tdiu New Guy Wth Big Problem.

[kymike]

Hello everyone, my name is Mike. I'm a veteran of the first Gulf War. I been coming to this forum for about six months but until now I've never posted anything.

My computer and writing skills are a little rusty and been hesitent to speak up. But these are desperate times for me, so I'm forced to overcome my social anxiety and awkwardness.

I'm pleased to find this forum and all you great vets. Just being amongst you all and knowing somebody out there cares has made a big difference in my attitude.

I'll get to the chase. I'm sure on of you guys can point me in the right direction. I've a history of lower back and SI joint problems going back to GW1 in 1991.

I had a Lumbar fusion L2-S1 on 3/3/10 at VAMC Louisville for my " service connected" degenerative disk disease and HNP. VARO payed my temporary UI.

Everything seemed fine. Before surgury, on 12/30/2009 I filled for an increase for my DDD which was at 40%, and for unemployability,bi-lateral radiculapathy, stenosis,

... basicly residules from my service connected surguries. On 12/21/10 I get a letter from RO saying that they are denying all my secondary claims, unemployability,

and a proposing to reduce my SC from back to 10% because the rater made a mistake when he increase me from 10% back pain/ SI joint pain and recharacterized it as

DDD w/ HNP in june of 2005 without asking for a medical opinion from the C&P doc.

I'm angry, depressed, in severe pain, on Morphine and can't tie my own shoes. So they want to pull this crap now.

I need you guys help sorting this out. I'm hoping that you moderators out there can help me ask the right questions in the appropriate forum.

Thanks in advance. I hope somebody else can't sleep and can clue in on the first steps I need to take to staighten out this mess.

[jbasser]

Mike, I hope you have an outside doctor and dont have to rely on the VA. Do you have any outside evidence the VA does not have like a Doctor or XXrays or MRI reports?

You need to get an independant Medical examination and have this Doctor go over the record and put a timeline on it. What you have is a rated condition and increases in that condition over a period of time.

You can beat this one but you need a good doc to time line it for you.

Contact a Good IMO doctor in the Louisville area, The best way to do this is to find a SSDI attorney and ask them who they use for IME's for the back.

Hang in there.

J

[Hoppy]

Mike,

In this post I will explain how I and several other members of hadit helped another veteran go from 20% to 60% service connected for a back condition. As far as the reduction goes listen to the other hadit members.

The problem was that I was so incapacitated by chronic pain that I could not work about three months a year. The veteran we helped go from 20% to 60% was also incapacitated by chronic pain. There has not been much talk about incapacitating episodes lately. I hope things have not changed. Anyway here I go.

The VA will give higher ratings for back conditions for range of motion and neurological complications. They can also rate a back condition based on incapacitating episodes. If you have incapacitating episodes that require six weeks of bed rest per year the VA can rate you at 60%. The bed rest must be prescribed by a treating doctor.

The problem is that I cannot find any objective definition of"bed rest". The cases I have read on the BVA that were successful involved keeping a log of the days missed from work and have a treating doctor write a prescription for bed rest that corresponds with the days you missed from work.

The cases I found on the BVA had different diagnoses resulting in incapacitating episodes of pain. I have a condition that has been diagnosed as "chronic lumbosacral strain". I have episodes that put me out of commission about two months a year and I have never had surgery and I have not even reported the episodes to a doctor since I was 30 years old. However, I am significantly disabled by this back condition.

You might want to find the rating info on incapacitating episodes and see if it applies to your claim. Obviously you feel more disabled than what the VA is telling you. I would bet that you are dealing with a lot of pain issues.

Edited June 27, 2011 by Hoppy

[kymike]

Thanks everyone for all the great advise. I retired on disability from Homeland Security because of my back issues. Lucky, I kept my BC/BS health insurance just in case I had problems with the VA.

Here is what I'm going to do to help solve some of these issues this week.

I have an appointment with a private rehab Doc. On Wednesday. What should I ask him?

I'm going to my VA clinic for a bladder scan tomorrow at 14:00. To rule out reasons for my urgency issues.

I'm filing for SSDI.

[kymike]

Sorry I must have hit reply. I'm using my Android phone. No home computer.

I'm calling around to Doc's and Lawyers I know to find an IME. My spine surgeon doesn't want to get involved. I have the cell number of a Orthopedic surgeon who does IME's but he is a casual drinking buddy of mine and afraid to ask him. But will make myself call him this week.

I've got a copy of my C-file. There are things missing that the VA references in other documents.

Here are some issues on my mind at this late hour.Maybe you guys can way in?

The VA is arguing that my DDD, Spondylosis, etc. was not diagnosed until 2006. My active problems list from VA dated 4-12-96 showed all of these things. I was discharged on 8-9-95, wouldn' t this fall in the presumptive period? The problem is I can't find the treatment notes from 96 to back this up. I went to ROI at VAMC, nothing even showing I was seen on that date.

good news is the Doc that entered this into computer is now Chief of Staff for that VAMC. unless she had a crystal ball she made those diagnosis' with predicting my lumbar fusion in 2006. The documents must have existed. what kind of legal weight does Active problems list have with RO/BVA?

The Va never ordered me an MRI until 2006. Just xrays and a CT scan. I have no proof that my DDD existed prior to 2003. My next question is, if a VA doc saw this Active problems list with a diagnosis of DDD from 1996, would they feel the need to order test to confirm this diagnosis? Or just treat the symptoms, which is what they did in my case.

Next thing I'm confused about is now they are saying that I am no longer service connected for DDD/ HNP just back pain/ SI joint pain. they have said nothing on how to distinguish what part of my limited range of motion is due to my lumbar Ddd and what is caused by my SI joint dysfunction. but are still reducing my rating based on a previous C& P exam in 1994. Which was before my last 2 periods of active duty .

This is making my head hurt. please feel free to chime in, your all's words of advise are helping me a great deal. Mike

[Pete53]

For your claim to suceed your IMO opinion must link it to your service and the opinion has to be very strong. The Doc needs to review your Service Medical Records and show where your service is responsible for the injury.

Good Luck

[Hoppy]

The active problems list that prints out normally on your progress notes is only a portion of the information. If you go to the patient advocates office

they can pull up a screen and print it out. It should show the name and date of the doctor who inputted the diagnoses on to the active problems list. Get a print out and go to the doctor who placed this info on the active problems list and get help finding the reports that led to that entry. I am not sure how they would interpret only a single reference on the active problems list without any other reports.