Getting med boarded in residency

[doctorpurple]

Hi I have made some posts here in the past regarding my health conditions. Now a year has passed, and my health has worsened. I already had multiple hospitalizations, and my care providers and I are contemplating about med board. So long story short, shortly before starting residency, I was hospitalized for septic shock. I almost died. I had pulmonary edema and was intubated for a week, had AKI, and was in the ICU for two weeks. Before this, I was a model student, and graduated med school at the top quartile of my class. I never had problems.

I forced myself to come back to work but I was in no shape or form capable. I was weak, fatigued, and easily got sick from patients. However, I started residency on time because I had military orders. I started having debilitating chronic almost daily migraines, and barely able to function. I tried to get a leave of absence but was discouraged from doing so.

My body continued to deteriorate. In November, I was admitted for severe abdominal pain, which turned out to be erosive gastritis. Likely stress related. I took two weeks off. I came back working, and around March, my case of depression got worse. I'm still suffering from headaches and I was in pain everyday and my chronic pain and sense of helplessness fueled my depression. I started having suicidal ideation, and was told by Chiefs to go the the ER. I was placed in inpatient psychiatry for a week and was discharged with Prozac and got a week off. I came back and tried really hard but I was in pain, still depressed. Now recently have bladder issues and pelvic pain, and was diagnosed with endometriosis based on endometriomas seen on imaging. I just got out of the ER for urinary issues and they think I have instertial cystitis.

Now I'm just so fed up and I can't see myself practicing with all these problems medically. My question is if I get med boarded is there a possibility that they will still find me fit for duty? Also, I have an HPSP scholarship. Do I have to pay them back if I get med boarded? I know I need to talk to a military lawyer and that's what I'm heading to. I just can't do this anymore. I need to stop torturing myself. All my relationships are suffering. I'm suffering.

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[Helpful Troll]

Hi I have made some posts here in the past regarding my health conditions. Now a year has passed, and my health has worsened. I already had multiple hospitalizations, and my care providers and I are contemplating about med board. So long story short, shortly before starting residency, I was hospitalized for septic shock. I almost died. I had pulmonary edema and was intubated for a week, had AKI, and was in the ICU for two weeks. Before this, I was a model student, and graduated med school at the top quartile of my class. I never had problems.

I forced myself to come back to work but I was in no shape or form capable. I was weak, fatigued, and easily got sick from patients. However, I started residency on time because I had military orders. I started having debilitating chronic almost daily migraines, and barely able to function. I tried to get a leave of absence but was discouraged from doing so.

My body continued to deteriorate. In November, I was admitted for severe abdominal pain, which turned out to be erosive gastritis. Likely stress related. I took two weeks off. I came back working, and around March, my case of depression got worse. I'm still suffering from headaches and I was in pain everyday and my chronic pain and sense of helplessness fueled my depression. I started having suicidal ideation, and was told by Chiefs to go the the ER. I was placed in inpatient psychiatry for a week and was discharged with Prozac and got a week off. I came back and tried really hard but I was in pain, still depressed. Now recently have bladder issues and pelvic pain, and was diagnosed with endometriosis based on endometriomas seen on imaging. I just got out of the ER for urinary issues and they think I have instertial cystitis.

Now I'm just so fed up and I can't see myself practicing with all these problems medically. My question is if I get med boarded is there a possibility that they will still find me fit for duty? Also, I have an HPSP scholarship. Do I have to pay them back if I get med boarded? I know I need to talk to a military lawyer and that's what I'm heading to. I just can't do this anymore. I need to stop torturing myself. All my relationships are suffering. I'm suffering.

Do you intend to complete a residency at some point? Are you eligible to get an unrestricted license? Read this DoDInstruction starting at page 28.

 

[j4pac]

Hi I have made some posts here in the past regarding my health conditions. Now a year has passed, and my health has worsened. I already had multiple hospitalizations, and my care providers and I are contemplating about med board. So long story short, shortly before starting residency, I was hospitalized for septic shock. I almost died. I had pulmonary edema and was intubated for a week, had AKI, and was in the ICU for two weeks. Before this, I was a model student, and graduated med school at the top quartile of my class. I never had problems.

I forced myself to come back to work but I was in no shape or form capable. I was weak, fatigued, and easily got sick from patients. However, I started residency on time because I had military orders. I started having debilitating chronic almost daily migraines, and barely able to function. I tried to get a leave of absence but was discouraged from doing so.

