rentalguy1

I have two separate appeals at the board as well but they are both new. One for PCAFC since July '23 and the other for comp issues since October '23. I am hopeful the caregiver claim has different rules and is processed more quickly but something tells me it's not. I can't work up the courage to investigate.

nothing to worry about. All of the spine dx codes are rated under the same criteria based on range of motion. The only difference is that the dx you had (DDD) falls under the rating criteria for IVDS and you can actually achieve a 60% maximum rating under that dx code (5243) if you have doctor prescribed bed rest in excess of 6 weeks in a year. That is almost impossible to obtain. Otherwise, 40% is the max rating under all the other dx codes for the spine. If you have not had a MRI, I would get one to confirm a diagnosis so that you can receive proper medical treatment and know exactly what to expect in the future. They told be lumbosacral strain for over a decade, and I never question it. In fact I had DDD the whole time and it went untreated and I was hard on my body on top of it. I ended up with DDD, spinal stenosis, and facet joint arthritis. All of that arthritic damage has led to pinched nerves which cause severe sciatica, severe urinary inconitance, a weak leg and a foot drop. If I had known it was DDD from the beginning, I could have gotten proper care and instruction on how to take care of myself. It would have had no impact on my service connection whatsoever, though.

I stand corrected...the BVA has granted for both left and right sided sciatica, concurrently.

BVA Case Granting Bilateral Sciatica

Bilateral Factor: left sciatic granted at 10%, right sciatic granted at 10%, combined under VA fuszzy math to equal 19%, times (X) 10% equals 1.9%, add that to the combined total to get a final total of 20.9%.

10% + 10% = 19% X 10% = 1.9% + 19% = 20.9%

Then this 20.9% is combined with all other ratings as normal, i.e. 60%, 30%, 20.9%, 10 = 80%

MRI vs X-ray won't make a difference on the rating. Only range of motion measurements will matter on that. It would make a difference on the dx code used. The findings of the MRI make your condition Intervertabral Disc Syndrome, not a lumbosacral strain. Unless you can get lots of prescribed bed rest, though, it would only be semantics. Your rating percentage would remain the same under either code.

Where it says loss of normal disc signal at T11-12 and L4-5, that means disc dessication. The disc has dehydrated, in other words. This is part of Degenerative Disc Disease. It also says there is mild disc space reduction at these levels. This is also DDD. The discs at these levels have lost their elasticity and now are performing like a worn out shock absorber.

At L4-5 you have a herniated disc that covers a broad area of the disc space. At the back portion of the disc, toward the spinal canal, the annular material is torn allowing the disc material to spill out into the spinal canal. This is a true ruptured disc. This is causing central canal stenosis; your spinal canal has been made smaller by the disc material that now fills it. This leaves less room for the spinal cord to function, and can cause all kinds of radiculopathies in your hips, legs and feet.

I don't think I would NOD based on this evidence. It would not make a difference in your claim, other than make you wait on pins and needles for months on end only to end up with a denial. What I would do with this is go to your PCP and start a managing care plan. Pain meds, muscle relaxers, and whatever physical therapy you can stand. These things have the ability to heal themselves some times if you have taken it easy, but if you have worked hard for a while, it is most likely permanent. Whatever you do, from this point on, take it easy on your back. The damage has already been done. The level of physical stress you put on your back from this point on will determine how bad it will eventually get, and how fast it will get there.

Today I get Baclofen in the mail. We cancelled this muscle relaxer a couple of months ago and switched me back to cyclobenzaprine at my request. This was my first visit with the new PCP. The second visit is when they cancelled my pain meds. I am totally confused now. I am going to put in a message for her to call me, but I since she never returned my call the other day, I doubt she will this time either. No instructions to stop the cyclobenzaprine. No instructions on how to taper off the darvocet. Nothing to replace the darvocet with. Do I take both muscle relaxers together? If I do will I have a accidental overdose? I'm getting effin pissed!!!!!!!!!!!!! B)

I'm still considering the option of stepping down to a non-narcotic. I just don't know how I would tolerate the pain in the winter. I had finally gotten myself stable with the pain/spasms, but I don't know if it is due to the narcotic, or from not working for almost a year now. I do know when I over do it just a little bit, it puts me down for a day or two.

Here's a quick update:

Had a appt with the PCP yesterday. I explained the situation, and she was receptive, but decided to berate me anyway. That pissed me off and I snapped. I told her that if the VA would have called me like they were supposed to this wouldn't have happened. She speaks up and says that she is the one who actually sneaked the random test in on top of my regular scheduled labs. She said she wasn't required to call me if I was coming in for a scheduled lab. I don't know how valid that statement is. She further told me that I should have EXPECTED a urine test because they always do it with labs. At that point I had her check my lab records to see how many times I've had a urine test since 2007. Of course, I already knew the answer was once. She was flabbergasted to find that out. Then she asked if I would mind taking a drug screen right then. I told her that would be fine, then we whipped all my pills out of my wife's purse and told her to count them in the name of full disclosure.

