What Is Considered "chronic"?

[JuanP]

I am trying to connect my current condition of severe neck pain back 16 years to my time in service. I have medical records that go back 11 years (am missing the first 6 because of a lack of insurance) ?

I have 5 instances of Sick Call for back and / or neck pain over a period of a year and a half while in the Navy. Is this considered to be "Chronic"?

[Hoppy]

Service connecting your neck condition is more complex than the answer is to your question. You do not need to show a chronic condition in the military. All you need to do is show that your current condition is chronic at this time and is more likely than not related to your in-service condition. If you keep investigating the VA laws you will find that if it is determined to be chronic while in the military this will make the case easier to win. However, if it is not chronic in the military then continuity of post service symptoms can also be used to win the claim. Continuity of symptoms can also be shown as accelerated degradation of the spine depending on the medical evidence. You need to start reading BVA cases regarding neck claims. http://www.index.va.gov/search/va/bva.html

I will post some BVA cases in the future. I need to know what your current diagnosis is before I can start searching the BVA. Like many other veterans here on hadit I also have battled chronic neck pain for decades. It is no fun. Mine is not service connected.

I worked for workers compensation attorneys prior to the invention of the MRI. In these cases a determination was made as to whether or not the condition is more likely than not to have lifelong residuals based on clinical observations only. In many of these cases it was determined a permanent disability was likely even though the claimant had recovered and was relatively pain free at the time it went to court. After reading 100’s of BVA cases it became apparent to me that the military made it a habit of sweeping back conditions under the carpet and discharging veterans without a proper medical workup or proper legal representation.

Depending on the answers to the questions below I can direct you to literature explaining how the in-service symptoms may be related to your current condition. You can use this literature to focus your position and obtain medical opinions that are also focused. Hopefully, the VA will schedule a C&P. From what I have seen on the BVA website your claim will require a very focused and logical development.

What is your current diagnosis for neck and back? What were the in-service diagnoses for each visit for your neck and back? How long did the pain in the neck and back last before it subsided? Were there flares or was it one continuous period of pain during which you went to sick call. If it was one period of time how long was there continuous pain? Did you miss any duty assignment or were you placed on limited duty? If yes, how long? The answers to all of the above questions must be fully stated in the SMR. You cannot use your recollection of your symptoms to answer these questions.

Your symptoms in the military may well be considered as chronic by a doctor. The problem is that if the doctors in the military do not specifically say the condition is chronic then the raters will almost always say your condition was not chronic in the military. One big problem that you have showing that your condition was chronic in the military is that the military had the option of service connecting you at the time of discharge and chose not to. If you can find some notes where doctors in the military recommended a medical board and this recommendation was ignored this could be evidence in support of your claim. I do not think that a six year gap will be an overbearing issue. It depends more on the evidence in the SMR. The VA will also want to know if there were any post service injuries and what type of work you did after the military. They will use any post service injuries and other possible causes as evidence against your claim.

[Hoppy]

Check out these links. they both had an eight year gap between military and first post service treatment.

It is very important that a doctor specifically state that after review of the entire medical history your current condition is as likely or not related to the inservice treatment or events shown in the SMR.

http://www4.va.gov/vetapp03/Files/0307024.txt

http://www4.va.gov/v...les/0304669.txt

More later

Edited September 28, 2010 by Hoppy

[JuanP]

Wow Hoppy, Thank you! Ok, I'll try my best to post everything from my SMR that I could read or make out. But I will start with my current diagnosis:

My VCAA letter has a vague claim for Neck injury, Back injury and Hernia Operation.

Keep in mind, in 10/2001 I had a Spinal fusion from C5-C7

MRI on 4/08/2010:

C4-C5 - DDD with Uncinate Process Hypertrophy and Osteophyte formation resulting in decreased diameter of spinal canal and foraminal narrowing, findings greater on the right.

C5-C6 - Posterior Osteophyte results in flattening of the cord.

Nerve Conductivity Study on 12/07/2009 :

Basically <sic> shows decrease in recruitment pattern in muscles related to the C7 Nerve root.

Also, "evidence of early active denervation seen in the right triceps muscle"

CT Scan 12/14/2009:

C3-C4 Degenerative changes and possible small disc bulge, spinal canal is 10 mm and minimal uncovertebral osteophyte formation.

C4-C5 there is a possible small disc bulge, the spinal canal is 10 mm and there is minimal uncovertebral osteophyte formation.

C5-C6 the spinal canal is 9 mm and there is a partially calcified disc bulge with minimal right foraminal stenosis.

C6-C7 there is a possible slight disc bulge and the canal is 11 mm.

