Nasal Bone Fracture Service Connected Could The

[mountain tyme]

I just need some insight into this claim...

This service veteran retired after 21 years of service...

in 1989 during desert shield he sustained a fractured nose...in his VA paperwork that was done at the time of his discharge...(yellow paper)

it states

"Service connection is warranted for a fracture of the nasal bone and a less than 10 percent evaluation is in order"

also...the same paper work states

"Service connection for muscle tension headaches"

Service medical records show initial complaints of headaches as early as 1983 at which time migraine was diagnosed. Subsequent service medical records show diagnosis of tension headaches or muscle tension headaches and this was the diagnosis at the time of the VA exam. A diagnosis of migraine headaches was not given, however. The veteran stated that these have been present for 15 years and are located in the posterior occipital area. They occur approximately every 10-12 days and last about 4-8 hours. However, they are not accompanied by nausea or vomiting and there is no vision change. Service connection is afforded as the headaches were chromic in service, However, as migraines were not involved a 10% percent or higher evaluation is not in order. (Which could be assigned with characteristic prostrating attacks averaging one in two months over the last several months).

Ok with the above said....this veteran applied for an increase for headaches...in 2006 and he received there dicison on Oct 19, 2007...

it stated " evaluation of muscle tension headaches, which is currently 0 pecent disabling, is continued.

The VA states...

"VA exam shows you reported that you have two to three headaches per week that are not prostrating. Your motor and sensory exams were normal.

The evalution of muscle tension headaches is continued as 0 percent disabling because the evidence fails to show this condion has worsened to a compensable level. A noncompensable evaluation is asigned unless there are characteristic prostrating attacks averaging one in two months over the last several months."

this veteran has been treated for headaches since he retired in 94...in Feb 2007 he was seen at the Family practice clinic on base (air force base he has tricare)

and the diagonis...was

1. Migraine headache: maprosys 500 mg bid for 2 weeks then PRN. Imitrex not aborting migraines so will switch to Maxalt consider prophylactic medicine.

Rizatriptan (Maxalt) PO 20 MG TAb PO@onset of HA

Napoxen (Naprosyn) PO 500 MG tab-1T TB PO BID WF

_________________________________________________________

This veteran and his wife told me that he works rotating shifts...and due to this he had and has been laid up in bed for two or three days at a time but ironically when he has these migrain attacks they seem to fall on his days off..or they begin at the end of a shift and by the time he arrives home it is a full blown migrain...that is why the doctor put him on the above medication...to help prevent the migrains from coming on or controling the serverity.

when I went through his medical records for the last year...he had gone to the doctor about once every 8 weeks for the migrains...and the appointments were in the middle of the week..(his days off).

so that is where we stand now...

I told him he should do a NOD...or perhaps a reconsideration...and have his wife write a statement that due to the serverity of the headaches that he was in bed for 2-3 days...and he had called in sick...I told him that he will need to get something from his employer as to days he called in...it won't say why because his employer does not require a doctor note unless they do not have any sick time left...

how would he go about putting in for a reconsideration or a NOD...the veteran states he told the C/P doctor at the VA that he did miss work...but on his C/P it does not state that...or is it marked occording...

any advice would sure help...or any help on how to write a NOD on this situlation...

also could a fractured nose cause sleep apena? and the fact during his enlistment he was on rotating shifts??

thanks in Advance

MT

[LarryJ]

Yes, a fractured nose, especially a deviated septum, can cause all sorts of breathing problems including sleep apnea. He needs an ear/nose/throat (audolaringologist, I think) to look at him.

If the local VAMC supports a sleep apnea clinic then he needs to make an appointment - he'll have to get set up by his PCP, and it takes a while.....sometimes longggger than a while.

Obviously, loss of sleep will cause "migraine-like" headaches. So to will anything impeding the sinuses, such as poorly positioned severe broken probiscus.

Of course, if he is even slightly overweight, the sleep apnea folks are going to tell him to lose weight......that puts the problem back in the vet's lap, and gets it out of the VA's.

[mountain tyme]

LarryJ wrote: "If the local VAMC supports a sleep apnea clinic then he needs to make an appointment - he'll have to get set up by his PCP, and it takes a while.....sometimes longggger than a while"

Larry he has already been diagosised with sleep apenea and has a c-pap machine...he was diagnosed with sleep apena in 2005...

He put in a claim for sleep apena but the VA denied it due to there was no mention of it in his service records...he did however get statements from buddies regarding his heavy loud snoring...it seems to me by the time line I did with his medical records and buddy statements that the loud snorning and falling asleep during the day...started about one year after his nose was fractured...also noted in his medical records service and after service are numouous doctor appointments due to sinus problems and ear aches...not sure if that would have anything to do with the fractured nose he did have surgery on the nose to fix it while in the military.

