lumbosacral Claim Denial By False Logic

[monochaser]

Have nexus, evidence, and living with pain, yet a claim for an increase from 0% was denied with lightning speed. I don't know what to do next. Am willing to shell out $$ for a civilian ortho MD if it will help, but I don't have health insurance, so I must know what kind of evidence and info I'm looking for before I go.

Long story short- SC 0% upon discharge for Lumbosacral Strain. Back pain has progressively gotten worse in last 10 years until 2003. 5 consecutive months of (intermittent) incapacitating back problems in that year, VA performed MRI and diagnosed a herniated disk. With this I applied for an increase, and with murphy's law in full force, my back pain was in remission when C&P time came around. But I had my evidence. Surely the good doc would see that. Well, the examiner was an openly hostile retired "rent-a-doc" who insulted my profession. Not a Good day.

He gave his opinion that Lumbosacral strains are not causitive of a Herniated Disk (no kidding), and any pain I was experiencing was from the disk condition, not the service connected back strain. Claim Denied.

What this einstein did not adress is, when did the disk condition occur? It could've happened in the military and been the cause of the back problems since then. They never CT'd or MRI'd back then. The denial knocked the wind out of me and the year passed by- but I want to re-open a new claim as I'm living with pain on an almost daily basis. Unfortunately all the VSO's are concentrated over a hundred miles away and are so backlogged with cases it is difficult to get some face time with them.

The most frustrating aspect of this is contained in the first sentence of this post. I provided the VA with everything we have been told is required, but they played games with the cause-result factor- but for this I think it is possible to argue against their position due to their lack of scientific evidence. How can they can get away with these weak excuses for denial. Every time I limp from one room of my house to another in agony, I curse the flippant, direspectful attitude of that overpaid c&p MD.

Since nexus is established, I am frustrated with having to go bust a hump and collect evidence- any suggestions for what I should include in my next claim for an increase? And what do you think about using one of those state employed VSO's? They are only 50 miles away- still pretty far. Thanks for any light you can shed on these circumstances.

[Jay Johnson]

Keep journals of when you have pain, how severe it is and how it affects your life at the time. Try to get into some form of long term rehab and/or regular exams for your back and keep ALL the evidence you acquire. Find out the criteria minimums for the various levels in regards to back injuries and try to formulate your journal, and medical evidence, to meet said criteria. You need to spoon feed them the information so that they have NO choice but to grant the level you are seeking.

[Guest Berta]

They need evidence like this:

http://www.neurosurgerytoday.org/what/pati...e/herniated.asp

"Causes

A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture."

But better yet, a documented medical statement that supports this fact.

Is there any time at all since you got the denial left to file a Notice of Disagreement?

The above abstract, attached to the NOD, supports your claim.

These claims can succeed with good medical evidence:

"This appeal arises from a May 1992 rating decision in which

the regional office (RO) denied entitlement to service

connection for degenerative disc disease of the lumbosacral

spine, status post laminectomy and denied entitlement to an

increased evaluation in excess of 10 percent for residuals of

a lumbosacral sprain. In June 1996, service connection for

degenerative disc disease of the lumbosacral spine, status

post laminectomy was granted, in part and parcel to the

service-connected lumbosacral strain disability and the

assigned 10 percent evaluation was increased to 20 percent."

From : http://www.va.gov/vetapp97/files2/9716400.txt

The decision however denied higher rating-

the veteran maintained the 20% rating.

[john999]

Mono

You need medical evidence in the form of a narrative from your own doctor that will connect the back strain in service to your current problems. You just have to pound them with evidence and the more the better.

[monochaser]

Unfortunately I don't have a doctor other than my PCP at a VA outreach clinic who I've seen 2x in the last year- I'm one of those people the politicians are always talking about- an American without health insurance. Must say the VA has provided some excellent care, so no complaints there.

Thanks for the responses. My time to file a Notice of Disagreement has expired- has been 1 yr and some months since the denial. I'm going to go to private doctor, that's why I was asking about what kind of evidence is needed. I would imagine one meeting with a specialist will cost almost $200 so I would like to be prepared before I go.

I've moved a lot. Is it possible my c file wasn't with my claim? Do I need to check with the RO to find out where my file resides? It would be handy to have a service officer to ask these questions, but they are 100 miles away, and busy. If they are as bad as some people say they are, how do we navigate through this confusing process? By the way, the SO that helped me with this claim last time was supposed to be the best. After the denial he said- well, that's it. You lost. Tough luck. Nothing more we can do. Thank God for this website.

[vaf]

Page 121 of John Roche's book, "The Veteran's Survival Guide," addresses the subject of exams conducted while a condition is not active. He advises that you should contact the VA Medical Center to advise of this fact so you can be rescheduled and evaluated when the condition is active and can be observed by a physician.

"Failure of the VA to evaluate your condition during an active stage is grounds for reversal if the claim is denied."

He goes on to cite Ardison v. Brown, 6 Vet. App. 405 (1994). In that decision, the Court ruled the VA failed in its duty to assist by relying on an examination that was performed during an inactive stage.

You might try CUEing it to seek an approval effective when you first filed. It's worth a try.

[Guest allanopie]

Low Back Pain and Herniated Disk

http://ww3.komotv.com/Global/story.asp?S=1230546