Spine Claim Questions

[rdnkjeeper]

I am new here and been reading information on this site for the last couple of days. There is so much information here that it has made my head spin. A little history so maybe someone can help me ask for the right things. I hit a towel bar in the military on my middle back and a few days later I was playing racketball and jumped to get the ball and went numb from my chest down. Spent three days on bedrest. I do have all the records supporting this. These injuries occured a few months before getting out. The Dr at my final physical told me to keep my mouth shut about my back, until I get got out and then put in a claim with the VA.

I got out and put a claim in with the VA, it took them about a year and service connected my middle back with chronic muscle spasms. I have been complaining about my back for years, but the VA didn't want to do anything. I opened a claim in June about connecting my lower back. I started noticing shooting pains down both legs for about a year before opening a claim. The VA got a new Dr at the clinic I go to. He said he reviewed my records and found that I have had back issues for years and what did any Dr say was wrong with my back. I told him muscle spasms....he then asked if I had had an MRI, told him no. He was shocked and order one right away.

The MRI showed that I have......(will type in the report and maybe someone will help me decode it)

Finding:

Thoracic spine: There is preservation of vertebral body height and alighment throughout the thoracic spine. The bone marrow signal is unremarkable. The thoracic cord demonstrates normal caliber and signal. There is a prominent central disc herniation at T9/T10 resulting in a mild indentation of the cord at this level. There is also a disc herniation, asymmetric to the right resulting in narrowing of the right portion of the thecal sac at T3/T4. Disc bulges are also present at T4/T5, T7/T8, T8/T9, and T11/T12.

Lumbar spine: There is preservation of vertebral body height and alignment throughout the lumbar spine. The bone marrwow signal is unremarkable. There is a loss of T2 signal within the L4/L5 and the space height at L5/S1. There is a focus of increased T2 signal within the posterior aspect of the L5/S1 disc compatible with annular tear. The conus ends at L1. No abnormal conal signal is present.

The L1/L2 and L2/L3 levels were not image in the axial plane but appear unremarkable on sagittal images.

L3/L4: There is a diffuse posterior disc bulge with bilateral facet hypertrophy in mild to moderate central canal and mild bilateral neural foraminal stenosis.

L4/L5: There is a left posterolateral disc herniation resulting in mild narrowing of the left lateral recess and mild left neural foraminal stenosis.

L5/S1: There is a central disc herniation resulting in mild central canal stenosis.

Impression:

Multilevel degenerative changes are present as described within the thoracic and lumbar spine.

Like I said my head is spinning so any help anyone can give me would be greatly appreciated. I plan on waiting until this claim is done then opening another or appealing depending on what happens. Sorry for such a long post, but I also need to know what to ask for. I don't know what I am entitled to. They are pushing for surgery on the T9/T10 one right now. I am really nervous because I am the only bread winner in my house and if I can't work after the surgery what am I going to do? I have not decided if I am going to have surgery or not, but it is getting harder and harder to make it through a shift at work.

Thanks everyone.

[rdnkjeeper]

Should say that of all the records I have some say middle back injury and some say lower back injury....my military records.

[jbasser]

The VA rates the back as 1. They dont separate middle and lower.

Your 40 percent rating I assume is for the back and you are seeking an increase.

Under the rating criteria the 40 is next to the highest percentage. 60 is the highest they will go and that is with documented incapicitating episodes or bed rest within a specified time frame.

You can look at RentalGuys spine claim repository as it goes into detail on the back as he has done a good job in putting it together just for situations like yours.

J

[rdnkjeeper]

Sorry should have said I am 20% on my back. I have read his links, but like I said the more I read the more confused I become. I am assuming that part of that is that I don't really know what my results mean. I also talked with my union and they told me to keep the herniated disc to myself, if my employeer found out about it I would be fired. I can't do my job anymore. I am more than frustrated and more than a little stressed.

[rentalguy1]

First of all, welcome to Hadit! Second, thank you for your service! Third, I am sorry about your back troubles, but as a fellow spiney, I can tell you that this is somewhat manageable if you do the right things for YOUR body.

