Vync

I just had an appointment with another doctor, but she was unwilling to write a nexus letter. I am hoping to find someone in my area who would be willing to do this without charging an excessive fee. Anyone have any tips on how to find a doc who will do this? Note: Still no word regarding my official MRI results or f/u appt to give me some relief of my pain.

Travel pay is kind of wierd. I go to the VA medical center and get travel. Sometimes the agent at a particular clinic wants to argue that I don't qualify for travel. When that happens, I just go to the Travel office at the facility and they straighten it out.

spqr, Welcome! Like Pete, I was not impressed by Voc Rehab either. I was told that I would not qualify because I was still employed, despite the fact that I am receiving pressure from management regarding the amount of work I miss because I have to go to the VA medical center. They also said that they would not send someone to school to become a Software Engineer. Bleh. Best of luck on your appeal!

MRI is complete. No official radiologist report yet, but I noticed a few things visibly. The herniated discs are no longer blown wide open. I see bits of debris around where the tears were. The lordotic curve is totally gone. My spine is straight as a ruler from the thoracic region to the first segment of the sacrum. Back to this: Code 5243-XXX (38 CFR 4.71(a)) - Part 1 Under the spine codes for 20%, other than ROM, it indicates 'or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis'. I guess having no lordosis may qualify as "abnormal spinal contour" I have another appointment on Monday with a different doc. Will ask for their opinion and IMO. Will be up front about it too.

I had one injection back in 2006 and must have got lucky. Pain subsided steadily over several weeks, but never really went away. Now it's back. It stinks that I have to take a half a day off work to visit docs like this, but might eventually run out of time off. Don't want to give my boss anything to worry about.

I'm still new to the claim process, but understand the connection between back pain and it's side effects. If I have to escalate my back claim to the DRO, I am taking a list of talking points so that nothing gets overlooked. I don't know if this helps much, but others with DRO experience should be able to chime in on it.

Hello everyone, I visited the Neurologist yesterday. I went in hurting and with a moderate back spasm, came out feeling worse. I have a new MRI scheduled for this afternoon. He is leaning toward another epidural pain block, unless surgery is required. Here's the scoop: Doc is reluctant to provide a written IMO because he did not treat me in 1990-1995. Forward flexion: 10 degrees Hyperextension: 0 degrees Right Lateral Bend: 5 degrees Left Lateral Bend: 5 degrees Has some straightening of the lumbar lordosis. Sitting straight leg raise positive in bilaterally in back only. Diagnosis: Degenerative disc disease, lumbrosacral spine w/radiculopathy

My father served in Vietnam, but I have no idea if he was exposed. Does anyone have a link showing the areas which were impacted by AO?

Berta, The neurosurgeon is seeing me regarding the back issues. Relative Equipoise? Sounds interesting. Let's hope it doesn't get to that point. But, I did send them new evidence which was never previously submitted. Erich, I'll check out that site. I do have the opportunity to work remotely, but my workplace has put forth the effort to make my office environment/cubicle ergonomically suited for my needs. I don't know if they would do that for my home, plus I have to rely on high bandwidth for my job. Thanks!

Berta, Wow, I really appreciate your input here. You're awesome! Let me respond to each section... Re-injured? Initial injuries occured during active duty. My private medical files between my ETS in 1995 and and first signs of bulging discs and bone spurs in 2004 were lost by my physician. They claims they can only go back a couple of years. A dual disc herniation nightmare in 2006, when I was diagnosed with DDD. From what I hear, DDD onset takes time, usually years. EED For my 40% SC, the EED is 1995. If I somehow succeed, would the effective date be 1995 or my reopened claim submitted in 2008? C&P Exam Original C&P exam was in the late 1990's. Due to what I experienced between 2004-Present, I requested the claim be reopened in 2008. They have not performed a new C&P. IMO My neurosurgeon appointment is tomorrow. No idea if he will write me an IMO. My girlfriend works on a surgical team. Does the IMO have to be issued by a neurosurgeon or would a general surgeon suffice. She's well liked by several of them and they might be willing to do it. ROM In my original C&P, I do not remember a goinometer being used. They did when I had physical therapy in 2007. They got me back to 'normal' ROM, but I was loaded up with Lortab and Soma. I relapsed late last year and had more therapy. The VA probably found a couple of specific instances where I had normal ROM to make a blanket statement. I believe my ROM is no longer normal. I cannot afford to live in physical therapy and stay juiced up on pain killers and muscle relaxers all the time. I will ask the doc to use a goinometer tomorrow so I can have accurate numbers. SOC I cannot find the original SOC from 1995. My SOC from 2000 indicates 'You were found to have other non-service connected disabilities', but it either did not list them or I lost them. I need to request my C-file. The SOC prior to this one (in my posting below on Sep 18 2009, 6:49 PM) indicated I had chronic low back pain. They seem to have removed 'chronic' in the most recent SOC, which is absolutely incorrect in itself. Entrance/Exit Exam The SOC simply indicates 'Copies of service medical records', but it does not specifically indicate the dates of specific instances of treatment. I do not have proof that they actually reviewed every item, but only that blanket statement. Should I first try to submit this as additional evidence or file a NOD? This alone should qualify as the 'incurred or aggravated' requirement. NOD What is best? Brief 'disagreements' or a very detailed listing every instance of injury during/post military service? I reviewed the NOD topics and see differing recommendations on this. Code 5243-XXX (38 CFR 4.71(a)) - Part 1 Under the spine codes for 20%, other than ROM, it indicates 'or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis'. If we throw ROM out the window, I do have indications in my private medical records regarding reversed lordosis. If all else fails, is this worth pursuing? Code 5243-XXX (38 CFR 4.71(a)) - Part 2 Also, check this out. This is below the % ratings. 'Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.' I frequently experience back pain and negative side effects at the worst possible times, like when my girlfriend and I are intimate, but I am not going into the specifics about it. I hate to admit it, but it does happen. Should I also file this as 'an associated neurologic abnormality'? I am thinking cause and effect here. If this is a possibility, I don't know how they would go about evaluating it...

