Neurologist Consult Note (attached)

[cannoncocker]

Second page states " pain in leg because/began ? in service and did not improve. This is what he handed me and I have an approved fee basis letter from the asheville VAMC to corroborate this note. As in it isn't just something I wrote, they followed through and I did the PT and meds and declined the needle in the back and surgery.

will this carry any weight at my DRO hearing? Evidently they ignored it on my requests for reconsideration.

Note attached front and back on their stationary.

what I actually told them the leg pain increased in 2005, when I began seeking treatment, but my MRI's absolutely demonstrate pre 2005 back injury as explained and pointed out by the doctor referencing light and dark disc fluid.

Edited August 30, 2009 by cannoncocker (see edit history)

[jbasser]

I dont want to alarm you but that is very weak.

To give some sort of explanation for a condition a Doc must state that the entire medical record was reviewed and then state an opinion. The VA uses the percentage rule.

With this not being done, the RO will most likely ignore it or not give it any weight.

You need a statement stating records were reviewed and the opinion must state that your leg condition is at least as likely as not related to the condition you had in service.

If I were you I would take the records to another Doc to get an opinion.

J

[john999]

I agree it is weak. As John says you need a medical opinion that states the doctor has reviewed your SMR's, current medical records, and says that your condition is at least as likely as not related to your service. You may need what we call an independent medical opinion from a doctor. Here at Hadit there are examples of how the report should look like and what it should address. We have had this discussion many times about medical reports. We all start out with these kinds of hen scratches from doctors and learn usually the hard way that they won't cut it with the VA. Words like "possibly, probably, maybe" are death to a claim.

[cannoncocker]

I dont want to alarm you but that is very weak.

To give some sort of explanation for a condition a Doc must state that the entire medical record was reviewed and then state an opinion. The VA uses the percentage rule.

With this not being done, the RO will most likely ignore it or not give it any weight.

You need a statement stating records were reviewed and the opinion must state that your leg condition is at least as likely as not related to the condition you had in service.

If I were you I would take the records to another Doc to get an opinion.

J

Really do appreciate your reply. Your reply is exactly why I posted this, that is to get an idea of what that meant in terms of relevance to my claim because on their reconsideration they basically said 180 degree opposite of what that said, saying only conservative treatment, which was my choice, not his directive. But anyway my plan is to take my SMR's which consists of ER notes and unit aid station notes changing meds, 2 MRI's, and radiology evaluations for both MRI's, possibly notes from that consult if that would add to my claim, then find someone on the cheap side (haha). Maybe chiropractor or neurologist depending on cost, in my area to write a nexus ltr.

Hope that sound like a reasonable plan. Where on this forum can I find the variations of language required for a good nexus? Or is that it, I have reviewed XXXXX records and find that his current condition XXXXXXX is/more than likely/possibly/more likely than not. I want to make it as simple as possible for the reviewer and want to provide them with an example of what I am looking for. My VSO as usual has been of zero value in this regard but why break a trend now.

Nope, I wasn't planning on that being my sole evidence but being a Safety and Occupational Health Specialist trained by the Army, I would think the NIOSH lifting table would at least provide some connection between Herniated discs and Degenerative disc disease and sciatica from pinched S1 would provide an accepted standard which should not be a stretch to see the connection between that and repetetive lifting of projo's from ground level to shoulder level that weighed about 1.5 x my weight x 6.5 years.

Good/bad/thick as a brick?

[carlie]

It reads to me as if that part of a statement was probably made from the history you reported.

I agree,very weak and no weight will be afforded to it in the VA disability claims process.

jmho,

carlie

[cannoncocker]

I agree if I was planning on using that solo, but on the other hand I did not tell him to write down the options I wanted or was part of my medical history. Actually the whole thing was them. The reconsideration denied any epidural injections or surgery which are listed on that. Those definitely are not part of my medical history, only options they offered. Since I have the letter of approval for injections on fee basis that I declined along with the surgery. I'll pass on both.

I can assure you that I did not tell them that my leg pain originated from a pinched S1 nerve which is also documented on the MRI evaluation, nor did I tell him I had herniated discs. the MRI's clearly show: protruded, extruded, degenerated ......discs. Did not tell them the numbness on my thighs-bilateral was from groin nerves. I have had doctors specualte on that from pre diabetic to things I can't pronounce. They have no idea about that.

Other parts could be interpreted as my words and they just wrote it down in the middle of my options. Why they would do that is curious since he pointed out how he could tell an old injury from and new injury by the color of the disc fluid which presumably whoever I get to do my nexus letter will be attune to.

This sounds like a DRO Hearing and you guys are trying to help. I don't mean it that way but do want to know how to responde and don't want to be suprised. Like the saying goes in law, don't ask a question you don't already have an answer to.

Thank you for the critque and I will use that in my planning.

[Rockhound]

I mere statement of, "it is just as likely as," will not suffice. The IMO will have to not only include that he has reviewed both the service medical records and any civilain or VA medical records, but that they have also examined you and found that your injuries and limitations were consistant with, as per the CFR schedule of disabilite rating/ which percentage rating that matches your condition. Then they must given their rationale/ reason and basis for their opinion, noting specifics of your case and as to how they apply to his opinion and provide any supporting documentation/treateses that he can along with a history of his schooling, specialtese, experience, and any cirtification in any related specialties that support his knowledge and opinion.

