Nexus From Neurosurgen

[81150 CAFB]

I received a nexus letter from my neurosurgen today in the mail. He is very nice and the first surgery I had with this group was with a different doctor who said he does not do disabilty and how should he know if they are related(1989 surgery and his surgery in august 2009) and would not even think of writing a nexus for me. So happens my next surgery, about three months later (all at L4-L5), was with this other doctor who is younger and the only one in their neurosurgical group that does fusions. I am very thankful for this letter.

Please let me know what you think. Keep in mind I might not get him to change much. I feel he has done so much for me. Please look at the big picture as a nexus and let me know if you think it will fly.

81150 Carswell AFB

"To whom it may concern:

Mr. Hurt Back is a 40 year old gentlemen and patient of mine who recently underwent a redo L4-5 laminotimy, medial facetectomy, and foraminotomy with transforaminal lumbar interbody fusion. He asked me to personally review his miltary service records in regards to his history of back and leg pain, as well as mutiple surgeries at the L4-5 level.

When reviewing his military service medical records, I noted he had a right-sided L4-5 laminotimy and diskectomy performed in November of 1989 during his military service. This was done for right sided sciatic nerve pain. The patient did well after surgery but re-herniated his disk in 2009. He then underwent a redo left L4-5 laminotimy and diskectomy performed by one of my partners, Dr. Grouch, in August of 2009. The patient initially did well after after this surgery, though he developed new back pain and left leg sciatic nerve pain later in the year.

He then underwent CT myleogram, which showed a left posterolateral disk herniation effacing the left L5 nerve root and causing severe degenerative disk disease at the L4-5 level. This resulted in left leg sciatic pain and low back pain. He then subsequently underwent the previously mentioned decompression and fusion at the L4-5 level.

Based on my experience, it is likely that his mutiple problems at L4-5 are related to his initial injury and surgery in the late 1980's. This led to progression of his degenerative disk at this level, ultimately for him to have spinal fusion. I am hopeful that now with spinal fusion and decompression of both sides, he will have good long-term success, but he will never be completely pain free.

It has been my pleasure to take care of Mr. Hurt back and please call me with questions.

Sincerely,

Neurosurgen"

I know he didn't use more likely then not etc... but do you think his connection is solid? My other concern is sciatica that I still have that is probably permanent-can I claim it even though he doesn't diagnose in this letter?

All help/comments are appreciated.

Thanks!

[carlie]

jerr,

The entire cfile and medical evidence of record is supposed to be considered.

VBA is supposed to weigh all evidence regardless of whether

it helps or harms the granting of claims for disability.

I feel pretty confident that the VBA decision maker will take

into consideration the doctors statement of,

"The patient did well after surgery but re-herniated his disk in 2009.",

and this statement could have a negative impact on the claim.

Any medical evidence that could be used for a denial or lowballed

percentage - - will be used.

jmho,

carlie

[john999]

Jerr

Under what conditions did you re-herniate you disk in 2009? If it is a natural progression of having a weaken back from SC incident in the military that is different than having a re-herniation due to a traffic accident. You see what I mean? Almost 20 years elapsed between the operation to repair disk and the re-herniation in 2009. If there is some NSC reason for the re-herniation the VA will jump on that. It seems odd to me that that particular disk was re-herniated. It seems to me that would point to some service connected weakness in the disk, but the VA loves to find NSC reasons to deny or low ball claims. You don't want to leave strings for the VA to pull on in a medical report because pull they will. I know this from painful experince. One wrong phrase and the VA turns your IMO around to hurt you.

[jerrbilly]

Ok, I think I see what you mean here John. There would have to be another "stressor" to re-herniate the disk and I now see why the VA could use that against his claim.

Thanks, jerr

Jerr

Under what conditions did you re-herniate you disk in 2009? If it is a natural progression of having a weaken back from SC incident in the military that is different than having a re-herniation due to a traffic accident. You see what I mean? Almost 20 years elapsed between the operation to repair disk and the re-herniation in 2009. If there is some NSC reason for the re-herniation the VA will jump on that. It seems odd to me that that particular disk was re-herniated. It seems to me that would point to some service connected weakness in the disk, but the VA loves to find NSC reasons to deny or low ball claims. You don't want to leave strings for the VA to pull on in a medical report because pull they will. I know this from painful experince. One wrong phrase and the VA turns your IMO around to hurt you.

[81150 CAFB]

I am just using the letter as a nexus connecting the problems that are at the same disk level. The reherniation was just degenerative and no trauma.

From the letter;

"Based on my experience, it is likely that his mutiple problems at L4-5 are related to his initial injury and surgery in the late 1980's. This led to progression of his degenerative disk at this level, ultimately for him to have spinal fusion. I am hopeful that now with spinal fusion and decompression of both sides, he will have good long-term success, but he will never be completely pain free."

I like the progression of degenerative disk - I think this is the main part.

"The patient did well after surgery but re-herniated his disk in 2009.",

and this statement could have a negative impact on the claim.

I hope not. I just read it as surgery went fine in the Air Force but 20 years later the same disk ruptured twice. Leading to the above statement regarding the progression.

[81150 CAFB]

jerr,

The entire cfile and medical evidence of record is supposed to be considered.

VBA is supposed to weigh all evidence regardless of whether

it helps or harms the granting of claims for disability.

I feel pretty confident that the VBA decision maker will take

into consideration the doctors statement of,

"The patient did well after surgery but re-herniated his disk in 2009.",

and this statement could have a negative impact on the claim.

Any medical evidence that could be used for a denial or lowballed

percentage - - will be used.

jmho,

carlie

What do you mean with the above harming or helping (medical evidence) can be used for denial? NSC trauma or just the one statement regarding he did fine? My current back issues are degenerative at the same disk level with no trauma.

[81150 CAFB]

81150,

I think the letter is good for getting your problem SC'd

but I have no speculation as to what percentage level.

jmho,

carlie

All I am looking for is to get my back issue service connected. I guess the percentage would be based upon my forward flex, which is currently around 20%.

Should I see if I can just state that I had the surgery in 1989 and take out the he did fine part? I feel that I did do fine after surgery (it worked) but the initial injury/surgery caused the current problems - severve degenarative disk disease that lead to two ruptures (no trauma) and utltimately the fusion.

Thanks for any help!

81150