So I got to thinking that perhaps the fractured nose was the cause of the sleep apena...also after the fractured nose happened was the same time the migrains really picked up...hummmm also...in his medical records I noticed that they had him go to relaxion clinic due to the headaches....he also had a weight problem during the last 10 years of his enlistment...

in Nov of 07 he did elect to have gastic by pass surgery due to being over weight and has since lost 85 lbs...yet the migrains and the sleep apena is still present...he also is s/c for gerds that began in service as well.

I told him that he most likely will need to go to an ENT doctor for a IMO as to weather or not the sleep apena was more then likley caused by the fractuered nose...

As far as the Migrains go...he needs to do something...I poured over his medical records...and in Feb 07 it clearly states that his migrains need to be controlled with medication and that it is also clearly stated that he has voimiting with the migrains...

I feel his headaches warrent at least 30 percent...

but how would we develop the NOD...

that is the part we are stuck on...

MT

[Rockhound]

Even though a Veteran is over weight, even obese. You can ask for an opinion as to how much the broken Nasal bone contrilbutes to his Sleep Apnea. If it is sufficiant to say that even without the Veteran being over weight, the Broken Nasal bone, with deviated septum would still pose a contributing factor to the Sleep Apnea, then he could get at least a 10% rating.

I have a constricting/restricting lung disorder, with a contributing factor of morbid obesity. It is only surmised at this point that the C/R lung disorders is the result of the obesity, since I have a autoimmune disease called Sarcoidosis which can also cause these types of disorders. I also have a Nasal Fracture with a deviated septum. It requires daily nasal spray of a corticosteroid at the highest recommended dosage to maintain an open passage through the Nasal passages.

During my sleep study that was recommended by my ENT and PCP Dr's. I was diagnosed with minor obstructive sleep apnea with Nocturnal Hypoxia, which requires treatment with oxygen when I sleep.

So as you can see, it is tantamount that you get a proper medical opinion and diagnosis of your sleep apnea and a determination of how much your Broken Nasal Bone and possible Deviated Septum and/or should you be over weight, might be contributory factors.

I wish you good luck, but it is apparent you will need more than one opinion and the multiple opinions must take into account any contributory factors, to overcome the VA logic that if your over weight, then that is why you have sleep apnea and not your fractured Nasal bone.

I hope I have made some since. I'm on quite a few medication right now, some are for psychatric problems and may interfere with my logic and cognitive functioning at this time.

Rockhound :)

Edited January 24, 2008 by Rockhound

[mountain tyme]

rockhound....

I think I understand what you are pointing out...he had been denied once for sleep apenea...he had sent in his sleep study and the need for his c-pap machine...after reviewing his service medical records...he was on the weight program quite a few times after he fractured his nose...he weight gain could have been from the lack of sleep...stress...there are many factors when it comes to weight gain or weight loss..

after he was denied the first time...he went and had buddy statements written out hoping to reopen the claim...I told him that his buddy statements were helpfull only is showing that he did snore...and fall asleep during the day...but they are not doctors and can not render a decision weather or not he had sleep apena...and that would not be considered new material evidence...needless to say he was denied a second time and the claim was not re-opened...

now fast forward it to 2007 at the same time he put in his claim for sleep apena...he also put in a claim for increase in headaches...since he was given s/c but 0 percent...

he was denied an increase in Oct. 07...yet this vetran has been seen over the years since discharge for the headahes/migrains...the last doctor entry was the following...

this veteran has been treated for headaches since he retired in 94...in Feb 2007 he was seen at the Family practice clinic on base (air force base he has tricare)

and the diagonis...was

1. Migraine headache: maprosys 500 mg bid for 2 weeks then PRN. Imitrex not aborting migraines so will switch to Maxalt consider prophylactic medicine.

Rizatriptan (Maxalt) PO 20 MG TAb PO@onset of HA

Napoxen (Naprosyn) PO 500 MG tab-1T TB PO BID WF

ok...in this diagnois it also states voimiting along with the migrains...

he has also missed worked he misses or should I say he is in bed for the migrains at least 3-5 days per month...with them.

yet the VA did not increase his percentage saying

"The VA states...

"VA exam shows you reported that you have two to three headaches per week that are not prostrating. Your motor and sensory exams were normal.

