Active Duty AF physician facing med board/HPSP implications

[drmanhattan]

Hi all,

I'm an Active Duty Air Force physician currently serving my 2nd year of my 4 year commitment. I had the HPSP scholarship to pay for medical school and did a civilian residency. In early 2019 I had an injury which required surgery (C5-7 disc extrusion and myelopathy, requiring Anterior cervical disc replacement). I was unable to finish my last PT test due to pain in my back and I got an MRI which showed significant cervical stenosis. I'm being referred back to neurosurgery and My PCM is placing me on a permanent no-run profile, so I may be facing a med board. My question is about how this would affect my HPSP commitment. Do I have to pay back the 2 years I may not serve? Will they allow me to just finish my commitment without taking any PT tests? (This would be ideal, as I really want to finish my commitment). I know the Air Force is crazy about these PT tests though. Has anyone on this forum had any experience or know someone who went through this situation? Any feedback or insight would be greatly appreciated. Thanks for reading!

---

Members don't see this ad.

 

[pawprint]

You’re going to have to do the PT test. Nobody is going to let you serve if you can’t do it, so it’s that or face a medical board. And the medical board may deem you fit for service, your PCM’s recommendation on duty limitation isn’t the final say. I’ve recommended folks to medical boards that ultimately get told to basically “suck it up” or get admin seperated for failing to be able to do PT. Also, medical boards are taking FOREVER right now. Like, 1-2 years. So if you finish your service obligation but are still on a med board, you won’t be able to leave until the medical board has completely gone through. So you could end up serving longer than your original contract while you wait for disposition. I’ve seen this a bunch over the past 12 months.

I would go back and look at the HPSP contract and see what it’s contingent on. There is likely a clause for medical separation that explains if you need to pay back anything for medical separation (I doubt it, but I’d go look at the fine print).

The best thing is to do what you need to do to be able to do your PT tests and get out. Findings ways to circumvent the PT test (even if justified) could get out stuck in the Air Force for a lot longer than what you intended.

 

[usma05]

Hi all,

I'm an Active Duty Air Force physician currently serving my 2nd year of my 4 year commitment. I had the HPSP scholarship to pay for medical school and did a civilian residency. In early 2019 I had an injury which required surgery (C5-7 disc extrusion and myelopathy, requiring Anterior cervical disc replacement). I was unable to finish my last PT test due to pain in my back and I got an MRI which showed significant cervical stenosis. I'm being referred back to neurosurgery and My PCM is placing me on a permanent no-run profile, so I may be facing a med board. My question is about how this would affect my HPSP commitment. Do I have to pay back the 2 years I may not serve? Will they allow me to just finish my commitment without taking any PT tests? (This would be ideal, as I really want to finish my commitment). I know the Air Force is crazy about these PT tests though. Has anyone on this forum had any experience or know someone who went through this situation? Any feedback or insight would be greatly appreciated. Thanks for reading!

You’re going to have to do the PT test. Nobody is going to let you serve if you can’t do it, so it’s that or face a medical board. And the medical board may deem you fit for service, your PCM’s recommendation on duty limitation isn’t the final say. I’ve recommended folks to medical boards that ultimately get told to basically “suck it up” or get admin seperated for failing to be able to do PT. Also, medical boards are taking FOREVER right now. Like, 1-2 years. So if you finish your service obligation but are still on a med board, you won’t be able to leave until the medical board has completely gone through. So you could end up serving longer than your original contract while you wait for disposition. I’ve seen this a bunch over the past 12 months.

I would go back and look at the HPSP contract and see what it’s contingent on. There is likely a clause for medical separation that explains if you need to pay back anything for medical separation (I doubt it, but I’d go look at the fine print).

The best thing is to do what you need to do to be able to do your PT tests and get out. Findings ways to circumvent the PT test (even if justified) could get out stuck in the Air Force for a lot longer than what you intended.

YMMV, but my experience honestly hasn't been analogous with pawprints'. Im sure there are différences in services and differences in being at an MTF vs. a line unit. Im AD army; i trained at a joint Army-Navy hospital and i currently work at a joint Army-Air Force one. In 13 years, individuals that practice in my specialty who have had non-deployable conditions or conditions preventing them from taking the PT test were med-boarded, almost always found retainable, presented their permanent profile every PT test but didnt take it, and went on their merry way after their ADSO was up (military needs the physician workforce). I have not seen people forced to take a PT when they have a physician saying its not conducive for their medical condition (thats the key, you have to have documentation from a physician with the commiserate expertise, its the neurosurgeon's opinion not yours that matters). Sure, in the line the commander can always overrule it but few do for legitimate issues (at least after discussing it with their unit surgeon). Ive not seen a hospital commander overrule a specialist at an MTF. Different story for people who dont have the paperwork or legitimate condition altogether. Hope that helps.

