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Chronic Left Lumbar Radiculopathy


cannoncocker

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I am scheduled for a lumbar exam next week and would like to hear from someone who has been through that experience in order to better know what to expect.

Thank you

Could not find a beeter place to post this.

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  • Content Curator/HadIt.com Elder

Hey Cannon,

I just had one of these exams a couple of weeks ago. Here is a link to the questionnaire used by the examiner:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm53.htm

I hope that helps. It pretty much goes down the line of what I experienced. By far, the worst thing was when the doc was assessing my range of motion. The straight leg raise caused some real pain

You might consider not taking any medication which could make your back feel a lot better. Do this for about a week ahead of time. This will allow the examiner to see your baseline condition, not a pharmaceutically improved condition. I did this and it was tough to even get some sleep at night because I was hurting a lot. When I got a copy of my results, I was surprised that I was in worse shape than I thought. I'm no doctor so skip the meds only if you feel like you can make it there. You can usually get a copy of the results within a week or two after the exam occurs.

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Hey Cannon,

I just had one of these exams a couple of weeks ago. Here is a link to the questionnaire used by the examiner:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm53.htm

I hope that helps. It pretty much goes down the line of what I experienced. By far, the worst thing was when the doc was assessing my range of motion. The straight leg raise caused some real pain

You might consider not taking any medication which could make your back feel a lot better. Do this for about a week ahead of time. This will allow the examiner to see your baseline condition, not a pharmaceutically improved condition. I did this and it was tough to even get some sleep at night because I was hurting a lot. When I got a copy of my results, I was surprised that I was in worse shape than I thought. I'm no doctor so skip the meds only if you feel like you can make it there. You can usually get a copy of the results within a week or two after the exam occurs.

You don't have to "skip" your pain meds for a week, 1 day is fine. Because, the meds are metabolized in less than 24 hours with the exception of a fentanyl patch.

Bergie

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  • Content Curator/HadIt.com Elder

Good point, Bergie. I was just describing from personal experience. When I have my pain blocks, they pull me off the meds for a week prior. The first day or two are bearable, but as I got closer to the seventh day, I was hurting pretty bad. They pulled me off of opiods, NSAIDs, and a couple of other meds, including blood thinners. It might be different for everybody.

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Good point, Bergie. I was just describing from personal experience. When I have my pain blocks, they pull me off the meds for a week prior. The first day or two are bearable, but as I got closer to the seventh day, I was hurting pretty bad. They pulled me off of opiods, NSAIDs, and a couple of other meds, including blood thinners. It might be different for everybody.

For any invasive procedure they will stop any meds that inhibit clotting. NSAIDS, aspirin, ect for 7-10 days. But, for a C&P exam 1 day is adequate. No need to suffer any more than necessary.

Bergie

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Very useful information and I'm sure you can see that it is just easier to encounter an experience with some information available. I think the med info is useful and will split the difference and cut off at 3 or 4 days.

Many thanks

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Also, make sure the examiner uses a goniometer to measure range of motion, and doesn't just casually eyeball these measurements and approximate them, which often happens. If he or she doesn't, and your C & P exam does not favor your claim, I would object to the examination as flawed and request another, or use that as grounds for appeal.

Also, remember, your examination begins while you're sitting out in the lobby waiting to be called in. Your posture in the chair you're sitting in will be noted, as well as whether or not you shifted positions often in an attempt to deal with your pain. This can take place before you set foot in the examining room.

As for pain meds, the point is well taken that the examiner cannot measure what he or she cannot find. Symptoms masked by pain medications are assumed to be non-existent, and not just mitigated by medication.

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Vaf if you help much more if I had a payroll I'd be compelled to add you. I went to the QTC Severity Exam on 4/19 and have since heard comments pointing to common complaints regarding QTC as opposed to VA C&P exams. I am quit cynical so regard my point of view with that assumption.

I have been examined by both and have not really experienced any more bias from one than the other. That just being me so that's hardly scientific evidence. In my view they both have a quota, not meaning each doc has only so much they can find as SC'ed or very severe etc. That would not be functional or possible to implement. I think it is easier for the VA to control outcomes with less cupability though than sending a memo to each VARO saying our budget is this so you must meet X$'s by outsourcing. That sounds ridiculous to some but I do not believe VA raters are just thinking up ways to down rate back problems just for kicks. I believe it is plain institutional policy driven by budget. Hence this Lumbar Strain nonsense. Here a rater is reading a radiology report: large L5 Protrusion pushing S1 to forward facet. Similar on up the lumbar/Degenerative disease/...= strain. That doesn't even pass the laugh test. Budget?