After all of that, she has the nerve to tell me that she has the ultimate, final decision on this. I snapped again and reminded her that she was just a PA and in actuality needed a MD to sign off on everything that she does, and that moreover, I know that there is a formal appeals process to this matter. That seemed to take the wind out of her sails a bit. So then I went and tinkled in a cup for them and left. She said that she was going to get the ball rolling that day, and that I should expect a phone call soon. Well, I haven't heard from her yet, and now it is the 4th of July holiday at the VAMC, so I won't hear anything until at least the first of the week, but that is expected.

gruntdaddy: I wasn't really thinking about the whole thing when I was there originally. I just needed to be done and get out of there at that moment. What is really throwing me off is that the lady that seems to be in charge of the vampire squad told me to call the hospital and reschedule it, like it wouldn't be a problem at all. This is the one and only time I will jump through their hoops, though. If the screw me around here, I will either drop what little narcotics I take for something non-narcotic, go outside of the VA for my pain management, or self medicate. I'm not the good little patient that complies with a bunch of BS. I try to live my life on the straight and narrow, and I refuse to be looked at like a drug seeker, drug user, or drug dealer.

1. you are asking for a complete copy of everything contained within your cliams file. If you say C-file, they will know what you are talking about.

2. Send it to your local VBA Regional Office.

3. It is better to get a copy for yourself, and then look it over without a VA employee standing over your shoulder and rushing you. In addition to that, you can send in any missing documents via certified mail/return receipt requested, and be sure that it was received.

4. More information on this topic here.

5. This thread reminded me that I need to get a copy of my own c-file, now that my claims have been decided.

If the C-File being present is part of the procedure, then why is it rarely available to the examiner? Many of us here have had exams where our C-Files were nowhere to be found, and I personally have several C&P exam records where it states that the C-File was not present or requested. I think we would all live to hear an inside explanation of this phenomena and what kind of recourse we have to this.

To ensure continued compensation to your dependents should you die before the 10 year mark. If you become rated P&T, and then die from a unrelated condition five years later, your dependents lose any DIC and DEA that your P&T status entitled them to. If you have a secondary condition that could kill your before your 1 year mark, and you are able to get that condition rated, even at 0%, and then die from it before your 10 years are up, your dependents keep those benefits.

To ensure continued compensation to your dependents should you die before the 10 year mark. If you become rated P&T, and then die from a unrelated condition five years later, your dependents lose any DIC and DEA that your P&T status entitled them to. If you have a secondary condition that could kill your before your 1 year mark, and you are able to get that condition rated, even at 0%, and then die from it before your 10 years are up, your dependents keep those benefits.

To ensure continued compensation to your dependents should you die before the 10 year mark. If you become rated P&T, and then die from a unrelated condition five years later, your dependents lose any DIC and DEA that your P&T status entitled them to. If you have a secondary condition that could kill your before your 1 year mark, and you are able to get that condition rated, even at 0%, and then die from it before your 10 years are up, your dependents keep those benefits.

To ensure continued compensation to your dependents should you die before the 10 year mark. If you become rated P&T, and then die from a unrelated condition five years later, your dependents lose any DIC and DEA that your P&T status entitled them to. If you have a secondary condition that could kill your before your 1 year mark, and you are able to get that condition rated, even at 0%, and then die from it before your 10 years are up, your dependents keep those benefits.

Just found this: VA Training Letter on SCI. Originally posted by allan on 3/5/07

July 10, 2003

Director 211A
All VBA Regional Offices and Centers Training Letter 03-04




SUBJECT: Training letter on spinal cord injuries and potential complications

1. This training material was written in cooperation with Dr. Barry Goldstein, Assistant Chief Consultant, Spinal Cord Injury and Disorders Strategic Healthcare Group, Seattle, Washington. It includes primarily medical information on spinal cord injuries and complications from spinal cord injuries. The intent of this letter is to increase rater sensitivity to the catastrophic nature of these types of injuries. This letter is not intended to make policy.

2. If you have any questions or comments about the content of this letter, or note any errors, please check the appropriate calendar pages at: http://152.124.238.193/bl/21/publicat/Letters/TrngLtrs.htm




/S/

Ronald J. Henke
Director, Compensation and Pension Service




Enclosure


An injury or disease that affects the spinal cord may profoundly change one

hollywoodnc:

Thanks for the kind words. I have read your posts of late, and you are a wealth of information yourself. Pleas keep up the good work, as there are still many vets out there that need all the help they can get.