Let's get the MRI out of the way;

Thoracic spine: There is preservation of vertebral body height and alighment throughout the thoracic spine. The bone marrow signal is unremarkable. The thoracic cord demonstrates normal caliber and signal. There is a prominent central disc herniation at T9/T10 resulting in a mild indentation of the cord at this level. There is also a disc herniation, asymmetric to the right resulting in narrowing of the right portion of the thecal sac at T3/T4. Disc bulges are also present at T4/T5, T7/T8, T8/T9, and T11/T12.

There are four segments of your spine; the cervical (C-spine, neck), thoracic (T-spine, middle), lumbar (L-spine, lower), and the sagittal (S-spine, tail bone). This is saying that at the T9-10 level there is a disc that is herniated directly in the middle that is touching your spinal cord. This is most likely the result of the towel bar incident, and what causes your chest down numbness. There is also a bulging disc two levels higher at T11-12, and most of the remaining levels below T9-10. Bulging discs are similar to a herniated disc, but they do not protrude into the spinal canal far enough to impinge the spinal cord. At the T3-4 level you another disc herniation that is offset to the right and either higher or lower than the center line of the disc. That is what they mean by asymmetric. This herniation pushes against the thecal sac, which is basically a fluid filled sack that protects the spinal cord. This results in less room for the spinal cord to move and flex, but it isn't constantly impinged like at the T9-10 level.

Lumbar spine: There is preservation of vertebral body height and alignment throughout the lumbar spine. The bone marrwow signal is unremarkable. There is a loss of T2 signal within the L4/L5 and the space height at L5/S1. There is a focus of increased T2 signal within the posterior aspect of the L5/S1 disc compatible with annular tear. The conus ends at L1. No abnormal conal signal is present.

The L1/L2 and L2/L3 levels were not image in the axial plane but appear unremarkable on sagittal images.

L3/L4: There is a diffuse posterior disc bulge with bilateral facet hypertrophy in mild to moderate central canal and mild bilateral neural foraminal stenosis.

L4/L5: There is a left posterolateral disc herniation resulting in mild narrowing of the left lateral recess and mild left neural foraminal stenosis.

L5/S1: There is a central disc herniation resulting in mild central canal stenosis.

This is saying that your spinal cord ends at L1, and transitions into the cauda equina (horse's tail), which is the remainder of the the nerve roots for the lower half of your body. This is normal. It also says that you have degenerative disc disease (DDD) at L4-5 and L5-S1. DDD is marked by disc dessication (dehydration) and a loss of height. This narrows the amount of space that the cauda equina has to function in.

At L3-4 you have a wide disc bulge and central canal stenosis. Central canal stenosis is a narrowing of the space where the spinal cord or cauda equina resides. The less room there is, the more it is impinged, and the more pain and nerve related problems you will have. You also have bilateral (both sides) foraminal stenosis at this level. Foraminal stenosis is a narrowing of the holes where the nerve roots exit the spine. These holes are created by gaps in the spinal segments called vertebra. This also creates nerve pain. Also at this level you have bilateral facet hypertrophy. That means that the little wing-like bones at the rear of your spine have arthritis and are trying to grow into the facet joints at the next level up, or down, or both.

At L4-5 you have a disc herniation to the left side that is causing left-sided central canal stenosis (for lack of a better term). It is not the same as at L3-4, because the disc is causing this problem by itself, without the other arthritic problems. This disc is also causing left sided foraminal stenosis, where the nerve root exits the spine on the left side.

At L5-S1 you have a disc that is herniated right in the middle. The MRI picture shows that there may be a annular tear at this herniation. The annulus fibrosis is the heavy duty material that covers the outside of the disc, and holds back the nucleous pulpous. The necleous pulpous is a jelly-like material that gives the disc it's shock absorber capability. When you have a herniated disc, the annulous is worn thin, or stretched and the nucleus pulpous is pushing outward. Imagine a thin spot in the skin of a ballon, with air or water pushing it outward. When you have a annular tear, the nucleus pulpous is actually coming out of the disc. Your herniated disc at this level is causing "mild" central canal stenosis.

Clear as mud, right?

