Result Of C&p "less Likely Than Not"

[Quint7]

Hi All,

I went and got the copy of my C&P for knee and back that was done 10 days ago. The results are unusual. I will start by saying that I claimed an increase for my 0% knee, a claim for my back being secondary to my knee and a reopening that my back alone is SC.

My measurements were:

Knee 0-90 degrees out of 140 degrees.

Back 0-20 degrees forward out of 90 degrees, 0-5 degrees extention out of 30 degrees, 0-20 degrees right lateral flextion out of 30 degrees, left and right rotation is 0-30 degrees out of 30 degrees.

The PA that examined me mentions that I have had therapy for both problems. She also mentions that I had a MRI and that it shows DDD and Stenisis along with disc buldge.

She then states that the "spine condition is less likely as not secondary to his right knee condition. The vet has a lot of other contributing factors to his back condition, including his occupation as a firefighter. The vet's gait was normal on exam today. The MRI findings do not support spinous condition as secondary from the right knee. It is more likely from other causes."

OK, a few things:

I had the actual MRI films with me and I asked the PA to look at them, to which she said "I don't need to, I have the report here".

I have been a firefighter for 11 years. I filed originally for my back upon my end of enlistment in 1994. I also saw a chiropractor in 1998 or 99 (XRays from then show some disc damage already) which is only 1 or 2 years into my firefighting career. She made no mention of this in person or her report yet it claims she reviewed my file.

She claims there are "a lot of other contributing factors" yet other than my job, she does not mention any.

As I posted before, she had 2 huge folders that were my file with her. My exam lasted 20 minutes at most.

Any comments or suggestions?

She states that no further tests are needed.

As I see it, she did not fully review my folder, did not ask my history, automatically took my current career over my explanation that I have had this problem since I was in the service. She did mention that I have had the pain since 1992.

thanks!

jason

I can post any other info from the paperwork I received that might be relavent if I am missing something.

[rentalguy1]

I hear ya Quint. I have pretty much given up on SO's and vet reps. I like the guy that I have always went through, but he is swamped, and he is having major health problem of his own that keep him out of the office frequently. As to hopefully getting a rater that "was a vet and understands the military," we all hope for that. The truth is, even if the rater is a 100% disabled vet with 30 years in the military that started out as an E-1 and retired as a O-6, he is still bound by the laws and regs. My best advice that I can offer anyone is:

1. Stop viewing the VA as advesarial. They have a job to do, and, at worst, we can lump them in the same pile with debt collectors. For the most part they are just trying to follow the rules and put food on the table for their family.

2. Take the energy that we have all wasted on being mad, frustrated, and upset and put it to use in a more meaningful way by learning the system.

3. Learn every word, verbatem, in 38 USC, 38 CFR 3 and 4, M21-1, M21-1MR, every training letter, fast letter, this letter and that letter that VA has ever put out. Learn everything there is to know about each disability that we suffer from. If there are ten treatment options for that disability, the vet needs to know them. If there is a surgical option for that disability, the vet needs to know everyithing about it, even how to perform it blindfolded (that was a dramatization, but you get my point). Gather a complete copy of every medical oriented appointment that you've ever had, and know them forwards and backwards. Basically, learn every possible thing that VA can use against you, and know how to defeat it before the issue ever comes up.

4. Once you've learned all this vast amount of information, and you're on your way to success on your claims, start helping other vet's through the process. Some of these guys and gals are so debilitated by their physical and mental injuries, that there is no way they can learn to navigate through this beaurocratic maze. It is up to people like us to help them. On top of that, it gives meaning and purpose to all the crap that we have had to suffer through with the VA.

That's my $.02. Hope it helps.

[ruby]

As a RN, I can tell you that your radiological film reports are only as good as the person that reads them.

Case in point, I have the same films read by three people in the VA one a radiologist says they are normal, another one says there are spurs and the rheumatogist says DDD L4-L5 with spurs--

Just because someone is a specialist doesn't mean they have any knowledge-trust me on that one.

In the VA they put xrays on a disc that are difficult to read-you need the actually films to get a clear picture.

The CE docs read the reports only, they don't look at the films, most don't know how to read them, so they don't. Its the luck of the draw on films, just hope the person reading yours knows what he is doing and he is rushing to read them.

My second CE was done by a neuro guy, he said you need to file for secondary, according to your films you shouldn't be able to walk. I thought I was being seen for my back, but I didn't understand the system and filed my request wrong. He looked at my films had I been seen for what I thought I was being seen for I would have been 100%.

My 3rd CE, the doc refused to look at my films, I knew why, he didn't know how to read them, but I didn't stop until he looked at them. Again my request was not filed properly and they didn't rate me for my back.

I am now trying for a 4th time, to get this request thing right.