The Neurosurgeon in Miami says that the condition (I assume the stenosis) is inoperable because of the danger and lack of successful recovery rate.

I really don't know what the diagnosis is, other than what is listed in these test results. In my current medical records I can't find a black and white "diagnosis". I see "neck pain with right radiculopathy" but no real black and white clearly stated diagnosis. I may just not be able to find my way through these VA records printouts........

Ok, now for my service records, I can't really read much of anything in them, but am positive in what I can read :

May 10, 1990 Boot camp Orlando (about a month into boot camp) : Sore throat, and pain in left upper arm. I can't read anything else.

May 14, 1990 Follow up for May 10 visit, but I can't read this as well.

Great Lakes ET "A" school :

Jan 22, 1991: Nausea, sore throat, run down. Back Pain. Treated with Tylenol

April of 1991: I was jumped on base, on a bridge and hit in both sides of head, went to sick call for R ear pain.

April 16 1991: Insomnia for 11 days, treated with a muscle relaxer.

"C" School in Norfolk, VA :

August 26, 1991 : Diagnosed with hernia to R side of groin. Repaired by surgery around Sept 23, 1991 given light duty upon my return to the ship.

USS Paiute ATF-159 :

March 25, 1992 : Neck pain for 4 days straight R side. Treated with warm moist heat. Gave a general back exam, once again, I can't read anything. It looks like I was given a 2 day supply of a pill that starts with an "N". Certainly no x-ray ordered.

June 18, 1992 : I reported to sick call for Back Pain of 3 weeks straight. "c/o LBP, described as sharp, constant and aggravated by bending over, climbing ladders. Denies trauma. " at this point I can't read anything but the phrase "related by patient " a few times with some other scratch. It says that I am taking Motrin 800 mg tabs every 4 hrs. with temporary relief. It says that I am also applying heat balm occasionally. The doctor again performs another back exam. No x-ray. Has "A=Lumbo-Sacral strain and P= 1 D/C Motrin 2 Mo. Eval.

July 7, 1992 : Referred to Boone MSC for LBP. Unable to evaluate patient due to sick bay being disestablished for decommissioning.

Then it refers the reader to the June 18 entry.

July 7, 1992 at Boone Branch Medical clinic. Says patient presents with LBP for 2 months. Goes on to state what was written before that it's worse when climbing ladders and that this began while I was carrying heavy equipment. Denies PM# of Same (?). Denies Trauma. No mention of an x-ray or of Light duty. Prescribed Tolectin (?) for 15 days and then to be rechecked in 15 days.

I have found no record of a follow up.

At this point I should note that this was a small ship. And these last couple months we were stripping the ship for decom. So the workload was heavy for everyone. And I damn sure pulled my weight during this time.

I got out in april of 1993. I did get an honorable discharge but the circumstances were because I refused level three alcohol treatment. My feeling at the time was that I wasn't going to a rehab for a month after just getting back from a Med Cruise. (One which I might add, that I didn't have a drop to drink abroad)!! Anyway....... that may or may not be relevant.

As you can see, a big problem I have is that I can't really read my SMR. But am pretty sure that the only x-ray I had was for my arm at one point when I took a fall on board the Kennedy. And while my recollection of events is not proof, after reading my record, it did bring a lot of memories back, it was kind of useless to go to sick call, the standard fix for everything was motrin, which never did anything to help.

Thanks Hoppy.

If there is anymore information I can give you let me know.

[Teac]

In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a persistent and lasting medical condition. Chronicity is usually applied to a condition that lasts more than three months. The opposite of chronic is acute.

Examples of chronic diseases include:

• Asthma
• Chronic fatigue syndrome
• Chronic osteoarticular diseases: rheumatoid arthritis, osteoarthritis
• Chronic respiratory diseases: chronic obstructive pulmonary disease, asthma, pulmonary hypertension
• Chronic renal failure
• Diabetes mellitus
• Chronic hepatitis
• Autoimmune diseases, like ulcerative colitis, lupus erythematosus
• Cardiovascular diseases: heart failure, ischemic cardiopathy, cerebrovascular disease
• Epilepsy
• Neoplasic diseases not amenable to be cured
• Osteoporosis
• Cancer
• Sickle Cell Anemia

Edited September 29, 2010 by Teac

[Hoppy]

JUANB

Help me with these historical questions.

It appears to me that you were 30 t0 35 years old when you had surgery on your neck. How old were you when you had the surgery. Also, how old were you when you went to a doctor post service for neck pain? Is there anything in the records about the time of the surgery that identifies if the condition of your neck was due to birth defects? Was it determined that the condition of your spine was due to a recent accident or injury?.

