Traumatic brain injury (TBI) is becoming a common wound of modern warfare. It has even been coined the “signature wound” of the War on Terror. While TBI is becoming more prevalent in wartime activity, many service men and women continue to go undiagnosed. Institutions, like the US Department of Veterans Affairs, are working to make quick and accurate diagnoses in order to prescribe appropriate and effective treatment.

TBI is caused by forced trauma to the head, either by being shaken or hit. The severity of a TBI varies from case to case, but symptoms range from mild concussions to a debilitating state. The majority of TBI’s acquired by military personnel are classified as mild traumatic brain injuries (MTBI). Initial symptoms of MTBI consist of loss of consciousness, disorientation, loss of memory, headache, and temporary loss of hearing and vision. They are often partnered with anxiety, irritability, difficulties processing information, limited concentration amongst other problems experienced down the road. While MTBI is most common amongst the men and women of the armed forces, more severe cases of TBI are happening much more frequently and often require the victim to attended specialty rehabilitative nursing centers, like CareMeridian.

The most common cause of a TBI in the military is due to blasts. There are three degrees of blast injuries where a TBI is common; Primary (due to blast itself), Secondary (due to objects being propelled by a blast) and Tertiary (due to a collision with a third party object). According to the Veterans Health Initiative, active male members of the military from the ages 18-24 are hospitalized with a TBI at a rate of 231 per 100,000 and females 150 per 100,000. Based on military force projections this would mean that 4,141 military personnel are hospitalized on average each year with a TBI, and these numbers often rise during wartimes.

The best prevention for veterans to avert the long-term effects of a brain injury is to recognize the symptoms of a TBI. Once the symptoms are identified an individual should take basic precautionary measures in order to begin the healing and recovery process until a more specific diagnosis can be made.

Service men and women give so much to protect this country and they deserve to come home to a happy and healthy life. Creating awareness about TBI will help ensure their long term health. By helping our veterans, their friends and their families recognize the early warning signs of a TBI, treatment can be sought as early as possible.

After being medically discharged or retired from the military, most soldiers are encouraged to also seek compensation from the Veterans Administration (VA). This process is just as confusing and drawn out as the process with the Army.

My husband submitted his packet to them at the same time that his medical packet was presented to the MEB. For months following that, we received letters every few weeks that basically stated ‘we haven’t forgotten about you but we’re swamped with cases that need to be reviewed’. We joked that if they spent as much time reviewing cases as they did sending those letters, their backlog may not be quite as large.

He went for his evaluation by the VA in the fall. During the evaluation with the VA, it is important to note that they do not go by what the Army has done. While that information can be added to your record, they conduct their own evaluations (there is talk of this being combined but as of this writing, it has not). Also, the VA evaluates everything that possibly could have happened to you during your time in the service. You are not limited to only filing for the disability that created your discharge or retirement. It’s also important to note that you do not have to be medically discharged or retired from the military in order to file with the VA. Their rating and compensation system is separate from the Army.

In December (eight months later), we received the letter in the mail that his rating had been established and he would begin receiving X amount per month in compensation. The kicker is that you cannot receive payments from the VA and the Army. Also the Army payments are taxable whereas the VA payments are not.

When we received this, the VA let the Army know of the decision as well. By doing this, it reduced the amount of pay received by the Army and he now receives a check from both the VA and the Army. If at some point, the VA quit paying him, then his Army check would revert back to the previous higher amount he was being paid. If for some reason the Army quits paying him, then his VA check will continue unless he is also reevaluated by them as well.

It’s easier to explain this with examples. These are not real numbers and are not based on true compensation. I just used round numbers to make it easier to explain.

Scenario A:

Soldier is receiving $1000/month from the Army as retirement pay, which is taxable. The VA awards him $400/month, which is non taxable. The maximum amount he can receive is $1000. So from this point forward, he will receive two checks. He will receive a check from the Army for $600 before taxes ($1000 – $400) and he will receive a tax free check from the VA for $400 for a total of $1000. So now instead of paying taxes on $1000/month, he only pays taxes on $600/month. If for some reason, the VA discontinued their pay, he would begin receiving $1000 from the Army again. If the Army discontinued their pay, he would continue to receive $400 from the VA.

