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

[vaf]

I work at a place where I qualify for FMLA, but I also have decent short and long term disability insurance. Not going the FMLA route unless it becomes absolutely necessary.

My girlfriend and I talked about having another pain block, so I am going that route within the next two weeks. Before then, I am hoping to find a doc who is willing to write a nexus letter. Finding one in my area who will do it under my insurance is going to be a challenge.

Understood, but please know that you cannot apply for it retroactively after you've been terminated. In this economy, we never know from one day to the next, with ALL certainty, that we're going to have a job, and older people who make more, and people with chronic health issues that cause absences, are normally the first to go. Yes, I know there are laws against that, but the truth is most of the time, victims of these actions don't seek relief due to the cost and the hassle.

Long and short term disability policies have nothing to do with FMLA, that's like the proverbial closing the barn door after the cows escaped. And, many of us here have had to take our short and long-term disability insurance companies to court because they refused to pay any benefits when the veteran actually needed them (my husband settled his claim after almost two years of appeals then filing a lawsuit).

Should you be terminated due to excessive absence, without FMLA protection, any relief you would receive after that occurrence would result from your taking legal action, based on the fact that your employer should have offered you FMLA coverage when they noticed the extent of your absences. My suggestion to you is to enroll in it anyway, and if you don't use it, that's fine, but at least it's there if you need it. It's been my experience that employees with chronic health problems would be well-advised to avail themselves of the federal protections offered under FMLA, even if they never actually need to use them. My husband didn't want to apply for it, either, and for the most part, he hardly used any of it. However, his last year of employment, he came very close to maxing it out, which actually helped when he applied for Social Security disability.

Edited October 26, 2009 by vaf

[Vync]

vaf,

I appreciate the information. I think I will look into it with my HR department. You're right. It is better to cover all the bases.

Thanks!

[Vync]

I just got a letter in the mail from the VA regarding my claim. This is dated 11 days after the SOC denial letter. From what it says, it sounds like my claim is not actually closed. Anyone else have this happen to them?

Here is what it basically says:

We are working on your claim for:

- Back disability to include neck and lower spine

Where should you send us what we need:

{RO address}

How soon should you send what we need:

We strongly encourage you to send any information or evidence as soon as you can. If we do not hear from you, we may make a decision on your claim after 30 days. However, you have up to one year from the date of this letter to submit the information and evidence necessary to support your claim. If we decide your claim before one year from the date of this letter, you will still have the remainder of the one-year period to submit additional information or evidence necessary to support your claim.

what have we done?

We have requested copies of treatment records or other evidence from:

{list of 10 civilian treatment providers}

Even though we have asked for this information, it is your responsibility to see that VA receives it (except for any evidence kept by the VA, military or any other federal government agency).

Medical evidence from private provider.

How can you contact us?

{VA contact methods}

[Vync]

Ok, here's the latest on my issue.

- Recently saw a neurologist and had an MRI done(see below)

- Finally got the MRI results (see below)

- Had another epidural pain block injection yesterday (very sore today)

- Requested copies of medical records from the VA

- Planning on requesting my C-File next...

The neurologist is still hesitant to write an IMO. I hope to find something between 1995 and 2004 in my VA medical records. It's a long time ago, but worth digging around.

Inspection-deformity:

He has some straightening of the lumbar lordosis. He has hypersensitivity to even light touch sensation in the lower spine more along the right side and the left side.

Range of Motion:

Forward Flexion: 10 degrees

Hyperextension: 0 degrees

Right Lateral Bend: 5 degrees

Left Lateral Bend: 5 degrees

Sitting Straight Leg Raise:

Right: positive in back only

Left: positive in back only

Impression & Medical Decision Making:

- Degenerative Disc disease

- Lumbrosacral spine w/radiculopathy

MRI:

1. Midline bulding disc in the last two lumbar levels along with degenerative disc disease.

1. No disc herniations.

Edited November 4, 2009 by Vync

[tck5810]

Hello Vync and everyone else. I'm new to these forums and trying to become active in them. I have had both neck and lower back injuries and issues since active duty. I was luckily able to get 10% for my lower back (I say lucky because I have a battery for a cervical spinal cord stimulator riding in my hip so all I can get are normal x-rays and not MRIs. I have gotten very little for my neck, even though I've had two surgeries. One was a double ANCF, with a plate between C4-6. That didn't help all that much, because once the discs were removed, the stenosis proved so severe that my pain continued. That led to a double laminectomy at the same area from the rear C4-6. Unfortunately for me that one led to nerve damage in my left arm and hand (I'm continuing to lose function in that hand, although I'm only at 20% for it). I tried to hold off from that second surgery for nearly a year. I had a course of 6 epidural injections into the site and each one worked less...the last one not at all. Plus mentally, I didn't want that needle going down into my spine anymore.

I'm currently getting ready to fight a reduction in the rating (20% to 10%) for my neck DDD, becaused based on the range of motion finding the QTC doctor submitted in August this past year, I have full range of motion. He must have mixed up my file with someone elses! I can barely move my neck in any direction (part due to pain, part due to all the hardware sitting in there), let alone the full range. And he said he observed no problem with repetitive motion, and he didn't even test me for that; nor did he use any instruments when he watched from across the exam room at me trying to move my neck when he asked me to during the exam. Anyway, now I'm going to fight that.

[Vync]

tck5810,

Wow, I definitely understand the kind of pain you must experience every day. I hope you are able to find some kind of pain relief. Definitely fight that rating reduction. It does not surprise me that the QTC guy gave you a shoddy examination. It really stinks that the examiner was a lamer.

There are times when I have full range of motion, but those times are usually when I am taking a lot of pain meds and muscle relaxers followed by a couple of months of physical therapy. I keep the full ROM for a couple of weeks and then things slowly go back to the way they were. After about a month, I am ready to go in for another round of physical therapy and meds, rinse and repeat. Paying a co-pay for every PT and doc visit adds up, especially when they send you to PT 3-5 days a week.

I did not dare let the VA give me a pain block. My girlfriend recommended a very skilled anesthesiologist who did my last two. I had me last one in the middle of December and must have got lucky, because my pain level is way down lately.

Latest claim denial

I just got another claim denial from the VA. This one is weirder than the previous ones. It says they received additional evidence for February 22, 2008, but the evidence listed is dated from April 2006 through October 2009. They can't even get their evidence receipt dates straight.

The records reviewed shows you have received treatment from several physicians for a back condition. The records show your pain is provoked with walking, standing, weight bearing and any activity. You state the pain is relieved with rest. Treatment includes medication and steroid injections. The records show the pain radiates to the lower extremeties. The records show you state your back condition started during your period of military service. Dr{omitted} stated considering your age that you may have a family history. Your claimed has previously been denied as there was no chronic back condition found during military service. The evidence reviewed fails to show your back condition started during your period of military service.

So much for benefit of the doubt. As soon as I get my tax refunds, I am going to get an IMO from a private doc, so I hope to get that taken care of my the end of February.