That is very beneficial information about the goniometer(plastic hand held low tech angle finder) that he did in fact use this time which they would otherwise guesstimate the distance which could make the difference from one rating to the next, all this after 1 year earlier finding my spine in normal condition. Yes, same QTC Doc, but he did a thorough exam and it did in fact help to haul in all my radiology reports, discs, reports, and etc. He sent his nurse out front to get some radiology reports from past MRI's and Flexions. Which ones she picked I do not have a clue but otherwise they are running on just their own opinion rather than having to knowingly report contrary to previous findings. I have no doubt this gentleman is very competent but what I do not know are QTC's marching orders and the raters actual boundaries. I will report back when the rating is in, but it stands at 20% now from the VA.

For future examinees:

Lumbar Spine Exam

bend forward

bend lateral left and right

bend back

twist left and right

SLR bilateral

reflexes

verbal history (on their questionaire I was rather expansive so that either surprising, irritating, or both to him but hey I wanted him to have all the info I could get to him).

dorsiflex bilateral feet

no wood pin pricking but light touch for numb and tingling areas

3 xrays 1. flat on your back 2. left side 3. right side.

the end.

possible checks for truthfulness for example seating you then straighten leg for some other reason then observe reaction. Many more of those possible.

That pretty much covers my experience which no doubt will vary from doc to doc and place to place.

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Vaf if you help much more if I had a payroll I'd be compelled to add you.

Thanks! We've found that most of the justice we've received for my husband's claims has come from the Board and the Court, not the VARO. The good news is that my husband was eventually rated 100% schedular, but we had to scrape for every inch of that over 17 years, and are still fighting for an earlier effective date. He holds ratings for both lumbar and cervical spine problems, so I do understand the difficulty in getting anything over 10% or 20% without a major struggle. Evidence eventually wins out, the challenge is getting someone to actually read it.

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  • Content Curator/HadIt.com Elder

I agree! Hopefully our cases will not need to go to the board or CAVC in order to be resolved correctly.

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  • HadIt.com Elder

The straight leg test stretches the sciatic nerve. If your foot is dorsiflexed ((pulled backward, like they are supposed to) it puts pressure on the sciatic nerve, so when they apply dorsiflexion and then lift your straight leg they can look for a reaction. Plantar flexion (the foot/toes pointed down) releases some of this tension on the nerve during a straight leg test so when they raise your leg it should hurt less. They also sometimes to test with a bent knee (releases pressure, doesn't cause stretching) and I had one guy push on the top of my head for a lumbar exam (no load borne by lumbar spine, so no pain).

Vaf if you help much more if I had a payroll I'd be compelled to add you. I went to the QTC Severity Exam on 4/19 and have since heard comments pointing to common complaints regarding QTC as opposed to VA C&P exams. I am quit cynical so regard my point of view with that assumption.

I have been examined by both and have not really experienced any more bias from one than the other. That just being me so that's hardly scientific evidence. In my view they both have a quota, not meaning each doc has only so much they can find as SC'ed or very severe etc. That would not be functional or possible to implement. I think it is easier for the VA to control outcomes with less cupability though than sending a memo to each VARO saying our budget is this so you must meet Xs by outsourcing. That sounds ridiculous to some but I do not believe VA raters are just thinking up ways to down rate back problems just for kicks. I believe it is plain institutional policy driven by budget. Hence this Lumbar Strain nonsense. Here a rater is reading a radiology report: large L5 Protrusion pushing S1 to forward facet. Similar on up the lumbar/Degenerative disease/...= strain. That doesn't even pass the laugh test. Budget?

That is very beneficial information about the goniometer(plastic hand held low tech angle finder) that he did in fact use this time which they would otherwise guesstimate the distance which could make the difference from one rating to the next, all this after 1 year earlier finding my spine in normal condition. Yes, same QTC Doc, but he did a thorough exam and it did in fact help to haul in all my radiology reports, discs, reports, and etc. He sent his nurse out front to get some radiology reports from past MRI's and Flexions. Which ones she picked I do not have a clue but otherwise they are running on just their own opinion rather than having to knowingly report contrary to previous findings. I have no doubt this gentleman is very competent but what I do not know are QTC's marching orders and the raters actual boundaries. I will report back when the rating is in, but it stands at 20% now from the VA.

For future examinees:

Lumbar Spine Exam

bend forward

bend lateral left and right

bend back

twist left and right

SLR bilateral

reflexes

verbal history (on their questionaire I was rather expansive so that either surprising, irritating, or both to him but hey I wanted him to have all the info I could get to him).

dorsiflex bilateral feet

no wood pin pricking but light touch for numb and tingling areas

3 xrays 1. flat on your back 2. left side 3. right side.

the end.

possible checks for truthfulness for example seating you then straighten leg for some other reason then observe reaction. Many more of those possible.

That pretty much covers my experience which no doubt will vary from doc to doc and place to place.

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