If they read the reports only I would get the actual films and get the IMO/IME from the films. If you have a report that says they you have changes let the doctor know that they have been read to show whatever, if he doesn't know how to read them but pretends to at least your giving him a clue on what to look for.

It's sad but true.

[Quint7]

Ruby, I had the actual MRI films with me at the C&P and told the PA that even I could see as soon as they were held up to the light that I literally have almost no discs left at L4-L5 and L5-S1. That is when the PA said she didn't need to see them, that the report (which makes the situation seem a little better) was all she needed. I had the full, huge set, prob. 10 films, plus my whole set of files, military and civilian. She never asked for anything other than the letter from the radiologist. My sis is a nurse and as soon as she and everyone at the office she works at saw the films they gasped. Every medical professional I have seen says that a 37 year old should NEVER have degeneration like I do.

The other thing that I was thinking about is the C&P says that my back is less than likely related to my knee, but the result of many things, ESPECIALLY MY WORK AS A FIREFIGHTER. Now, how does the PA know what my job as a firefighter entails, that it could override my work in the Marines. Oh, wait, she never asked what I did in the Marines (I was on an Amphibous Tank thing). So what "expert" opinion can she give about my work now?

Six years of driving a 26 ton tank over rough terrain along with running 3- 5 days a week, etc, etc. would seem to me to be a lot more of a beating than 11 years of being a firefighter where we spend 99% of our time doing something besides beating our bodies up and only working 40 hours a week.

I can see a million ways to fight this, but I want to find out what the rating board says.

I don't know if I should write a letter stating my opinions about the C&P and document that the examiner didn't ask about previous exams or careers, etc........ it just seems to me that the VA makes it so that you have to be extremely specific to everything, yet they can generalize if it makes it easier to deny you.

Also, I filed this claim as secondary to my knee AND as an attempt to get the original SC for my lower back pain. The C&P doesn't mention anything about SC'ing the back injury on it's own, only allowing it as a secondary issue.

The C&P paperwork was only 2 pages long and cites no specific incidents from my military record anywhere in it.

[ruby]

Ruby, I had the actual MRI films with me at the C&P and told the PA that even I could see as soon as they were held up to the light that I literally have almost no discs left at L4-L5 and L5-S1. That is when the PA said she didn't need to see them, that the report (which makes the situation seem a little better) was all she needed. I had the full, huge set, prob. 10 films, plus my whole set of files, military and civilian. She never asked for anything other than the letter from the radiologist. My sis is a nurse and as soon as she and everyone at the office she works at saw the films they gasped. Every medical professional I have seen says that a 37 year old should NEVER have degeneration like I do.

The other thing that I was thinking about is the C&P says that my back is less than likely related to my knee, but the result of many things, ESPECIALLY MY WORK AS A FIREFIGHTER. Now, how does the PA know what my job as a firefighter entails, that it could override my work in the Marines. Oh, wait, she never asked what I did in the Marines (I was on an Amphibous Tank thing). So what "expert" opinion can she give about my work now?

Six years of driving a 26 ton tank over rough terrain along with running 3- 5 days a week, etc, etc. would seem to me to be a lot more of a beating than 11 years of being a firefighter where we spend 99% of our time doing something besides beating our bodies up and only working 40 hours a week.

I can see a million ways to fight this, but I want to find out what the rating board says.

I don't know if I should write a letter stating my opinions about the C&P and document that the examiner didn't ask about previous exams or careers, etc........ it just seems to me that the VA makes it so that you have to be extremely specific to everything, yet they can generalize if it makes it easier to deny you.

Also, I filed this claim as secondary to my knee AND as an attempt to get the original SC for my lower back pain. The C&P doesn't mention anything about SC'ing the back injury on it's own, only allowing it as a secondary issue.

The C&P paperwork was only 2 pages long and cites no specific incidents from my military record anywhere in it.

Did your written report reflect your films correctly. You probably pissed her off saying you can see the problem. Some people are touchy when a lay person say I can----

Then you might have approached this wrong. Perhaps you need to file a new claim for your back and not as secondary.

The MRI findings do not support spinous condition as secondary from the right knee. It is more likely from other causes."

She is not saying you don't have problems with your back, she is saying its not from your knee. If your back is that bad I would say its not from the knee too when your talking about stenosis/ddd.

Her comment about your job is sterotyping.

I filed originally for my back upon my end of enlistment in 1994.

What did they say about this, was it denied/remanded ?

In your current job, did you do a pre employment physical and if you did, did you ever mention any back problems?

At this point all you can do is wait for the answer, which according to your CE it will be denied.

Now is when I would start looking for BVA opinions, go through your medical records with a fine tooth comb and look for any mention of seeking medical care for back problems. If you had xrays in 98-99 do you think you could get someone to say the damage on those films are consistent with injury's that occurred while on active duty.

Xray evidence of arthritis usually takes at leat 1 year to show, once an injury occurs sometimes years.

