Claim For Chronic Pain Syndrome Denied Because "pain" Was Used As A Factor To Grant My Original Cliam.

[sawgunner]

Hello all.

First let me say that I am stunned and in a bit of a state of shock to learn that I have been denied.

I thought I had all my ducks in a row and had VERY strong evidence in my favor.

I am service connected at 10% each for the folling conditions.

10% Iliobial bany syndrome, "Snapping Hip Syndrome".

10% DDD Lumber spine L5, S1.

10% DDD cervical spine at C5, C6.

10% GERD secondary to lower back and hip for the use of pain meds and anti-inflamitory meds.

10% reflexes for each arm and leg sceandary to the DDD in my lumbar and cervical spine.

I have a total of eight 10% ratings for a total of 60%.

Last spring I was diagnosed with Chronic Pain Syndrome with depression by a private Psychologist. He wrote a wonderful letter on my behalf stating that my CPS "IS" caused by my service connected condictions.

I will post that letter in this thread.

At the time of my diagnosis for chronic pain syndrome, I was only rated at 20%. 10% for the DDD in my lumbar spine and 10% for the IT band in my left hip. The VA had used "flet pain" to determine my first cliam that got me my first rating of 20%.

The folling is the letter I used in support of my claim for Chronic Pain Syndrome.

To Whom It May Concern at VA.

Please be advised I have evaluated the above named Veteran for his complaints of Chronic Pain.

I understand his service connected injuries are now well documented in your file. I will opine as to the presence of a chronic pain syndrome and wheather it relates to his service connected conditions. Mr. sawgunner has provided for review medical records pertaining to his injuries and medical treatment.

A review of those records indicates the presence of a service connected iliband syndrome of the left hip and DDD L5S1 conditions. I have also reviewed and evaluated Mr. sawgunner's complaints of chronic pain.

It is my opinion that sawgunner's complaints of pain constitute a Chronic Pain Syndrome and that this chronic pain syndrome is directly related to his service connected medical conditions. The intensity, duration, and frequency of his pain are consistent with this diagnosis and the nature of his service connected medical problems.

I additionally believe the medical problems and resulting Chronic Pain Syndrome haas a significant impact on his day to day functioning, affecting concentration, momory, irritability, frustration tolerance, mood and mood lability, and his ability to interact socially. There is a negative impact on Activities of Daliy Living and result in a Global Assessment of Functioning in the 60 range.

I also believe Mr. sawgunner manifests depression as a direct result of the chronic pain he experiences. The prognosis is now gaurded, reflecting the chronicity of his condition. Mr. sawgunner has agreed to being outpatient treatment for his Chronic Pain Syndrome.

I hope this information is helpful. If you have any questions please do not hesitate to contact me.

sawgunner's doc, Ed.d,LPC,NCC

Next if a follow up to that nexus letter from my primary care who is a PA at my local clinic.

To Whom It May Concern at VA.

This letter is to acknowledge the receipt and review of Dr. ********", Ed.D, LCP, NCC, letter in regards to the said patient, sawgunner. Patient is currently under my care with a diagnosis if iliotibial band syndrome, being treated with medication regimen conjunctively with physical therapy. Sawgunner began taking Pamelor 12/2009 and has been taking this alongside and NSAID, Voltaren, most recently. Past treatments of primary pamelor did nto provide total relief. If there are futher questions, please contact my office.

They forgot to mention the Lunesta I take for sleep along with the several injections and oral steroids.

Here is the letter I got today from VA.

We determined that the following conditions were not related to your military service, so service connection couldn't be granted.

Chronic Pain Syndrome secondary to ilioban syndrome of the left hip and DDD, L5-S1.

Depression as secondary ro all service connected conditions.

We determined that service connection for the purpose of establishing eligibility to treatment is denied.

Blue pages...

The records reflect that you are a veteran of the Gulf War Era.

We made the folloing decisions on your claim.

1. Service connection for chronic pain syndrome secondary to iliobial ban syndrome of the left hip and degenerative disc disease, L5-S1 is denied.

2. Service connection for depression as secondary to all service connected conditions is denied.

3. Service connection for the purpose of establishing eligibility to treatment is denied.

( I don't even know what number 3 even means and did not know I filed for it).