Scenario B:

Soldier is receiving $1000/month from the Army as retirement pay, which is taxable. The VA awards him $1200 a month which is tax free. He will receive $0 pay from the Army and will receive a tax free check of $1200/month from the VA. If for some reason the VA discontinued his compensation, he would again receive $1000/month from the Army. If the VA reduced his compensation below $1000, it would play out the same as Scenario A

While permanent retirement pay from the Army is just that – permanent; VA compensation can change if you request another evaluation. This evaluation can result in your VA compensation remaining the same, increasing or decreasing. If the VA decides to change your compensation, it does not change your Army retirement pay as they are two separate systems. It will only effect it as described above in scenarios A & B.

There are some exceptions where soldiers are eligible to receive the full amount from the Army and the VA. This applies to soldiers who retired from time in service and have received a certain disability rating from the VA. It is referred to as Concurrent Retirement and Disability Payment (CRDP) Program.

Also, as with everything in the Army, there are exceptions to whether the medical retirement pay is subject to federal tax.

For more information, visit the VA’s website at www.va.gov.

When we first found out that my husband was being medically retired, I had a wide range of emotions. On one hand, I was thrilled that I would never have to hear the words ‘I’m being deployed’ again. I thought surviving four deployments was quite enough! But on the other hand, I was very sad.

Part of my sadness was that we were leaving so many friends behind. One of the biggest draws (to me) of military life was the fact that it comes with a built in family. You automatically have something in common with so many people. It’s easy to meet new people and there are always activities to be involved with if you wish. The friendships that you develop, especially over a deployment, are much deeper than many of my ‘civilian’ friendships. And it seemed like no matter what, there was a list of people who could be called at the spur of the moment to go out to dinner or go down to River Street.

Part of it was also that there is a certain amount of pride that is associated with being a military wife. I felt like to a certain degree that was being left behind as well. Because my husband had served in a special ops unit, it was going to be more difficult to keep up with the soldiers he served with and continue to support them during their deployments. So it seemed as if, at the time any way, that we would be cut off from the world we had grown to love.

And finally, I felt like I had put a great deal of effort and work into a website dedicated to Army wives and Army families and now I wasn’t even going to be a military wife any more. How would all that work? Would the ladies, fellow Army family members, on the message board feel like I didn’t belong after he retired? Of course, that didn’t happen but there was a sense all around of being thrown to the curb. It’s like you were being kicked out of a club and would forever be only on the outside looking in at what you were at one point very involved in and consumed by.

We’ve managed to keep in touch with friends better than I thought we would be able to. A lot of that is thanks to Facebook. We moved to the opposite side of the state and my husband returned to school to finish his degree. He found a job that was nothing even remotely close to the level of what he was doing in the Army and was surrounded by an almost entirely female staff. That was quite the adjustment for him as well since he had been in an all male special ops unit.

We found it hard to meet people and begin friendships because so much of our most recent life was centered around the Army and its deployments. Our new neighbors and contacts really didn’t have the first clue about the military lifestyle and for the most part, really didn’t care. It was an entirely new situation for us to not be in a military community and we began to miss our past life.

It hit my husband hardest when his unit deployed again. He knew that he should be with them and it was killing him that he was sitting in a classroom while they were overseas. Phone calls from his buddies about their training and what had been going on only made him miss the lifestyle even more. Couple that with the fact the he is attending a military college and takes classes with cadets in ACUs every day.

Every time I logged onto the message board or answered emails from anxious Army wives, girlfriends and family members, I felt that twinge of jealousy. They were able to live the lifestyle that we wanted to live but weren’t able to because of whatever it was that caused his condition on that first deployment.

I get very excited when I see someone with a DoD decal on their car or wearing a proud Army wife shirt. When I went to the doctor and the patient ahead of me in line pulled out a military ID, I felt an odd sense of comfort. It’s a much rarer sight around here and just makes me feel at home. It’s been great when some of his buddies have come to see us or I get to talk to an Army wife who supported me through deployments on the phone. I can talk like what has become normally to me, using acronyms and terms that those outside of the military community just don’t understand. It has been strangely comforting to be around these people again and share stories about the “good old days”.