To answer your questions; I sent in six scholarly articles over the course of my claim being processed. They were acknowledged in the "Evidence Considered" portion of my decision letter simply as "Article, followed by the title and url." They did not call any of them lay evidence, but they did not mention them with any specificity in the "Reasons and Basis" sections. It is funny that they did not mention the 2002 VA Training Letter on IVDS. There is no way that they could have argued against their own publication. I don't know why they chose to take the articles I submitted at face value. They were all from peer review medical journals, and some were even written by VA physicians. I think the acceptance of such documentation varies greatly from VARO to VARO, and even rater to rater. I use the Nashville, TN VARO, and I have always contended that they are fair and accurate the vast majority of the time.

As I recently told another veteran, and you are already keenly aware; the human body is a well-balanced machine. It has a specific center of gravity, and all orthopedic sytems work around this. Any time that one of the systems is damaged, it will have a negative effect on another system, and this begins a cascade of problems to the machine. It's as simple as the old "foot bone is connected to the leg bone" song. Any physician is going to know this, and I suspect that most raters know it, too. The difference is that raters HAVE to have things in very specific language. They are bound by the laws and regs and have cery little wiggle room.

I cannot think of a specific regulation that would tie a hip disability to a spine condition. The VA Training Letter states the fact that a spine condition can and will cause other orthopedic problems, though. If it can work one way, it certainly can work the other, though. I am certain that if you did a thorough search of BVA and CAVC cases, you will find several that fit the same description as yours. Keep in mind that BVA cases are not binding, but they can be useful in showing a rater how he should be viewing the evidence before him. You also ask about having a viable case in a federal court. I am not sure if you are saying your appeal is going to the BVA, the CAVC, or the Federal Court of Appeals. I also don't have a crystal ball to see what a judge may think (although I wish I did ;) ).

The main caveat in your claim is the MVA that caused a lumbar spine condition. The VA will always use something like this against a claimant in the absence of medical evidence to the contrary. It is very evident that in your case you are going to need at least one IMO from a doctor who specializes in spine conditions. This should preferably be a orthopedic surgeon, since the hip seems to have caused the spine condition. I am afraid that without it, you are dead in the water. I also need to warn you that a IMO that interjects new evidence into the claim at this point can completely change the effective date of your claim. You need to build a good relationship with this doctor before they write the letter. It will need to be written in very specific VA language, and it will need to be very emphatic that the spine condition has always been either caused or aggrivated by the hip condition and the shortening of your lower limb, as well as the antalgic gait. It will also need to thoroughly discount the damage done by the MVA.

I won't lie. It's going to be hard to get exactly what you need from a doctor. You may have to "interview" several of them before you get a competent one that sees the picture with clarity. Most of them want to consult with a patient, then slice and dice them, and then head out to the lake. Not downing the profession at all (I was headed into medicine myself before I became sidtracked by journalism of all things), it's just that it is getting harder and harder to find a compassionate surgeon in this day and age. Another good idea for a IMO would be from a occupational therapist. I don't know where you live, but jbasser has a contact for a great OT in Kentucky. Sorry I wasn't more help. Maybe you can start a new thread and post a scan of your decision letter(s) and we can get a more clear picture of the VA's reasons and basis for the denial(s).

I am in agreement with Carlie (as usual). Yes, they can rate based solely on the new medical evidence on record, if they bother to actually request that information from the VARO. If the medical evidence resides outside of the VA system, it is up to the vet to get that information to the VARO, via signed release of information forms, and my preferred method of gathering those records yourself and then sending them in along with the request for increase. The usual scenario would be for the VARO to request a updated C&P, however. How long this can take depends on a few factors, such as how many other claims are in line ahead of you, and how many new claims from one of the "priority" groups are filed after your request. As was already said, this is also geographically dependent, too. If Dago, it can take a long time. In Nashville or Waco maybe in just a few months.

I also agree that you have to have this evidence of symptoms in written form, from a doctor with a psychiatric/psychology specialty. It's not enough for you alone to think that you have these symptoms for the higher rating, or even for a nurse practitioner, physician's assistant, or a general practioner to have stated so in your medical records. The only way your medical records from a treating physician or IMO will outweigh the VAMC C&P examiner's is if their credentials are equal to, or greater than the examiner's. You should go over the rating criteria and the Mental Health C&P Exam Quide several times. If you don't know what either of those is saying, Google the phrase in question. You have to have a knowledge on the material greater than that of the rater, and as equal to the examiner as you can. This way you can tell the examiner exactly what is going on with you, and nothing will be lost in medical translastion, as often happens.

Good luck!

Mental Health C&P Exam Worksheet:
http://www.vba.va.gov/bln/21/benefits/exams/disexm37.pdf

Criteria for rating mental disabilities:
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=29f9b18a74de457da30287fab936b31b&rgn=div8&view=text&node=38:1.0.1.1.5.2.111.73&idno=38