The reason I ask is because if you were less than 35 years old when your neck symptoms degraded to the point that you needed the surgery there will be no problem getting a doctor to write a report that your neck condition resulted from the degradation of a prior injury if the medical reports do not identify a developmental deformity or recent accident as causing you post service condition..

Then the question becomes whether or not it can be shown that you sustained an injury in the military that more likely than not was capable of resulting in ongoing degradation that resulted in the surgery. If you had a post service injury this would be evidence against the claim. I have seen reports of post service injuries that did not result in disqualifying service connection, It depends on the specifics of each injury.

The notation that you had four days of neck pain in and of itself does not put me in a position to forward any literature that will help you. However, what needs to be investigated is the time you were “jumped” and the possibility that you sustained a whiplash injury. There is tons of research on whiplash and long term ongoing degradation of the spine.

The fact that the four day period of pain occurred after the time you were “jumped” does work in some slight way in favor of a connection to the being “jumped”. Also. It appears that the pain on the right side of the neck and the right side radiculopathy diagnosed also works slightly in your favor.

It would be good to find out if the records say anything about neck pain at the time you were “jumped”. Also, it needs to be determined if the muscle relaxers were the type of medication that is commonly given for insomnia. I wonder if they gave you the muscle relaxers because you complained that headaches or neck pain was keeping you awake. Neck pain and or headaches are definitely associated with a whiplash injury.

The information in bold type was taken from a research study. Basically it states that trauma accelerates degeneration of the spine and that disc disease can occur without trauma in the fourth or fifth decade of life. The training manual that raters use also contains this information.

________________________________________________________

The only point, which was very well accepted, was that symptoms from degenerative disease might be accelerated in their appearance by trauma. This mechanism for the failure of symptoms to settle after an injury is commonly used to explain why patients remain symptomatic even in the absence of severe injury or fractures. This therefore seems, from these results to be truly conventional wisdom.

It is not surprising that the majority of experts in this study felt that degenerative disease becomes spontaneously symptomatic in the 4th or 5th decades of life, as this is common experience and demonstrated in the majority of studies that have looked at investigation or surgical treatment for degenerative disease in the spine

http://www.mayoclinic.com/health/whiplash/DS01037/DSECTION=symptoms

Most whiplash symptoms develop within 24 hours of the injury and may include:

§ Neck pain and stiffness

§ Headaches, most commonly at the base of the skull

§ Dizziness

§ Blurred vision

§ Fatigue

Some people also experience:

§ Difficulty concentrating

§ Memory problems

§ Ringing in the ears

§ Sleep disturbances

§ Irritability

Wow Hoppy, Thank you! Ok, I'll try my best to post everything from my SMR that I could read or make out. But I will start with my current diagnosis:

My VCAA letter has a vague claim for Neck injury, Back injury and Hernia Operation.

Keep in mind, in 10/2001 I had a Spinal fusion from C5-C7

MRI on 4/08/2010:

C4-C5 - DDD with Uncinate Process Hypertrophy and Osteophyte formation resulting in decreased diameter of spinal canal and foraminal narrowing, findings greater on the right.

C5-C6 - Posterior Osteophyte results in flattening of the cord.

Nerve Conductivity Study on 12/07/2009 :

Basically <sic> shows decrease in recruitment pattern in muscles related to the C7 Nerve root.

Also, "evidence of early active denervation seen in the right triceps muscle"

CT Scan 12/14/2009:

C3-C4 Degenerative changes and possible small disc bulge, spinal canal is 10 mm and minimal uncovertebral osteophyte formation.

C4-C5 there is a possible small disc bulge, the spinal canal is 10 mm and there is minimal uncovertebral osteophyte formation.

C5-C6 the spinal canal is 9 mm and there is a partially calcified disc bulge with minimal right foraminal stenosis.

C6-C7 there is a possible slight disc bulge and the canal is 11 mm.

The Neurosurgeon in Miami says that the condition (I assume the stenosis) is inoperable because of the danger and lack of successful recovery rate.

I really don't know what the diagnosis is, other than what is listed in these test results. In my current medical records I can't find a black and white "diagnosis". I see "neck pain with right radiculopathy" but no real black and white clearly stated diagnosis. I may just not be able to find my way through these VA records printouts........

Ok, now for my service records, I can't really read much of anything in them, but am positive in what I can read :

May 10, 1990 Boot camp Orlando (about a month into boot camp) : Sore throat, and pain in left upper arm. I can't read anything else.