We both miss the military lifestyle greatly. Yes, it has its downsides. There are definite bumps in the road and I’m not too sure I would really want to endure another deployment. But it also made our marriage stronger and it made both of us stronger and more confident as individuals by dealing successfully with all that we did while he served. It’s rare for a day to go by without one of us talking about the Army and I wouldn’t have it any other way.

When a soldier is placed on the temporary disability retirement list (TDRL) or Permanent Disability Retirement List (PDRL), he is given the same benefits as if he had served for twenty years or more. A medical retirement or medical discharge is always honorable (unless there were other circumstances involved other than the medical).

Pay

For soldiers now, the pay is based on the High 3 method. This is the average of the three highest base pay rates received. While on TDRL, a soldier must receive a minimum of 50% of the high 3 regardless of the disability rating. If on PDRL, the pay is based on the disability rating. A disability rating of 30% would equate to retirement pay of 30% x the high 3 average whereas 60% rating would equate to retirement pay of 60% x the high 3 average and so on. If the soldier had twenty years of service, he will receive the higher of the regular retirement rate or his disability retirement rate. Retirement pay from the Army is taxable. From the time my husband was medically retired until we received his first retirement paycheck was about six weeks. Also, keep in mind that his final active duty paycheck will likely be delayed to double check for any inaccuracies before paying him.

Health Insurance

Retired soldiers and their family are still entitled to TRICARE benefits including dental insurance. If the soldier chooses TRICARE standard, there is no monthly or annual premiums but you are subject to co-pays and deductibles. If the soldier chooses TRICARE Prime, there is an annual enrollment fee that can be paid annually, quarterly or monthly. This fee can also be set up as an allotment from retirement pay. It is less than $40/month for family coverage.

Dental insurance can be set up on an allotment as well. The amount varies based on the type of coverage but it is considerably more than active duty premiums.

ID Cards

The soldier and his dependents will keep their ID cards and maintain commissary, PX and other post privileges. New ID cards will have to be made to show either the TDRL or PDRL status. My husband always gets strange looks when he shows a retired military ID at the age of 29. My ID looks almost identical to my active duty ID except beside the rank, it shows TDRL as well.

DoD Decals

Retired soldiers and their dependents are allowed to keep updated DoD decals on all of their registered vehicles.

On Post Resources

Retired soldiers and dependents maintain access to all on post resources including most travel deals. They can continue to use post lodging as well. There are some restrictions on these things but they are minimal.

Military Discounts

Many businesses only offer discounts to active duty personnel and their dependents. However, many businesses also do not recognize the difference in active duty IDs and retired IDs. So we’ve not had a problem continuing to receive discounts. I typically use my military ID when a business asks for ID as I hate my driver’s license picture even more than my military ID picture *wink* and they’ve always offered the discount. I have not asked for one since my husband retired.

A soldier is placed on the Temporary Disability Retirement List (TDRL) if during the MEB (Medical Evaluation Board) he was assigned a disability rating of 30% or more but the condition was not deemed stable enough for a permanent rating. TDRL entitles a soldier to all retirement benefits the same as if he had served twenty years or more.

A soldier can only be on TDRL for a maximum of five years. At the end of five years, a permanent decision must be made regardless of whether the condition is deemed to be stable. While on TDRL, a soldier undergoes a physical evaluation of his condition every 12-18 months. It is CRUCIAL while on TDRL to maintain excellent medical records through the physician or other healthcare providers as well as documenting how and when the condition has affected your life.

The soldier will receive a letter in the mail (and possibly a phone call as well) alerting him to the evaluation appointment. This is typically done at the nearest post that is equipped to perform these evaluations. The soldier will be reimbursed for travel expenses. Many of the tests that were run during the original MEB process will be run again for comparative purposes. The doctor will then form a recommendation and complete the packet. The packet is sent to the soldier to either agree or disagree with the findings. From the time the soldier receives the packet, he as five days to agree or disagree with the findings. If he disagrees, he must attach documentation as to why he disagrees. The packet is then forwarded to the board for a decision.