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

Talk about timing, I just got another claim denial in the mail from the VA. I posted the text of it here: Lower Back Claim I'll follow up with my claim problems there.

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.

Hey Allan, I don't work for a federal agency, but do work for a company that performs electronic document imaging. I must remain anonymous about which one, but definitely agree that electronic storage and archiving is a big help! -Vync

Pete's right. But for what it's worth, when I submitted my original claim, they lost everything including copies of my service treatment records when they were supposedly transferred from the VSO to the RO. When the board initially reviewed my claim, apparently they ended up reviewing an empty folder, claim denied. I am glad I kept copies of everything, so I provided them with another copy and my claim was approved. It turned out that my records were eventually found misfiled. Definitely stay on them. Hopefully they will turn up.

Berta, Thank you for responding. Did you NOD their decision and point out the in service evidence to them? Yes. Did they list this as Evidence in the SOC or simply just ignore it? They listed some, but not all of it. I sent them what they were missing. What was their exact wording of the denial? Here's the denial letter from the NOD I filed, but I can't find the original denial letter. I will probably need to go to the VARO and review my records, including getting a copy of my C-file. We determined that the following condition(s) was/were not related to your military service, so service connection remains denied: back disability 0%. Decision The previous denial of service connection for back disability (also claimed as upper and lower back condition) is confirmed and continued. Evidence (I am paraphrasing, for privacy purposes) - Service treatment records - ER treatment records - Orthopedic treatment records - MRI report - Epidural pain block treatment records - Neurologist treatment records Reasons for Decision 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. The service treatment records were considered in deciding your claim. Private medical records show you have been diagnosed with degenerative disc disease and chronic low back pain with lumbar disc displacement. You have received lumbar epidural steroid injections. Do you have copies of your SMRs that reflect the back problems? Yes, I have everything. Did you highlight these copies and send them to the VA to support the claim? Yes. I made sure that I sent them only copies the records related to the problem. Did yoiu attempt to get any buddy statements to prove the inservice nexus (link) to the back problems? I do not have any buddy statements, but my ex-wife did provide an objective statement of what she observed while we were married. However, we were not married while I was in the military. Based on the "incurred by or aggravated by military service" statement, they obviously ignored something because: 1. Entrance exam shows no back problems. 2. Service treatment records show numerous injuries and treatment for back problems 3. Exit exam indicates 'history of back problems'. Thanks, Vync

I have a doc visit this Thursday for my lower back. I called about a dozen doctors regarding an IMO. Only one in my area said they could do it for $800, but I will have to save up for that because my insurance says IMOs are not covered. I agree that having to save up a lot of cash to get an IMO is just crazy. Also, my entrance physical says nothing of back problems. However, my exit physical indicates explicitly that I have a history of back problems. Somehow, the VA could not connect the dots there...

I'm relatively new here and have also had some posts I made just not appear. For example, I may have posted to four separate topics, but only one or two actually got posted.

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.

Congratulations!

Any additional feedback on this would be greatly appreciated!

Others may be able to provide more helpful information, but I am SC for it. They did a CAT scan and found I had 90% blockage on one side and significant blockage on the other, coupled with polyps too. Having service medical records was a big help, as I had medical proof of a nose injury during training that was treated while I was on AD. I don't know the criteria they used, as I was granted SC quite a few years ago.

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

That's good info from everyone. I think I had indicated that I had the problems when I went on AD, but will have to dig through and check, but I never indicated the extent. I find it crazy that the VA puts you through the meatgrinder and they have strict guidelines to qualify someone for a percentage, but they can magically generate a "reduction" number out of thin air without any strict measurements. Also, visiting the RO to view my records sounds like a good idea. I am going to call them and see about making an appointment to to that.

Here is the breakdown of my 40% SC rating: 1. 10% asthma bronchiole (claimed as asthma) 2. 30% allergic rhinitis/sinusitis (reduced by 10% because the VA says I had a 10% pre-service disability) 3. 10% chronic allergic conjunctivitis, bilateral 4. 10% internal derangement of the right temporomandibular joint I posted on another topic about the pre-service disability rating and asking about getting it 'corrected'. Here is the meaty text from my back problem SC denial letter. As always, any feedback is greatly appreciated. We determined that the following condition(s) was/were not related to your military service, so service connection remains denied: back disability 0%. Decision The previous denial of service connection for back disability (also claimed as upper and lower back condition) is confirmed and continued. Evidence (I am paraphrasing) - Service treatment records - ER treatment records - Orthopedic treatment records - MRI report - Epidural pain block treatment records - Neurologist treatment records Reasons for Decision 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. The service treatment records were considered in deciding your claim. Private medical records show you have been diagnosed with degenerative disc disease and chronic low back pain with lumbar disc displacement. You have received lumbar epidural steroid injections. Based on this information, can anyone please offer opinions on where I went wrong?