This eBook will teach you how to get C-Files (paper and electronic) from the VA Regional Office.
How to Get your VA C-File


  • Topics

  • Forum Statistics

    • Total Topics
      60,370
    • Total Posts
      389,992
  • Topics

  • Posts

    • Should I file a claim now or wait?
      Sax, your NEW claim has no bearing or affect on the Issues being Appealed to the BVA. I don't recall you mentioning that you actually started a New claim on your E-Ben site. You know, right, just starting the Claim on E-Ben, establishes your Retro Date? Filing as an FDC, is the way to go. My experience has been very positive with filing FDCs, as soon as the New DX Condition is in my VMC Medical Record. Some would caution, that Filing New Claims would slow down your other older claims or appeals. I filed (2) Secondary FDCs 02 & 04/14, 4 yr old DRO Hearing request was held 06/29/14. Both FDCs (1 Denial, 1 Awarded) were done by 07/14.  Semper Fi  
    • Exams during flare up?
      Oh okay, very good info. Seems similar to the one I had as well. Crossing my fingers for an increase. 
    • DRO hearing
      Rpowell, I would hold off on this until John Dorle sees it.     I think that is the John D you mean. Maybe Dr Bash or even John Dorle could provide an Addendum solely supporting the P & T Issue. I do not see a CUE here. And I do not feel you should drop those pending issues if any of them could possibly cause or contribute to your death. P & T is a medical determination, and like all of the other disability ratings, it requires a C & P exam unless they have significant evidence already, as you said they do in the opinion from Dr. Bash. Even if this involves a new IMO ( Dr Bash might want them to do a new C & P so that his IMO can attack that word for word) it would be well worth the investment  (his fee) in my opinion because the benefits of 100% P & T to your dependents and even with impact on your property tax, depending on where you live, all of that would be worth an IMO specifically for the P & T.        
    • Need some advice
      I'd likely see about voiding the NG enlistment. Can't have both. I'd think that you would not be deployable with the problems you mentioned.
    • C&P Examiner Pushed Me...FORCED
      I want to know if any of you have been forced for movement in your c&p exams by an examiner? I was. In fact, at my exam the examiner went through with me my MRI and showed me MS spots all over my lower spine and all sorts of other problems, I just had surgery for blown discs and paralysis... a several moths prior, it was hard for me to even drive to the exam not being able to hardly feel my feet and I had severe arthritis since it was winter (nerve roots all clumped together), I got around with a cane. So, the examiner had me do the motions and pushed me down, and at the sides, etc... it hurt (she literally threw her hand and pushed me and caused nerve damage, my back was extremely swollen from arthritis), I had no idea what she was doing and because of my problems I had some incontinence which was embarrassing. I had developed this from exposures to certain things in OEF (spots on spine). I was so mad, how bad the VA was screwing me any way they could and hell I just got back from war a year prior and this is how I was treated for sacrifice to the country. I left in tears and dirty drawers. I had no idea what to do, the VA hospital refused me c&p records from this and the VA only used it against me and then ignored as the exam didn't exist and the service reps with DAV, American Legion, all didn't give a damn and since I was a very young guy-they didn't care either; being first wave of guys back from war it was sparse to see young vets since not being in war for a long time-I am sure-but they didn't give a damn-USELESS SERVICE ORGANIZATIONS. I tried to fight back, I got nowhere, the VA was against me, in a demonic way. THIS WAS A VERY, VERY, VERY BAD EXPERIENCE I WANTED TO SHARE WITH YOU.  I realized the examiner was puppet for money, the VA and some demonic people within the VA wanted to screw me and that VSO's are worthless and YOU are all on your own. By the way, why is it if you have pieces of your spine removed it isn't considered like a loss of a body part is, losing a leg or an arm is paid out SMC, but if your missing parts of your spine how in the world is that now considered a loss of a body part and not entitled to SMC? It would be like saying, oh you use a prosthetic leg, so you leg is fine, no loss. Hence, segments of spine removed and replaced, fused, etc. I wonder why this topic hasn't caused more fuss in the VA community as range of motion is a joke, and that just all that is used to rate. 
    • Need some advice
      Hello to my fellow Brothers and Sisters this is my first post, I've been a long time lurker. I am a recently discharged OEF Vet. I joined the National Guard prior to my ETS. I really only joined for the healthcare to help out my family members. I knew my mind and body was breaking down too much to carry on doing active duty Infantry and I wasn't allowed to re-class. The Guard offered me one so I decided to re-class in the Guard to a HR MOS. I didn't receive a bonus and haven't gone to my AIT for the re-class yet. I've only participated in one Drill weekend. I recently received my award letter for 100% SC P&T. I don't know what to do now about staying in the Guard? Will I be penalized by the VA? Will it change my rating? Will the Guard just MEB me? Any advice is appreciated.
    • Proof C&P Exams are often frauds
      We'll, I have been lucky so far, but we will see.  I have a C&P coming up for my secondary for heart disease from HBP.  I am scheduled for a echocardiogram. Just went throught all the tests with my cardialogist., to enclude an echocardiogram, and those records went in with my claim. I will compare the two. Maybe my C&P doc (or RN) will be a podiatrist.  You never know.. Hamslice      
    • Should I file a claim now or wait?
      Thanks everybody, I think I will go ahead and push that go button!  The main reason is I want to establish the effective date soon as possible. 
    • Proof C&P Exams are often frauds
      Well, yes, remember who pays for your C and P exam.  Still, regulations provide that if you have a balance where 2 docs differ on opinion, the VA CAN choose one over the other, but has to give a reasons and bases as to why.   For example, one doctor can do a more thorough exam.  Or, one doctor can be preferred if he states he read your records, while another doc does not say this.   If you have been denied, the VA is required to give you the benefit of the doubt if the claim is "in equipose", that is, there is a balance between positive and negative evidence.   When you appeal, you can certainly argue that your private doc did a more thorough exam.   HOwever, your private doc may/may not made an applicable nexus statement.  YOu need to check your records to see if the nexus is there.  
    • Reopened Claim & sent my Medical Records as evidence.
      No real update other than they've been treating my back/migraines with medication. They're setting up an eye exam to see if that has anything to do with the migraines. The doctor they sent me to examined me and was amazed at how bad my physical condition was and the VA not taking any responsibility by not service connecting any of my conditions. (They told me that on an MRI I had in 2000 that I had herniated/bulged discs) I'm still waiting on some kind of update, but it's still in 'gathering evidence' stage. They have my service records now as well as chiropractic records and the records from this recent trip to the doctor. Wondering if I'll get another C&P exam scheduled as I can't find anything in my eBenefits records history about the first one I had and the medical building I had it done at has been out of business for several years. They did send an email saying they should have a decision on my claim by April 2017??? Wow...That's weird they would even set that deadline so far out...so I really don't know what to do but wait...

  • HadIt.com Veteran to Veteran providing FREE information and community to veterans since 1997.

    I am proud that I've been able to offer all that HadIt.com has for free for 19 years and continue to do so. HadIt.com does accept contributions to help with costs we also offer paid ad free subscriptions. None of the paid options are required. The forum, the website, news site and podcast are free and will remain so. If you choose to support the site with a contribution or a subscription it is appreciated but never required. If you choose to make a contribution or purchase an ad free subscription, you can do so here. 

sixthscents

Va Eaminations And Rating For Back Injury

6 posts in this topic

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

Share this post


Link to post
Share on other sites




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.

Share this post


Link to post
Share on other sites

I am glad that you won your claim.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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)

Share this post


Link to post
Share on other sites
Guest
This topic is now closed to further replies.