I read here often, but post very infrequently. This may be a little long, so my apologies in advance. I recently (May 2007) had a C&P exam done in Columbia, SC for a possible increase in my benefits. I'm currently rated at 40%--30% for residuals of insomnia (persistent daytime hypersomnolence), 20% for cervical radiculopathy and strain with left upper extremity weakness, and 0% for left-sided sacroiliitis. After my initial claim was granted I had sleep studies and MRIs that showed that my 'insomnia' was actually a more serious sleep disorder called Idiopathic CNS Hypersomnia (similar to Narcolepsy, article here for anyone curious) and that I have Cervical Degenerative Disc Disease with loss of lordosis and also Lumbar Disc Disease.
My new claim asked them to consider the new diagnoses for the sleep disorder and the arthritis. When I received the copy of my recent C&P exam for those conditions, I was unsure if what the doctor (Dr. Durkin) had to say was helpful or harmful in any way. He did not have my C-file when he did the exam, and it doesn't appear that he reviewed it afterwards. Some of the things he says are slightly inaccurate, such as that movements of my neck and lower back aren't painful. He also left out a statement that I made to the affect that I didn't believe I was currently able to hold employment outside the home because I didn't know of any employer that would put up with me falling asleep on the job. I would love to know what anyone thinks of whether his report will help or hurt my claim, and of the possible ratings for the conditions based on his report. I'm a little confused by how to interpret the ROM percentages, too. The diagnoses for the hypersomnia and arthritis are well documented with sleep studies and diagnostic imaging, as well as treatment notes from the sleep specialist and neurologist. The symptoms for everything and the ongoing treatment for those symptoms is also well documented in my SMRs. My claim went to the ratings board less than a week after my exam--May 18th, 2007 and it is still there. Thank you in advance for any advice/opinions. The report stated the following:
This 29 year old white female, who is left-handed by her report, served in the active duty military from 05/99-05/05. She states that in 2004 while in military service she became extremely tired and had daytime sleepiness. She also sometimes does not sleep well at night and she attributes this in the past to her neck pain and more recently due to her low back pain. Apparently, she had a sleep study at night which was normal. The daytime study, however, showed a short sleep latency, and apparently a diagnosis of idiopathic hypersomnolence was made. She was placed on Provigil 400mg daily which helped some. She stopped the medication when she became pregnant. She states that she was screened for depression in the military, but otherwise a search for a psychiatric cause for her sleep disorder has not been made. The veteran states that she tries not to drive by herself because she is afraid that she will fall asleep driving. She has not had any motor vehicle accidents attributed to falling asleep.
As far as her neck is concerned, it started bothering her in 2001 while in military service. She denies any injury and denies any problems with her neck prior to military service. She has neck pain which radiates posterolaterally down the left upper extremity into the thumb and index fingers. Her neck does not affect her ability to walk, and she denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her neck but has had some facet joint injections which helped for about a month and a half. She states that she had an MRI of her cervical spine in 2006 in Lancaster, CA which showed facet joint disease and some bulging discs. She is not currently working. She has two children and is 30 weeks pregnant with her third child. When she was in the military she worked as an Avionic Sensor Technician doing electronic component repair. She states that the neck would interfere with any kind of work which required lifting more than 5-10 pounds. This limitation on lifting also affects her activities of daily living. She denies any flare-ups and does not use any assistive devices.
As far as her lower back is concerned she began having pain in late 2004 and early 2005 while in military service. She did not have any injury. She denies any problem with her low back prior to military service. She complains of lower lumbar and midline and left sacroiliac pain which sometimes radiates posteriorly down the right thigh to the distal right thigh. Because of her low back, she does not walk any distances. In this way, her low back affects her ability to walk. She denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her low back. Prior to her pregnancy, she took Ultram and Vicodin for her low back. Prior to her separation from the military her low back did not interfere with her work, but it seems to have gotten worse. She is concerned that if she were to work her limitation in bending and lifting due to her low back would cause a problem with her work. The limitation in bending and lifting does interfere with her activities of daily living, and her low back bothers her at night. She is pregnant at the present time. She denies flare ups. She does intermittently use a sacroiliac belt which helps a little.
PHYSICAL EXAM: Well developed, obviously pregnant white female in no acute distress.
Neurologic: She is alert and cooperative with normal speech. The cranial nerves are intact. Motor strength and tone are normal in all four extremities, although there is some incomplete effort in the left upper extremity. Her optic discs are sharp. Finger-to-nose and gait are normal. The deep tendon reflexes are 2+ and symmetrical in all four extremities. Light touch sensation is normal in all four extremities.
Examiniation of the cervical spine reveals flexion to 40 degrees and extension to 35 degrees. Rotation is 40 degrees to the right and 45 degrees to the left. She can laterally flex 35 degrees in both directions. These are without pain and do not change with repetitive use on exam. There is no spasm or tenderness on palpation of the neck.
Examination of the low back reveals flexion to 70 degrees. Again, she does have a large gravid uterus. Extension is to 25 degrees. Lateral flexion is 35 degrees in both directions. Rotation is 45 degrees in both directions. Lumbar range of motion is not painful. Cervical range of motion is likewise not painful. The range of motion of the low back is not additionally limited following repetitive use on this exam. There is no spasm on palpation of the lumbar musculature. She is tender over the left sacroiliac joint. Straight leg raising is negative bilaterally.
Clinical and diagnostic tests: none are requested today.
Diagnoses:
1. Idiopathic Hypersomnolence
2. Cervical degenerative disc disease
3. Lumbar disc disease
4. Left sacroiliitis
Comment: The above diagnoses are based on the veterans history and the reports of tests in the general remarks section.
