Dr. Bash

[JohnM]

We have sent the form in for Dr. Bash to help us with my brothers claim. Does anyone know how long it takes for him to reply and how much it will cost? Thanks for advise in advance.

Dianne

[jbasser]

He has the right to refer you for an opinion is he is not sure, But he does not have the right to treat.

These radiologist can really make or break a claim. They often interpet their own personal points and many over read Xrays.

One even told me I had lymphoma in 2005 and scared the crap out of me.

J

[Quint7]

I didn't waant to hijack this thread with my case, but again I wasn't clear. I claimed a "back condition" originally, (because I was ignorant of how the VA worked at the time... no more thanks to THIS site!). because I was just finding out about what exactly was going on with my back. I requested that it be a stand alone claim and also considered as secondary to my SC knee.

The exam asked that both of these be considered. The examiner (a PA, on contract w/ the VA), claimed to have reviewed my records, documented that I had IVDS/DDD and did the ROM test. I would assume that since VA has a training letter out on all of this that examiners and raters are expected to be aware of this training letter and follow it when appropriate.

The letter makes the statement:

"2. What are some problems related to examinations for IVDS?

Unless done by an orthopedic or neurologic specialist, examinations for IVDS have often been less than adequate, but nonetheless have been accepted for rating purposes. The neurological component of the examination (assessing motor loss, sensory loss, and reflexes) in particular has often been incomplete or lacking. However, it is not necessary for rating purposes that all examinations for IVDS be conducted by a specialist."

It also states:

"b. Raters do not always insist on an adequate examination.

Example: One veteran was suspected by the examiner of malingering. An inadequate examination, which was the only examination of record, was performed. It did not include any of the tests described under #4d or f. Nevertheless, the veteran was assigned 60%.

Example: WWII POW had DDD diagnosis. Examination showed lumbar spine flexion of 60 degrees, left and right bending of 20 degrees. Neurological examination was called "grossly normal". However, a separate examination for cold injury residuals found sensory and motor neuropathy of lower extremities. This discrepancy called for reconciliation of the strikingly different neurologic findings, and an opinion as to whether the findings are all due to cold injury or whether any may be due to DDD, but this was not requested. DDD was rated at 40% without further examination."

Finally, it states:

"12.What are some important rating points under the revised evaluation criteria?

• First, the alternative methods of evaluation must always be considered and the method more favorable to the veteran (after combining all evaluations for SC conditions) applied.

• Second, insisting upon a comprehensive and adequate examination that follows the examination worksheet guidelines and includes assessments of both the back or neck area and a neurologic assessment of affected extremities (and other areas, such as bladder, when indicated) is the best way to assure that an evaluation accurately reflects the veteran's disability. Accepting an examination that is less than complete may shortchange the veteran and make the evaluation inaccurate.

• Third, the neurologic and orthopedic evaluation criteria used must be carefully selected to make sure they are the most appropriate. (Both the neurologic and spine sections of the rating schedule are in the process of being revised, so the available evaluation criteria will be changing.)"

My point is that the person who examined me was not qualified and should have been trained to a level to recognize that and reported that as part of the exam. Instead this person made a decision that my disease was "less likely than not" related to my service. The rater should also have recognized this and requested another exam following the entire criteria spelled out in this letter. Once it was documented that I had not a "back condition", but a specific disease I should have been treated and examined for that. As we all know, VA is not going to do the right thing, it is going to do the easy thing.

On topic, after all of the info that I have dug up about this (thanks also to Rentalguy!), I expected a much more in depth report from Dr. Bash. I didn't get that, but I feel that I still will make my case. It isn't a matter of money to me as even with the correct rating I am only looking at 10% more in total... 20% at best, it is about VA being responsible for me when I am in a condition to not be able to take care of myself.

[carlie]

Quint,

To ease your worries a little, any vet SC'd at 50 % or higher, VA by regs, has to

take care of all your medical conditions, not just the one's that are SC'd but ALL

of them and all medications RX'd.

jmho,

carlie

[dav_marine72]

Just wanted to put my piece in on this since I am using Dr. Bash.

I was able to get SC for a back condition in 2000 on my own. It started in 97 which was 2 years after I got discharged but I had a surgeon and a podiatrist write a letter stating it was possible my back was SC directly to service or secondary to my SC feet. just a quick tour of the claim at stake. From 1997 to 2000 I saw 4-5 surgeons about my back issue. I had 4-5 MRIs and a disco-gram. By 2000 I was diagnosed with severe DDD at three levels, L3-4, L4-5, L5-S1. L3-4 had a large herniation pushing into the nerve root and was desiccated, L4-5 had a moderate herniation pushing into the nerve root, and L5-S1 had a bulge pushing on the thecal sac. No surgeon wanted to touch me. Just in case your wondering I didn't file SC before 2000 because I was hoping I could get fixed. I was a serious athlete before this. Anyway surgeon from Yale decides he can help me and recommends a fusion of the two higher discs. Right before surgery he changes mind and wants to do two level discectomy. He also warns should this fail I would need a fusion down the road to stabilize my back. Surgery takes place and turns into a discectomy / laminectomy at the two levels. In the beginning while convalescing I seemed to feel better. I of course didn't get any money for this because I wasn't service connected (I know stupid). I go to see the doc and he states patient has had maxim recovery (this used against me in rating). Once I go back to work the back, thigh, buttock, and leg pain / symptoms return but are actually worse. Doc has me get a new MRI. MRI shows nerves clean with some scarring at the site of surgery. He says sorry can't do anything for you.