1. Chronic Pain Syndrome left hip and DDD L5-S1.

The evidence does not show that chronic pain syndrome secondary to IT band left hip and DDD L5-S1 is a disability in and of itself. It is a symptom associated with iliobial band syndrome and DDD and has been considered in those service connected evaluations.

Rating decision dated September, 2009 granted service connection for iliobial band syndrome of the left hip as well as service connection for degenerative disc disease, L5-S1. Each of the evalutions were assigned using pain as the reason for the grant of 10% service connection. Aseperated evaluation for chronic pain syndrome of your back and hip conditions would not be warranted as you are already reciving compensation due to pain for these conditions. A seperate evaluation for pain would be (PYRAMIDING). An evaulation using the same symptoms under a seperate diagnosis is to be avoided. Therefore, service connection for chronic pain syndrome secondary to IT band syndrome left hip and DDD L5-S1 is denied because you are already service connected for these conditions due to symptoms of pain.

Service connection for chronic pain syndrome is denied on a direct basis because chronic pain is not a disability, it is a symptom.

***** ( That last part is news to me as I understood Chronic Pain Syndrome to be considered a mental health issue, rated by itself) *****

I smell a rat with that last part.

2. Service connection for depression as secondary to all service connected conditions.

The evidence does not show that depression is related to any service connected conditions, nr is there any evidence of this disibility during military military or post military service.

A review of your service treatments show that on January 26, 2003, during a pre deployment health assessment you stated that you were under psychiatric care at that time. There were no detail regarding the care nor were there any additional records to show further treatment. No other mentions were made regarding psychiatric care in your service treatment records.

**** ( That part is pure bull-crap) ***** The reason I was psychiatric care at that time was because of the deployment!!!!!!!!!!!!!!!!! My Grandmother, who I had lived with my entier life and was very, very close to.. Had become hospitalized upong hearing that my National Gaurd unit had been deployed for the war.

***** My Grandmother died as my unit was making deployment preperations and I left home within 2 days of putting her in the ground. I was in a state of shock and utter sadness that i can't begin to describe to you.*****

*****It was the only time in my life when I can say that my thoughts were not my own.. I was not able to focus my mind in any one direction. I was totally numb.*****

I also WAS under psychiatric care for Ft. Eustis... No.. It was not included in my medical records, no was the PT I was in over my back and hip, or anything else that pertained to my back and hip.. It took years and my Congressman before I could secure those treatment and medication records. THEY WERE NOT INCLUDED IN MY MEDICAL RECORDS.

Back to the VA's letter.

Treatment records from Dr. ***** show that you were negative for anxiety and depression in December 2009. We have no additional information regarding a diagnosis or treatment for depression. Since there is no current treatment for this condition it is determined that the mention on psychiatric was acute in nature. A disibility which began in service or was caused by come event in service must be considered "chronic" before service connection can be granted. Although there is a record for treatment in service for psychiatric care, no permanent residual or chronic disability subject to service connection is shown by the service medical recordsor demonstrated by evidence following service. Therefore, service connection for depression is denied.

3. Determination of service connection.

Gulf War veterans who develop an active psychosis or any active mental illness during or within two years from the date of seperation from such service or within two years of the eand of the war period, whichever is earlier. You were discharged on June 7, 2003 and served during the Gulf War period. There is no diagnosis for a psychosis/mental illness. Entitlement to treatment is not established because a psychosis/mental illness has not been diagnosed and /or was not diagnosed within 2 years from your release from active duty.

Ok.......

I would like to point out at this time that I did not file for depression due to the events of my Grandmother's death and my deployment. However, I might if I am able to do so.

The VA states that they did not know the details of my care back in 2003..... The deployment was the whole point to my care then and the Doctor I saw then, the same Doctor who wrote the above letter.. (The first one) Recomended that I not be deployed under the mental conditions I was in at the time. I was deployed anyway and pent 5 months with my Unit at Fort Eustis VA before having our orders cut.

During that time I re-hurt my hip and back that I first injured at Ft. Leonard Wood back in 1998.

It's odd that I saw my VA doc for only the second time at the local VA clinc yesterday and we were talking about my sleep apna like conditions that were deteriment by the Sleep Specialist to be an anxiety based insomina. The VA doc made me an apointment to see VA mental health for the very first time next week.

Should I bring all this information up to the VA mental health doc????