 

[flightdoc09]

Med boards come back with a determination of fit for duty or not fit for duty. They don't determine if you're fit for full duty. A "not fit" for duty determination generally means that they determined that you deserve some sort of compensation for either a career cut short due to medical issues out of your control, or a disability caused by the military. If you can reasonably perform the duties of your job as an airman doctor, then you will likely be found fit for duty. If, for example, you broke your hand and couldn't operate as a surgeon, you'd probably be found unfit. But if you were a radiologist, you might be found fit, even though neither of you could do pushups. At that point you'd do as many partial PFTs as you could and then get administratively separated if you command chose to go that route.

OR, they could be kinda mean and make that surgeon sit in an office all day doing PHAs, medical clearances, med boards, etc.

Most of the services do allow for permanent profiles/LIMDUs. You may be a candidate for one, or even an extended period of profile/LIMDU that is normally limited to one year.

Lots of possibilities here, just depends on lots of variables.

 

[drmanhattan]

You’re going to have to do the PT test.

Pawprint, I'm sure you're coming from a good place, but I'm sad how reflective this line is of toxic military culture & the worst qualities of SDN. And for the record, nobody at my base has EVER suggested that anyone would have to take the PT test if they're injured and could potentially worsen their injury.

Also, medical boards are taking FOREVER right now. Like, 1-2 years.

I know this to be false. I am on the AMRO board reviewing RILO cases and we regularly get people through the med board process AND through the VA stage in 2-3 months. Honestly I'm not sure how your Air Force experience has been so different than mine, but there you go.

The best thing is to do what you need to do to be able to do your PT tests and get out. Findings ways to circumvent the PT test (even if justified) could get out stuck in the Air Force for a lot longer than what you intended.

Also sounds like fear-mongering.

 

[drmanhattan]

In 13 years, individuals that practice in my specialty who have had non-deployable conditions or conditions preventing them from taking the PT test were med-boarded, almost always found retainable, presented their permanent profile every PT test but didnt take it, and went on their merry way after their ADSO was up (military needs the physician workforce).

This is EXACTLY what I have been hearing. I'm the only Psychiatrist on a base of >4,000 people and I'm happy that it appears the AF is sensible enough to utilize my expertise to help it's members even if I can't run laps Thank you kindly usma05 for your well-informed feedback!

 

[drmanhattan]

Most of the services do allow for permanent profiles/LIMDUs. You may be a candidate for one, or even an extended period of profile/LIMDU that is normally limited to one year.

flightdoc09 thanks for your insight and feedback! Much appreciated

 

[pgg]

No one's going to force you to run and injure yourself further ... but there will be people who will let you do it, or imply that you should. Ignore those people.

In general, persons who suffer injuries or acquire diseases/conditions that are incompatible with military service get med boarded out, and are NOT billed for remaining obligated service. A rare exception to this might be for injuries sustained as a direct result of misconduct.

Most sick/injured physicians who can still do the doctor job are retained to finish their service obligations. It's common for the fitness tests to be waived for extended periods because of injury or illness, while the physician continues to practice full or part time. I've seen this happen countless times over my career in the Navy. This may limit that person's ability to get promoted to O5 or O6 however, as it may not be feasible to serve in certain positions generally regarded as helpful to getting promoted. But if your grandest ambition is just to serve our your last two years, no worries.

Don't let anyone talk you into gutting out the PT test, and risking further injury, for fear of what the Air Force might do to you. If you're on a profile, don't sweat it. Get healthy.

 

[pawprint]

Geez.

I’m an active duty navy flight surgeon working with the marines. I’m telling you, I’ve referred many Marines to medical boards that are still sitting up in DC >12-15 months after initial med board submission. I’ve had 2 come back finally around the 24 month mark….so 2-3 months is not my experience. You can get stuck waiting on medical board disposition for a long time.

Typical timeline that I see:
Initial injury -> 90 days light duty -> reevaluated, sent to specialists -> 6 months of 1st limdu period -> reevaluated by specialist -> 2nd 6 months of limdu -> reevaluated by specialist, if no improvement, referral to med board -> med board determines if patient has duty limiting condition -> referral to physical evaluation board (takes 1-2 years for disposition) -> PEB determines patient no longer fit for military service and given 30 day separation notice upon final results. If found fit for service, patient has 90 days to complete PT test. If patient fails PT test, sent on FAP. If patient fails 2nd PT test, patient is sent for admin separation.