This is why it is hard to get a decent opinion to knock down what the VA uses. Unless the IMO is loaded for bear, even if the Evaluation of your condition came from a NP like mine did, your not like to get a change in their opinion or if your lucky, have your IMO used to outweigh the other VA doctors or C&P examiners opinion during the rating process.

Rockhound Rider

Edited August 31, 2009 by Rockhound (see edit history)

[cannoncocker]

I mere statement of, "it is just as likely as," will not suffice. The IMO will have to not only include that he has reviewed both the service medical records and any civilain or VA medical records, but that they have also examined you and found that your injuries and limitations were consistant with, as per the CFR schedule of disabilite rating/ which percentage rating that matches your condition. Then they must given their rationale/ reason and basis for their opinion, noting specifics of your case and as to how they apply to his opinion and provide any supporting documentation/treateses that he can along with a history of his schooling, specialtese, experience, and any cirtification in any related specialties that support his knowledge and opinion.

This is why it is hard to get a decent opinion to knock down what the VA uses. Unless the IMO is loaded for bear, even if the Evaluation of your condition came from a NP like mine did, your not like to get a change in their opinion or if your lucky, have your IMO used to outweigh the other VA doctors or C&P examiners opinion during the rating process.

Rockhound Rider

Mr. hound sir: That was an excellent if not daunting treatise on IMO's. So I write this down in a outline form, goto cfr 38 and copy the schedule of disabilite rating and go find somebody that I can afford. However this works out, which I already said, I am continuing this because it is a matter of justice, but this was news I can use . Excellent for a layman such a myself, not assuming I know things I don't.

Not to complain, because I am nothing if not grateful for all the help, but there is a tendency since a lot of you guys know this stuff forward/backards etc. so you tend to leave out details that are neccessary to actually put the advise into action. Not all, but just an observation. Something to ponder when you consider who you are talking to.

thank you very much!

[carlie]

Mr. hound sir: That was an excellent if not daunting treatise on IMO's. So I write this down in a outline form, goto cfr 38 and copy the schedule of disabilite rating and go find somebody that I can afford. However this works out, which I already said, I am continuing this because it is a matter of justice, but this was news I can use . Excellent for a layman such a myself, not assuming I know things I don't.

Not to complain, because I am nothing if not grateful for all the help, but there is a tendency since a lot of you guys know this stuff forward/backards etc. so you tend to leave out details that are neccessary to actually put the advise into action. Not all, but just an observation. Something to ponder when you consider who you are talking to.

thank you very much!

cannon,

This link may be of interest to you.

carlie

http://www.hadit.com/veterans_self_help_guide.html

Edited August 31, 2009 by carlie (see edit history)

[cannoncocker]

cannon,

This link may be of interest to you.

carlie

http://www.hadit.com/veterans_self_help_guide.html

Thank you as always plus I intend to buy Veterans Benefit Manual(VBM) today which will put me up to speed but it really irks me about the idea I am required to pay heaven only knows how much to get some IME to write a report to rebut their IME (who only took x-rays as opposed to MRI's and did not do a slr test, which I failed) paid for with my tax dollars, and who do you think he is going to hop in bed with. Well, with the dude with unlimited funds=US Treasury.

Sorry bout that, got carried away.

Thank you

Edited August 31, 2009 by cannoncocker (see edit history)

[carlie]

Thank you as always plus I intend to buy Veterans Benefit Manual(VBM) today which will put me up to speed but it really irks me about the idea I am required to pay heaven only knows how much to get some IME to write a report to rebut their IME (who only took x-rays as opposed to MRI's and did not do a slr test, which I failed) paid for with my tax dollars, and who do you think he is going to hop in bed with. Well, with the dude with unlimited funds=US Treasury.

Sorry bout that, got carried away.

Thank you

VBM is a great tool.

carlie

[john999]

Cannon

Keep asking your questions because that is how all of us learned what we know. When I came on this site I did not know what TDIU meant. 18 months later I had it. IMO's for the VA are sort of like Freshman English essays. They are more about form than content. You don't always have to get the most expensive IMO, but it has to be in the form the VA will accept. You need the buzz words and phrases. The one that gets lots of claims denied is the lack of a plausible statement that the IMO has reviewed all your SMR's and medical history.

[cannoncocker]

Cannon

Keep asking your questions because that is how all of us learned what we know. When I came on this site I did not know what TDIU meant. 18 months later I had it. IMO's for the VA are sort of like Freshman English essays. They are more about form than content. You don't always have to get the most expensive IMO, but it has to be in the form the VA will accept. You need the buzz words and phrases. The one that gets lots of claims denied is the lack of a plausible statement that the IMO has reviewed all your SMR's and medical history.

That is very true about different ranges of IMO costs of course. I just, well any body thats read this forum for a bit can feel the frustration mounting. Again, as I have said I could just walk away but I refuse to just give them a win.

Such Wise words and I had forgotten that honestly, the form over fuction aspect, which is going to be my primary rating mark on who I pay to do the IMO. I have mentioned I worked for years in their DAC world and their is no greater truth than that.

Beyond the knowledge I gained here, the encouragement is just as important because if you don't follow through you might as well know nothing about it.

Where are my tissues? No, I really do appreciate the considerable help you provide here. And remember, get behind the canon when it is fired, not out front or even with the muzzle or you will bust your ears. Ear plugs right, what did you say?

Thank you John