Confusion Leading to the End?

I am sitting at the Naval Hospital in Bethesda waiting to see my Neurologist. Holly blogged yesterday that I was going to see my Neurosurgeon, but she was slightly off. I saw my Neurologist two weeks ago and at that time he answered all the additional questions that the MEB doctors had. In the past few weeks I have seen all the specialists involved in my care so that they could enter final notes into the system for my MEB. They call these addendums. I thought everything was done and I went to see the PEBLO (Physical Evaluation Board Liaison Officer), the guy that is the go between the MEB docs and everything else. He went into the system, printed out all the notes and said he would pass them to the MEB docs. I got a call a few hours later from my PEBLO and he said the MEB docs were ready to move forward with the process... Except for one thing. When I saw my Neurologist two weeks ago, he said he was going to dictate a new board. What that means is he would speak into a microphone all the new information and it would have to be transcribed and sent over to Walter Reed. Minimum time? About two to three weeks. So that would stop everything in it's tracks... Again. So, my question is why?

If he already answered all the questions... Why do this again? I already have a board dictated. Okay... Terminology break. When a doc dictates a board, the resulting document is called a Narrative Summary or NARSUM for short. A NARSUM initiates the Medical Evaluation Board process (MEB for short). From there it moves on to the Physical Evaluation Board or PEB. More on that when we get to it.

So, I already have a NARSUM. It was a very poorly written document and it was out of date. I told this to my Case Manager at the time and she said that was fine. That updated information could be added via these addendums. As far as I understand, all the addendums are in. But as I said, my Neurologist wants to dictate a new NARSUM. He asked to bring my old NARSUM, which I did. But I still don't understand why he couldn't ask the doc that did it in the first place since he's in the office next door! Talk about the right hand not talking to the left!

Anyway, I have no idea what's going on. The big question that I have today is, if all the questions the MEB docs were answered in the addendum, why does a new NARSUM have to be dictated?

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Okay, he just called me back and said that he is going to enter the new information, whatever it is, into the electronic system - a new addendum. He says he's putting in a new NARSUM. Whatever. I think I better call and see if what he's doing is valid.

I just called my PEBLO and he said he just left me a voicemail! He said that he can enter a new NARSUM into the system and the docs can start on my case as early as Friday!

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I will update you later on what exactly takes place the rest of the day. Looks like things might be moving along! :-)

Order Mania

I haven’t really posted much since the promotion. Life here at WRAMC has been steadily amusing. And I don’t mean that in a good way. Let me take you back to last week. Here’s a little teaser of things to come in this blog. You read my last post, right? The one where I got promoted? You know how I found out I actually got promoted? I happened to log on to our HR website and noticed that my rank was changed there. Nobody called me to tell me the good news; nobody patted me on the back. In fact, I didn’t even get any orders. When I went to the staff here, they said they couldn’t pull up my orders. They told me to go to another office on base. I walked there and they could not either, they sent me to another office. The last office said they could not either. So here I am, I know I got a promotion, but I have no way to prove it because I have no orders. Without the actual orders in hand, and can’t wear the new rank. I’m going to stop here on this story. Remember where we left off, okay?

Speaking of orders… I needed orders assigning me to WRAMC. Easy enough, right? When I came over here the week of April 23rd, they started to in-process me. My other orders were set to expire on April 27th, so they put in a request for orders (RFO) assigning me. They finally came on the 26th, but I thought the start date would be the 28th, they came with a start date of the 23rd! This really worried me since I had already paid for a week’s worth of lodging in Rosslyn. Anyway, without getting too complicated, they amended my original orders that ended on the 27th to end on the 22nd, and then they amended them again putting them back the way they were to end on the 27th, finally they cut a new order rescinding the original order that brought me to DC in the first place so that the medical retention processing (MRP) order bringing me to WRAMC could take effect. Confusing? You bet. That’s three orders, remember that. To make matters worse, I then had to go to the Malogne House, which is like a hotel here, to get what is called a statement of non-availability (SNA) to say that the hotel was full and I had to stay in Rosslyn so that I could get paid for the week I was worried about. Here’s the clincher… you remember the three orders? Nobody here could produce those for me either. One guy gave me one of them, but I needed all of them.

So I had three assignment orders and a promotion order somewhere out in space that I could not get. So you know what I did? I made a few phone calls to the place I was working here in DC. I called up my co-worker Angela and she gave me some numbers for people I knew could help me. I called up the office that could help me and within fifteen minutes I had all four orders in my inbox. I love having connections.

Other than that, last week went okay. I had a dental exam and they didn’t see anything to worry about – I just need a cleaning in the near future. I also talked to my neurosurgeon, Dr. Rosenbaum, and he is going to work to get my NARSUM completed. In fact, I got a call from one of the neurologists over at NNMC who is working with my neurosurgeon and neurologist to get it done. He said it should be completed early next week. You see, that’s why things here take so long here. One thing has to happen to trigger something else. And if one thing gets delayed, everything else gets delayed. Patience is key, but it is hard sometimes.

