Andyman73

Do I need to get an IMO/IME if my secondary issue falls exactly as the CFR states how the symptoms manifest? Background, November 2015 I had a C&P for hip pain. X-rays show hip joints are fine. Exam finds that where I'm pointing out the pain and burning is not actually my hips, but SI joint and SI crest area. However, ROM of my hips is noted as reduced in most, or all directions(flexion, dorsiflexion, abduction and so on.). Examiner recommends MRI, but won't order it. Says I need to see my PCP to get that ordered. Long story cut short, PCP sends me to PT for consult, had 3 sessions, PT stopped due to no improvement and fear of making it worse. Physiologist looks me over, recommends pain injections in SI joints. Went, got it done. Relief lasted a week. Then follow up, anethesiologist offers some other choices that carry a higher risk, like epidurals and such. Back to Physiologist, who sends me to Chiropractor for 6 VA authorized sessions. Chiro stopped after 5th session, noting short term little relief, but no progress. This ended in December 2016, a year after the C&P exam took place. Have a VA acupuncture appointment in a week or two. I've been trying to do things the right way, more so backwards and upside down, than right up the middle. According to CFR 4.66, covering the SI joints, one of the indicators is painful ROM of the hips. Normally this whole area is bullet proof, with limited exceptions, like severe trauma directly to the area. Also traumatism(fell down stairs at boot camp which is documented in my smr) on top of transitional anatomy(congenital partial lumbarization of S1, of which I have according to numerous VA x-rays) can cause problems with the SI joint region, felt as pain and burning sensations along the SI crests and outer thighs. And painful ROM of the hips. I have that noted by the PT, my PCP, and the Rehab dept. Physiologist, and from that C&P exam back in November 2015. Also there is a separate condition covering the burning pain felt along the outer thighs. So, this brings us back to my question. Do I need to get an IMO for this, since I already am SC 40% for low back strain/pain. And I've been going through the VA for treatment and DX for this pain. The Physiologist noted that this is most likely due to my low back strain, and DJD. Is this enough or do I need more? Thanks. Andy

So there you have it, Armyvet89, way to go, Buck on the info!

No sir, I have a 10% per side for mild instability, and a single 10% for pain. As for both ROM and instability, you would get which ever rates you higher. And then a separate rating for pain. When I had my exam for increase for my knees, the examiner told me he was going to do that. I know, totally strange, that an examiner would put you in for something so obviously in your favor and tell you that, too. Originally my knee rating was a single 10% for bilateral patella femoral pain syndrome. Come to think of it, I probably should have argued for 10 each side, way back in 2000, but didn't know any better. I suppose it's possible to have more than one rating for your knee, but would have to be two separate issues.

What about this, tho? Do I claim this as secondary to my low back and SI joint issue? I had a C&P exam a year ago for that, and the ROM was noted as moderately reduced with pain throughout my sacroiliac crest bilaterally. According to the 38 CFR 4.66, it states as I quoted reduced ROM of the hips is also a part of it.

What about this, tho? Do I claim this as secondary to my low back and SI joint issue? I had a C&P exam a year ago for that, and the ROM was noted as moderately reduced with pain throughout my sacroiliac crest bilaterally. According to the 38 CFR 4.66, it states as I quoted reduced ROM of the hips is also often a part of it.

Buck, It's not that I wanted help, just wanted folks to give their 2 cents worth, tell me I'm dumb, or tell me I have a mouse's chance in a catnip factory. I suppose it's real easy for the raters to misinterpret the manual and read the exam notes upside down and backwards, especially after the exam was performed by a lower level med tech. Flores, The examiner did NOT state whether or not anything for my SI joint issue. As for the bunion, she did state less likely as not caused by, and ignored the aggravated bye, part of what makes up secondary SCDs. I know the VA does not recognize bunions as primary SC based on medical science, which shows that bunions are actually not caused by foot wear, but genetic code. Studies show equal rate of occurance between shoe wearing and non-shoe wearing peoples, world round. My VA Podiatrist told me that this is the VA's official position on bunions. So, very clearly, by omission, bunions would be SC secondary via aggravated by SCDs.