My body continued to deteriorate. In November, I was admitted for severe abdominal pain, which turned out to be erosive gastritis. Likely stress related. I took two weeks off. I came back working, and around March, my case of depression got worse. I'm still suffering from headaches and I was in pain everyday and my chronic pain and sense of helplessness fueled my depression. I started having suicidal ideation, and was told by Chiefs to go the the ER. I was placed in inpatient psychiatry for a week and was discharged with Prozac and got a week off. I came back and tried really hard but I was in pain, still depressed. Now recently have bladder issues and pelvic pain, and was diagnosed with endometriosis based on endometriomas seen on imaging. I just got out of the ER for urinary issues and they think I have instertial cystitis.

Now I'm just so fed up and I can't see myself practicing with all these problems medically. My question is if I get med boarded is there a possibility that they will still find me fit for duty? Also, I have an HPSP scholarship. Do I have to pay them back if I get med boarded? I know I need to talk to a military lawyer and that's what I'm heading to. I just can't do this anymore. I need to stop torturing myself. All my relationships are suffering. I'm suffering.

The mental aspect can't be underestimated when it comes to pain issues. It seems to me that you need an extended break. Being bombarded with stressor after stressor with poor health...you just don't have the opportunity to heal mentally and physically. If it takes years...it takes years.

Talk to your JAG disability attorney...if you have on. And if you don't have one, request one...they do exist in the Navy.

 

[pgg]

OP, very sorry to hear about your problems. It's hard to predict whether any med board will find a person fit for duty or not. I've been surprised time and time again, in both directions. Generally speaking, if the military boards someone out for a medical problem that is not the result of criminal activity, no recoupment is sought.


For others reading this thread, consider purchasing a good own-occupation disability insurance policy that includes at least some mental health provision. Mass Mutual will underwrite active duty physicians; some of the others won't. There's this perception that the med retirement system is sufficient "disability" insurance. At best, medical retirement will provide income that is a portion of base pay. IMO most military physicians, whether attendings or still in training, are grossly underinsured in this area.

 

[DrMetal]

Hi I have made some posts here in the past regarding my health conditions.

And you really shouldn't do so. You've disclosed enough information here to easily give away your identity.

I already had multiple hospitalizations, and my care providers and I are contemplating about med board. So long story short, shortly before starting residency, I was hospitalized for septic shock. I almost died. I had pulmonary edema and was intubated for a week, had AKI, and was in the ICU for two weeks.

What is the physiological etiology of these frequent hospitalization, episode of septic shock, etc...? Any of your cultures come back positive (sound ID like). Are you immunosupressed?

I ask, because I'm wondering: are you trying to seek medboard for some particular physiological problem, or a psychiatric one?

 

[Gastrapathy]

A week off of residency after an inpt psych admission. WTF. You need a real break. LIMDU is the right next step.

 

[doctorpurple]

And you really shouldn't do so. You've disclosed enough information here to easily give away your identity.


What is the physiological etiology of these frequent hospitalization, episode of septic shock, etc...? Any of your cultures come back positive (sound ID like). Are you immunosupressed?

I ask, because I'm wondering: are you trying to seek medboard for some particular physiological problem, or a psychiatric one?

At this point I'm going with psychiatric route. Septic shock was caused by improper IUD removal causing one of the arms to be embedded and infection arising from there. Although not very well known fact, post sepsis syndrome does cause some level of immunosupression.

 

[Kingfisher]

Medical Boards tend to go differently for Doctors. Things that would have regular service members medically retired usually don't get us released. If you can still practice in any capacity, there is a pretty good chance you will be found fit for service. You most likely could get limitations on service locations/duties.

If found medically unfit for service, you will not have to repay the government.

 

[DrMetal]

At this point I'm going with psychiatric route.

That's a toughie. It's hard to get medboarded for a psychiatric diagnosis. If you don't have that much time in service, you could be recommended for a routine administrative separation as per an Adjustment Disorder diagnosis. This is what we do most commonly for our trouble maker E-4 and below. It's not so common for officers, but it is something on the table. It is a routine ADSEP though, not a medboard, and you would be responsible for any financial obligation.

Sorry to be blunt: but if you're are a big pain in the !@#$, they will try to pursue this routine ADSEP course of action. You'll then have to take that recommendation and separate, pay the gov't back, find a civlian residency and start all over again. Careful what you wish for, tread cautiously here.

Septic shock was caused by improper IUD removal causing one of the arms to be embedded and infection arising from there. Although not very well known fact, post sepsis syndrome does cause some level of immunosupression.

Ok...so your medical issues should be resolved then. Remove the IUD, admit/treat your for sepsis, whatever outpatient course/treatments...If you're otherwise young and health, you shouldn't have any further medical issues, and you're certainly not chronically immunosupressed. You are right to forgo the 'medical' rout in your medboard attempt.

