Crabcake

Andy - no worries at all. I try not to take online comments personally because it's hard to convey someone's intent or meaning, and it's usually not meant that way anyway, so it's all good my friend. ;) And I know exactly what you mean about your body not 'looking like how it feels'; you're not alone in feeling that way. On the outside and on a 'good' day, I'm sure I look like the average 42 year old. But if someone saw the 'routine' I need to go through just to get out of bed every morning, or when my pain flares up throughout the day inhibiting my ability to walk, they would have a clue; but I am pretty closed off about letting people in or see me in that way, so I tend to lay low, don't go places, etc. I hope your appt with the Ortho proves helpful for you. One thing I think - and perhaps this is obvious to everyone else and I'm just slow grasping it - is this: each time I have had an x-ray or MRI over the years, the 'findings' are always only specific as to what the complaint is at that time, and are silent to anything else that may be 'visible' even if perhaps 'unrelated' to what is currently going on. And I'm wondering if that's why (for example) my recent images' findings don't mention the things earlier images' findings note (e.g., about my SI joints, because they weren't the specific complaint when I went to the ER, rather the neck & lumbar pain, and shooting pain & numbness down my legs). The radiology report only commented on things he saw that could be causing my nerve issues. That's why I am asking my private ortho to look at it ALL and provide a complete diagnosis based on what he sees (via images and exam). I don't know if my perception is correct or not, but just a thought about how you might ask your doctor for your appt; I do plan to ask my dr when I see him. All the best to you with your appt; do let me know as I'm curious what your dr says about your SI joint issues. I hope you get some answers that lead down a path for effective treatment to help minimize the pain. And I hope you & yours enjoy a happy Thanksgiving.

Hi Andy. I quoted below what I shared earlier in the thread about one of my injuries; you and I had commiserated a few pages back about some of our condition similarities. ;) In addition to below, I also had a hard fall square on my butt/tailbone area, and a rear-end car accident during active duty. I've read that injuring the SI joint is a very difficult thing given it's 'a very strong and practically immovable' joint (or something to that effect). But I've had multiple impacts/injuries to that area (both in service & out), but the SI joint problem is very documented in my service records. Nevertheless, that IS where one/some of my problem is, in addition to a fractured coccyx (from the fall) and the other lumbar & cervical issues from all this stuff. And when I saw my private ortho post-service, I shared that history with him, so he made sure to request the SI joint area & look closely at it on the images/rad report. So you might very well see about doing the same with your private ortho. I wouldn't say though that my pain/injuries are 'worse' than yours or someone else's; we're all suffering with and impacted by our conditions, and my pain threshold perhaps is less than yours. I think I used to have a higher tolerance for pain, and would push through it and do what I needed to do, but that tolerance gets less and less as I get older and the episodes are more intense/severe and frequent. But admittedly, when I talk to my local vet friends who sustained injuries/conditions (some obviously far worse than mine) in combat/overseas, it makes me feel a sort of 'guilt' or shame about having service conditions that impact me the way they do, but were sustained during peacetime in comparison to theirs. Re: MH, I sent my PCM a message this afternoon. If I don't hear back from them by mid-day tomorrow, I'll do exactly as you suggested; thank you!