Bump

armyvet89, I can't say whether or not it's pyramiding, since I'm not familiar with it enough to know. There are some on here who can give you a better answer. But I can tell you this, I have 10% for each knee and 10% for bilateral patella femoral pain syndrome. But originally it was just the 10% for the pain. Then 15 years later got the 10% each for ROM/instability. Most likely you will get the more serious issue for the rate(by law they have too)per knee depending on which is more severe, the ROM or instability. Those are both physical manifestations of the disability, and pain is how it feels. It is possible to have reduced ROM or stability without being painful. Hope this doesn't muddy the water too much more for you. Andy

armyvet89, Your best bet for knee ratings is to check out the rating chart, on this site, and see where you fall according to your ROM and such. Yes, you will get the bilateral factor. Here's how that works, first you need opposing body parts to be SC, for you both knees will cover that. For sake of argument, I will use the rate figures you used at 20% each knee...20%+20%=36% combined rating. Bilateral factor is an additional 10% added straight to the bilateral rating, not factored in as an additional rating but added like regular math. So...36%= 3.6 bilateral factor. And therefore 36%+3.6=39.6%. Then your next rating would be added to that VA fuzzy math style. Now if you add that additional 10% to the 36% you would end up at 42%, and the bilateral factor would be 4.2, bumping you to 46%, and therefore your comp pay rate would be 50%. Those bilateral factor points make a huge difference at the end of the day, because it usually gets you bumped to the next higher pay rate. And as you can see from my math, the bilateral factor is worth several hundred dollars a month. Hope that answered your question. Semper Fi

On the 14th I had a C&P exam for SI joint/crest pain. The examiner used the low back dbq for the exam. Question, if so, then what ever findings would just be lumped in with the low back rating, right? That was the idea the examiner was trying to convey to me, that the max is 40%, which I already have. If so, then, would the SI crest pain, which is a pretty nasty burning sensation, be secondary to the low back? I know it gets a separate rating, since I had already looked it up on the rating chart. That exam was so...bogus, for lack of more polite way to say it. I wrote a pretty lengthy new topic post for that, first thing this morning, but as soon as I hit submit, it disappeared and wanted me to log in again!!! That examiner, a PA, spent more time focusing on my lower back, to which I have been SC since 11/98, than the SI joint area. After I saw the exam notes on myhealthyvet, I fired off a complaint via IRIS, about how this PA was downplaying what my local VAMC doctors had already DXd and been treating me for. Told them(IRIS) that I feel quite put upon, to have an under trained, under educated med tech, examine me and report findings that barely even match what my VA Dr had DXd! Told them I felt that this was just a ploy to set me up for an easy denial. At no point did I use any foul language or personally attack the examiner. GRRRRR!!! §4.66 Sacroiliac joint. The common cause of disability in this region is arthritis, to be identified in the usual manner. The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes. X-ray changes from arthritis in this location are decrease or obliteration of the joint space, with the appearance of increased bone density of the sacrum and ilium and sharpening of the margins of the joint. Disability is manifest from erector spinae spasm (not accounted for by other pathology), tenderness on deep palpation and percussion over these joints, loss of normal quickness of motion and resiliency, and postural defects often accompanied by limitation of flexion and extension of the hip. Traumatism is a rare cause of disability in this connection, except when superimposed upon congenital defect or upon an existent arthritis; to permit assumption of pure traumatic origin, objective evidence of damage to the joint, and history of trauma sufficiently severe to injure this extremely strong and practically immovable joint is required. There should be careful consideration of lumbosacral sprain, and the various symptoms of pain and paralysis attributable to disease affecting the lumbar vertebrae and the intervertebral disc. Where it says limited ROM of hip, does this mean a separate rating, for loss of hip ROM, apart from low back strain? Strangely enough, I have a congenital defect of "transitional anatomy" in the form of a partial L6 fused to the sacrum at S1. And my fall down the stairs contributed the "Traumatism". Any ideas or comments?

Dang!

danjenh, Did you have any falls or any injuries from the hard landings? Some spinal injuries can take years to show up. Do you have anything like that at all in your service medical/treatment record? I fell down a flight of stairs during boot camp. Had pain in my neck, back, knees and so forth. But the only injuries that were DXd at that time were low back and knees. 20 years later I started having a lot of neck pain, and upper extremity numbness and pain issues. I have had both X-rays and MRIs on my neck, which do show issues at C5, C6 and C7, but am left with having to get an IMO/IME to get this service connected. And that is with proof of original injury in my SMR/STR. Andy

Lilbit, I think you will probably need a nexus letter from your gastro stating "at least as likely", unless he feels it's more certain than that, then your gastro should write "more likely as not caused by your hypothyroidism. Andy

ketchup56, Only thing I can tell you is that ebenefits is notorious for being incorrect, slow, backassward and so on. Pretty much it's going to be hit or miss any time you long on there to check the status of any in progress claims. Give it a few days and check it again, never know what you might see(box of chocolates and all that). Andy

Gastone, Sure hope that Saxman see the pathway you laid out and start off down that road. Especially since anything can happen, and as we all know establishing the EED is very important too. I think I need to go back over my exam notes again. I think I may have something like Saxman's situation, but don't remember anymore. armorer, I don't believe any of us here ever got any SCD primary or secondary based on additional DXs made during a C&P exam. I finally have found myself in the perfect spot with upcoming appointments for IMOs for my neck and ENT specialist for chronic sinus issues.

