Lower Back Claim

[Vync]

Hello everyone,

I am new here, so I am asking folks to please review and offer your opinions. Any assistance is greatly appreciated.

While I was on active duty from 1990-1995, I was injured numerous times during military training. I originally filed a claim back regarding my back in 1995, but it was denied. I am currently 40% SC, thanks for SC approval for several unrelated problems. While on active duty, the military took x-rays and diagnosed me with lumbar or muscular strain and prescribed medication, exepted me from physical activity, and also sent to physical therapy.

In early 2006, I suffered an injury to my L4-L5 and L5-S1 and was given an MRI, I was diagnosed with lower lumbar spondylosis (moderate narrowing of the disc cavities), degenerative disc disease, herniated vertebrae discs contacting the nerve roots, muscle spasms and strains, reversal of the lordotic curve, and and even advised to seriously consider surgery. I was given more loads strong medication, an epidural pain block, and eventually sought help from physical therapy and even a chiropractor.

In 2008, I filed another claim regarding my back, but it was denied. I spent time gathering copies of my service medical records and civilian medical records and re-filed again in August of 2008, providing counters to each reason the RO claimed was a basis for my denial. I also got a written statement from my ex-wife, who described her observations of my back problems. I just received a letter asking me to fill out medical release forms or provide medical evidence, even thought I sent the medical records already.

It seems very obvious that my back injuries during military service were the root cause for my current problems. I now have a sedentary desk job with an ergonomic chair and a wonderfully supportive girlfriend. Over time have had to re-train myself how to avoid reinjuring my back while performing normal daily duties. Quite often, I can control the pain and problems with medication, but when I simply sneeze or cough, I always worry about having to take another unplanned visit to the emergency room.

Questions

1. Given the nature of my injuries, what type of percentage would I qualify for?

2. With respect to my overall 40% SC rating, could I potentially see this increase or will they just embed it and leave me with the same rating?

3. Since I did not 'keep alive' the back injury portion of my original claim in 1996, if my back claim is approved, what could I expect as an effective date?

4. If I kept records of my out of pocket expenses for doctor and medication co-pays, if my back claim is approved, will the VA allow me to file for some sort of reimbursement?

Thanks,

Vync

[Vync]

Any info, opinion, interpretation on this is greatly appreciated.

Thanks

[Vync]

Any additional feedback on this would be greatly appreciated!

[Vync]

Hey everyone,

I sent off my updated claim evidence last week, but while going through my service medical records, I found something interesting that might be helpful to everyone. Some of the papers were double-sided containing separate instances of medical care. During my re-review, I found three additional instances where I was treated for my lower back. Also, I pulled up my entrance and exit medical exams. My entrance exam shows no indication of back problems. My exit exam indicates "hx of lower back pain". I plan to get copies of these into the mail asap.

[Vync]

Wow, talk about fast track claim denial. I just got my denial letter in the mail about 20 minutes ago.

What should I do now?

Am I filing for the wrong thing?

What am I doing wrong?

Also, I have an appointment with a neurosurgeon on Thursday.

Here's what the claim denial letter said:

DECISION

The previous denial of service connection for back disability (also claimed as upper and lower back condition) is confirmed and continued.

EVIDENCE

- Private physician records, {physician name}, from {start date} through {end date}.

- Copies of service medical records were received August 17, 2009.

- Medical records from {various physicians and treatment facilities} received August 17, 2009.

- Statement from {ex-wife} received August 17, 2009.

REASONS FOR DECISION

Service connection for back disability (also claimed as upper and lower back condition).

The service medical records are a duplicate of medical record previously considered. The private treatment records show that you report you reinjured you back several years after active duty. You are shown to have degenerative disc disease, low back pain, and disc displacement. You were show to have normal range of motion on flexion, extension, and rotation. You have received epidural injection and have been to physical therapy. The prior decision denying service connection for condition for back disability (also claimed as upper and lower back condition) remains denied as your claimed back disability (also claimed as upper and lower back condition) was not caused by or the result of active duty.

The claim for service connection for back disability (also claimed as upper and lower back condition) is considered reopened. However, the evidence continues to show this condition was not incurred in or aggravated by military service.

[Vync]

On the way home, I called the VA's toll-free number and they were able to give me the codes used for my claims, both SC and non-SC. I don't know if this makes any difference with what I should claim, but here they are:

40% SC rating:

(6602) 10% asthma bronchiole (claimed as asthma)

(6522) 30% allergic rhinitis/sinusitis (reduced by 10% because the VA says I had a 10% pre-service disability)

(6018) 10% chronic allergic conjunctivitis, bilateral

(9905) 10% internal derangement of the right temporomandibular joint

0% Non-SC rating:

(5024) Joint disorder - hand/feet/knee/shoulder

(5237) Back disability (also claimed as upper and lower back condition)

(6079) Refractive error

(9900) Multiple-tooth extraction

[Berta]

EED-earliest effective date-

This would be the date you filed a claim that is awarded.

"The service medical records are a duplicate of medical record previously considered. The private treatment records show that you report you reinjured you back several years after active duty. You are shown to have degenerative disc disease, low back pain, and disc displacement. You were show to have normal range of motion on flexion, extension, and rotation. You have received epidural injection and have been to physical therapy. The prior decision denying service connection for condition for back disability (also claimed as upper and lower back condition) remains denied as your claimed back disability (also claimed as upper and lower back condition) was not caused by or the result of active duty."

Looks like they are considering the post service back injury to rule out SC injury-BUT- they do say "reinjured"- which does validate a prior injury.

Would your private doctors or the neurosurgeon be willing to write an IMO for you?

The criteria for an IMO (Independent Medical Opinion) is in the IMO forum.

They must give a full medical rationale and be able to tie in your inservice medical records with a direct association to what problems you have now.They should try to detailed the service injury as causing problems that could have aggravated the post service injury and would need some before and after post service injury X rays or MRIs for that.

An IMO can be very expensive-maybe a doctor who has treated you already will prepare one for fee or small fee-I don't know.

They need to see the decision , and a copy of the C & P exam VA did, as well as all available records and the circumstances of the post service injury.

If you cannot obtain an IMO you need to NOD this (file Notice of Disagreement) raising every argument you can make with the decision.

Did they use a goinometer for the ROM?

Is this correct?

"were show to have normal range of motion on flexion, extension, and rotation"

I dont see any substantial VA medical rationale here at all. Is there more to the decision than this?

"The service medical records are a duplicate of medical record previously considered"

Is that a fact? Do you have any older SOC on this claim that refers to the SMRs?

wait a minute- I just caught this------

"Hey everyone,

I sent off my updated claim evidence last week, but while going through my service medical records, I found something interesting that might be helpful to everyone. Some of the papers were double-sided containing separate instances of medical care. During my re-review, I found three additional instances where I was treated for my lower back. Also, I pulled up my entrance and exit medical exams. My entrance exam shows no indication of back problems. My exit exam indicates "hx of lower back pain". I plan to get copies of these into the mail asap."

I am sure they never considered this evidence in your recent decision.They state evidence they got in August 2009-

Maybe (hope others give opinions here) a Request for Reconsideration should be filed with this additional evidence.

This wont stop the NOD one year clock so mark your calendar-

But this type of request could possibly get a better decision faster than a NOD would-

I would still try to get an IMO too if I were you-

I hope others might see basis here for a reconsideration request-

and chime in.