 

[jabreal00]

Medical Boards tend to go differently for Doctors. Things that would have regular service members medically retired usually don't get us released. If you can still practice in any capacity, there is a pretty good chance you will be found fit for service. You most likely could get limitations on service locations/duties.

If found medically unfit for service, you will not have to repay the government.

If the OP were to pursue the medical board route and is found unfit for service she would not be on the hook to repay the government. If someone gets sick while on active duty and the military feels they are not medically fit to do their duty and medically "retire" them, they are not on the hook for any obligation (time or money) owed. I am not sure if there would be any tax implications, as this could be looked at as loan forgiveness. However, the military could administratively separate someone without going through a medical board. In this instance, they'd be on the hook to repay loans.

 

[Helpful Troll]

Excerpt below from the DoDInstruction 6000.13 (Accession and Retention Policies, Programs, and Incentives for Military Health Professions Officers (HPOs)). Link to DoDI above. Along the lines of be careful what you ask for ... It's difficult for an AMEDD Officer to be found unfit. With an unrestricted license there is always something you can do. Separation of HPSP and other Health Professional obligated officers is not the same as for enlisted without the financial investment.

"When a participant is qualified for further service and has been relieved of an ADO, the participant may be given, with or without consent, one of the following alternative obligations, as determined by the Secretary concerned:
...
(2) An SO in a component of the SELRES for a period twice as long as the participant’s remaining ADO.
(3) Repayment of a percentage of the cost incurred by the Secretary concerned on behalf of the participant pursuant to the repayment provisions of section 373 of Reference (c).
(4) If a participant is relieved of an ADO because of separation for physical disability, an SO as a civilian employee employed as a health-care professional in a facility of the Uniformed Services for a time period equal to the participant’s remaining ADO. The participant will be referred to the servicing civilian personnel office for assistance. All statutory and regulatory requirements for employment must be adhered to."

 

[notdeadyet]

Echoing what DrMetal says, a med board for psych issues can be a challenge. And the concern for an Adjustment Disorder diagnosis is also valid. The OP had no issues to speak of throughout medical school, top of the class, then apparently decompensated psychiatrically in response to health issues. It would be hard to consider that anything other than Adjustment Disorder, at least on face value.

 

[pgg]

I can't imagine getting 1099'd for "loan forgiveness" ... they paid our tuition directly and any cash given during school was income that was reported and taxed already.

 

[notdeadyet]

I can't imagine getting 1099'd for "loan forgiveness" ... they paid our tuition directly and any cash given during school was income that was reported and taxed already.

Yup. This happens for those of us who receive military loan repayment benefits.

I receive $40K loan reimbursement for federal medical student loans as part of the Reserve Corps' HPLRP. I don't see the money (the Army pays it directly), but eventually it gets taken off of my federal loan debt.

But come end-of-year, I receive my tax form indicating $40,000 in "Wages, tips, other compensation" in Box #1 and I owe the taxes on it.

 

[pgg]

Yup. This happens for those of us who receive military loan repayment benefits.

I receive $40K loan reimbursement for federal medical student loans as part of the Reserve Corps' HPLRP. I don't see the money (the Army pays it directly), but eventually it gets taken off of my federal loan debt.

But come end-of-year, I receive my tax form indicating $40,000 in "Wages, tips, other compensation" in Box #1 and I owe the taxes on it.

Well, that's a wage used to repay a loan. It's income, of course it's taxed.

Getting HPSP benefits followed by a forgiven ADSO isn't the same thing. It's not a loan, it's not a wage. It's like the tuition assistance and stipend ROTC people get - untaxed. If you dishonorably fail to serve the ADSO, the military comes after you for repayment, there's no write-off and 1099.

 

[notdeadyet]

Ah, sorry, I must have misunderstood your post. My bad.

 

[NavyFP]

As noted above it is exceedingly difficult for a physician to be found unfit by the Physical Evaluation Board. There is a different standard for doctors and admirals. As Kingfisher commented, if you can practice medicine in any capacity, you will almost assuredly be found fit. The instruction for the Navy is 1850.4E.

 

[deuist]

I know of only one physician who was sent through a medical board. The process took years and I'm not sure if she was formally thrown out for medical reasons, or if the official reason for separation is listed as her own decision to resign her commission. The physical standards for physicians is so low that once you're in, you're not getting out.

 

[didja]

I've known 2 physicians who were medically retired because of malignancy. One had a guarded prognosis but the other had a pretty good prognosis so you never know.