And how should I counter-attack the VA's letter with new letters of my own???? I want all my ducks in a row before I file my NOD.

If anyone here would like to discuss this case with me via e-mail orover the phone, I'd be more than happy to post my phone number in a PM.

If you guys need any other information... Ask away.

Thanks so much.

sawgunner

Edited April 16, 2011 by sawgunner

[john999]

File an appeal. Chronic pain disorder is a psychological and physical condition that results from the experience of chronic pain. It is usually accompanied by depression, insomnia, effects of pain medications and other problems. You can only be rated on one mental disorder and chronic pain syndrome is considered a psychological disorder. I am SC'ed for it. Do you use the VA pain clinic? Do you see a psychiatrist at the VA?

[sawgunner]

File an appeal. Chronic pain disorder is a psychological and physical condition that results from the experience of chronic pain. It is usually accompanied by depression, insomnia, effects of pain medications and other problems. You can only be rated on one mental disorder and chronic pain syndrome is considered a psychological disorder. I am SC'ed for it. Do you use the VA pain clinic? Do you see a psychiatrist at the VA?

I am seeing a VA psychiatrist this week for my sleep condition that has been diagnosed as an anxiety based insomina.

VA doc asked if I was ever deployed, then asked about the anxiety/sleep condition. Then stated something about stress and being National Gaurd.

I figure I will tell the VA psychiatrist about this situation and see if I can get a letter from her for my appeal.

But I would like to know exactly how any such letter should be worded in order to combat the VA's denial letter in a most effective manner.

[carlie]

Hello all.

First let me say that I am stunned and in a bit of a state of shock to learn that I have been denied.

I thought I had all my ducks in a row and had VERY strong evidence in my favor.

I am service connected at 10% each for the folling conditions.

10% Iliobial bany syndrome, "Snapping Hip Syndrome".

10% DDD Lumber spine L5, S1.

10% DDD cervical spine at C5, C6.

10% GERD secondary to lower back and hip for the use of pain meds and anti-inflamitory meds.

10% reflexes for each arm and leg sceandary to the DDD in my lumbar and cervical spine.

I have a total of eight 10% ratings for a total of 60%.

Last spring I was diagnosed with Chronic Pain Syndrome with depression by a private Psychologist. He wrote a wonderful letter on my behalf stating that my CPS "IS" caused by my service connected condictions.

I will post that letter in this thread.

At the time of my diagnosis for chronic pain syndrome, I was only rated at 20%. 10% for the DDD in my lumbar spine and 10% for the IT band in my left hip. The VA had used "flet pain" to determine my first cliam that got me my first rating of 20%.

The folling is the letter I used in support of my claim for Chronic Pain Syndrome.

To Whom It May Concern at VA.

Please be advised I have evaluated the above named Veteran for his complaints of Chronic Pain.

I understand his service connected injuries are now well documented in your file. I will opine as to the presence of a chronic pain syndrome and wheather it relates to his service connected conditions. Mr. sawgunner has provided for review medical records pertaining to his injuries and medical treatment.

A review of those records indicates the presence of a service connected iliband syndrome of the left hip and DDD L5S1 conditions. I have also reviewed and evaluated Mr. sawgunner's complaints of chronic pain.

It is my opinion that sawgunner's complaints of pain constitute a Chronic Pain Syndrome and that this chronic pain syndrome is directly related to his service connected medical conditions. The intensity, duration, and frequency of his pain are consistent with this diagnosis and the nature of his service connected medical problems.

I additionally believe the medical problems and resulting Chronic Pain Syndrome haas a significant impact on his day to day functioning, affecting concentration, momory, irritability, frustration tolerance, mood and mood lability, and his ability to interact socially. There is a negative impact on Activities of Daliy Living and result in a Global Assessment of Functioning in the 60 range.

I also believe Mr. sawgunner manifests depression as a direct result of the chronic pain he experiences. The prognosis is now gaurded, reflecting the chronicity of his condition. Mr. sawgunner has agreed to being outpatient treatment for his Chronic Pain Syndrome.

I hope this information is helpful. If you have any questions please do not hesitate to contact me.

sawgunner's doc, Ed.d,LPC,NCC

sawgunner - What type of doctor is this - as I do not recognize any of this pedigree ?