At this point, a variety of decisions can be made.

1. The soldier is found fit for duty. Usually, if this happens, the soldier is given the option whether to reenlist or be discharged. There is no disability compensation for this.
2. The soldier is given a 0%-20% disability rating. He will be given a severance package the same as if this finding had been made during the original MEB process.
3. The soldier is given a rating of 30% or more and the condition is still not rated as stable enough for a permanent rating. The soldier remains on TDRL and will be evaluated again in 12-18 months.
4. The soldier is given a rating of 30% or more and the condition is stable enough for a permanent rating. The soldier is placed on PDRL the same as if this had happened during the original MEB process.

If the soldier does not agree with the decision, he can appeal. There is a very short timeframe in which he can file the appeal. If he appeals, he will appear in front of the formal board to plead his case. This is generally done with the assistance of JAG or personal counsel, though it does not have to be. If the soldier cannot appear in person, many times the board will allow the soldier to have his appeal heard by phone.

If the soldier is given a rating of 30% or more qualifying him for retirement, this is a risky game to appeal. When the soldier appears in front of the formal board, they can change the decision in either direction which includes dropping the rating below 30% which would then disqualify the soldier for retirement. Be sure to discuss all of your options with counsel before pursuing an appeal. On the other hand, if you were given a rating of 0% and know you can’t be found fit for duty, you really don’t have much to lose by going to the board to appeal the decision. This is a personal decision that must not be taken lightly.

It is crucial that the soldier keep his address updated with the Army while on the TDRL. Failure to report for an evaluation can result with being dropped from TDRL.

Our personal story…My husband was medically retired in June with his last evaluation the previous April. In December, he was called and informed he was due for his evaluation. When he questioned the timing (it had only been 8 months), he was told that the doctor was deploying soon so he had to come in within the next few weeks. He agreed and was seen in January. The physician questioned why he was there so early and when my husband told him what he was told, he replied that it was news to him. Very frustrating!

He was sent his packet to review at the end of February. Again, this was very confusing. The packet is large and unlike with the original MEB, there’s not a physician sitting there to explain to you exactly what it says and what it could be mean at the board. There were discrepancies throughout his packet. But the option was to agree or disagree and if he disagreed, he had to attach documentation as to why. The doctor’s recommendation was also very vague. It basically stated that his condition had not improved, would require follow up and he recommended removal from TDRL and that a permanent decision be made. But we were left wondering what kind of permanent decision? We agree that his condition has not improved but was he recommending discharge (which we disagreed with) or retirement (which we agree with). There was no way to tell and we also had no one to call. I was lucky that when I posted about it on my blog, several soldiers who had been through the process emailed me about it.

We ended up agreeing with it and attached a document that we referenced on the agree/disagree form that cleared up the inaccuracies that were throughout the report. As of the time I’m writing this in the middle of March, we do not yet have a decision. I don’t think I’ve had a good night’s sleep since the process started. We are hoping for a decision in the next few weeks so we at least know what we are dealing with and facing.

UPDATE: My husband’s TDRL was extended until May of 2009 when we will go through the process again.

Going through a medical evaluation board (MEB) can be an overwhelming experience. You are dealing with so much of the unknown and the process can be very confusing. When my husband went through his, we were only aware of two options – discharge and discharge with settlement. We did not know any other options even existed but we quickly found out that they did.

If your soldier is going through the MEB process, these are the main outcomes that he could expect:

1. To be found fit for duty. If this happens, he will return to his unit and continue to serve.
2. Assigned a disability rating of 0% to 20%. Just FYI, a 0% rating is considered a disability rating. If this happens, your soldier will be honorably discharged with a settlement. The settlement is based on the time in service and his rank. There is a formula that basically works out to 2 x ‘years of service’ x ‘high three pay rate’. The high three pay rate is the average of the three highest base pay amounts that your soldier has earned. This severance package is taxable. He can also seek VA compensation if this happens.
3. Assigned a disability rating of 30% or more with a condition that is not rated as stable. He will be assigned to the Temporary Disability Retirement List (TDRL). On TDRL, he receives full retirement benefits the same as if he had served twenty years or more. He will have to be reevaluated for up to five years until he can be removed from TDRL or his condition warrants a permanent rating. He can seek VA compensation as well.
4. Assigned a disability rating of 30% of more with a condition that is rated as stable. In this case, he will be assigned to the Permanent Disability Retirement List (PDRL) and will be permanently retired. He will receive all benefits the same as if he had served for twenty years or more. His retirement compensation will be based on High 3 x the disability rating he received.  He can seek VA compensation as well.

