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?

[Yellowstone Electrician]

Today, I received my requested C&P exam results. Wow, what a shocker! It was quite disappointing.

First, I did walk into the office with a normal walking gait. Yet after doing the side twisting rotation for motion testing, a large popping noise emitted from my spinal area. It turned out to be the "locking" aspect of my back problem. I suspect lumbar facet syndrome.

I walked out of the office with a waddling effect. No mention of my gait in her report. This implies nerve root compression. ;o(

Second, how does an X-ray that says only the following describe the nerve root compression in my left leg "at least partially sacralized L5 segment with narrowing of L4-L5 disc space." No more....

My left-side thigh hurts, my left foot often feels cold, I urinate over 10X's a day, if I twist too much, my normal walk turns into an abnormal gait. All of this was presented in the C&P.

Second, tramadol was not listed as one of my medications prescribed by the VA. It is used to treat mild to mildy severe pain.

Third, spine flexion was noted at 55 & extension at 20. I could barely bend because my back was locked. I am not implying that she was lying but I was breathless & extremely stiff. I was locked!

Afterwards, I barely walked out of the office!!!!!!!!!!!!!!!!!!!!!!!!

Geez! It appears that I was destined to fail at the beginning. I guess the battle begins!

I am preparing for the worst case decision. I have already requested my service & medical records. I did not earn two Naval letters of comendation for sitting on my ass!

Any advice while preparing?

Dear Hoppy,

Yes, cumulative trauma claim. I will research it!!

Thanks, YE

[Hoppy]

Yellowstone,

"Second, how does an X-ray that says only the following describe the nerve root compression in my left leg "at least partially sacralized L5 segment with narrowing of L4-L5 disc space." No more...."

Have you had any MRI's or EMG's? Do you work? If not, have you applied for social security disability?

ALso, if you verbally supplied your post service work history to the C&P examiner I do not think the VA will accept any evidence based soley on what you tell an examiner. It might not matter if the burden of proving post service onset is on the VA

Post service work history is an interesting question. If you claim were to be considered valid and the only issue was post service work history there is a question as to who bears the burden of proof. Do you have to show a complete verified history of your jobs and an analysis of the job duties from each job that is favorable, or is the burden of showing post service onset on the VA. I anticipated that the VA would make an issue out of my post service employment. However, I was of the opinion that the burden of proving post service injuries would have been on the VA. I submitted a statement in support of my claim that contended that my job duties and diagnosis in the military were sufficient to establish inservice onset and that an analysis of post service intercurrent injuries would not be feasible due to the fact that no tests were known to medicine that would indicate that such condition in the military would have resolved. I submittted literature that the condition was "as a general rule of medicine known to be chronic and often become more severe later in life". I guess it worked.

[Hoppy]

I just thought of one big issue.

You say you have nerve compression. What is causing the compression? Do people who have this arthritic condition that is caused by micro injuries early in life degrade to nerve compression. If the VA is of the opinion that the degradation involving nerve compression goes beyond what would be expected from the micro injuries then there could be a big problem.

The VA weighs evidence in support of a claim against evidence unfavorable to the claim. They could easily say the nerve compression could be causing your range of motion issues and thus the diagnostic picture is not sufficiently clear to award service connection.

There is a requirement that when symptoms are intertwined then the service connected condition will be rated as causing the symptoms. I had confused this question in my claim and was told by old timers on the board that this provision only kicks in when service connection is already established.

[Yellowstone Electrician]

Sorry I haven't written sooner. My frustration needed a break.

Of course, I am still reading about the meniscoid lesions or simply tear(s) that can occur in the lumbar facet joints. It is relatively easy for doctors to view for example knee meniscoid tears and do an appropriate surgery to repair it.

I have never found anything about repairing a verterbrae's facet joint in the same way. So how can the VA or anyone else say that these tears did not happen as a result of continued lifting, carrying, etc.?

An excellent animation of facet joint irritation leading to full-fledge lumbar facet joint arthritis with the fall of the disk space at L4/L5 & L5/S1 sacralized fusion can be viewed at:

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http://www.espinedoctor.com/diagnosis_lum_arthritis.htm

A brief excerpt: The lumbar facet joints consist of bone, cartilage, synovial tissue and menisci. Micro-trauma of the facet joints can produce pain. A facet injury often occurs without trauma and may simply be the result of a sudden movement of the low back.

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http://www.emedicine.com/pmr/topic68.htm
http://www.abcphysicaltherapy.com/Secondar...cet_Impingement

It is interesting that multiple pathologies can exist for lumbar pain. They can be a simple strain (which so many times are verbally diagnosed on a ship!), joint locking/subluxation, ligament sprain, facet syndrome, piriformis syndrome & disk related problems.

I'll keep researching & passing on info. My emotions need better preservation. ;o)

I am writing a basic paper for my veteran specialist who will help represent me in a likely appeal process. I will obviously need an outside medical opinion. This will be difficult to obtain $$$.

[Yellowstone Electrician]

One more website (an Adobe PDF) is excellent at:

http://www.eorthopod.com/Booklet?ClinicID=...1335f674627ccc4

[Yellowstone Electrician]

http://www.eorthopod.com/public/spine_lumbar_guides

Try the above website

For some reason, the previous offered website would not allow me back into it?

E Orthopod is an excellent website for viewing all of the body parts!