Lastly, Friday afternoon, I got a call from my Platoon Sergeant. She said that since I got promoted, I was no longer eligible to stay in the room where I am now. I was going to have to move out into another building that is supposedly a step up from where I am now. That has been an adventure in itself, but more on that tomorrow.

All Day at the Hospital, New Meds

Today was a pretty stress free and straight forward day. I got up, headed to Bethesda NNMC on the metro and saw my Oncologist for my 1130 appointment. It was a fairly easy visit. He had a resident there learning today so I got the help teach strength, balance and memory testing. They do this every few visits just to gauge my level and see if there any differences from last time. I think my strength gets better each time, but the memory stuff stays the same. I'm not getting any younger!

After that, I grabbed a quick bite and then headed to my Neurology appointment. We discussed my last seizure and also talked about the strange twitches going on around my right big toe and the side of my foot. For about two months before the seizure, the activity was so pronounced that I would lay in bed and could feel it. Sometimes it would keep me awake for a while. Then, after I had the seizure, they seem to have slowed down quite a bit. He was interested by this and seemed fairly certain that these were, in fact, tiny focal seizures occurring throughout the day. I thought it was just my brain confused and healing doing that, but that is basically a type of seizure, I guess.

We did more strength testing and he also seemed satisfied with my improvement, but wanted to control the seizures. I am at the maximum dosage for Keppra at 2,000mg per day. He also told me that Keppra is good at controlling generalized seizures, but not so good at focal seizures. I tend to have focal seizures that progress to a generalized seizure. So, he waded through the list of additional medications that he could add and finally ended up at one called Tegretol. I’ll be taking 400mg per day to start. I took my first 200mg tonight and feel okay – a little drowsy – which is a side effect. He said that it also might make my stomach feel upset for the first few days, but it should pass. It’s feeling pretty good so far. The only issue with the Tegretol is that it can increase liver enzymes, so he’ll need to draw levels to make sure that I’m getting enough of the medication into my system and that my liver enzymes don’t increase to a dangerous level. He also wants to do an EEG on Tuesday, just to see what kind of activity by brain is creating. He mentioned that there may be some scar tissue or something else in my brain that is irritating it and causing these seizures. It is apparent that something in the part of my brain that controls my right foot around my big toe is irritated. He said that if I was interested, they might be able to pinpoint it in time, and possibly go back in to remove the irritation. Hmm… we’ll cross that bridge when we get to it. He was also happy that I had an MRI scheduled for later in the afternoon and would use the data from the EEG and MRI to compile the NARSUM for my MEB. He said that he’d have a better idea of what to include in the NARSUM, but was not going to do it until I was stable. That means that next week, WRAMC will only transfer me into their system, I’ll have to move there and then will have ongoing appointments until the doctors think my condition is stable enough to begin the board process. In addition, my doctors don’t want to see me moved to a different location – they would prefer that I stay close to them for my care during the MEB process. My Neurologist said, “Why start you over again with a new doctor? That’s just stupid.” I agree. I hope WRAMC agrees.

After the visit with him, I went down to MRI, and after a short delay due to an emergency MRI, I had my time in the machine and actually fell asleep inside the magnet again. I didn’t have a chance to get a CD of the images because it was after 1800 when I finished, but my Oncologist is going to call me Saturday morning with the results. I’ll pick up a CD on Tuesday when I’m there for the EEG and will try to share them with you.

After the MRI, I high tailed it back to Clarendon and joined up with Amanda, Buddy, Ryan, Zach (John’s brother) and Tamra for dinner to celebrate Tamra’s getting out the Army. We went to The Cheesecake Factory and ate a lot of food and of course, dessert too. Buddy and Amanda gave me a ride home and hung out for a while with me. All in all – another good day. I’m looking forward to a weekend of rest and beautiful weather here in DC. I’ll let you know what my Oncologist says about the scan results tomorrow.

Can you say confusing?

Today was my first day back at work and boy… was it a doozie! First of all, I’ve been having a hard time getting to sleep here in my new digs. The first night, Saturday, it rained all night. There is some kind of metal skirt that sticks out from the building on my floor, so guess what? I got to hear the pitter patter of drops falling off the building onto the metal skirt. I didn’t get to sleep until nearly 2am and then was woken up by jets making their approach to Reagan National Airport at 6:30am. Yes, I am a light sleeper. Last night, Sunday, the wind was howling like crazy. The northeast has been getting pummeled by this storm and it just won’t die. It sounded like things that were loose on the building were being tossed around outside.

I got to sleep around 2am again and managed to get up around 8am. I grabbed a quick bite in the store downstairs and headed off to work. I got there around 10am and was warmly greeted by everyone. My boss was happy to see me too, but apparently there were some issues with my evaluation not being turned in yet. In the Army, Non-Commissioned Officers (NCOs) and Officers are required to be evaluated annually. They are supposed to be done by a certain time of the year, and when things fall behind, the people up the chain get hounded for not having the evals of their people done on time. I knew this before I went on leave and completed my part of my NCO Evaluation Report (NCOER.) Well, I guess we are cutting it too close for comfort since everyone from my unit in Fort Worth to the people at work want to know where it is.

