tdiu Va Eaminations And Rating For Back Injury

[sixthscents]

First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

[Stretch]

Yea, I know what you mean about the Neurotin. Pharm. says that the Gabapentin (Neurotin), I am taking, will cause seizures if you stop suddenly. This is a concern.

[Pete53]

I am glad that you won your claim.

[wayne]

Bob thanks for the the info. I've been suffering with my back since early 2000. I've had numerous x-rays, MRI's, CT scans and C&P exams. All the VA has done is watch my condition get worse. I've got DJD, spinal stenosis, ruptured disk and nerve impengment both sides of my lower spine. I was sent fee basis for a evaluation of my condition. The doctor looked at all my test and wrote that since the stenosis is to the point where sugery probably wouldn't help. He did recommend the spinal steroid shot, which the VA did about a week ago.

I've heard horror stories about this shot but I must be one of the lucky ones. This is the first time in six years I haven't been in severe pain. I don't know how long it's going to last but I thank God for the relief. I was told you could only get six shots per year. I also have DJD in both knees. I take 240mg of Morphine daily to help with this pain.

I applied for TDIU in jan 2000 and haven't received and answer yet. My appeal is in DC and I'm hoping there's not another remand. I have to deal with the RO Columbia, SC. I don't know if you've heard any horror stories about them, but if you have it's all true. All I can do now is wait. I've been waiting for six years.

WAYNE

[wallyg]

I am one of the lucky ones with severe osteoarthritis - for me Glucosamine sulfate/Chondroitin sulfate supplement works. According to the research done outside the AMA, it helps 72% of those who take it, sometimes as quickly as one month after start; although 6 months is a more realistic figure if you decide to try it.

Talk to your doctor about it, research it on the Internet, after more than 5 years, the AMA has finally decided to fund some studies on it.

Doctors who look at my X-Rays, MRIs and EMG/NCVs wonder how I am still able to walk, and mostly have intermittent pain, which is only occasionally severe enough to keep me at home.

The VA gave me neck and spinal braces, a wheel chair and Lofstrand crutches three years ago, and about a year ago, knee braces and ankle wraps. I also have from the VA, a hot pack and a TENS unit.

Some of this I use all the time, but most is only used intermittently.

Why?

Well, I prescribed Gluc/Chon for myself 4 years ago, after I spent a year trying to get the VA to give me something besides acetomeniphen and Indomethacin.

It took about three months for me to see noticeable difference, and I took it for two years. Then, because of cost, I stopped taking it for a year. After about 6 months, I started looking for a cheaper source, as my problems were returning. I started mail order from the US, and even with Philippines Customs Dues, it is worth while. One month back on it, and I was able to regain some more mobility and freedom from pain.

The dosage depends upon your weight, at 200+ I take 2000/1600mg per day in two doses. Below 200lbs I believe it is 1600/1200mg recommended. It is not cheap, but compared to US medicine prices these days, it is quite reasonable.

If you are one of the lucky 72%, you should know within 6 months of starting.

Good Luck

[newbe]

WOW GREAT POST!!! YOU KNOW YOUR STUFF.

First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

B) B)

WOW GREAT POST!!! YOU KNOW YOUR STUFF.

First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

B) B)