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]

Here is a BVA search that is for "At least as likely as not" in the claim. There are 15,475 claims that have this statement in them in the year 2009.

http://www.index.va.gov/search/va/va_searc...0&UA=Search

This is all I will say about this issue.

[jerrbilly]

Sorry to hear your struggles. I don't think the phrase "with all medical probability" is decisive enough. This phrase is too general in nature. Many things can be presumed probable in the medical field and this is why they require the doctors opinion.

We are talking about "likely" "as likely as not" "more likely than not" etc.....

All I know is what I was taught on Hadit. Three of my claims said at 'least as likely as not'. These three were rated 100, 20, 10 SMC.

One of the best ENT surgeons in the country wrote "With all medical probability" after reviewing all medical and service medical records that the injury was related to military service. This was an ENT that operated on my nose and throat, removing my tonsils, right after injuries in service, and this surgeon knew that the Dentist and he were a team, put together, to fix my service injuries. This claim has been denied four times even with several IMO and IME from original doctors. It is still on appeal for over 30 years.

Do what you like. I am just talking about my own experience. I am not just speculating.

Edited February 7, 2010 by jerrbilly

[Vync]

I guess that's why they call it practicing medicine

[Testvet]

I guess that's why they call it practicing medicine

doctors and lawyers all have the word "practice" in their windows and we are all their guinea pigs each and everyone of us they get paid regardless of what happens to us

[carlie]

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:

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!

81150,

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

but I have no speculation as to what percentage level.

Something that jumps out at me is where the doc states,

"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."

Being that you were separated in 1991, I have no idea how this

will play out with a VBA decision maker.

jmho,

carlie

[jerrbilly]

Carly, I think this was mainly just a "nexus" letter. I'm sure CAFB has medical notes that will determine the rating percentage.

81150,

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

but I have no speculation as to what percentage level.

Something that jumps out at me is where the doc states,

"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."

Being that you were separated in 1991, I have no idea how this

will play out with a VBA decision maker.

jmho,

carlie