Question
sleepyjenn
I read here often, but post very infrequently. This may be a little long, so my apologies in advance. I recently (May 2007) had a C&P exam done in Columbia, SC for a possible increase in my benefits. I'm currently rated at 40%--30% for residuals of insomnia (persistent daytime hypersomnolence), 20% for cervical radiculopathy and strain with left upper extremity weakness, and 0% for left-sided sacroiliitis. After my initial claim was granted I had sleep studies and MRIs that showed that my 'insomnia' was actually a more serious sleep disorder called Idiopathic CNS Hypersomnia (similar to Narcolepsy, article here for anyone curious) and that I have Cervical Degenerative Disc Disease with loss of lordosis and also Lumbar Disc Disease.
My new claim asked them to consider the new diagnoses for the sleep disorder and the arthritis. When I received the copy of my recent C&P exam for those conditions, I was unsure if what the doctor (Dr. Durkin) had to say was helpful or harmful in any way. He did not have my C-file when he did the exam, and it doesn't appear that he reviewed it afterwards. Some of the things he says are slightly inaccurate, such as that movements of my neck and lower back aren't painful. He also left out a statement that I made to the affect that I didn't believe I was currently able to hold employment outside the home because I didn't know of any employer that would put up with me falling asleep on the job. I would love to know what anyone thinks of whether his report will help or hurt my claim, and of the possible ratings for the conditions based on his report. I'm a little confused by how to interpret the ROM percentages, too. The diagnoses for the hypersomnia and arthritis are well documented with sleep studies and diagnostic imaging, as well as treatment notes from the sleep specialist and neurologist. The symptoms for everything and the ongoing treatment for those symptoms is also well documented in my SMRs. My claim went to the ratings board less than a week after my exam--May 18th, 2007 and it is still there. Thank you in advance for any advice/opinions. The report stated the following:
This 29 year old white female, who is left-handed by her report, served in the active duty military from 05/99-05/05. She states that in 2004 while in military service she became extremely tired and had daytime sleepiness. She also sometimes does not sleep well at night and she attributes this in the past to her neck pain and more recently due to her low back pain. Apparently, she had a sleep study at night which was normal. The daytime study, however, showed a short sleep latency, and apparently a diagnosis of idiopathic hypersomnolence was made. She was placed on Provigil 400mg daily which helped some. She stopped the medication when she became pregnant. She states that she was screened for depression in the military, but otherwise a search for a psychiatric cause for her sleep disorder has not been made. The veteran states that she tries not to drive by herself because she is afraid that she will fall asleep driving. She has not had any motor vehicle accidents attributed to falling asleep.
As far as her neck is concerned, it started bothering her in 2001 while in military service. She denies any injury and denies any problems with her neck prior to military service. She has neck pain which radiates posterolaterally down the left upper extremity into the thumb and index fingers. Her neck does not affect her ability to walk, and she denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her neck but has had some facet joint injections which helped for about a month and a half. She states that she had an MRI of her cervical spine in 2006 in Lancaster, CA which showed facet joint disease and some bulging discs. She is not currently working. She has two children and is 30 weeks pregnant with her third child. When she was in the military she worked as an Avionic Sensor Technician doing electronic component repair. She states that the neck would interfere with any kind of work which required lifting more than 5-10 pounds. This limitation on lifting also affects her activities of daily living. She denies any flare-ups and does not use any assistive devices.
As far as her lower back is concerned she began having pain in late 2004 and early 2005 while in military service. She did not have any injury. She denies any problem with her low back prior to military service. She complains of lower lumbar and midline and left sacroiliac pain which sometimes radiates posteriorly down the right thigh to the distal right thigh. Because of her low back, she does not walk any distances. In this way, her low back affects her ability to walk. She denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her low back. Prior to her pregnancy, she took Ultram and Vicodin for her low back. Prior to her separation from the military her low back did not interfere with her work, but it seems to have gotten worse. She is concerned that if she were to work her limitation in bending and lifting due to her low back would cause a problem with her work. The limitation in bending and lifting does interfere with her activities of daily living, and her low back bothers her at night. She is pregnant at the present time. She denies flare ups. She does intermittently use a sacroiliac belt which helps a little.
PHYSICAL EXAM: Well developed, obviously pregnant white female in no acute distress.
Neurologic: She is alert and cooperative with normal speech. The cranial nerves are intact. Motor strength and tone are normal in all four extremities, although there is some incomplete effort in the left upper extremity. Her optic discs are sharp. Finger-to-nose and gait are normal. The deep tendon reflexes are 2+ and symmetrical in all four extremities. Light touch sensation is normal in all four extremities.
Examiniation of the cervical spine reveals flexion to 40 degrees and extension to 35 degrees. Rotation is 40 degrees to the right and 45 degrees to the left. She can laterally flex 35 degrees in both directions. These are without pain and do not change with repetitive use on exam. There is no spasm or tenderness on palpation of the neck.
Examination of the low back reveals flexion to 70 degrees. Again, she does have a large gravid uterus. Extension is to 25 degrees. Lateral flexion is 35 degrees in both directions. Rotation is 45 degrees in both directions. Lumbar range of motion is not painful. Cervical range of motion is likewise not painful. The range of motion of the low back is not additionally limited following repetitive use on this exam. There is no spasm on palpation of the lumbar musculature. She is tender over the left sacroiliac joint. Straight leg raising is negative bilaterally.
Clinical and diagnostic tests: none are requested today.
Diagnoses:
1. Idiopathic Hypersomnolence
2. Cervical degenerative disc disease
3. Lumbar disc disease
4. Left sacroiliitis
Comment: The above diagnoses are based on the veterans history and the reports of tests in the general remarks section.
Edited by sleepyjennLink to comment
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