Hi Andy. I agree - MRIs/X-Rays/etc. don't really tell the whole story (my PT guy said that very thing yesterday as well), and our pain thresholds definitely are different. I just find it baffling that my images and VA rad reports "say" my SI joints are 'unremarkable' yet Monday morning, I could barely get out of bed and could not walk unassisted (and even then, I was bent over like an 80-year-old); I felt like my sacrum was crumbling with every movement, and that is coupled with all the other issues (back/neck pain and nerve/numbness in legs & arms). Also, in looking at my historical reports, there are conflicting 'findings' which leads me to believe the VA does not interpret the images completely or perhaps 'fairly', or perhaps they only report on what they see that could be related to the complaint, but I don't know. A 2013 lumbar x-ray I have notes "dextroconvex scoliosis, facet sclerosis of L4/L5 and L5/S1 and lumbar spondylosis". And a 2008 Lumbar MRI I have notes "1) Bilateral sacroiliac joint dysfunction; 2) Central disc protrusion at L4/5; 3) Clinical impression of left L4 and L5 radicular pain." A 2013 cervical CT scan noted "mild cervical spondylosis". I guess when you put all of that together, it 'paints' a more thorough picture overall. I'm obviously not a doctor, but logically I can see some things perhaps 'improving' to some degree (e.g., a protruding disc that perhaps - with traction - moves back in place or muscle spasms that ease up with PT), but to have so many different 'interpretations' of the same patient/anatomy that - over time - experiences worsening pain levels of the same condition/s is kind of befuddling to me. I dropped the VA images & reports off at my private ortho's office yesterday after my PT consult. Private ortho will take about a week to review, then schedule my exam. Yesterday's PT Consult (@ VA) resulted in: submitting an urgent referral for 16 PT sessions (I call the Choice people today to ID the PT clinic so they can get the ball rolling; and thankfully, the PT clinic attached to my private Ortho is on the list, so that is where I'm going); a cane to use when the SI Joint/Sacrum pain makes walking unbearable; a 4-pack of strap-on microwaveable heating pads which are helpful because I can move about while keeping the heat on; and a tens unit which historically has helped manage some of the pain, but obviously doesn't really 'correct' anything (neuro-brain games). He also said that if I don't see any improvement in 3 weeks, or if after 5/6 weeks only slight/minimal improvement, to let him know, and he will refer me to Neuro/Ortho, that I won't need to wait 4-6 months like the PCM said. I also asked the PCM at both appts for referral to Mental Health for my anxiety (which is high - for me at least - while I'm dealing with all of this), and while she noted it both times in my record, I've yet to receive a call to schedule or an appt notification, so I'll call them today to see if she did submit the referral and if I can self-schedule. I'm having a hard time dealing with this - at each appointment, I end up in tears over my pain levels, not to mention the episodes of panic driving to these appts.

In re-reading the DBQ page again just now, I found that private physicians can complete those forms, so that question is answered. I guess what I'm curious about is would I be better off to have my private dr complete them, or - assuming my private dr confirms (with more specificity) what the rad reports & PCM said (about the radiculopathy in my legs & arms being due to my neck & lumbar) - is that 'enough' evidence to submit my C&P claim, and have the VA drs schedule exams and complete the forms or whatever they do? I just want to get an idea of whether I should mention this to my private ortho when I do meet with him. Thanks!

Andy - I'm sorry that you're feeling like you're getting the run around. That's so frustrating, and the whole reason I avoided VA care over the years, and I'm being reminded of it now as I go through this. I hope you get a course of treatment that leads to some relief soon. Buck - As always, great advise; thank you! So, a few updates: I had the MRIs of C & L spines last Tuesday. As soon as my MRI (both C & L spines) was completed, I went to Release of Information and requested a copy of my images & reports on CD. I received them in the mail (no lie) 2 days after my MRI. I was SHOCKED - fastest response I ever had from VA, so kudos to them there. Here is what the Rad reports say: I don't know what a lot of that is/means, but I did note the disc bulges, and asked the PCM about those. She said "those are probably what is pinching the nerves going down my legs & arms." *Probably* ... and that is why I would rather see a specialist. At the PCM follow-up last week, she noted in my records that (per MRI) that I have "degenerative changes to spine" and "radiculopathy (c-spine & l-spine)"; as well as "anxiety". She said these degenerative changes are consistent with age progression (I am 42 years old!), and is referring me to PT (consult tomorrow morning), and Mental Health (to be scheduled) for the pain-related anxiety. I asked the PCM if/when I would be referred to an orthopedic specialist for the issues with my back & neck, and she said that until we exhaust the conservative options (PT, injections/pain mgmt, etc.) and she feels surgery is necessary, there is no reason for me to see an ortho. This is kind of concerning to me - no disrespect to her (and I told her such) - because she is not a specialist. Nevertheless, that is her recommended course of action. She said if PT and Pain Mgmt (after PT) doesn't yield any results in 4-6 months, then she'll refer me to ortho. Four to Six Months ... to see an ortho!!! I did get a second Toradol shot, which helps for a short-time with the immediate pain, but doesn't do anything to reduce the numbness and shooting pain down the arms & legs (which makes sense if the disc is bulged and putting pressure on or pinching the nerves). This morning, I could barely get out of bed or walk because my sacrum/SI joint area was excruciating (as usual when I wake up, but this morning it was probably the worst it's ever been), and I'm baffled how the MRI & X-rays appear to see no problem with that part of my back unless I'm missing something. So, I gathered up all my records from the VA (ER notes and PCM) and my private records from the last 10 years and the disk with the MRI & X-Ray images & reports, and I'm dropping them off at my private ortho tomorrow after my PT consult. He is going to look everything over and have me come in for an exam once he reviews everything. I am going to ask him to clearly document the applicable diagnoses and reference the leg & arm nerve issues, noting if they are related to the neck & low back issues (I recall the verbiage that needs to be used being along the lines of "is at least as likely as not" etc. Should I ask him to complete the DBQ forms as well for the neck & back? Or are those only to be completed by VA C&P doctors, and I should just ask for a letter from dr w/diagnoses and 'nexus' comment re: 'at least as likely as' sufficient? Thanks all for your ongoing input, guidance & suggestions. These last several days have continued to be an ongoing battle of pain management, which certainly didn't have me feeling all that 'appreciated' this Veterans Day. And being on all of these meds has me feeling like I don't even know who I am half the time which is why I don't like taking them. :(