Misunderstood I must add that not only educational benefits but not having to worry about retirement either. Since I am the sole breadwinner it concerns me greatly about if or when I can retire. Reaching 100% via extra schedular will remove that worry for sure. I know my body won't hold out that long, but I can probably force myself to make the minimum requirements at my job.

Grunt11b, Late this past Summer I received an EED retro payment that reached back to March 2006. I got a direct deposit for the full amount before I knew anything. My only clue was the SCD date for that issue changed from 7/15 to 03/06 on my disability list on ebenefits. Two days later that Eagle landed in my account. The only things that can slow it down are things like amount, bigger $ amounts require higher ups to sign off on, and yours will. Also if you are retired from the service, then a concurrent receipt audit must be done first. I hope and pray it hits ASAP! Merry Christmas Grunt11b! Semper Fi

Gastone, What would Saxman use for his evidence, the examiner's notes, for that FDC for the pain down the legs as secondary? Or would he need to take that info and secure an IMO/IME? I have a few IMO/IME appointments in the next few weeks and possibly face a very similar situation as Saxman.

Congratulations! Now you can focus on your kids and Christmas and recuperate from your battle with the VA. Whenever a Vet gets what is owed them, we all win. I have 3 and a half years before my first born graduates high school. Seems like a long time, but not really. Kid number 2 is only in 4th grade and the Foster baby is only 10 months old. I sure am looking forward to those Ch. 35 educational benefits!

I want to add to what Ms. Berta said... the VA will not do the right thing most of the time. Do not make the mistake most of us have made at least once, by expecting them to actually do what they are supposed to. Not sure how this works, as far as being medically retired, but what way were you notified that this was going to happen? Any documents/letters that you received stating what the reason is for med retirement should be strong evidence for your claims. Quite simply, if your issue is severe enough to warrant being medically retired from the service, then it certainly proves the link for SC. To reiterate what Berta said, please please please keep any and all letters and documents pertaining in any fashion way or form to your medical retirement.

Dang, sorry to hear that.

Had a C&P exam yesterday for a few things, bunion-secondary to pes cavus & plantar fasciitis, SI joint pain, and breathing issues(bronchitis according to the examiner's notes). So X-ray for back showed transitional anatomy at my L-5/S1, which had been on my x-ray reports before, but this time I asked for an explanation. So...according to the images I have a partial L6 between my L5/S1, and it is fused to my sacrum(?). I guess that's not normal, and doesn't make me more flexible or taller. While telling her where it hurts when she had me move this way and that, I expressed pain in between my shoulder blades when she pushed on the spine. Said she can't mark that down since the claim was for low back. Does that mean I need to file a claim for upper part of my back? Bunion, who knows, she used the x-rays from this summer when I was at the podiatrist. For the breathing issues, the pulminary function specialist had me blow on the machine, not too fun. Then took a 10 minute break to breathe on a nebulizer(first time ever!), while hooked up to a pulse and pulse O2 monitor...which showed my o2 level dropping into the mid-90s level while sitting there. Then back to the blowing on the machine for round too. Several times I nearly passed out from blowing all my breath out till she said stop. So...not sure what that means, but there it is. I told the C&P examiner that I spend 5.5 years on the flight line breathing jet and prop exhuast, jp fumes and aircraft soap fumes. For the first time ever, had some incorrect info mixed in with mine, according to the examiner. She read that I was having issues due to flat feet, aka pes planus. Showed her my feet, said look at them, they sure aren't flat are they? We both agreed that my feet were not flat at all. I said look on your computer, it shows that I currently have a 30% rating for pes cavus(claw feet) with plantar fasciitis bilateral. She confirmed that, and said she will make a note that there was incorrect info regarding my feet. Not sure how this will effect the outcome of my claim for secondary bunion.

Buck! Damn the torpedoes, full speed ahead! So, well, I emailed her.

Thanks Buck, but I'm going to have to put this on the back burner for now. Was talking with the wife about this and she says what if it interferes with our possibly adopting our foster child. Didn't even think of that...so...yeah...can't win for losing...road blocked no matter which way I go.

Buck, I will check out her website this evening. Thanks for her info. I just want to talk to someone who understands and really does want to help me. As for medical records, I don't have any pertaining to MH while in the service. But do have the entry related to my alcohol related incident and subsequent substance abuse evaluation. Would that be enough to get the ball rolling with my VAMC MH department for a non-combat PTSD evaluation? It really bugs me that my current doc didn't want to do one for shits and giggles. Not only that, but he never wants to talk about what got me there to begin with. I would be fine to answer hundreds of questions, if they would just give me the chance. I hope and pray they do. Thanks Buck.