You can Easily be Found Unfit Despite Perfect Performance.

Peb Process
By: Joel Pettit • May 12, 2023

“But I’ve been doing my job for 15 years with no problems. Why, suddenly, does the military say I’m unfit for my job when nothing’s changed? It’s a mistake, right?” Clients ask me this question at least once per month. And, no, it’s never a mistake. The fact is all the military services – including the Coast Guard – are slowly culling their ranks of Service members who take medications commonly referred to as ‘biologics.’ Most, if not all, of my clients faced with this grim reality have trouble reconciling the military’s motivation for separating good Service members who, in all respects, have done nothing wrong and having nothing wrong with them. Understanding what biologic medications are and how the military medical establishment views them is the first step in appreciating the seriousness of these cases.

Put simply, biologics are a subset of a class of medications called disease-modifying antirheumatic drugs (DMARDs). Nonbiologic, or conventional, DMARDs, such as methotrexate, are drugs composed of small molecules made from chemicals in a lab. Biologics are large molecules produced in living cells. Both help protect against the effects of inflammation, but in different ways. Although this may seem complex, the only relevant fact for Service members is that biologics suppress the immune system. The medical practitioners in the Military Departments have unanimously agreed that biologics suppress the immune system enough to place Service members at too great a health risk when deployed.

I will not delve into the different types of deployments (OCONUS or Combat); the PEB does not split hairs, neither will I. The key to understanding the military’s reasoning is appreciating one major line of logic underpinning the Integrated Disability Evaluation System (IDES): risk management. DoDI 1332.18, when defining the criteria for referral into the IDES, references two specific considerations that Service members would do well to keep in mind concerning risk management of medical conditions that 1) represent an obvious medical risk to the health of the member or to the health or safety of other members or 2) imposes unreasonable requirements on the military to maintain or protect the Service member. Therefore, regardless of individual PEB members’ opinions about medical care, the IDES is designed to ensure that Informal and Formal PEB’s err on the side of caution.

This is especially important to anyone diagnosed with a condition potentially requiring biologic medication, such as Stelara, Humira, Remicade, Enbrel, etc. Ironically, as an IPEB attorney I did not see many Service members found unfit because of immunosuppressive drugs, despite the IDES requiring anyone rendered non-deployable for one year or more to undergo a Medical Evaluation Board. Why? While investigating this rare occurrence for a client at Camp Lejeune, NC, medical staff explained to me that the personnel in charge of notifying anyone about a Service member’s inability to deploy were the Limited Duty (LIMDU) Coordinators; simply being prescribed biologics doesn’t warrant a LIMDU status. Therefore, because Service members prescribed biologics went unnoticed unless there were other issues necessitated referral into the IDES.

Oddly enough, these Service members didn’t have issues passing deployment physicals, or they simply received waivers. Only when issues with storage, supply, or symptoms arose during deployment did many of these Service members get referred to the PEB.This is no longer the case. Automation may make many processes smoother, but it also makes it quite simple to alert physicians that Service members whose ulcerative colitis will require an indefinite Humira prescription should be referred into the IDES.

Unfortunately, I have seen dozens of cases involving Service members with as many as 17 years of military service before being referred into the IDES. Although programs like Permanent Limited Duty (PLD) and various forms of early retirement exist, this does not dull the sting an unfit finding inflicts upon stellar Service members who see separation or retirement under these circumstances as a punishment against themselves, their units, and their country. Nonetheless, whether individual Service members agree with their physician’s medical assessment and the PEB’s decision is irrelevant. The fact remains that an immunosuppressed Service member falls squarely into the risk management mindset propagated in the IDES.

If you are facing a situation in which your prescribed biologic medication may cause you to lose your career, please call Joel Pettit Law. We understand the intricacies of these cases, and have crafted strategies to assist our clients to avoid having IDES referral. Moreover, if you’ve been referred to the IDES, please don’t wait to contact Joel Pettit Law.

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