Thank you for the perspective Buck, as well as the template. I guess I am just trying to "think through as I go through", if that makes sense, so I can make sure I am asking the Drs the right questions, ensuring - where I need to - I make notes at appts, ask for the dr to document things where it may be necessary, etc. Today's appt was ... okay. It was a rough start because they didn't check me in properly, so when my appt time passed by 15 mins with others coming in & going back while I waited, I politely asked the reception person if I was forgotten, and he said the other person didn't check me in right. So, by the time I actually got in with the PCM (a NP), half of my 60-min appt passed, and she curtly said "since you were late, we won't get to cover everything today ...". I arrived 20 mins early for my appt, checked into reception, and waited patiently for 30 mins, so I politely but firmly corrected her assumption about my "tardiness", and really did not appreciate feeling rushed. I was in a lot of pain, had already had one panic attack just driving there, and then two more while in her office just talking through my conditions. Her attitude made me feel like I did not matter or was impeding her from something - so, not a really good "first impression", and sadly a reminder of why I went with private Drs the last 10+ years. ? Nevertheless, I did get some pain relief via a torodol shot (which I didn't even feel due to how numb my rear & legs are). I can move my neck a little better right now, the SI joint/lumbar area inflammation has eased up some, and I can walk with a little less pain, but my thighs are still half-numb/tingling with some shooting pain, and both my arms and legs still feel 'heavy', like it's a chore to move them. I don't know how long this shot will last (12 hrs, a couple days...). She reviewed my current meds and family medical history, but we didn't get to half of my list. She focused on the immediate issue of my current pain which makes sense, checked my ROM, and we have another appt next Thurs to hopefully finish my list and review MRI (Tues) results. She is putting in a few referrals to include mental health, physical therapy, and one other I cannot recall off hand, but I think she was waiting to do ortho referral pending the MRI results. I will see what shows in the notes when they are available to me.

Yikes! Good luck with the chiro. I wish you the best outcome for getting relief; SI joint pain is an unbearable bear. I have done all three at different points with decent results - injections for keeping inflammation at bay, PT for muscle strengthening, traction, and flexibility, and chiro for adjustment & alignment. What frustrates me about it is I KNOW my SI joints have a problem, but the VA Drs keep saying "si joints appear fine on X-ray" and then overlook them and my pain with them, except my private Drs. Did your SI joint problems show on X-ray or MRI? My MRI is Tuesday morning and I believe will cover cervical/spine through sacrum/SI, so I look fwd to reading that report and seeing what it reveals. One question I asked earlier in this thread and am still unclear on is if - when I refile my claim - would I claim the shooting pain/numbness problems with my legs & arms as separate conditions from my back & neck pain (disability for legs, disability for arms, etc), or is the pain in them factored into the back and neck ratings? I am not clear on the whole "grouping" of conditions factor. If anyone can clarify that or share a link that articulates the groupings matter, I would appreciate it.

