Claims Advice

[TLaff]

My original claim was for my Cervical and Lumbar and when i filed the claims I didn't think to make claim for my thoracic, however I got a 20% for my cervical and a 10% for my lumbar in which I am going to file a NOD. The C/P examiner stated she was new and I believe I was her first exam and when she examined me she forcefully pushed my head to get a measurement causing pain and popping like chewing on gristle. She also eyeballed allot of it and the answers she put into her report are not my answers.

Further I am placing below my conditions and would like any suggestions, help and cold someone tell me what all I can make claims for??

I also am going to the doctor because since my cervical fusion I have headaches every day and I never use to snore and I snore really bad and gasp for air and believe the metal in my neck causes some kind of air restriction.

Dr. States;

This gentleman comes in for evaluation of his cervical, thoracic and lumbar spine. He has had a 3 level cervical fusion of his C4-5, C5-6, C6-7, cervical degenerative facet arthropathy, reversal of the cervical lordosis, apexing at C4 accompanied by right sided cervical listing, apophyseal articular degenerative alteration throughout the cervical spine.

Thoracic multisegmental mid to lower thoracic dicongenic spondylosis, T12 vertebral body compression which is likely chronic in nature, multiple thoracic intervertebral dysrelationships (subluxation).

He has schuermann’s disease in his low back involving his L1-2, 2-3 and 4-5, He has an

Annular tear at his 4-5 (spinal stenosis, ruptured disc, intervertebral disc syndrome, sciatica, radiculopathy), degenerative disc disease and arthritis degenerative throughout his entire spine.

His conditions have progressed over time and will continue to do so and I am afraid to offer him anything more surgically by virtue of the fact it’s hard to know where to stop or start.

His best treatment at this time is going to be on muscle relaxants and anti-inflammatory.

He should stay away from pain medicines if at all possible as he will simply get hooked on them, I suggest he see his primary care physician and or pain management at this point. I strongly feel it’s not in his best interest to continue carpet cleaning because of the stress it places on his entire spine.

Further Mr. Lafferty has had several incapacitating episodes in the past many resulting in

Steroid injections and bed rest. Being that he has been self employed there was no reason to write it out (whom would he have given them too?). I would be happy to see Mr. Lafferty again should the need arise.

Any advice would be greatly appreciated.

Terry

[*Bergie*]

My original claim was for my Cervical and Lumbar and when i filed the claims I didn't think to make claim for my thoracic, however I got a 20% for my cervical and a 10% for my lumbar in which I am going to file a NOD. The C/P examiner stated she was new and I believe I was her first exam and when she examined me she forcefully pushed my head to get a measurement causing pain and popping like chewing on gristle. She also eyeballed allot of it and the answers she put into her report are not my answers.

Further I am placing below my conditions and would like any suggestions, help and cold someone tell me what all I can make claims for??

I also am going to the doctor because since my cervical fusion I have headaches every day and I never use to snore and I snore really bad and gasp for air and believe the metal in my neck causes some kind of air restriction.

Dr. States;

This gentleman comes in for evaluation of his cervical, thoracic and lumbar spine. He has had a 3 level cervical fusion of his C4-5, C5-6, C6-7, cervical degenerative facet arthropathy, reversal of the cervical lordosis, apexing at C4 accompanied by right sided cervical listing, apophyseal articular degenerative alteration throughout the cervical spine.

Thoracic multisegmental mid to lower thoracic dicongenic spondylosis, T12 vertebral body compression which is likely chronic in nature, multiple thoracic intervertebral dysrelationships (subluxation).

He has schuermann's disease in his low back involving his L1-2, 2-3 and 4-5, He has an

Annular tear at his 4-5 (spinal stenosis, ruptured disc, intervertebral disc syndrome, sciatica, radiculopathy), degenerative disc disease and arthritis degenerative throughout his entire spine.

His conditions have progressed over time and will continue to do so and I am afraid to offer him anything more surgically by virtue of the fact it's hard to know where to stop or start.

His best treatment at this time is going to be on muscle relaxants and anti-inflammatory.

