Lower Back Claim

[Vync]

Hello everyone,

I am new here, so I am asking folks to please review and offer your opinions. Any assistance is greatly appreciated.

While I was on active duty from 1990-1995, I was injured numerous times during military training. I originally filed a claim back regarding my back in 1995, but it was denied. I am currently 40% SC, thanks for SC approval for several unrelated problems. While on active duty, the military took x-rays and diagnosed me with lumbar or muscular strain and prescribed medication, exepted me from physical activity, and also sent to physical therapy.

In early 2006, I suffered an injury to my L4-L5 and L5-S1 and was given an MRI, I was diagnosed with lower lumbar spondylosis (moderate narrowing of the disc cavities), degenerative disc disease, herniated vertebrae discs contacting the nerve roots, muscle spasms and strains, reversal of the lordotic curve, and and even advised to seriously consider surgery. I was given more loads strong medication, an epidural pain block, and eventually sought help from physical therapy and even a chiropractor.

In 2008, I filed another claim regarding my back, but it was denied. I spent time gathering copies of my service medical records and civilian medical records and re-filed again in August of 2008, providing counters to each reason the RO claimed was a basis for my denial. I also got a written statement from my ex-wife, who described her observations of my back problems. I just received a letter asking me to fill out medical release forms or provide medical evidence, even thought I sent the medical records already.

It seems very obvious that my back injuries during military service were the root cause for my current problems. I now have a sedentary desk job with an ergonomic chair and a wonderfully supportive girlfriend. Over time have had to re-train myself how to avoid reinjuring my back while performing normal daily duties. Quite often, I can control the pain and problems with medication, but when I simply sneeze or cough, I always worry about having to take another unplanned visit to the emergency room.

Questions

1. Given the nature of my injuries, what type of percentage would I qualify for?

2. With respect to my overall 40% SC rating, could I potentially see this increase or will they just embed it and leave me with the same rating?

3. Since I did not 'keep alive' the back injury portion of my original claim in 1996, if my back claim is approved, what could I expect as an effective date?

4. If I kept records of my out of pocket expenses for doctor and medication co-pays, if my back claim is approved, will the VA allow me to file for some sort of reimbursement?

Thanks,

Vync

[Vync]

Berta,

Wow, I really appreciate your input here. You're awesome! Let me respond to each section...

Re-injured?

Initial injuries occured during active duty. My private medical files between my ETS in 1995 and and first signs of bulging discs and bone spurs in 2004 were lost by my physician. They claims they can only go back a couple of years. A dual disc herniation nightmare in 2006, when I was diagnosed with DDD. From what I hear, DDD onset takes time, usually years.

EED

For my 40% SC, the EED is 1995. If I somehow succeed, would the effective date be 1995 or my reopened claim submitted in 2008?

C&P Exam

Original C&P exam was in the late 1990's. Due to what I experienced between 2004-Present, I requested the claim be reopened in 2008. They have not performed a new C&P.

IMO

My neurosurgeon appointment is tomorrow. No idea if he will write me an IMO. My girlfriend works on a surgical team. Does the IMO have to be issued by a neurosurgeon or would a general surgeon suffice. She's well liked by several of them and they might be willing to do it.

ROM

In my original C&P, I do not remember a goinometer being used. They did when I had physical therapy in 2007. They got me back to 'normal' ROM, but I was loaded up with Lortab and Soma. I relapsed late last year and had more therapy. The VA probably found a couple of specific instances where I had normal ROM to make a blanket statement. I believe my ROM is no longer normal. I cannot afford to live in physical therapy and stay juiced up on pain killers and muscle relaxers all the time. I will ask the doc to use a goinometer tomorrow so I can have accurate numbers.

SOC

I cannot find the original SOC from 1995. My SOC from 2000 indicates 'You were found to have other non-service connected disabilities', but it either did not list them or I lost them. I need to request my C-file. The SOC prior to this one (in my posting below on Sep 18 2009, 6:49 PM) indicated I had chronic low back pain. They seem to have removed 'chronic' in the most recent SOC, which is absolutely incorrect in itself.

Entrance/Exit Exam

The SOC simply indicates 'Copies of service medical records', but it does not specifically indicate the dates of specific instances of treatment. I do not have proof that they actually reviewed every item, but only that blanket statement. Should I first try to submit this as additional evidence or file a NOD? This alone should qualify as the 'incurred or aggravated' requirement.

NOD

What is best? Brief 'disagreements' or a very detailed listing every instance of injury during/post military service? I reviewed the NOD topics and see differing recommendations on this.

Code 5243-XXX (38 CFR 4.71(a)) - Part 1

Under the spine codes for 20%, other than ROM, it indicates 'or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis'. If we throw ROM out the window, I do have indications in my private medical records regarding reversed lordosis. If all else fails, is this worth pursuing?

Code 5243-XXX (38 CFR 4.71(a)) - Part 2

Also, check this out. This is below the % ratings. 'Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.' I frequently experience back pain and negative side effects at the worst possible times, like when my girlfriend and I are intimate, but I am not going into the specifics about it. I hate to admit it, but it does happen. Should I also file this as 'an associated neurologic abnormality'? I am thinking cause and effect here. If this is a possibility, I don't know how they would go about evaluating it...

[Berta]

The effective date would be the date you re-opened this claim.

Only a successful CUE claim could bring potentially more retro- not worth thinking about CUE yet-

but with SC award for back-then the CUE potential would possibly come in .

The new evidence in your SMRs could trigger a C & P exam.

Any doctor who has expertise in the field of your back disability could opine on your claim and the nexus to your service.

Is the neurosurgeon seeing you regarding the back issues?

Even if a VA C & P is negative to your claim, a strong IMO can raise the evidence to Relative Equipoise- meaning if equal evidence for and against the claim-the veteran still gets an award under Benefit of Doubt.

They denied without a C & P because they said you had not sent them new evidence.

It seems you do have evidence they didnt get when they made the denial decision.

This evidence should trigger them to give you a C & P but I think you will still need a strong IMO -in case the C & P goes against the claim.

The ROM you were given was based on an older exam- we have some back experts here -I dont know how much weight the VA puts on the ROM for a percentage.

[Erich]

I too have a back injury and have a hard time working. But find it helpful to work at home online to suppliment my 60% disab.

Erich

[Vync]

Berta,

The neurosurgeon is seeing me regarding the back issues.

Relative Equipoise? Sounds interesting. Let's hope it doesn't get to that point.

But, I did send them new evidence which was never previously submitted.

Erich,

I'll check out that site. I do have the opportunity to work remotely, but my workplace has put forth the effort to make my office environment/cubicle ergonomically suited for my needs. I don't know if they would do that for my home, plus I have to rely on high bandwidth for my job.

Thanks!

[Erich]

Ok Bertha

Just make sure you read the folowing articles before you choose anything. There are a lot of scams and other questionable opportunities to work at home. My google sponsored links and infolinks are constantly updated and I have little control over them. These two guides will help you:

http://www.work-at-home-directory.com/scams.html

http://www.work-at-home-directory.com/self-employment.html

Erich

[Berta]

??? Thanks but ..... I am retired. and so busy I dont have time to work.

Maybe you meant this info for anyone here in general and I agree that there are many scams out there.

Some of these work at home outfits have cost people a lot of money. Good info.