Maybe the Air Force is different, but in the navy and marine corps, if you can’t do a PT test, you’re going to either get a medical separation or an administrative separation depending on the results of a medical board. You can’t be in the military and not be physically fit to serve. The Navy/Marines corps maxes out at 12 months of LIMDU. I’ve had both line and staff corps (including medical officers) seperated for not being able to do annual PT tests. You can disagree with me, but I’m telling you what I see in my clinic. OP needs to know that this is a reality. Maybe other providers don’t see it play out this way, but I do and am just passing along my experience. Just because you are a doctor, doesn’t mean you get a free pass from the PT requirements as others have suggested.

 

[flightdoc09]

Geez.

I’m an active duty navy flight surgeon working with the marines. I’m telling you, I’ve referred many Marines to medical boards that are still sitting up in DC >12-15 months after initial med board submission. I’ve had 2 come back finally around the 24 month mark….so 2-3 months is not my experience. You can get stuck waiting on medical board disposition for a long time.

Typical timeline that I see:
Initial injury -> 90 days light duty -> reevaluated, sent to specialists -> 6 months of 1st limdu period -> reevaluated by specialist -> 2nd 6 months of limdu -> reevaluated by specialist, if no improvement, referral to med board -> med board determines if patient has duty limiting condition -> referral to physical evaluation board (takes 1-2 years for disposition) -> PEB determines patient no longer fit for military service and given 30 day separation notice upon final results. If found fit for service, patient has 90 days to complete PT test. If patient fails PT test, sent on FAP. If patient fails 2nd PT test, patient is sent for admin separation.

Maybe the Air Force is different, but in the navy and marine corps, if you can’t do a PT test, you’re going to either get a medical separation or an administrative separation depending on the results of a medical board. You can’t be in the military and not be physically fit to serve. The Navy/Marines corps maxes out at 12 months of LIMDU. I’ve had both line and staff corps (including medical officers) seperated for not being able to do annual PT tests. You can disagree with me, but I’m telling you what I see in my clinic. OP needs to know that this is a reality. Maybe other providers don’t see it play out this way, but I do and am just passing along my experience. Just because you are a doctor, doesn’t mean you get a free pass from the PT requirements as others have suggested.

I just finished my flight surgery tour with the Marines. If you don't have your local PEBLOs on speed dial, checking up on PEB packages every few weeks, this will happen. Stuff slips through the cracks all the time. COVID did cause a log jam of PEBs, but they were back down to 6-8 months when I finished my tour this past summer. I even got one through in 4.5 months.

If someone has no legitimate prognosis of returning to full duty, skip LIMDU and just put them on a medboard. Now sometimes it makes sense to just LIMDU them till they EAS, but most of the time just get rid of the dead weight.

If you don't have an account on the Navy Op Med Wiki site, you should. It'll be your best friend as a GMO/Flight Surgeon - Login required - Know Your Chit (navyopmed.com)

 

[pgg]

No military doctor is going to get adsep'd while serving an ADSO for being unable to do the PT test, if they can practice medicine on a schedule approaching full time. True, nothing is 100% ...

You can’t be in the military and not be physically fit to serve.

I don't know what to tell you. Beyond just telling you that doctors can serve on active duty for a long, long, long time in a non-deployable status, being waived for part/all of the PFA (BCA is a separate issue), if they're still able to practice medicine. They tend to not get promoted but they can stay if they want to and the service needs them. Injuries, cancer, HIV, you name it. It's not super common because they're typically happy to get out and the military won't make them stay. But if they want to stay, and they can see patients ... There's more of them around than you might think. And that's OK.

 

[pawprint]

Flightdoc09, that’s great you had a better experience with limdu/med board stuff than I do. I stay on top of my unit, and still have these crazy timelines, which is consistent with the other flight surgeons and GMO’s at my duty station.

Pgg, I’m glad you have those experiences too, but I have seen the flip side where GMO’s paying off their time have been adsep’d after failing to get a medical board to agree with a medical discharge.

The point is that as a doctor you don’t get a free pass on waiving PT tests. Sometimes people get by, but sometimes they don’t. It’s not something to assume that you’re going to get. Being able to do a PT test is a requirement in the military for everyone, and there are people out there that have no problem separating someone because they can’t run. Are there 18 year doctors who haven’t run a pt test in a decade? Sure, but when giving someone advice on this forum, they need to know they shouldn’t expect that. It’s part of the contract you sign when you sign up for HPSP, failing PT tests can cause you a lot of trouble.