My advice is to get to a neurosurgeon and let them have a look at the MRI. You may need to get the L5-S1 disc repaired fairly soon, but that will be a call the doc will have to make. They may choose to wait, though, since the MRI wasn't definite about there being a actual annular tear there.

Some of the docs will tell you that you can get better, but don't believe them. You have degenerative, arthritic conditions in your spine, and they are just that. Some that is degenerative will continue to degenerate, and there is nothing that can be done to stop it. You can slow the progress, though, and make yourself feel better. There are several things that can be done. The typical course that a doc will try is to put you on non-steroidal anti-inflammatory medication (NSAID). This will relieve some of the inflammation to the muscle and soft tissues that the degenerative changes, and pain are causing, which in turn will lessen some of the pain, and some of the nerve related symptoms. They will also probably put you on some form of pain medication. I use Darvocet, but with limited results. I have also tried methadone, but nearly lost my mind on it. The doc now wants me to try morphine, but I am hesitant. Your doc will have to experiment till he finds what is right for you.

A lot of docs want to try physical therapy. Some folks have good results with it, some don't. I know several that it has actually made worse, myself included. My best word of advice on PT is to not let the therapist push you beyond the pain. The pain is there for a reason, and it is best to listen to it. If you don't, you are just asking for more damage to be done. Some docs like chiropractic. Approach this method exactly the same as PT. More damage can be done just like with PT. Another thing that a lot of folks have tried is what is called a TENS unit. It sends mild electrical pulses to the muscles in your back to relieve muscle guarding. Muscle gaurding is the result of constant pain. The muscles in the area of the injury tend to tighten in a effort to hold the broken pieces together and cause less pain to the body. Eventually they forget how to let go, and this causes even more pain.

I have very good results, albeit short lasting, from plain old heat and ice therapy. Use a heating pad for 15-30 minutes, and then a ice pack wrapped in a towel for 15-30 minutes. The ice will hurt very bad, but after you alternate these two for a few hours, you should notice that your back has loosened quite a bit. The VA prosthetics department can issue you a Thermaphore heating pad if your VA doctor prescribes one. This heating pad is about twice the length of a normal one, so that it can cover the entire back at one time. It is a moist heating pad, so it better penetrates the muscles, too. It also goes up to 180*, which is much higher than standard heating pads. Because of this, you let the heating pad lay on you, instead of the other way around. I cannot lay on my stomach, because of the condition of my back, so I have to lay on top of my heating pad. This means I can only stand 5-10 minutes due to the heat, before I have to switch to the ice, but I get the same effect.

Another option is massage therapy. It will take several sessions before you really begin to loosen up, but when it starts working there is nothing like it. The problem with this is that it can be expensive. Sometimes is costs up to $60/hour, depending on your area. My therapist charges $40/hour, so I don't get to see her as often as I'd like, but it is worth every penny when I do. The VA doesn't accept massage therapy as a viable option yet, and they won't pay for it on a fee-basis, either (in most areas). A word of caution on gettin loosened up, though. You will start to feel like your old self again, and you will have the urge to do the things you used to do. DON'T!!! You will cause a relapse that can be worse than before. Do too much today, and you will likely pay for it for the next week.

The last option docs like to take before surgery is epidural steroid injections (ESI). They numb the area of the back where needles are to be inserted, then under a fluoroscope (c-ray) the inject a steroid solution at the points of nerve impingement. The docs say that the results are pretty good with this treatment, but from others that I've talked to it seems kind of hit and miss. I'll be getting my first ESI on the 20th of this month, so I'll know a bit more about it then.

There are several different types of surgeries that can be done. For the conditions that you have, I would imagine that a discectomy is what they will look at for your L5-S1 problem. This is where they remove the nucleus pulpous from the disc. For the stenosis, they would probably look at a laminectomy. This is where they take out the lamina, or side sections on the back of the spine. Sometimes this causes instability in that part of the spine and they also have to do what's called a fusion. This is where they insert metal rods into the bone to fuse the section of spine that had the lamina removed to the next section of spine above. Your doctor will describe these treatments in much more detail, and you can find all kinds of information on Google about all of these treatments.