He should stay away from pain medicines if at all possible as he will simply get hooked on them, I suggest he see his primary care physician and or pain management at this point. I strongly feel it's not in his best interest to continue carpet cleaning because of the stress it places on his entire spine.

Further Mr. Lafferty has had several incapacitating episodes in the past many resulting in

Steroid injections and bed rest. Being that he has been self employed there was no reason to write it out (whom would he have given them too?). I would be happy to see Mr. Lafferty again should the need arise.

Any advice would be greatly appreciated.

Terry

Well, you already said you were going to file a NOD, which I think is a very good idea. From what you describe above your spine is in really bad shape. One thing not mentioned in your post is whether or not you have any nerve involvement. For example I have radiculopathy in both arms, do you have any from your neck. What about low back like sciatica, numbness, tingling toes. These residuals can increase your overall compensation by a great deal. What about IMO's, have you got any from your doctors. What I've said are the things that I'd do, so maybe it will help you.

JMO,

Bergie

[john999]

Like Bergie says you need an IMO and I would file a claim for TDIU now. The C&P doctor says you should not continue to work at your business. What are you supposed to do for money? You need your own doctor to tie all this stuff together and and paint a picture that represents your true level of disablility. How long does it take you to get out of bed in the morning? Just from the C&P exam you sound like you have severe disability, but a doctor has to say it is bad enough to keep you from doing any work that is above poverty level. I would see a psychiatrist as well because I bet all that pain and disability must be causing you major depression and chronic pain disorder.

[TLaff]

Like Bergie says you need an IMO and I would file a claim for TDIU now. The C&P doctor says you should not continue to work at your business. What are you supposed to do for money? You need your own doctor to tie all this stuff together and and paint a picture that represents your true level of disablility. How long does it take you to get out of bed in the morning? Just from the C&P exam you sound like you have severe disability, but a doctor has to say it is bad enough to keep you from doing any work that is above poverty level. I would see a psychiatrist as well because I bet all that pain and disability must be causing you major depression and chronic pain disorder.

[TLaff]

I think there is a misunderstanding the doctor that describes my problems Cervical Thoracic /Lumbar is my orthopedic doctor, not the C/P examiner.

What is IMO? TDIU? and can you explain also Chronic Pain Disorder? If you read my post it states radiculopathy in my lumbar.

Another question is it good or a plus or negative to say (Chronic in nature).

???

Thanks for your imputs.

Terry

[TLaff]

Oh by the way my primary doctor at the VA ask me why don't you go apply for disability with social security.

Terry

[broncovet]

Terry...These abbreviations have been posted elsewhere, but I will do it again for you:

IMO Independent Medical Opinion. This often happens when you ask for Service connected benefits, and the VA doc makes a statement such as "Veterans.....condition is most likely NOT related to military service".

Often a private doc, such as Dr. Bash, will review your medical history and give you a "nexus" such as: "In my professional medical opinion the Veterans condition is at least as likely as not due to military service".

In this instance, the IMO is probably your only chance to get service connection, because one the doc makes some kind of statement opining it is not related to military service, the only way a Veteran can "counter" that position is to have another doc say that it is related to military service.

Sometimes, the VA doc wont say either way, and you need an IMO to win benefits.

An IME (Independent Medical Exam) often carries more weight than an IMO. With an IME the doctor physically examines you, and your records, then offers an opinion. With an IMO, usualy the doc just looks at your records and does not examine you.

TDIU = Total Disability Individual Unemployability. This means you are disabled and unable to obtain "substantial Gainful employment" (SGE) It means that you are not working and cant get a job due to service connected disabilitie(s). That is, it has to be substantial, and taking a job and geting fired after a week is not SGE. Usually you need to earn more than the poverty level, that is about 10k per year for it to be considered SGE. There are specific rules the VA follows before they award TDIU. If awarded, you are paid at the 100% rate.

A "chronic" condition means it is ongoing. If you get hurt, say you break a leg in service, but have no chronic problems, you are unlikely to get benefits. However, if your broken leg is "chronic" and requires ongoing treatment...cast, physical therapy, treatment for pain, loss of use of leg, required use of wheel chair etc, over time, this becomes "chronic". Chronicity is pretty much required. They dont give you disability benefits if you get better and have no problems.