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!

[Stretch]

I do understand that when we get out we want to get as far away and as quick as possible from service. I was just wondering about the MEB. Seems they would have done something about it. Guess they just pass us over sometimes.

Then we are stuck, years later, trying to dig out all the evidence that we can from what is left.

Your nexus letter sounds pretty good. It is too bad that the doc didn't say "as likely as not" or "more likely than not" related to you service operation.

Stick with this and maybe, if you don't go adding secondary conditions that will prolong your claims, you will have a favorable decision soon. My decision took over 5 years, but I was set in a 'BVA mind set' from the start. Get your foot in the door.

[81150 CAFB]

Stretch- now that I think more about my separation I think they just got a lot of us "stop loss" guys out as quick as they could. When you mean secondary are talking about future claims or my initial. I plan to file for everything related to my back to include sciatica and depression as secondary.

[81150 CAFB]

As I said, I think your neurosurgon wrote an excellent letter for you. It pretty much covers all bases and reads well. Wait and see what they say, good or bad you can always file NOD if they don't grant sciatica. However, I suspect they will have no alternative but to grant due to the thoroughness of the letter.

Regards,

Bergie

Thanks for the response. When I read the letter it reads as though I had it but

it is ok now. Meaning he doesn't come out and say he additionally has permanent scitica issues...make sense.

I really loved reading your response to the letter. Made me feel great. I will hope that and think that likely is probably better then more likely then not...Since he pretty much says likely (definately >50%).

I love this site. So many helpful veteran's.

Hard to do this typing on iPhone though.

81150

[*Bergie*]

Thanks for the response. When I read the letter it reads as though I had it but

it is ok now. Meaning he doesn't come out and say he additionally has permanent scitica issues...make sense.

I really loved reading your response to the letter. Made me feel great. I will hope that and think that likely is probably better then more likely then not...Since he pretty much says likely (definately >50%).

I love this site. So many helpful veteran's.

Hard to do this typing on iPhone though.

81150

81150,

Have you had any "nerve conduction studies" done or EMG. These tests will give you undisputable evidence to prove sciatic nerve damage. What is nice about these tests are that there is no denying the presence of nerve damage, good or bad they will also determine the severity of nerve damage. I say good or bad because it may show just mild damage and what your looking for is moderate or severe, as the rating is substantially higher especially if bi-lateral. Don't worry, if the C&P rater down plays your sciatica or denies it you can ask your neurosurgon for these tests if they have not been done. However, if you have had either test than definately submit copies with your claim. Also, be sure to have the VARO "time stamp", and give you a copy with the time stamp on it just in case anything gets lost...

Bergie

[*Bergie*]

Stretch- now that I think more about my separation I think they just got a lot of us "stop loss" guys out as quick as they could. When you mean secondary are talking about future claims or my initial. I plan to file for everything related to my back to include sciatica and depression as secondary.

81150,

Although many think the words "as likely as not" or "more likely than not", is necessary, it is not. It is more important to have the statement " I have reviewed his military service medical records". This shows that your doctor examined all available medical records in making his diagnosis and determination relating to your condition. My neurologist said neither statement and I was just fine. I received 20/20% for bi-lateral radiculopathy.

Regards,

Bergie

[81150 CAFB]

81150,

Have you had any "nerve conduction studies" done or EMG. These tests will give you undisputable evidence to prove sciatic nerve damage. What is nice about these tests are that there is no denying the presence of nerve damage, good or bad they will also determine the severity of nerve damage. I say good or bad because it may show just mild damage and what your looking for is moderate or severe, as the rating is substantially higher especially if bi-lateral. Don't worry, if the C&P rater down plays your sciatica or denies it you can ask your neurosurgon for these tests if they have not been done. However, if you have had either test than definately submit copies with your claim. Also, be sure to have the VARO "time stamp", and give you a copy with the time stamp on it just in case anything gets lost...

Bergie

No EMG or NCS by neuro-he thought it wasn't necessary and subjective. The only thing he did was light touch and pin prick. I did feel these, but I tried it with a toothpick later and hit pretty hard in my calves and felt the pressure but no pain. I also have some tingling in legs and although I have feeling in my toes, if you touch the toes minus big one, I can not tell which toe you are touching. It also feels like my Achilles area on my left side is sometimes rubbed with a Brillo pad. The absolute worse pain is is still in my left buttock-this was the first symptom I had in April 2009 and it has not gone away and is really aggravated by sitting. The neuro did say he was concerned about this and it may be permanent. I haven't received his last exam report and I also have a follow up in 3 weeks. If I still have this pain he might do more testing or at least have good documentation from the visit that I can use.

I guess overall I know I have issues with my legs and hopefully a C&P will rate properly.