Wow Andy, it does sound similar (minus the flight stairs); I'm sorry you're suffering with it as well. I had a duffle bag full of equipment (printer, laptop, etc) on my back during a training exercise, and since we were in full MOP gear walking in the dark, I didn't see a step down, and I went down with it all. Do you mind sharing what sort of treatments they have you undergoing for the SI joint pain? Just curious what I might expect them to offer in terms of pain management (I like to research things when I can). SI joint pain SUCKS! I've told the drs for years that when I get up from bed in the morning or if I walk/step 'wrong' (e.g., uneven surface), it feels like someone taking a baseball bat to my sacrum and it sends lightning down my legs, yet I keep seeing mixed 'reports' on films when they look at it (that they look fine); yet, when I've had injections in the joints over the years, they have seemed to help cut down the frequency & severity of the pain.

Thanks for the input Buck; I'll definitely take that into account re: the hospital director. I called yesterday to schedule my MRI since I didn't hear from anyone; it's scheduled for this coming Tuesday morning. One positive note - I mailed off the release form this past Saturday to link my records into heathevet's site, and today (3 business days after I mailed it) my acct changed to 'premium', and the ER notes & x-ray details were uploaded from the ER (but none of my previous trips to the VA to include 2005/6 or any of my C&P exam notes, but maybe I'm not looking in the right place. I'm sharing the x-ray reports below, though I am not familiar with the terminology (will research), and I will note that there are things the doctor said & wrote on the x-ray pic (on the Wednesday ER visit) that are not on the radiologist's report, such as arthritis, extremely narrow disc spaces at bottom of c-spine, as well as she told me specifically arthritis & degeneration in the SI joints (I wrote that down along with the other things she noted), which the rad-report is silent to except to say they 'normal appearance'. I also received yesterday the medical records from my private ortho specialist who treated me for and after the last car accident I had (2013), and I've added the x-ray reports for then below as well to show the comparison. Those x-rays were also taken in an ER, but not the VA. 2016 C-Spine: Findings: The cervical spine is visualized from C1-C7. No prevertebral soft tissue swelling is seen. The cervical alignment is maintained without spondylolisthesis. There is mild (C4/5 and C6/7) to moderate (C5/6) osteophytic changes in the anterior regions of vertebral bodies. No significant foraminal narrowing. No acute fracture is identified. The vertebral body and disc space heights are preserved. The odontoid process is intact. Impression: No evidence of acute osseous injury to the cervical spine. Moderate degenerative disc disease at C5-C6. 2013 C-Spine: had to attach below 2016 L-Spine: Findings: There are five lumbar vertebrae in normal alignment with no evidence for fracture or subluxation. There is mild narrowing at the level of T12-L1, L1-L2 and L5-S1. Mild osteophytic changes of L1-L2 and L5 vertebral bodies.. There are no destructive bony lesions.Normal appearance of bilateral SI joints. Impression: 1. Mild joint space narrowing of T12-L1, L1-L2 and L5-S1 with osteophytic changes as above consistent with mild degenerative joint disease of the lumbar spine. 2013 L-Spine: had to attach below I'm going to keep digging through what I have from prior treatment to see if I have other x-ray reports to compare/show progression, if for no other reason, my own information/awareness.

That is correct. The ER doctor on Sunday said he would order an MRI to be scheduled. I asked 'can I just go down now and get it done'; he said it doesn't work that way, has to be scheduled, and his diagnosis on my discharge document was "nerve pain in both legs & arms".

I did go to the VA ER - both last Wednesday and again on Sunday when things worsened (my only option till I get into the clinic and system). That's why I was frustrated they wouldn't do the MRI he *said* he ordered ... because I was already there at the VA hospital ER, and he said the MRI is done there at the hospital as well. :(

Thanks Buck; that makes sense. I hope they can get me in somewhere for treatment soon. My left arm is half numb right now, and feels like it weighs 50lbs even when it's on the arm rest of my chair. When it got this bad three years ago, I had to pick my left arm up with my right hand just to move it, and I worry about permanent nerve damage.