Sec. 4.125 Diagnosis of mental disorders. (a) If the diagnosis of a mental disorder does not conform to DSM-IV or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. (b) If the diagnosis of a mental disorder is changed, the rating agency shall determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. If it is not clear from the available records what the change of diagnosis represents, the rating agency shall return the report to the examiner for a determination.(Authority: 38 U.S.C. 1155)[61 FR 52700, Oct. 8, 1996]

Next if a follow up to that nexus letter from my primary care who is a PA at my local clinic.

To Whom It May Concern at VA.

This letter is to acknowledge the receipt and review of Dr. ********", Ed.D, LCP, NCC, letter in regards to the said patient, sawgunner. Patient is currently under my care with a diagnosis if iliotibial band syndrome, being treated with medication regimen conjunctively with physical therapy. Sawgunner began taking Pamelor 12/2009 and has been taking this alongside and NSAID, Voltaren, most recently. Past treatments of primary pamelor did nto provide total relief. If there are futher questions, please contact my office.

They forgot to mention the Lunesta I take for sleep along with the several injections and oral steroids.

sawgunner - I don't think this PA rises to the correct level of pedigree. Also, it states absolutely nothing in regards to any

mental health problems that are considered to be secondary to your service connected disability's.

Why are you RX'd oral steroids ?

Here is the letter I got today from VA.

We determined that the following conditions were not related to your military service, so service connection couldn't be granted.

Chronic Pain Syndrome secondary to ilioban syndrome of the left hip and DDD, L5-S1.

Depression as secondary ro all service connected conditions.

We determined that service connection for the purpose of establishing eligibility to treatment is denied.

sawgunner - Say WHAT ? You're 60 % SC'd - the VA has to provide treatment for any and ALL

medical/mental problems except dental !

Blue pages...

The records reflect that you are a veteran of the Gulf War Era.

We made the folloing decisions on your claim.

1. Service connection for chronic pain syndrome secondary to iliobial ban syndrome of the left hip and degenerative disc disease, L5-S1 is denied.

2. Service connection for depression as secondary to all service connected conditions is denied.

3. Service connection for the purpose of establishing eligibility to treatment is denied.

( I don't even know what number 3 even means and did not know I filed for it).

1. Chronic Pain Syndrome left hip and DDD L5-S1.

The evidence does not show that chronic pain syndrome secondary to IT band left hip and DDD L5-S1 is a disability in and of itself. It is a symptom associated with iliobial band syndrome and DDD and has been considered in those service connected evaluations.

Rating decision dated September, 2009 granted service connection for iliobial band syndrome of the left hip as well as service connection for degenerative disc disease, L5-S1. Each of the evalutions were assigned using pain as the reason for the grant of 10% service connection. Aseperated evaluation for chronic pain syndrome of your back and hip conditions would not be warranted as you are already reciving compensation due to pain for these conditions. A seperate evaluation for pain would be (PYRAMIDING). An evaulation using the same symptoms under a seperate diagnosis is to be avoided. Therefore, service connection for chronic pain syndrome secondary to IT band syndrome left hip and DDD L5-S1 is denied because you are already service connected for these conditions due to symptoms of pain.

Service connection for chronic pain syndrome is denied on a direct basis because chronic pain is not a disability, it is a symptom.

sawgunner - some smuck has tried to SC your mental health disability due to chronic pain on a direct basis

when it is clearly a secondary and distinctly separate disability, caused by the already SC'd condition.

This decision maker must be right out of training or ready to retire.

Here's a link to BVA decisions that you can use to research your issue.

http://www.index.va.gov/search/va/bva.html

***** ( That last part is news to me as I understood Chronic Pain Syndrome to be considered a mental health issue, rated by itself) *****

I smell a rat with that last part.

2. Service connection for depression as secondary to all service connected conditions.

The evidence does not show that depression is related to any service connected conditions, nr is there any evidence of this disibility during military military or post military service.

A review of your service treatments show that on January 26, 2003, during a pre deployment health assessment you stated that you were under psychiatric care at that time. There were no detail regarding the care nor were there any additional records to show further treatment. No other mentions were made regarding psychiatric care in your service treatment records.

**** ( That part is pure bull-crap) ***** The reason I was psychiatric care at that time was because of the deployment!!!!!!!!!!!!!!!!! My Grandmother, who I had lived with my entier life and was very, very close to.. Had become hospitalized upong hearing that my National Gaurd unit had been deployed for the war.

