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I am Daniel B., a 43 year old male, married and with one son named Luke, who is 7 years old. We live in Missouri. I am a member of the Missouri Army National Guard. I have been deployed three times.

1991 Desert Shield/Desert Storm (6 months Saudi Arabia,Iraq,Kuwait)

2003-2005 OIF (15 months Ballad Iraq, Kuwait)

2008-2009 OIF (12 months Biap, Tallil, AL Kut, Iraq, Kuwait)

My job in the military is to work on UH-60 Blackhawk helicopters. I am a staff sergeant in charge of a maintenance section in the Missouri National Guard. My full time job is working for the Civil Service on UH-60 Blackhawk helicopters in the Quality Control Section.

Before leaving on my last deployment I was having issues after eating. I would become warm and flush red in the face after eating. I went to a specialist at the Lake of the Ozarks. He performed an upper and lower GI, and diagnosed me with Esophagitis gastritis grade I. He prescribed some medication to cut down on my stomach acid and sent me on my way.

I was then cleared by doctors at the Fort Leonard Wood Hospital for my last deployment. We departed for the MOB station at Ft. Sill, OK and from there I once again was cleared for deployment by their medical section.

I then deployed with my unit to Iraq for a year. We returned in July of 2009, I then went on leave and then back to work. In August of 2009 I went to a new family physician. I wrote down all my issues and went to my appointment. The doctor noted the pain under my rib cage on the outtake of breathes as a possible gallbladder problem and ordered an ultra sound at the Lake Regional Hospital. The ultra sound revealed that my gallbladder was normal. However the spots on my liver were not. A Cat Scan was ordered and the Carcinoid Tumors were found.

I then opted to go to The Center for Advanced Medicine at Barnes Jewish Hospital in St. Louis, Missouri. My new doctor there ordered several tests for me including the Octreotide scan, CT scan, and blood tests. My tumors were confirmed as Carcinoid with high receptors. My prognosis was given as 3-5 years.

TACE (transcatheter arterial chemoembolization) treatments were next on the schedule for me. The right side of my liver was injected on October 16, 2009, the left side of my liver on November 18, 2010. Mixed results were noted on the CT scan one month later. The wait and see approach was next with 20MG of Sandostatin LAR injections every four weeks. During this time frame I ran out of sick leave and vacation time and my fellow employees donated 192 hours of their vacation time so I never missed a pay check.

November 31, 2010 I was pulled back on active duty into the Wounded Warrior program as I was still in my 180-day window from my deployment. So, I still had Tri-care coverage.


I requested a second opinion after reviewing the Heartland Carcinoid Support group website pages and reviewing other patients' therapies and prognoses.

Dr. Botha stood out with his two stage liver resection. I requested consultation and received approval from my primary care physician. At the consult I found out that I was not a candidate for this two stage surgery. Other options were presented. Liver transplant, multi-organ transplant, and PRRT, if we had the means to support it.

Dr. Botha's referral was for my mid-gut primary tumor to be removed followed by PRRT or a liver transplant. However after another CT scan he decided PRRT should be done first.

I presented this referral to my primary physician and he was supportive. The Brigadier General was supportive of the therapy as well, as there are sections in the Tri-Care manual that cover rare diseases and treatments in other countries. Experimental medicine was mentioned, but Dr. Baum's track record with PRRT for the last ten years sufficed for proving it was a safe treatment. Dr. Baum reviewed all my history and scans. In his opinion I was a good candidate for PRRT.

The WTU at Ft. Leonard Wood arranged for my travel to Germany. The WTU in Schweinfurt, Germany arranged for my lodging and transportation to the Zentralklink in Bad Berka, Germany.

I received my first treatment in June 2010 from Dr. Baum with no issues.

I returned for my second treatment in September 2010 and reviewed the results from the first treatment which showed a 30 to 50% reduction in tumors. I received my second treatment with no issues.

I returned for my third treatment in December 2010. The results from my second treatment showed stabilized disease and more reductions. I received my third treatment with no issues.

My fourth treatment was given in April of 2011. My MEB/PEB board has been started and my treatment plan is not completed. I am facing some issues with the change in status for me and Tri-care coverage since my treatments are in Germany.

If I am active duty with Tri-Care Prime, then I am covered 100%. If I retire and receive Tri-Care for life I have no coverage for this treatment.

If I REFRAD (released from active duty) and go back to the Missouri National Guard I have no coverage for non-FDA approved treatments. This means no coverage for treatments in Germany. And if I go to the Veterans Administration I have no coverage

for my treatments either. These are issues that military personnel should be aware of as they plan their treatment.

I can be contacted by email from the website if you have questions regarding military coverage of my treatment in Bad Berka.

Dan B.