 

[flightdoc09]

Flightdoc09, that’s great you had a better experience with limdu/med board stuff than I do. I stay on top of my unit, and still have these crazy timelines, which is consistent with the other flight surgeons and GMO’s at my duty station.

Sorry if it sounded like I was criticizing. Just meant as a general point of education for anyone else that may be be reading. Even in my last couple months I'd still miss stuff that would prolong time on PEB.

 

[DOswag]

Pawprint, I'm sure you're coming from a good place, but I'm sad how reflective this line is of toxic military culture & the worst qualities of SDN. And for the record, nobody at my base has EVER suggested that anyone would have to take the PT test if they're injured and could potentially worsen their injury.



I know this to be false. I am on the AMRO board reviewing RILO cases and we regularly get people through the med board process AND through the VA stage in 2-3 months. Honestly I'm not sure how your Air Force experience has been so different than mine, but there you go.

Also sounds like fear-mongering.

drmanhattan I am also an air force psychiatrist who sits on the AMRO board at our base. I am amazed that you're able to get patients through the VA portion that quickly. I've been where I'm at for 2.5 years and we have people who are still going through the process that started before I got here. Several that have crossed over the year mark. My most recent AMRO meeting we had 3 that were inquired about that all had NARSUMs submitted in the past 3-4 months and PEBLOs said "I'm not tracking that one". It's been somewhat of a nightmare with getting patients through the MEB process so it's refreshing to learn that there are places that it doesn't take years to get them through it. It's not completely the PEBLOs fault though. They throw new people in to assist about every few months, then will take one of the airmen away randomly for a couple of months. They're way overwhelmed here. Hired a civilian once who stayed for a few months and things were getting better then she got burned out pretty quick and left for the VA.

Regarding your initial question I really doubt that you'd be MEB'd for this. They try to keep docs in so I truly think you'll be able to finish your commitment. I've been in ARMO's where they reviewed plenty of enlisted personnel with permanent exemptions and they do whatever they can to retain docs. The permanent no-run profile would need to be renewed yearly by your PCM though it could get referred to AMRO, may even require an iRILO depending on other factors but I suspect very likely would get returned to duty and maybe c-coded or something. Are you able to do any component of the fitness exam?

 

[Chenzo26535]

Can any physician start a med board or does it specifically have to be your PCM?

 

[Dr. Wexler]

If it is like the army the med board will find you fit for duty. You could never do a PT test and they wont boot you but you wont get promoted.

 

[TheEarDoc]

My guess is even if they send you to a medboard they will find you fit for duty. You have to be pretty broken in medical to be medically separated. Most likely you'll end up on a temporary profile and they will do alternate events for a PT test. That's how it's handled in the Army. We have plenty of medically broken folks in the reserves who are on permanent profiles and still serving. They just do the alternate events on the PT testing.

As for having to pay back your money if they do medically separate you? Unless it was negligence on your part I don't see that happening.

Focus on getting well and let the process play out. Don't take a PT test if your doctor says not to no matter what anyone tells you. Have a copy of that temporary profile with you in case you get some other officer or SNCO who wants to play that game so you can produce it if they want to play said games.

 

[DOswag]

Can any physician start a med board or does it specifically have to be your PCM?

I don't know how it is for other branches of service but for Air Force, we have to go into a system (ASIMS now AGAM) and refer someone to the AMRO. For medical issues it's the PCM who does this. For mental health, I as the psychiatrist can refer them to AMRO or their therapist can as well (i.e. psychologist, social worker). The AMRO typically consists of PCM, SGH, SGP, PEBLOs, and a mental health representative. They discuss who all has been referred to the AMRO and decide if the person should be placed on a code 37 to start an iRILO where it gets sent to AFPC. It's not officially a med board until AFPC determines the member to go through a full board. This is the part where they can be returned to duty, c-coded, or be determined full board etc.

 

[pawprint]

For the Navy, anyone can start a med board but specialists are supposed to be the ones who do it. The med board process is usually initiated after a patient is sent to a specialist who recommends that the patient is not fit for further service due to their specific condition. Therefore, the specialist has more knowledge of why the condition is duty-limiting and can write more detail about the issue. I hated writing medical boards about stuff that I didn’t know as well as the specialist…the only times I wrote them were when the specialist took too long to do the paperwork