The first thing I did was track down the guy that I knew could tell me where it was. I found him and was told to talk to another person higher up. That person knew that it was missing but didn’t know where it was either. Basically, all the people that needed to sign it had already signed it and they were just waiting for my signature. But now the eval was no where to be found. This person said they would talk to another person and see if they can track it down and that I should check back later. I checked back later and the person was gone. There was some kind of sewer leakage that blocked one of the entrances on and off base today, so they let people that lived far away go home early. I guess that person left? I stayed to get my work done… I won’t be at the office tomorrow, so I hope they find it so that I can sign it on Wednesday. My boss wondered why they just could not print out a new one and have everyone sign it again… I have no idea.

Speaking of work, I made quite a few phone calls regarding the Medical Evaluation Board (MEB) process that I am about to begin. The issue is… I have no idea how I’m supposed to initiate it! I think I know the problem though… normally a soldier doesn’t have to initiate it – it begins when they get hurt and then they get worked through the system. My issue is that because I have been having all my treatments done at the Navy hospital, the Army hospital has no idea what’s up with me. They don’t know I need an MEB! At first I thought I was supposed to begin out-processing from my office, and also take the paperwork that I do have to Walter Reed Army Medical Center (WRAMC) and that would start the process. But when I ran this by my Reserve Management Office (RMO), they said that I should probably not do that quite yet. Instead, I should call WRAMC and the office that does the out-processing and see what they say.

I followed their instructions and called WRAMC. I explained my dilemma to someone there and they told me that they would have to speak to someone above them to see what needed to be done. To my surprise, a few minutes later they paged me and I called back. They had a list of things that needed to be done and paperwork that I needed to gather in order for everything to go smoothly. A plan! It sounded good to me, so I took notes and hung up. One of the items on the list required that I ask the out-processing office a few questions too. I called them up and they had a similar, but slightly different plan. They urged me to call a different person at WRAMC, but to come to them to begin out-processing immediately! I called the person they suggested I call and they were very helpful. They told me basically the same things the first person at WRAMC told me with a few slight changes. I called the first person back and left a message with them explaining that I had spoken to the out-processing people and this other person at WRAMC and that the plans were slightly different – I expect a call back from them tomorrow.

Okay, so all these details, right? Here’s what it comes down to:

1. When you can’t physically perform your duties in the military because of an injury or disability, they put you on what is called a profile. They have temporary and permanent profiles. I have been on a temporary profile since the surgery, but my main doctor recently put me on a permanent profile because you have to have one to start the MEB process. First thing tomorrow, I have to make the trek to my medical clinic in the Pentagon to get a copy of that P3 profile. Simple enough, right? We’ll see.
2. I need to begin the out-processing process which has to be done at Fort Belvoir, which is about 30 miles south of DC. I can’t drive, so our good friend Tamra, who is also in the Army and happens to work at WRAMC, is going to give me a ride. There, I’ll begin the process, but when I get to medical, they’ll see my past history and things will screech to a halt. They will immediately refer me to WRAMC for an MEB. Then we’ll drive to WRAMC and I’ll meet with some of the people that I spoke with on the phone today. And it all works out perfectly because Tamra needs to take care of some business there tomorrow too! I’m not sure of what all will happen when I get there – I’m kinda flying by the seat of my pants on this one.
3. I need a Narrative Summary (NARSUM) from my doctors explaining what happened to me and what conditions I have now. I have appointments with my Neurologist and Oncologist on Friday to knock this one out of the way. BTW, I also have a follow-up MRI Friday afternoon to see how things look up there. Pray that everything is still getting better for me, okay?
4. Since this happened to me while I was on Active Duty, it is considered a Line of Duty injury (LOD). Apparently there was supposed to be a form filled out quite some time ago (a DA2173 to be exact,) it was never done, so the folks at WRAMC will take care of that for me.

Wow! So those are the major things at this time that I know of. In addition, I was told that once I go to WRAMC and they begin the process, they will put in a request to the Army to cut a new set of orders assigning me to the Medical Holdover Company at WRAMC. The Army will then have 72 hours to cut the orders. Whatever date the orders say I am assigned to WRAMC is the date that I have to move out of this temporary apartment and into the housing at WRAMC. My current orders expire on April 27 – I’m sure they will be done by then. In fact, if I go there tomorrow, they might be cut by this Friday. I was kind of hoping to spend one more weekend in this apartment close to everyone I know, but I might have to move before then. Or, they might cut the orders by Friday, but the effective date won’t be until sometime next week. That would be preferable since I have medical appointments pretty much all day Friday and it would suck to move over the weekend. So, let’s pray that I am told to move next week too.

Confusing? We’re just getting started. Tomorrow should be a fun filled day of running around and being told different information. I pray that it goes well. I know I’ve probably given you way too much information, but I wanted to tell you everything and it also gives me a way to put it on “paper” to make sure that even I have it right. I’ll update you tomorrow evening. And if you have questions for me, please leave a comment and I’ll answer them. Now it’s close to midnight again and I’m still up. So, I’m posting this and going to bed.