I get direct service connection for back rated 20% under 4.71A 5295 lumbarsacral strain. I send NOD and DAV writes a letter stating that I should be rated under 5293 Intervertebral disc syndrome for at least 40%. DRO assigned and hearing set. During the hearing the DRO commented about how they went out of their way to give me the lowest possible ratings. Granted I have 9 SCs. This seemed like a good hearing. At this point I figured I'm good but more ammo can't hurt and I found Dr. Bash. I have to admit I wasn't 100% happy with paying $2000 but I did it because I thought I could get the return off the right rating. He writes me a letter stating I should be 60% under 5293 IDS and includes reasons why. He also states about how bad my DDD is, how I can't sit, stand, drive for very long, leg pain, etc.

Granted it was easy for the RO to discount me because with all the symptoms I have going on I had been doing yoga and stretching to try and get some relief. One of the exercises mimics the bending piece of the back exam. So being honest I bent to where I could and of course on the two days in questions I had no flare-ups. My bending fit into the 20% rating of the 5295 rating. Of course nothing was taken into consideration about the straight leg raises or DDD or anything else. Makes me wish I did something different at the exam.

Well DRO decision comes in and other than service connecting me for two things at 0% and finally getting my 30% Asthma rating correct I got nothing on the back. DRO says she took into consideration my testimony and Dr. Bash's letter but the evidence outweighed us.

I send NOD and appeal to BVA. During this decade of waiting (joke) my back gets 100% worse (2005). I go to the VA many times in sever pain and limitation of motion, spasms etc. They won't give me anything for pain even after I beg. Thank god my wife has insurance and she begs me to go to civilian. I do and they order MRI, give me Vicidon, and send me to pain clinic. MRI shows pretty much the same after the surgery (Severe DDD), three levels of collapsed discs, and the scarring is worse at the surgery site (words from neurosurgeon). Pain doctor diagnoses me with neuropathic component in the L3 and L4 nerve roots, diagnosed with epidural scar tissue that has been there for some time, my hope is to break up the scar tissue which is clearly entrapping the nerve roots causing his symptomatic complaints, my concern, however is that the scar tissue has had many years to form and become more solidified making it more difficult to destroy. Many different docs write that I am having 3-4 panic attacks a day from the severe pain. I go from Vicodin to percocet to 4 doses of OXY now. I fax all this evidence to the BVA and have the fax log showing their machine received it. I contact Dr. Bash just to ask him what he thinks about the RO decision and the BVA. He states I need a follow-up letter and ask for another $2000. I tell him I have had five jobs in eight years and I don't have $2000. He says he can;t do anything unless he gets $1000. So against my fear I give him my last $1000 in savings. I have three children so If I lose a another job were screwed. He writes the new letter rebutting the RO's decision and incorporates all my new evidence. This goes to the BVA too.

March 2008 BVA decision comes. With all the above evidence they give me 10% for neuro component of back and keep 20% rating the same. No mention of Dr. Bash what so ever.

I am now at USVACA. I guess one shining light is my lawyer who hasn't received my c file yet of course is definitely going to use the no IME (Bash) by the BVA and lack of a proper Deluca work-up.

I guess the jury is out for me - it looks like his IMEs might be some weight for the court to remand- then again until I get a remand and possibility rated higher I don't know what my return on investment will be. It seems Dr. Bash is helpful if you need a nexus for service connection and might work for someone like me that needs a rating change but I don't think everyone needs to pay the big bucks.

[purple]

One of the big things that bothers me when I read everyone's experiences with this Dr. Bash fellow is how he insists on being paid up-front no matter what. That's always a huge red flag in any business!

Do you every pay for any car repair, plumber, roofer, etc up-front in-full before the work is done? No. Why pay this guy? Even lawyers aren't paid up-front most times unless you "win"!

Just seems odd that's all.

[dav_marine72]

I agree it is definitely a gamble. I guess the VA screwing with you makes you feel like you've got to do whatever is possible. I know I asked a couple of doctors myself to do something close to this for me and they all said no. It was like my opinion will be in your records but I don't know the VA so I can't really say. I offered the VA regs, etc. and they said they didn't have the time. Having Bash target exact VA law was attractive however risky.