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!

[81150 CAFB]

Y'all have me freaking out now. :D Just let me know what you think needs to change on the letter and I will see if he will do it. I thought it was fairly decent as a nexus connecting my back issues. I didn't think the time between surguries meant much since it was the same level and two have actually 3 ruptures in the same disk all within the last 4 months was odd for only being 40.

All help is appreciated.

Thanks,

81150

[Stretch]

http://www4.va.gov/vetapp09/files3/0918967.txt

(This was the top of the search in the list)

The Veteran was afforded a VA examination in September 2008.

The examiner stated the Veteran had urinary frequency,

erectile dysfunction, numbness, paresthesia, leg or foot

weakness, falls, and unsteadiness. The etiologies of these

symptoms were reported as not unrelated to the claimed

disability; however, the examiner stated some of the symptoms

were from medications. The examiner should identify which

symptoms, if any, are at least as likely as not attributable

to the Veteran's service connected back disability. No nerve

conduction studies were completed during this examination.

An addendum to the examination consisted of the examiner

stating they could not resolve the issue without mere

speculation and a neurological evaluation including a

magnetic resonance imaging (MRI) as well as electromyography

(EMG) studies was recommended. The examiner stated the

Veteran's pain may well be related to his back disability,

but the increase in radiation and weakness should be explored

more thoroughly.

For more please select any case from this BVA search below: (Read a Remand, a Denial, and Granted claim)

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

[Stretch]

Remand (this is the second claim in the search in the link within the last post)

http://www4.va.gov/vetapp09/files2/0918967.txt

b.) Assign any diagnoses relevant to

the right lower extremity and opine

whether any current right lower

extremity problems are:

at least as likely as not due

to the Veteran's time in

service or;

at least as likely as not due

to or aggravated by the

Veteran's service-connected

back disability.

The term "at least as likely as not"

does not mean "within the realm of

medical possibility." Rather, it means

that the weight of medical evidence

both for and against a conclusion is so

evenly divided that it is as medically

sound to find in favor of causation as

it is to find against causation.

c.) The examiner is further requested

to identify any neurological symptoms

or abnormal objective neurological

finds which are at least as likely as

not attributable to the Veteran's

service-connected back disability.

These include loss of sensation, loss

of motor function, radiculopathy and

bladder or bowel impairment secondary

to degenerative disc disease of the

spine. If neurological abnormality

such as partial paralysis is present in

an extremity, the examiner should

classify it as mild, moderate, or

severe. If the neurological symptoms

are due to some other cause, i.e.,

medications, state to what extent they

are caused by each etiology, and what

the medications are for, if possible.

[carlie]

I received a nexus letter from my neurosurgen today in the mail.

"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.

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"

81150,

If you are shooting here for initial SC of this condition,

in my opinion, a decision maker at VBA will want to see some

kind of continuity of care taking place over these past

twenty years.

The doc says yea - you had problems AD - had surgery - did fine.

NOW - you have reinjured your back as a civilian in 2009.

A decision maker is going to want to know how a problem that was "resolved"

20 years ago, has led to the progression of ....

I personally do not feel that the doc, in his statement of,

"This led to progression of his degenerative disk at this level,

ultimately for him to have spinal fusion.",

has provided adequate support with full medical rationale in linking the two.

I think a showing of some type of continuity of care will be needed.

BUT - don't freak out - it's only my opinion from dealing with VBA

and I have been wrong many times in what a decision maker may or may not do.

jmho,

carlie

[jerrbilly]

Like I said you have a great letter and the VA will decide your rating percentage based on the medical evidence of record. Your main concern right now it to get service connected and I think you have a strong case for that. Don't worry about the rating percentage they will assign right now.

I think everyone's input here is confusing you. You're doing the right thing and you're being pro-active.

Kudos, and I feel you will be awarded based on what you've shown us.

Y'all have me freaking out now. :D Just let me know what you think needs to change on the letter and I will see if he will do it. I thought it was fairly decent as a nexus connecting my back issues. I didn't think the time between surguries meant much since it was the same level and two have actually 3 ruptures in the same disk all within the last 4 months was odd for only being 40.

All help is appreciated.

Thanks,

81150

[81150 CAFB]

81150,

If you are shooting here for initial SC of this condition,

in my opinion, a decision maker at VBA will want to see some

kind of continuity of care taking place over these past

twenty years.

The doc says yea - you had problems AD - had surgery - did fine.

NOW - you have reinjured your back as a civilian in 2009.

A decision maker is going to want to know how a problem that was "resolved"

20 years ago, has led to the progression of ....

I personally do not feel that the doc, in his statement of,

"This led to progression of his degenerative disk at this level,

ultimately for him to have spinal fusion.",

has provided adequate support with full medical rationale in linking the two.

I think a showing of some type of continuity of care will be needed.

BUT - don't freak out - it's only my opinion from dealing with VBA

and I have been wrong many times in what a decision maker may or may not do.

jmho,

carlie

I really don't have any continuity of care for my back. I figured it is just degenerative and the way I looked at it is if I never injured my back in the Air Force and had surgery would I be having the 3 ruptures in the same disk in the last 4 months? Any thoughts on anything he should add to the letter?