question # 1 Does the veteran have a diagnosis of a back injury that is at least as likely as not 50 percent or greater probability incured in or caused by the back injury following being thrown from a humvee during service?
answer #1 yes, the veterans diagnosis of a back injury is at least as likely as not 50 percent or greater probability incurred in or caused by the back injury following being thrown from a humvee during service.
Rationale: It is more likely than not that this veterans service connected injury has resulted in progressive disabilty of the back.
Impression allowing for some variability in spinous processes alignment of the thoracic and lumbar spine is normal.
no evidence of fracture or traumatic subluxation.
few minor thoracic and lumbar degenerative features include the following t10 t12 l1 lower endplate schmorls nodes, mild loss of disc height at l1, l2 with small anterior ostephyte.
There is also a lower cervical spine level with mild loss of disc height and small ostephytes.
Thoracic and lumbar spine series are otherwise normal.
Some straightening of the thoracic spine which could be positional and secondary to muscle spasm.
Thoraco lumbar spine
thoracic degen joint and disc disease.
lumbar degen joint and disc disease.
Lumbar intervertebral disc disease with no prescribed bed rest.
analog pain severity scale is 4-7 and 8-10
the pain quality includes as follows aching throbbing burning dull grinding popping sharp and soreness
forward flexion 0-40
extension 0-15
right and left lateral flexion 0-15
right and left lateral rotation 0-30
veteran has radicular pain
right and left lower extremity= moderate
intermittent pain= moderate
paresthesias and dysesthesias = mild
numbness= moderate
Indicate nervce roots involved l4/l5/s1/s2/s3
indicate severity of radiculopathy and side affected moderate
Note: the veterans assertion of increased pain and loss of function are creditable. However, the probable etiology of the current additional intensity of pain and disability are more than might be expected with the current diagnosis. Therefore, the significant increase in intensity of pain from the anticipated level may suggest that it may be more likely than not attributable to these non anatomic causes. These non anatomic causes can increase patient perception of pain and loss of function. The current chief complaints of increased pain and loss of function are more likely than not the result of confounding factors.
Confounding factors are defined as those factors that may intensify the veterans perception of physical musclo skeletal pain, but from various etiologies unrelated to the service related physical injury.
Note: possible confounding factors identified in this veterans history include the following depression, ptsd, anxiety.
Note: Evaluating the possible impact of these multiple complex confounding factors effecting the veterans perception of musclo skeletal pain are beyond the technical expertise scope of the practice of the general medical provider. (I.e. Clinicans not specialized in psychological issues.)
Questions I have
Will these issues likely to be service connected, and if so how much?
What all problems are rateable, and is my nerve pain rateable or will they deny me because of confounding factors?
Also will my radiculpathy be denied because I have depression and ptsd and anxiety?
The cp exam said I did straight leg raises and the doctor checked the negative box. I did not perform this test. Also I told him I have muscle spasms, and the va prescribes me tizandine for them. The doctor did not check the muscle spasm box and check no. I did this test in Johnson city, tn. I have a feeling they are trying to screw me, and it seems like it.
Question
gass278th
question # 1 Does the veteran have a diagnosis of a back injury that is at least as likely as not 50 percent or greater probability incured in or caused by the back injury following being thrown from a humvee during service?
answer #1 yes, the veterans diagnosis of a back injury is at least as likely as not 50 percent or greater probability incurred in or caused by the back injury following being thrown from a humvee during service.
Rationale: It is more likely than not that this veterans service connected injury has resulted in progressive disabilty of the back.
Impression allowing for some variability in spinous processes alignment of the thoracic and lumbar spine is normal.
no evidence of fracture or traumatic subluxation.
few minor thoracic and lumbar degenerative features include the following t10 t12 l1 lower endplate schmorls nodes, mild loss of disc height at l1, l2 with small anterior ostephyte.
There is also a lower cervical spine level with mild loss of disc height and small ostephytes.
Thoracic and lumbar spine series are otherwise normal.
Some straightening of the thoracic spine which could be positional and secondary to muscle spasm.
Thoraco lumbar spine
thoracic degen joint and disc disease.
lumbar degen joint and disc disease.
Lumbar intervertebral disc disease with no prescribed bed rest.
analog pain severity scale is 4-7 and 8-10
the pain quality includes as follows aching throbbing burning dull grinding popping sharp and soreness
forward flexion 0-40
extension 0-15
right and left lateral flexion 0-15
right and left lateral rotation 0-30
veteran has radicular pain
right and left lower extremity= moderate
intermittent pain= moderate
paresthesias and dysesthesias = mild
numbness= moderate
Indicate nervce roots involved l4/l5/s1/s2/s3
indicate severity of radiculopathy and side affected moderate
Note: the veterans assertion of increased pain and loss of function are creditable. However, the probable etiology of the current additional intensity of pain and disability are more than might be expected with the current diagnosis. Therefore, the significant increase in intensity of pain from the anticipated level may suggest that it may be more likely than not attributable to these non anatomic causes. These non anatomic causes can increase patient perception of pain and loss of function. The current chief complaints of increased pain and loss of function are more likely than not the result of confounding factors.
Confounding factors are defined as those factors that may intensify the veterans perception of physical musclo skeletal pain, but from various etiologies unrelated to the service related physical injury.
Note: possible confounding factors identified in this veterans history include the following depression, ptsd, anxiety.
Note: Evaluating the possible impact of these multiple complex confounding factors effecting the veterans perception of musclo skeletal pain are beyond the technical expertise scope of the practice of the general medical provider. (I.e. Clinicans not specialized in psychological issues.)
Questions I have
Will these issues likely to be service connected, and if so how much?
What all problems are rateable, and is my nerve pain rateable or will they deny me because of confounding factors?
Also will my radiculpathy be denied because I have depression and ptsd and anxiety?
The cp exam said I did straight leg raises and the doctor checked the negative box. I did not perform this test. Also I told him I have muscle spasms, and the va prescribes me tizandine for them. The doctor did not check the muscle spasm box and check no. I did this test in Johnson city, tn. I have a feeling they are trying to screw me, and it seems like it.
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