Depending on how bad your xrays were in 98-99 they could possibly help prove your point.

I filed this claim as secondary to my knee AND as an attempt to get the original SC for my lower back pain. The C&P doesn't mention anything about SC'ing the back injury on it's own, only allowing it as a secondary issue.

I have made this same mistake, you only get what you ask for---period the end.

Now is the time to reasearch and wait for thier answer.

[Quint7]

Ruby, the main reason that I went and got the MRI films was because of the poor report written about them. There is no mention of any L5-S1 problem in the report and as I said, as soon as you look at the films you see that those two discs are almost missing. The back doc also said that there is "bone swelling" )edema) and that that is very rare too. I included his exam notes and there is no mention of those findings in the C&P, just the cursory findings of the radiologist.

As for the leg and back being linked, I was first seen for a torn meniscus in 1989. After years of Navy docs not knowing what was wrong they literally say in my record "nothing can be done." And, "not severe enough to rate a medical board". Every doctor I have talked to has said that the meniscus was torn the entire time and that that along with the obvious overdevelopment of not only my opposite leg, but the opposite side of my bad leg, show that I had a VERY longstanding problem and that there had to be an effect on my back. I told the examiner this and the only thing in the report that is mentioned is that my kneecap rides off to the side when my leg is flexed.

When I filed this claim I stated that I wanted my original denial from 1994 overturned as I was never properly notified to appear. I also (on advice of my vet rep) filed to have the knee and back connected. While I can't say that they are 100% connected, they have definately played off of each other. This is a 19 year period since I first claimed an injury to my knee. My SMR also indicates that I was forced to partake in marching, etc. when I was supposed to be onlight duty, etc. That means that I had my knee injury for 5 of my 6 years in the Marines. I do not and have never run since the end of my service and I can tell you that riding in a firetruck is a lot smoother than a tank! LOL

The reason for denial in 1994 for my back was that I didnt show for the exam (wrong contact info) and that the only "documented" back injury was while playing basketball in 1993. It does mention that I had to remain on my knees for 10 minutes after the injury. I also filed for "back pain" immediately after my discharge.

As for medical notes, I had no health insurance for 3 years after my service until I got on the fire dept. so there are no records of any care during that time.

The Xrays from 2000 show mild degeneration, which as I said is 5 years after my discharge. I would have to think that it would have been well on its way to show on an XRay already, since my XRays from 3 months ago say the same thing, yet the MRI confirmed a much more serious condition.

I know that I am babbleing, I am just trying to provide as much info as possible so that it might show up in a search or jog someones memory of a similar situation.

As for the examiner assuming something about my job..... that is where I think that I have my best shot on appeal. As I said, she asked nothing about what I did in service, yet assumes that my current career caused my situation or was the major contributor to it.

Thanks again everyone for reading this. Just kinda good to vent. My step-dad died a year or so ago from Agent Orange/ PTSD residules, which got me off my ass to finally get something going with VA and after seeing what he and my mom went through for SC, etc. I will take as long as needed to hold them accountable.

Oh, and on a lighter note..... I Googled the PA that examined me....... first thing that came up was an ad on CRAIGSLIST from her advertising for C&P examiners for here in Rochester and Bath NY. Now THAT is sad.............

[ruby]

start by researching, ddd, ivds, lumbar stenosis, bulging disc.

While I don't know I think your approaching this wrong.

You requested both SC for the back and secondary--I think it should have been one or the other but not both. Too confusing to an RO.

Did they decide on your request to reopen your back from 1994? I suspect the RO didn't ask the Comp person to even look at that issue, since they already decided to deny.--Thats exactly what happen in my case. My lumbar and SI's were never examined they were denied. I can fight that too.

In your physical for the fire dept did you ever claim any back problems--I suspect not, otherwise you probably would not get hired. If you did that actually would help you.

I have reactive arthritis and I thought I was filing for that but my request stated secondary to sc arthritis. Reactive has nothing to do with degenerative. All the RO ask from the Comp Doc was, is the other joints secondary to the cervical arthritis.

The answer is no. I did get an increase for my neck being worse and for pain in my hand and foot. Are the other joints related as secondary they could be, I have to over use the none sc joints to compensate for the sc hands and feet, does my cervical effect my back, yes, if one is out of whack it will effect the other. This will be a BVA case if I appeal.

In the meantime, I found out that I have the nexus to prove my reactive arthritis secondary to a sc issue after 30 years of a miss diagnosis.

Go through your records with a fine tooth comb for anything that relates to pain in your back, legs, feet. I would follow through on reopening your case from 1994.

I can't really help you but there are others here that can on how to appeal the decision. I am learning this VA thing myself through trial and error, mostly error.

One thing I would research is how long does it take for traumatic (degenerative) arthritic changes to show on xrays.