Again, a great resource is the PEB forum located at www.pebforum.com.

Unfortunately (or fortunately depending on how you look at it), my husband and I became more familiar with this than we ever planned to. Keep in mind that this is our experience and as with everything in the Army, the experience can vary greatly from one soldier to the next.

During my husband’s first deployment (of four that he completed), he began to have some respiratory issues. When he came back to the states, he noted his difficulties on his post deployment evaluation. His respiratory condition only continued to get worse and to make a long story short, he was moved out of his MOS of 11Bravo to a less physically intensive position.

At this point, the BN surgeon recommended that he begin a medical board. My husband did not want to do this and fought to avoid it. With the support of his 1^st SGT as well as several other higher ups, he was allowed to avoid the med board and serve in his unit in a different capacity.

After his fourth deployment, his condition had still not improved and his ETS date was now less than a year away. He was on a variety of medications (and still is) so the BN surgeon recommended a med board again so in his words ‘we could at least try to get his medications paid for’ as the running total for them was more than $300/month.

He reluctantly agreed to start the process. He went through a variety of testing, physical evaluations, etc. There was a great deal of paperwork that had to be processed. The process started at the end of October and his packet was not ready to go to the board until March. After all of his paperwork was complete, his packet had to be reviewed by three physicians before going to the board. They met with him as well and he had the opportunity to either agree with their findings or disagree and state why. He agreed and his packet was sent to Texas to be examined by the informal board.

From the time they received the packet in Texas until we received a decision was about 48 hours. It was remarkably fast and much quicker than either of us anticipated. He was called in again to discuss the findings and the next steps.

Up until this point, we had no idea that the option of retirement even existed. But we quickly found out that it did. He was given a rating of 30% which qualified him for retirement. Because his condition was not yet rated as stable, he was placed on the TDRL (Temporary Disability Retirement List). From the time he accepted the decision, he had to be outprocessed from the Army within 90 days. We pushed it until the latest possible time and he was officially placed on TDRL and removed from active duty in June. So the entire process for us (from beginning the med board until discharge) was about 9 months.

The process and length of time can vary greatly. While the main steps are the same, the amount of time it takes to get from one step to the next can be drastically different for each soldier. We were told that orthopedic cases take the longest to process. I have known some who have been outprocessed in as little as three months and some who are still in the process after 18 months.

I am by no means an expert on the process. In my quest to learn as much as I could and through others reading my blog and emailing me, I was able to find a message board that is dedicated to the Physical Evaluation Board (PEB) process. It can be found at www.pebforum.com. It has a wealth of information and is run by a former military service member who represented MEB cases while he worked with JAG. He is also on the board quite a bit and has been very helpful in answering questions. Check it out.

If your soldier is going through the MEB process, please email me your story so it can be posted. You can leave out any identifying information if you wish. It is always helpful to be able to read a variety of experiences rather than just having to depend on the experience of one person.

When some soldiers retire from the military, they are also eligible for disability compensation from the VA. Due to current guidelines, they are, in most cases, prohibited from fully collecting both. The CRSC enables the soldier to receive either partial or full concurrent compensation from both in certain situations.

For CRSC to apply, the service member must:

1. Have twenty years or more of qualifying service.

2. Have a disability rating from the VA and be receiving VA disability compensation that is offsetting retirement pay.

3. The VA disability rating must be due to a combat related disability.

4. The combined rating for all combat related disabilities must be at least 10%.

CRSC is a non taxable benefit that is retroactive to the date that the soldier became eligible to receive CRSC (after June 1, 2003).

Application for CRSC