May 14, 1990 Follow up for May 10 visit, but I can't read this as well.

Great Lakes ET "A" school :

Jan 22, 1991: Nausea, sore throat, run down. Back Pain. Treated with Tylenol

April of 1991: I was jumped on base, on a bridge and hit in both sides of head, went to sick call for R ear pain.

April 16 1991: Insomnia for 11 days, treated with a muscle relaxer.

"C" School in Norfolk, VA :

August 26, 1991 : Diagnosed with hernia to R side of groin. Repaired by surgery around Sept 23, 1991 given light duty upon my return to the ship.

USS Paiute ATF-159 :

March 25, 1992 : Neck pain for 4 days straight R side. Treated with warm moist heat. Gave a general back exam, once again, I can't read anything. It looks like I was given a 2 day supply of a pill that starts with an "N". Certainly no x-ray ordered.

June 18, 1992 : I reported to sick call for Back Pain of 3 weeks straight. "c/o LBP, described as sharp, constant and aggravated by bending over, climbing ladders. Denies trauma. " at this point I can't read anything but the phrase "related by patient " a few times with some other scratch. It says that I am taking Motrin 800 mg tabs every 4 hrs. with temporary relief. It says that I am also applying heat balm occasionally. The doctor again performs another back exam. No x-ray. Has "A=Lumbo-Sacral strain and P= 1 D/C Motrin 2 Mo. Eval.

July 7, 1992 : Referred to Boone MSC for LBP. Unable to evaluate patient due to sick bay being disestablished for decommissioning.

Then it refers the reader to the June 18 entry.

July 7, 1992 at Boone Branch Medical clinic. Says patient presents with LBP for 2 months. Goes on to state what was written before that it's worse when climbing ladders and that this began while I was carrying heavy equipment. Denies PM# of Same (?). Denies Trauma. No mention of an x-ray or of Light duty. Prescribed Tolectin (?) for 15 days and then to be rechecked in 15 days.

I have found no record of a follow up.

At this point I should note that this was a small ship. And these last couple months we were stripping the ship for decom. So the workload was heavy for everyone. And I damn sure pulled my weight during this time.

I got out in april of 1993. I did get an honorable discharge but the circumstances were because I refused level three alcohol treatment. My feeling at the time was that I wasn't going to a rehab for a month after just getting back from a Med Cruise. (One which I might add, that I didn't have a drop to drink abroad)!! Anyway....... that may or may not be relevant.

As you can see, a big problem I have is that I can't really read my SMR. But am pretty sure that the only x-ray I had was for my arm at one point when I took a fall on board the Kennedy. And while my recollection of events is not proof, after reading my record, it did bring a lot of memories back, it was kind of useless to go to sick call, the standard fix for everything was motrin, which never did anything to help.

Thanks Hoppy.

If there is anymore information I can give you let me know.

[JuanP]

I was a month away from turning 31. The surgery was October of 2001. My first exams for back pain was in 1999 when I first got insurance. I got out in March, 1993. Nothing about birth defects and nothing about a recent injury. I know that I never filed workers comp.

Side note: My doctor at the time, now has a service that kept his old records, They had destroyed the records in my file prior to 4/2002. But, in October of 2001 when I had my surgery, this doctor is listed as being my PCP. The point is that I have record of this doctor being my PCP farther back than my records indicate. Which would be 1999. Several times in the file he talks about me complaining of chronic back pain for a long time. In July of 2002 he mentions me having DDD as fact.

Never any record of an injury to my back post service. And I have a very clear statement from the +2 month back episode , from my ship and Boone Medical Clinic that I had hurt my back while carrying heavy equipment

during decommissioning. Unfortunately, I missed my follow up appointment with Boone because I was on leave and the reported to a new ship after returning from leave.

As far as the muscle relaxer prescription goes, through a friend of mine, a copy of most of my SMR was shown to another friend to try to decipher. He is a corpsman with SF (retired). The muscle relaxer is just a "night-night" pill. Thats it.

Next, and this jibs with my feeling now and then about not always going to sick call over everything, he said that "most corpsmen would look at my record and write me off as a sniveler,, without giving much real thought to any serious condition.

I laughed when this was told to me, cause it brought back so many memories, because it is true. The pressure to do your job, and be there to be counted on was enormous, and it stuck with me throughout life.

So, my next move is to get my SMR translated and to work at putting a timeline together in visual form. And I think that maybe I should try to track down the NIS in Great Lakes to see if they have the record of this incident.

Once again Hoppy, you bring me good information and I thank you. I have the case locator bookmarked and am finding it interesting to look through cases.