The evalution of muscle tension headaches is continued as 0 percent disabling because the evidence fails to show this condion has worsened to a compensable level. A noncompensable evaluation is asigned unless there are characteristic prostrating attacks averaging one in two months over the last several months."

should he put in for a reconsideraion...they already have the medical records...the only thing I can see why he did not get an increase was because the doctor did not note during the c/p that he has missed days of work due to the migrains...

yet the vet told him during the c/p that he had missed days here and there...depending on the shift he was working...

it is a mess....I told him that the medical evidence supports and increase for the headaches/migrains...

but as far as his sleep apena goes he will need an IMO as to sleep apena being secondary to the service connected fractured nose..

I told him he will probably need to drop his service veteran rep (state veteran rep.)due to the fact the rep. told him that he does not have time to help him develop his claim...

hence he found me through a friend of a friend...and I am a green when it comes to the VA and all there mumble jumble...

MT

[Ricky]

Tyme - you said "in Feb 2007 he was seen at the Family practice clinic on base (air force base he has tricare)

and the diagonis...was

1. Migraine headache: maprosys 500 mg bid for 2 weeks then PRN. Imitrex not aborting migraines so will switch to Maxalt consider prophylactic medicine.

Rizatriptan (Maxalt) PO 20 MG TAb PO@onset of HA

Napoxen (Naprosyn) PO 500 MG tab-1T TB PO BID WF"

Was this evidence ever presented to the VA during the time that the 2006 claim was pending?

If it was not then I would simply fill out a statement and simply ask for a reconsideration on the headaches due to the current diagnosis. If it was then a NOD is in order.

Please keep in mind that service connection for migraines is based upon a diagnosis. However, since pain, even that from migraines, is very subjective. Therefore, the rating level will mostly be based upon patient history at the level you are talking about. So he will also have to submit a new statement indicating that his symptoms have increased also in order to have the rating raised.

None of us except he and the doc knows what was said during the C&P so the rating may be correct based upon the history he provided to the examiner. It would help if his medical records (private tricare) indicated the increased symptoms needed for a 30 percent rating. Bottom line is what I am saying is that even if a diagnosis of migraines (or other headaches) is present much emphasis is place on the reported symptoms of the patient.

[mountain tyme]

Rickey wrote: "Tyme - you said "in Feb 2007 he was seen at the Family practice clinic on base (air force base he has tricare)

and the diagonis...was

1. Migraine headache: maprosys 500 mg bid for 2 weeks then PRN. Imitrex not aborting migraines so will switch to Maxalt consider prophylactic medicine.

Rizatriptan (Maxalt) PO 20 MG TAb PO@onset of HA

Napoxen (Naprosyn) PO 500 MG tab-1T TB PO BID WF"

Was this evidence ever presented to the VA during the time that the 2006 claim was pending?"

after you wrote me that question I went back and poured over his decision...that was date oct 07..he had put in claims for the following...New claims: Gerds, hypertension and asked for an increase for his s/c headaches/ muscle headaches...then asked to have his claim for sleep apena to be reopened using the buddy statements as new evidence for service connection.

The following was the decision...

Gerds...10% s/c (I think that was low balled)

hypertension was deferred until the VA doctor gives his medical opionion.

Increase for headaches stayed the same s/c at 0 percent

sleep apena was continued denied.

he is overall 40% service connected for DDD (degenertic disc desiease 4 and 5th L).

So I had quite a bit to look at...

when I read the VA evidence as to what they used to determine there decision I DID NOT FIND ANYWHERE THAT THE VA USED HIS MEDICAL RECORDS FROM FAMILY PRACTICE FROM THE AIR FORCE BASE WHICH IS PRIMARY CARE DOCTORS FOR THE PAST 4 years...prior to that he used private doctors after he retired out of the AF...because his employeer at the time had medical insurance.

So...the records that state he has migrains from Feb 07 was not used for evidence for the decision making...they only had his medical records from the miliatry from 72-94...

Now with that said...

should our plan of action be...

1.put in for a reconsideration with the doctors papers from Feb 07 stating his diagnois was for migraines perscribing him two medication to help control the onsets...also in these notes it is typed migrains accompanied with voitming.

2.should his wife write a statement as to how many days he is laid up due to the migrains...when he has his attacks he has to be in bed with curtains drawn shut...they even had to purchase special window treatments to keep the room dark.

3. he has called in sick due to the headaches but as I wrote before due to him working shift work many times the migrains would begin at the end of his shift rotation...3 days on 4 days off that he may have called in twice in the past year..the other times he would be in bed on his days off...

since he has been on the new medication regime he still has headaches but they only emerge into a full blown migrain may twice a month but he still has the headaches but not disabilitating like they were prior to the medications.

thanks for everyones insight into this matter...

MT