy. Symptoms such as headaches, memory loss, insomnia, quick temperament, anxiety, and speech difficulties were worsening and beginning to effect my job. Thus, I chose to seek treatment for my ailments.

As a result, I was referred to mental health and a concussion specialist. I also underwent CT scans and MRIs in hopes of discovering the source of my ailments. Mental health diagnosed me with anxiety and depression which I'd noticed were affecting me. I was starting to become anxious around large crowds as well as speaking in front of others. I would also become depressed due to the impact that my concussion symptoms, such as memory loss, were having on me. The concussion specialist had me perform a neuropsychological exam so he could diagnose any cognitive impairments.

All of the imaging came back negative, which was promising discouraging at the same time because it left me without answers. The neuropsych test did confirm my quick temper. It also evidenced weaknesses in executive functioning, perceptual reasoning, and balance. Consequently, the doctor recommended that I participate in cognitive rehab to assist with my deficiencies. To my dismay, the multi-session rehab was unsuccessful, as I failed to notice any improvements. This was thoroughly frustrating, thus I continued to seek treatment in hopes of rectifying my symptoms.

In between treatments, I received orders to my next duty station, relocating me from California to Georgia. While there, my ailments continued to worsen, so my new primary care doctor quickly referred me to a neuropsychologist. She confirmed some of the symptoms I'd been suffering, and also had additional imaging done to ensure nothing was overlooked. Unfortunately, the additional MRI revealed what the doctor believed to be a cyst. I was distraught to say the least. I was unfamiliar with the diagnosis, so I began fearing the worst; I didn't know if I would need surgery or would be permanently impacted.

The doctor ordered another MRI to confirm the finding, this time with contrast for a better perspective. Gratefully, the second MRI proved to be fruitful, as the aforementioned cyst turned out to be a benign space. I attribute this to God. I believe that there actually was a cyst, but God miraculously healed me of it. Although I was glad the cyst was gone, there was still no solution for my symptoms. Thus, I was referred to another neurology expert.

To compare my symptoms, the neurologist instructed me to complete another neuropsychology test, which revealed that my symptoms had objectively worsened. To help mitigate these new findings, I was referred to traumatic brain injury (TBI) and memory specialists, as well as occupational therapy. The treatments were helpful, yet I still did not recognize any improvement. Consequently, my doctor recommended me for an MEB in the summer of 2019. I was told that the average case took about 100 days, so I expected it to be resolved by the end of the year. Little did I know, I would not be receiving an MEB decision until long after Christmas.

There are multiple stages to an MEB. The first involves the Deployment Availability Working Group's (DAWG) decision of an Initial Review in Lieu of (IRILO) being necessary. An IRILO is an initial review of an Airman's medical records in lieu of a full examination to determine if there is a condition that may deem the individual unfit for duty. If an IRILO is necessary, a Physical Evaluation Board Liaison Officer (PEBLO) will reach out to the Airman and/or his leadership. PEBLOs are designed to assist Airmen throughout the MEB process.

If the IRILO reveals that the Airman is unfit for duty, then the MEB process is initiated.

For me and many others, the MEB process was grueling and widely extensive, further prolonged by COVID. Originally, it involved a lot of paperwork to enter the process, in addition to concurrence from my commander. After a few weeks, I was given a Veterans Affairs (VA) counselor to assist with the claims I'd be seeking. This required me to review my entire medical history to ensure I was including every ailment and condition suffered in the military that could be eligible for disability. Once I submitted this to my counselor, we coordinated VA appointments for each of the conditions. Fortunately, some of the related conditions were bundled into the same appointments such as leg injuries, hand/finger injuries, etc. All in all, I claimed disability for 41 conditions.

Although the VA ratings are separate from the Air Force's, the VA evaluation takes places in conjunction with the Air Force's MEB to provide a rating for the veteran if they are in fact medically separated or retired. This is known as the Integrated Disability Evaluation System (IDES). If a service member is medically discharged, then the Air Force's rating dictates separation versus retirement, which is significantly different. Furthermore, the Air Force only evaluates the conditions that one is being medically evaluated for, as opposed to the VA who reviews those conditions, as well as any other ailments an Airman claims.

