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Quiche Loraine

Denied An Increase And Wanting To Appeal

Question

Hi! I was recently (August 19, 2010) denied an increase for "chronic lower back pain with degenerative disc disease"- they have me currently at 20% evaluation under historical criteria 5293, based on the old VA Schedule for Rating Diseases and Injuries of the Spine before the revision September 26, 2003. "Chronic lower back pain", is a rather vague term, and doesn't describe the arthritis, spine stenosis or the bulging disc L4- L5, aside from the degenerative disc disease that I was diagnosed with by a VA doctor when I was 29, now about to turn 42, but that was what I was told when I asked specifically what was wrong with my back. I had an MRI done shortly after discharge, done at the VA, and I believe that it was that MRI that was used to determine my 20% rating. This recent exam I only received an x-ray. I suppose I didn't appear miserable and debilitated enough at my recent screening exam to rate an increase? I am currently not on medication- the side effects are worse than the little relief they provide, and pain medication, if I were to take it for my daily pain, pain being a normal thing for me (will inevitably worsen the older I get) I would quickly become an addict. Over the years I have been prescribed Salsalate, and Tramadol for pain, gone to physical therapy several times and the pain clinic. I have a 0% rating for G.U.R.D., reflux and gastritis caused by the anti-inflamitory medicines since I was in the service, had spent a week in the hospital while in the service (1990) for reflux and gastritis, and since my discharge (Apr 1991) I have made at least 3 trips to the ER, had at least 3 endoscopies, and had to be put on Zantac to be taken with Salsalate. Service connected- yes! I have been post-depression since 2007, but have suffered from severe depression, my depression started shortly after my discharge, and in 2000 was prescribed Zoloft, didn't work for me, prescribed Prosac, didn't work for me, spent a week in the VA hospital psych ward in 2003, and was prescribed 225 mgs. of Effexor (2003-2007). I suffered with TMJ and braxism (grinding my teeth), no doubt from the side-effects of Effexor. Consequently, I saw a psychologist while I was in the service for anxiety, and of course I was sent on my way, fit for duty. I broke my right tib/fib in 2007, which required reduction surgery- a metal plate and screws, and arthritis has spread to that leg. I suspected premature bone density loss with how badly my leg broke and given how I fell. Premature bone density loss has been connected with prolonged anti-depressant use, specifically Effexor. I had to have $13k worth of dental work done on my once perfect teeth (no cavities or fillings prior to taking anti-depressants), and the x-ray shows practically no disc left on one side of my jaw and premature bone density loss is evident. Depression/Anxiety service connected? It should be. I mentioned all of the above when I was examined. Wanting to know what the criteria was, I researched it, and aside from the medical diagnosis of my physical disability, I read that the rating is supposed to also be based on how the disability affects Quality of Life, and economic factors, specifically "earning capacity", yet I was not asked during the examination how my disability affected my daily life, daily tasks, or how it affected my ability to work, or lack of ability, or whether I had dependents and how my disability has affected them. Vocational Rehabilitation recognized that my disability, at 20% was a significant enough impairment in my ability to work, and keep a job, asked me about my QOL, and I was accepted into the program, and am enrolled in an on-line bachelor's degree program for Graphic Design. My counselor validated my experience, suggested that I insist that depression be rated, as she said, it has been part and parcel of my disability. I am extremely grateful for Voc Rehab, as that education in preparation for a career, is essentially my only hope of improving not only my circumstances and quality of life, but that of my family...hopefully we can survive the next four years. Over the years I have worked intermittently in unskilled labor, the only jobs I qualified for, literally until I would throw out my back, ending up back at the VA for treatment and physical therapy, lasting no longer than 3 months, 6 months, the longest a year on the job, before I had to quit or was let go, to the point where I became an employment risk, my job record has as many holes as a block of Swiss cheese. I have spent more time at home unemployed, reluctant, inadvertent stay at home mom, because of my disability and depression. As a result, we are POOR. My husband has been the sole provider for me and three children, $28k a year at best, and over the years we have been evicted several times, reduced our cost of living to the bare necessities, often had to make the choice between paying the rent or electricity, or electricity or groceries. We now live in a dumpy mobile home (we own it), in a bad, scary neighborhood...better than nothing, I suppose, and on the verge of starting school, hoping the people we rent the lot from will not evict us and give us a chance to catch up on the rent. If my husband passed away or became ill and unable to work, and I had to provide for just myself and my children, we would quickly be destitute! We have no Quality of Life! Had the VA ASKED how my disability has affected my earning capacity, and my Quality of Life (or lack of), which the VA considers as factors, aside from the physical disability, I might have gotten the rating I feel I deserved/deserve, including a rating on my G.U.R.D. and depression which should be service connected, which with my back problems have adversely affected my life and that of my family, and we might have been able to improve our circumstances...every little bit would have helped, would help, until I can finish school, earn my own living, become self-sufficient and be able to contribute to my family's income and better help provide for their needs and improve their Quality of Life.

Does anyone think I have a good case for an appeal or have suggestions or advice? I would greatly appreciate it.

I think I just needed to voice this. I have been so embarrassed and ashamed of my circumstances, and feeling very stuck and feeling like a burden, and not wanting to be.

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QL,

Sorry to hear of your suffering and economic stress- Many of us here can relate.

Have you talked to a Veteran's Service Officer?

It may really help to go over all of your medical records in person and see if there's more you can claim, aggravation etc.

Hang in there! :smile:

Edited by Notorious Kelly

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Sorry to hear about your suffering. I know how difficult it is living with back problems... I'm going on 5 years now with back pain and just recently submitted a claim for it also. I don't have any advice for the back claim. But on another note if you haven't already, ask your primary care doc for an appointment with mental health. Reading through your post and reading about your difficulties due to your service connected disablity its pretty obvious it is causing you depression. You need to be diagnosed from the mental health clinic and then gather those notes and file for depression secondary to your service connected disabilities.

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I think I just needed to voice this. I have been so embarrassed and ashamed of my circumstances, and feeling very stuck and feeling like a burden, and not wanting to be.

QL,

As for any embarrassment and shame regarding your circumstances, here at Hadit - don't you allow yourself to have it.

Many, many, many of us, either are, or have been there.

No one will be passing judgement on you for unpaid bills, a "dumpy mobile home - (you are so right, "better than nothing")

in a bad,scary neighborhood or anything like that.

Before anyone can make much comment on whether you, "have a good case for an appeal or have suggestions or advice"

it's very important to study exactly what is stated in the Reasons and Bases Section of the Rating Decision you want to appeal.

Can you scan and post or post it word for word - without personal info like name, SS #, address, etc...

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