Thank you Buck for the thoughtful suggestions re: the PCM appt; we are definitely on the same page there. I have a list of things that I want to make sure are addressed in the one-hour appt, and even went so far as to download a front/side/rear view of the body and have made notes on it reflecting where I experience radiating/shooting pain vs numbness vs 'localized' type pain. Is it "appropriate" to share with the PCM that I am also seeking increases/filing for these items, or is that something they don't specifically need to know? I don't know if it would help ensure they are more detailed in their documentation, or perhaps sway them to be less detailed.

Buck - I don't have "copays" with my private insurance; I pay out of pocket fully until I reach my max out of pocket/deductible. And that deductible is about to roll over and increase. My only 'issue' with getting VA medical care right now is the wait to be assigned/see a PCM, but that ball IS at least rolling. My first appointment is this coming Thursday, thankfully. Unfortunately, while I get that ball rolling for getting in the system and the necessary referrals, etc., I have been having a terrible time with my pain. I had to go back to the VA ER again today (since I am not yet assigned a PCM) because - after 4 days of recliner/bed rest & meds from Wednesday's ER visit - my legs and arms were going fully numb and my c-spine pain was worse than it was on Wednesday. Dr today listed the ER diagnosis as "nerve pain in legs and arms" while Wednesday it was degenerative disc disease & neck/back pain. He also changed a couple of my meds, and ordered an MRI to be scheduled. I wish they had done the MRI while I was there today so we would have a better idea of what is going on come Thursday. Also, being in so much pain heightens my anxiety, and I had a couple panic episodes in the ER as a result, especially when the dr suggested surgery may be necessary. I wish there was more the ER could do such as ordering PT or injections for pain. I know I need PT (traction) to help open the vertebral spacing, and injections would help with pain relief in the mean time; but I don't want to rush under the knife, and just hearing that sent me over the edge today, and is a large part of why I saw private doctors with more conservative approaches to pain management. I sent the letter into VA to link my medical records with the heathevet site so I can see more than just the ER diagnosis on my discharge document; the physician Wednesday said there was arthritis & degeneration in the SI joints while today, the ER dr said there was none. I don't understand that, but I guess I just need to be patient, get access to the records and see what they say, as well as my private ortho doctor's notes when I receive those. Till then, I will keep reading, reading, and reading some more. Thank you for the help & suggestions! I am keeping note of them for when I am ready to file my claim.

Thank you for your response, Broncovet. Yes, utilizing the VA for medical care has become a financial necessity for me due to increases in my private healthcare cost and deductible. For years, I've used my disability comp to help pay my copays, injections, meds, massage, chiro, etc. to manage my pain as well as help with things around the house as needed when I've been unable to tend to them (e.g., some housework, yardwork, etc.), but I just can't afford to do so anymore unless my ratings are increased, so in the mean time, while I pursue the rating increase, I am seeking SC condition-related care through VA. Yes, I am seeking to increase my already SC'd conditions - they all have increased in severity in the 18 years since initially rated. I believe I have my full c-file, except the notes from the 2005 C&P exam & increase for lumbar. When I dug out my service records, I didn't recall that I had requested it years ago after my initial claims. So I just need to get those 2005 notes, and I should have a sense for whether that increase included the sciatica or not, and would then exclude it from my forthcoming request; I don't believe it was. I'm don't anticipate any issues with documentation of the secondary disabilities being clearly linked to the initial disabilities. It's been verbalized by every doctor I'd seen, and I will ask them to provide such in writing if their notes don't specifically call that out. On the anxiety linkage, I know that is very well documented by my doctor and psychologist as well. What I'm unclear on is: if - in my claim - I should request the shooting pain/numbness in my legs and arms (resulting from the compressed nerves in my C- & L-spine) as separate/secondary items (rating for legs, rating for arms), or if they would be tied to the existing C- & L- spine ratings if they are the source of the problem; if the hearing would be a new SC claim, or secondary to the existing tinnitus rating; or, do I just request these as "service connected/secondary to ..." and let them decide? I feel like I need to be specific, but I'm afraid that - by doing so - perhaps I'm limiting the VA's realm of considerable options, and leaving them open to deny if it doesn't meet that exact 'standard'.