So, the first thing you need to do is seek treatment for these conditions. Since you are service connected for your back already, I'll suggest getting this treatment at the VA hospital/clinic unless it is too far away from you. This way it will be free, and it will be much easier to build your case for your claim. Every few weeks during your treatment, go to the release of information office and get a copy of your medical records. That way you can stay on top of your case. Then you will need to get a nexus form signed by a VA doc that states your current spine problems are related to your in service incident. When you have all of this information gathered, then file your claim. Since you have several conditions going on in your back, there are several different diagnostic codes that could be applied. They can only give you a rating under one code, though. I would suggest requesting them to place you under diagnostc code 5243, Intervertebral Disc Syndrome (IVDS). This will give you two seperate ways to be rated; range of motion or doctor precribed bed rest. You will most likely be rated under the range of motion cirteria.

You can also recieve ratings for radiculopathy as secondary to your spine conditions. Be sure to let the docs know of any associated problems you are having, such as urinary or fecal incontinence, erectile dysfunction, hip and/or leg pain (sciatica), chest/arms/groin/leg numbness or weakness. All of these things can have their own rating. Also think about your psychiatric care. That pissed off feeling that you seem to constantly have is called a Mood Diorder Due to a General Medical Condition. This is compensable as secondary to your spine problems, too. It took me a long time to realize that was what was going on, and admit that I needed help with it. It turns out to be a legitimate problem for those of us in constant pain though.

There are probably a lot of things that I am missing here, and I will post them as I can think of them. If you have any questions, just post them or pm me. I'll do the best I can to help. Also, click the link in my signature to view the Spine Claim Repository. I have been working on this for a while, and I have gathered all sorts of useful information about spine claims in it. You may find the help you need in getting care and filing a claim in there. Good Luck!

[Stretch]

We are not doctors here on Hadit. Many of us have learned a lot. As for me I can only learn of my own problems and in no way could make a diagnosis of anyone. I can only tell you what I did and found out for myself.

I am not suggesting that anyone does what I did. It is rough.

I wanted to work, like I did for 35+ years, and many buddies at work told me never to mention my back if I wanted to continue to work. I went underground and went to a chiropractor for many years, paying out of my pocket and off the records. I had a strong fear that if I ever said anything I would be banned from working.

I was in terrible pain most of the time, and I pushed people away in order to conceal my pain. I only spoke about it to other Vets on the job, Vets that I trusted. Alcohol became my self-medication for many years. I kept getting into trouble with alcohol, so I had to stop drinking. I was between a rock and a hard spot.

The only way for me to survive was to go into business for myself. I was told of all the fine programs the government had for helping Veterans in business. These programs were a bunch of Bull S---.

I was a very good machinist. I went into business in my own machine shop. This was a great way for me to endure my pain alone and not worry about being fired. Of coarse I had to produce top notch goods, which I did do. My down days could be made up latter.

I was somehow able to cut off the pain by pushing my mind as far as it could go. I knew this could only go on so long before I would collapse. I became a college CNC program instructor, was managing a corporation in manufacturing, running my own machine shop, and several other things when without notice my whole world crumbled. It was just becoming very interesting. My mind couldn't take anymore abuse. I couldn't even remember my own kids names.

I started my claims. Now I am trying to correct injuries done to my body 40 years ago while in service. My neck and lower back were severely injured while in service. I have a broken rib that I just found out about, could explain pain in that area that I have had from service injury. My neglect of fixing these problems ,years ago, have lead to other problems like the DDD (degenerative disk disease) that I think your report is diagnosing.

I don't know if I am to old to fix these problems now, or not. I am in the same boat as you. All you can do is learn and ask your doctor what is really going on. You could get a second opinion from another doctor outside.

There is just too much information on this site, and for you to try to take it in all at once will send you reeling. You just have to grow with us. Take your time.

For a doctor, in the service, to tell you not to say anything and wait for the VA to help you, is BS. What they are really saying is "Don't record your service injuries". The service doctor should be told to put his advice in writing and have a copy put in your service records.

[rdnkjeeper]

Thanks for all the replies so far. It is helping with getting my mind straight.