-Would should I start the process to get medically approved to separate?
-Any other Limfacs that I’m missing?
I imagine this is the most appropriate and generic place for advice on the matter: being medically prepared for separation. This is not specifically about a Medical Separation/Retirement via Medical Evaluation Board (MEB)/Integrated Disability Evaluation System (IDES) although many lines cross all the way through to the VA. These are just the cliff note items I would've started thinking about sooner rather than later in hindsight loosely in this order also.
1) (Realistically) figure out your end game for your known medical situation/record. Do you have a 9-5 lined up and don't care? Do you want to go Guard/Reserve/other branch? Do you want to attempt a medical separation/retirement? Are you going to need an FAA medical post separation/retirement? With your end game in mind...
2) Go to records and get a PRINTED copy IMMEDIATELY (yes records are electronic now but ask to have them printed). Once in hand READ every page back and front. The goal here is to get to know your record and know what AF Medicine has thought of you throughout your career. You want to have more than a general "who, what, when, where and why" of your history in black and white without a doctor filtering it. But what are you looking for...
3) Research (depending on your end game). But the overarching research topic pertains to Veteran Service Officer/Offices (VSOs). They are not all created equal and some have better track records with the VA than others but researching them can help no matter your end game. If you don't have the time to sift through thousands of sheets of your medical record a VSO will aide in that but I understood them to do this so they could make a subsequent claim to the VA. Regardless they know what they're looking for regarding follow on VA claims.
3)a. Do you have a 9-5 lined up and don't care? I recommend caring. Even if private healthcare is basically in hand knowing your military record thoroughly now can pay dividends if things that happened while in service get more severe and you want to take it to the VA. Keep in touch with a VSO should the need arise to file your claim.
3)b. Do you want to go Guard/Reserve/other branch? The biggest issue with this option in today's deploy or get out climate is meeting deployability standards which feeds into Retention Standards. The Medical Standards Directory (MSD) gives the cliff notes on retainability and waiverablity for the different classes of military physicals. Also 48-123 (or at least it was) was a good starting point regarding AF medical standards. DoD instructions related to medical standards will also factor into this.
3)c. Do you want to attempt a medical separation/retirement? For this the deploy or get out climate could work in your favor. If you do not meet deployability standards you theoretically do not meet Retention Standards and should be entered into the MEB/IDES per the black and white of the 48-123. The Medical Standards Directory (MSD) is a great resource along with 36-3212 and 32-2110. Various DoD instructions govern this also readily available on the google. Oh and probably the biggest help for this is pebforums.com. There are literally decades of data related to MEBs on there along with very experienced moderators who can help in a professional capacity with representation.
3)d. Are you going to need an FAA medical post separation/retirement? All i know via the interwebs was some dudes had their FAA medicals pulled for Military Medical issues that they did not disclose on initial applications. I don't know the specifics as to how the FAA got wind of the issues but I think there was a thread on BO at one time with more specifics. All this to say for dudes needing an FAA medical post service accomplishing item 2 will get you in know on your medical history written by medical professionals. Also when I applied, the FAA wanted additional data on my condition and I was able to pull lab results over my years of service that resulted in the FAA granting me my medical. I've since renewed it without issue.
4) Cross-Check. Apply your research regarding your situation to you record in hand. Is there anything in your record that would prevent you from achieving your end game or perhaps make your case/VA claim? Tab it out, know where it is, know what it says, know who said it and at what time etc. This leads to the next item...
5) Applicability/Waiverability. It's more research as to how to make your case for your end game. Regardless whether you need a waiver or want something to be applicable what you're researching here is PRECEDENT. For those wanting to continue serving the Air Force Waiver Guide is a treasure trove of information of condition waived/metrics/tolerances etc. I do not know if the FAA has a published repository of granted waivers for conditions. The VA website has a rather robust database of claims/appeals/outcomes etc. Proving your case with the VA with the published data and a solid VSO is very possible granted your history backs up your claim within reason.
6) Fight's on. Regardless of what you want out of your current and/former medical situations go after it. Much of MEB/IDES/VA fights are more a matter of legality rather than medical "expertise." Meaning the systems are a CYA for the DoD. The onus is on you the member to make your case rather than the entity correct their finding. A private lawyer is highly recommended based on my experiences. With regards to attaining an AF waiver to continue with the ANG/AFR I've heard having the right flight doc align with you opinion COULD get you in the door and the subsequent waiver...but this is all hearsay. I have not met anyone yet that was "broken" from big blue and gained by the ANG/AFR, although on BO it is much easier for rated in this regard.
7) I HIGHLY recommend the last item you do right before dropping off you CaC is pick up yet ANOTHER PRINTED copy of your medical record. The items above could be years in the making with subsequent entries from the last printed copy. Make sure to get your request in with Records so they have ample time to print it before your final out. If you attempt to acquire your printed medical record through the VA post separation it can take 6-9 months before you receive that copy.
7)a. Ditto for Dental. They'll say your xray is your history. That's fine and dandy but I had them PRINT a copy of my entire dental record. It's not official as the original in your folder is kept and retired but the copy gives you something in hand to take to you next provider.
***BREAK for Dependents BREAK***
1) Same as item 7 above. Get your spouses and kids records request for a PRINTED copy for pick up as close to your final out as possible. Of course records will say "oh just have their new doctor request it from us." Yeah...fool me once jokes on you, fool me twice...we know how that goes. Fun fact: you cannot request your spouses record they need to go in person to fill out the form. You as the sponsor can request records for your dependents under 18 i believe. Also if you have children you're probably already tracking that the Immunization record could be the most important document in your young off springs life. I requested multiple copies directly from Immunizations in addition to what was in the entire printed record.
2) Double down with Dental if were fortunate enough to have a dependent be seen on base.
Healthcare and the subsequent medical fallout from my service has been my biggest worry not only for my personal health but for my families mental, emotional, and financial health also. I hope this sheds some light on what you have to look forward to. Just remember you're not alone, there's someone out there who has gone through it before.