C&p Nurse Practicioner - Advanced Lumbar Facet....

[Yellowstone Electrician]

Wondering the following: was a shipboard electrician from 1983-1987. I lifted & carried many heavy items such as boat batteries, shorepower cables & motors. I complained a few times of left lower back & left knee pain at ship medical.

In 1997 had an MRI diagnosis of mild lumbar facet arthritis on same left side. Problem had aggravated me since exiting the service. I regret that I neither know the name of the chiropracter shortly after service (in Norfolk, VA) nor had a family doctor until 1995 (now out of business & cannot find records).

All that I was able to offer the "claim" was the 1997 MRI. HOWEVER

On 4/12/2007, I had a C&P with a nurse practicioner. Past two years' medications: Salsalate, Tramadol & Gabapentin. During C&P, back locked up (loud popping noise) after twisting thus practically no forward or backward flexion. A return to nerve root impingement in left leg with difficulty detecting pin prick sharp or dull sensations in same leg.

Not sure if I will be diagnosed after X-ray with Spondylolisthesis or continued lumbar facet sydrome. Either way if I am okayed, any idea how I may rate?

[Hoppy]

I agree that the SMR's will make or break your claim. How much work you missed and the types of meds prescribed will tell a story. The fact that a back condition was not service connected at discharge usually indicates that you are in for a battle with the VA. If you did not see a doctor from shortly after service and until you got a family doctor in 1995 the VA will jump all over this as a lack of continuity in treatment. Your in service medical records will need a diagnosis or xray result that jumps off the page and slaps the rater in the face to over come a huge time gap in the progression of treatment. If you can find medical records to fill the time gap it would be a good idea to get them.

[Yellowstone Electrician]

Another question regarding the C&P on 4/12/07: If the clinician noted nerve root impingement, should not this info be ASAP directed to my VA doctor (in the same bldg)?

I have requested the C&P clinician notes & X-ray and will take both to my VA doctor.

At present, my VA doctor has only requested an X-ray back in 12/2005 and prescribed pills. He has not looked at my back for potential lordosis, checked for nerve root impingement even though the Gabapentin is for nerve pain and has not checked for range of motion.

I have learned the above during and after my thorough C&P exam! Thank goodness! ;o)

Any suggestions?

[Yellowstone Electrician]

Regarding the delayed family doctor aspect:

After the military, I did not obtain a family doctor until 1995 because I worked for about 18 months before attending college. No money was available for health insurance.

So before 1995, I took OTC analgesics since the lumbar facet irritation was only an intermittant electric sciatic shock. This is common before it actually develops into chronic pain - facet syndrome. It leaves the sufferer wondering what the heck is going on? Is it in my head? Etc.?

The chiropractor is completely unknown since my ex-partner paid the bills. Early on during my initial claim status, I checked the Norfolk, VA chiros and found way too many. I called one and she noted that records are no longer kept from the late 1980s. How do older vets in the same spot fight for old details?

Again, it seems presumption to the characteristics of lumbar facet syndrome being: repeated menisual tears in the affected joint early in life, occasional electric shock sensations while walking or getting up for multiple years, eventual development of facet arthritis, full facet syndrome with locking, nerve impingement, etc. and maybe onto spondylolisthesis.

[Vike17]

Yellowstone,

I just posted the how the lumbar and cervical spine is rated in another post. Here it is;

"The spine (either cervical or lumbar) is rated according to range of motion (how far you can bend over), or incapacitating episodes (prescribed bed rest within the last twelve moths from a doctor), whichever results in a higher rating. Unless you have "unfavorable ankylosis of the entire thoracolumbar spine (50%)," or "unfavorable ankylosis of the entire spine (100%)," the highest rating one can obtain due to range of motion of the lumbar spine is 40%, which entails a forward flexion of 30 degrees or less. The highest rating one can obtain for incapacitating episodes is a 60% evaluation, which is bedrest and treatment prescribed by a doctor of at least six weeks within the last twelve months."

