Spine Exam Worksheet And Scholarly Articles

[halos2]

Rental and all,

So now I get another IMO with the Dr using the spine exam worksheet and print off copies of the rating criteria/or encorporate it with using is as 38 CFR 4.71a as referenced?

Do I have him also utalize the VHA Handbook 1176.1 spinal cord injury & disorders or use it for a reference?

Attach the whole scholarly article emedicine/pmr/topic133 or site parts of it?

Use the clinicians guide, and the training letter july102003, and the IVDS letter, and the Spine rating from 67 FR 54349-

Do I have him send along copies of all of these?

Do I have him use just the spine and muscle exam sheets?

The rest do I have him attach copies for his references?

I just finished with 69 pages of material you advised and I copied all so now am not sure how to proceed with this as I do not want to overwhelm the DR but I can have all copied material for him to send along with it.

Break it down if I need to change things around to best suit my case. Also I need to establish DeLuca in with the dr statement. Have only 28 days left.

Tick tock...

[rentalguy1]

Just have the doc do his IMO based off of the sine exam worksheet. You may want to show him the spine rating criteria, but if he doesn't want to see it, don't push it. He HAS to look at all of your SMR's, VAMR's, and CMR's. He also has to state in the IMO that he has reviewed all of those records, otherwise it will be completely worthless.

All of that other stuff is just used as reference material for the rater, and to show that person that you know as much about the system and rating criteria as he/she does.

[halos2]

Rental,

So glad you responded. Prior the Dr said he based his opinion upon review of my SMR and the original date of inservice injury including the months of treatment in service, medication, adaptive equiptment,corsettes, and all with no relief of pain...next he said treatment continued with his clinic by his father first in the early 1970's and with him starting in 1973...the condition had become worse over the years with vet being treated at the VA in the mid 1980's for 3 years.

He stated in his medical records he provided, 3 further injurys(falls, moving desk,auto accident) which caused futher damage to an already damaged weakened structural system. All modalities used tens, meds,exercises, therapy, epidurals, and pain has persisted. He stated I was awarded SSDI amongst back injury as one of the diagnoses granted for this awardance. The original injury contined to progress over the years and also suffers from degererative changes now....he did not dispute the fact that gonimeter was not used with VA C&P and did not add % used in SSDI report. The SS exam was done by a a neurologist and DR B did not use these findings within his exam report IMO...he thought they have exam and results so why tell it again.

Remember the NP that did my C&P lied so much and they removed her from doing any more exams, as they had so many complaints about her lies. I spoke to her 2 different times within 2 months after I got copies of my C&P and she said she never wrote that she said she put I was suffering since military injury and blah blah blah liar bitch!!!!

Their findings to dispute were:

... 1) You were injured on xxx and seen for low back strain from lifting. You reported for 20 pt visits between xxx to xxx (6weeks) and reported no improvement. X-ray of the lumbar spine was negative. "The separation exam dated xxx revealed a normal clinical eval of spine. You were noted to have full stregnth and range of motion of the back. It was determined that your lumber strain had resolved with no complications or sequel."

Fact: The front of form 88 and 89 have back injury checked yes, pain yes , corsette or brace yes...

The back page of this form is type written listing above yet it is not signed by the Dr who did the exam, and another person signed it not the Dr and the DR ( Lt Col)I had seen for months and was aware of my back problems, so this major lied and typed errors on the report and he signed it ... also the date they referrence as to "a one time injury datexxx is incorrect. The date they wrote is over 2 months prior to the date I injured my back and had all the treatments... so that is not correct as I was never treated or seen at the medical clinic for the date they say. The military records note pain radiating to thighs and legs...this is not addressed at all.

... 2) Progress note 2001 from Dr states chronic low back pain most likely fron degenerative disc disease, but maybe some early degenerative joint disease. VARO states you were a nurse all these years so you had alot of lifting in your years of experience.

... 3) "VA C&P exam 2005 examiner provides an opinion regarding any relationship between currect low back disability and lumbar strain noted in military service. She diagnosed herniated nucleus pulposus, lumbar spine without weakness, but noted fatigability and radicular symptoms of the right knee. She opinoned current DDD with history of HNP is not related to your musculosketal strain that occurred in the service. She further said evidenced changes are markedly degenerative in nature and more related to after service occupation of lifting as a nurse, and also from an injury 1998.( I moved a desk in office).

... 4) Treatment reports from VA hosp seen 1985 low back pain, had auto accident few mths prior,...treated with pain meds, hot packs, therapy, tens unit, corsett...fell later on wet floor in 1985, and you have constant pain radiating down legs to knees. Dx low back pain.

... 5) Statement by Dr A 2006 states long standind back pain that goes back to acute injury in xxx in military. He notes he read all SMR. He states back injury in service could be culprit that started creating discogenic problems noted on MRI...???He opinioned one cannot place an exact date of origin of the bulging lumbar discogenic problem???(don't know why he put that in)...He opined the findings on MRI are compatable with a back injury and more likely than not related to the documented back injury during active military service.

... 6) Starement from Dr B 2007 reports you informed him of your chronic low back pain began in and is related to your military duty. He was presented copies of your SMR which detail initial back injury in 1969 which detail strain, sprain, spasms to the area. He further states you have legitimate low back pain and the records in your file indicates you experienced back injuries and one must note the origin of the injuries in your records beginning in service military 1969.

... 7) Opinions do not take into consideration the vets entire medical history and other potential sources of claimed disability is not considered credible for rating purposes. Statements from Dr a and B are not credible as they were not based on a complete review of your medical records or history. There is no mention of your normal clinical evaluation on your military separation exam conducted xxx, nor is there mention of interrcurrent low back injuries in 1985 and 1998.

... 8) You submitted prescription from Dr B for medication in 1975 and 1976 meds for pain...a physician statement from 1983 shows treatment for backache...the evidence is nonspecific and fails to provide evidence od a chronic disability related to military service.

Service connection for HNP, low back pain is denied because there is no evidence of chronic low back pain in service, nor is there evidence of continous treatment for a chronic low back injury from the date of discharge to the present date. Inservice you were treated for low back strain that was shown to have been resolved upon discharge. Additionallv, as discussed above, there is no credible medical evidence linking a current lumbar spine disability to the lumbar strain during military service. Therefore, service connection is denied.

OK that is a condensed version of it. The way they knew about 1985 and 1998 was from Dr B medical records...we had nothing to hide and gave all the evidence. So now what is the best avenue for me/them to resolve this. Was seen by Drs since early 1970's. They have one Dr stating this Dr B in his IMO.

Edited September 20, 2008 by halos2

[halos2]

Rental, Carlie, Berta, Allan, Hoppy and others give me some more hints on my last post.

Tick Tock