***** My Grandmother died as my unit was making deployment preperations and I left home within 2 days of putting her in the ground. I was in a state of shock and utter sadness that i can't begin to describe to you.*****

*****It was the only time in my life when I can say that my thoughts were not my own.. I was not able to focus my mind in any one direction. I was totally numb.*****

I also WAS under psychiatric care for Ft. Eustis... No.. It was not included in my medical records, no was the PT I was in over my back and hip, or anything else that pertained to my back and hip.. It took years and my Congressman before I could secure those treatment and medication records. THEY WERE NOT INCLUDED IN MY MEDICAL RECORDS.

Back to the VA's letter.

Treatment records from Dr. ***** show that you were negative for anxiety and depression in December 2009. We have no additional information regarding a diagnosis or treatment for depression. Since there is no current treatment for this condition it is determined that the mention on psychiatric was acute in nature. A disibility which began in service or was caused by come event in service must be considered "chronic" before service connection can be granted. Although there is a record for treatment in service for psychiatric care, no permanent residual or chronic disability subject to service connection is shown by the service medical recordsor demonstrated by evidence following service. Therefore, service connection for depression is denied.

3. Determination of service connection.

Gulf War veterans who develop an active psychosis or any active mental illness during or within two years from the date of seperation from such service or within two years of the eand of the war period, whichever is earlier. You were discharged on June 7, 2003 and served during the Gulf War period. There is no diagnosis for a psychosis/mental illness. Entitlement to treatment is not established because a psychosis/mental illness has not been diagnosed and /or was not diagnosed within 2 years from your release from active duty.

Ok.......

I would like to point out at this time that I did not file for depression due to the events of my Grandmother's death and my deployment. However, I might if I am able to do so.

The VA states that they did not know the details of my care back in 2003..... The deployment was the whole point to my care then and the Doctor I saw then, the same Doctor who wrote the above letter.. (The first one) Recomended that I not be deployed under the mental conditions I was in at the time. I was deployed anyway and pent 5 months with my Unit at Fort Eustis VA before having our orders cut.

During that time I re-hurt my hip and back that I first injured at Ft. Leonard Wood back in 1998.

It's odd that I saw my VA doc for only the second time at the local VA clinc yesterday and we were talking about my sleep apna like conditions that were deteriment by the Sleep Specialist to be an anxiety based insomina. The VA doc made me an apointment to see VA mental health for the very first time next week.

Should I bring all this information up to the VA mental health doc????

And how should I counter-attack the VA's letter with new letters of my own???? I want all my ducks in a row before I file my NOD.

If anyone here would like to discuss this case with me via e-mail orover the phone, I'd be more than happy to post my phone number in a PM.

If you guys need any other information... Ask away.

Thanks so much.

sawgunner

[Veldrina]

The problem i see is that they made the chronic pain syndrome connected to your medical conditions as opposed to being it sown mental condition. Pain, in and of itself, is NOT a disability. It is considered a symptom, & the rater was correct in explaining that pain is already considered in your s/c disabilities (deluca factor). They are treating this as pain in general though, not chronic pain syndrome as a mental condition. Also , unless we have some kind of proof from service that you were seen for mental health, it is extremely difficult for us to make a determination that you;'ve had a mental problem since service or that was aggravated by service as there's no way to determine an onset.

You can try asking for a reconsideration and explaining that you did not file chronic pain syndrome as secondary, that you wanted it as its own disability. But i think your doctor is going to have to be a bit more specific on the mental side of it rather than the medical. I'm not at work so i dont have the rating schedu. in fornt of me, but can someone tell me the DC (diagnostic code) for Chronic Pain Syndrome? i dont think i've ever done a rating for one & am not familiar with it

[john999]

Many claims are SC'ed as secondary depression due to a SC condition. Anyone with chronic severe pain usually takes meds that can cause depression and being disabled, itself, is a cause of depression. Chronic pain and depression go hand in hand. You doctor has to spell it out and make the connection between the SC condition and secondary conditions.

[Berta]

Veldrina I have never seen any DC or rating for chronic pain syndrome.

As you correctly stated the Deluca Factor is supposed to cover it and as John said any painful condition can cause depression.

MANY SC meds have depression as a side affect too as John said.