Also, if you were discharged in 1987 and the next documented treatment wasn't until 1997 by that MRI, you'll probably need an IMO to make the connection of your current diagnosis and the ten years in between the 1997 MRI and the treatments while in service. The VA will need the IMO to rule out any possible condition or injuries ect... that may have happened in those ten which could have led back problems.

Furthermore, as Berta and Hoppy said, you'll need to obtain those sickbay reports that show you were seen for your back while on active duty. The only real plausible way you could receive service-connection without any documentation in your SMR's, is if you could show some type of objective findinds i.e. x-rays, that were taken within one year of your discharge and they showed degenerative arthritis of at least 10% disabiling at that time. Then you could receive service-connection on a presumptive basis.

"I have read up on lumbar facet syndrome & Grade 1 Spondylolisthesis (no diagnosis of latter yet) and both suggest that it takes years after early in life joint tear traumas for ex. (if not genetically born with predisposition) to develop arthritis in my affected joints... The joint tears can be very tiny but if not allowed to heal, their repeated tearing & minor healing can over time develop into major arthritis... The C&P clinician noted my post-military employments and none suggested any more work related injury potentials as the electrician shipboard service"

All of this infomation you posted really should be used to help the IMO I mentioned above. Have you doctor review this litrature and use it in his rational if it is applicable.

Hope this helps!

Vike 17

[Hoppy]

Yellowstone,

The problem is that medical theory is theory. You need to get a doctor to make an assessment that this theory is a reality in your case. As you mentioned you were a ship board electrician. The fact that this occupation caused these minor tears to your back is also theory at this time.

I would suggest that you find a way to show exactally how strenous your work in the navy was. That is of course the VA does not do it for you. I would not count on them doing anything. The VA might have some job descriptions that they review and use for this purpose. They claimed to have researched my duties when I claimed my angioedema was the result of my work environment.

If you can develop an argument supported by either known descriptions of your job or possibly avadits from other people who are familiar with the duties of a shipboard electrician and you get a doctor to review these work duties and the doctor agrees that these duties would cause the type of injuries cited as theory and your current condition then your case becomes much stronger. I really think that the theory has to be shown as a reality in your case.

Now the VA could put all these dots together for you. However, I would not count on it. Do there work for them, Get the medical evidence as supported by doctors opinions. I sent the VA medical literature for five years. I did not get anywhere until I got a doctor to write up an opinion that supported what I had already told the RO was in the literature.

I met I guy today who was being discharge for a chronic back condition. They were rating it at 20%. I told him that he was lucky and that I thought there were many veterans who had back injuries that went undiagnosed or under diagnosed in the military that were unable to get benefits. You seem to be ready to take them on. I wish you the best and hope that you can set a prescedent here on hadit. People with back injuries that file years after discharge that have posted to the board have not had a whole lot of success.

[Hoppy]

Yellowstone,

An additional point of interest. I have 5 herniated discs. I have had chronic pack and neck pain for 28 years. The first time I experienced back pain was in 1976, many after my discharge. I got a job running a V50 Miehle printing press. This type of printing press had been used in the industry since the 1920's. I picked up and moved over two tons of paper and printing forms in an eight hour shift. The doctors mis-diagnosed the early symptoms of sciatica as a bakers cyst in my knee. I was sent back to work moving all this paper and forms for another month before the all of a sudden they told me I had a back problem. They sent me to a clinic where they told me not to lift and reach at the same time. Their example was canned goods from a kitchen cupboard. I had been doing this repetitively with 35 pound metal forms 70 times in an eight hour shift for the entire month they mis-diagnosed the problem. I did not know what to do. But I was really peaved. This was a non union job working for the biggest printing company in the US.

I called the union and told them I messed up my back while running a V50. The union guy asked me if I was loading the forms through the side gate. I said yes. He said the union did not allow employees to load forms through the side gate since 1940 because it would mess up your back. Now I was really peaved. All this to say I know for a fact that there are jobs that will cause injuries to the spine. I settled a cumulative trauma law suit against the employer. What you are advancing with the VA is a cumulative trauma claim.