If the military assigns a rating between 0-20%, then an Airman is medically separated. 30 percent or greater garners medical retirement. The other alternative is return to duty if the condition is not rating at all, which is uncommon. The distinction between medically separation and retirement is imperative because it prescribes very lofty benefits. The first is that medical separation entails a lump sum payment based on one's disability percentage (there are some other calculations involved) that is paid out before receipt of VA disability pay. This is disbursed after one has been discharged. Thus, receipt of disability pay will be on hold until the lump sum's value reaches zero when subtracted by the veteran's theoretical monthly disability pay. Example: Veteran is assigned a VA disability of 90%, so they are entitled to $2,172/month. But because they were medically separated at the rank of Captain for a 10% rating for their MEB condition, they will be receiving a lump sum of $80,000 (taxable). It would take ~36 months for the $80,000 lump sum payment to reach zero when subtracted by the disability pay of $2,172 on a monthly basis. Therefore, This veteran would not receive their disability until those 36 months have passed.

Medical retirement on the other hand, calls for immediate payment of disability pay after discharge. The next major deference is medical care. Being medically separated does not grant the benefit of continued Tricare coverage upon being discharged. Most familiar with the military and healthcare know that medical care is free for all Airmen, but highly expensive for civilians. Medical retirement makes you eligible to continue using Tricare at the overwhelming cost of $50/month! The other differences surround retiree benefits such as a retirement ID card and access to base privileges (commissary/BX/etc.).

Several weeks after my VA appointments, I learned that I'd receive VA disability for 15 of my conditions after leaving the military. Most notably 50% for sleep apnea and 40% for my combined TBI symptoms. These are two of the higher ratings one can receive for a condition. Now, I continued to wait on the Air Force's decision regarding my medical board. By February, my anxiety had peaked as my entire life was on hold, and the 100-day period had well since passed. My 5-year commitment fulfillment was looming in the upcoming summer, which I had already been on the fence about continuing or punching out of the military. Because I was undergoing an MEB, I was also unable to participate in the widely popular SkillBridge program where one can intern with a civilian company during their last 6 months in the military, while still receiving military pay. The Air Force prohibits individuals from participating in SkillBridge while undergoing an MEB.

Finally, in mid-March, my MEB counselor called me in to reveal the results. The Air Force chose to medically retire me at 40%. The wait was over and I could now press forward. Moreover, the VA had rated me at 90% for all of my conditions, which is the rate of pay I'd receive upon discharge. However, I was placed on Temporary (TDRL) which is routine for TBI and cognitive related injuries because they tend to improve over time. Although I was on TDRL, my disability rating was raised to 100% by the VA just a few weeks later.

With TDRL, there are periodic re-evaluations to determine if there's been any progress. While possible, most Airmen placed on TDRL are permanently retired, and not returned to duty. Though I had no ambition of returning to the military, I was hopeful for improvement with my conditions; I'd been continuing medical treatment with the VA since I'd been out of the military. My first re-evaluation was consistent with the findings of my discharge. My final re-evaluation, however, was much different. This evaluation necessitated another neuropsychological exam for an objective outlook on my progress. To my dismay, the results were progressive, which under normal circumstances would have been encouraging, but I still had not seen any progress in my day-to-day life.

Furthermore, because of their perceived view of progress, the Air Force was recommending to reduce my disability from 40% to 10%. This meant that I would lose all medical retirement benefits, and would instead be medically separated. Thus, my VA disability pay would be suspended and I'd receive a lump sum payment from the Air Force. This would be a horrible turn of events, plus it did not accurately capture the state of my health. Consequently, I went to Lord for help. I also decided to appeal the decision and was appointed an attorney by the Air Force to fight my case.

Thankfully, I was able to win my appeal. Rather than reducing my percentage to 10%, it was only trimmed to 30%. This was substantial because it allowed me to maintain my medical retirement and all of its benefits. Additionally, the appeal victory finalized my retirement from temporary to permanent, so I'd never have to go through another review again. This was truly a blessing as God worked things out for me.

Clearly, the MEB process can be highly stressful, hence one of the reasons why I wrote this blog. If you have any questions, feel free to reach out! God bless.