Question Concerning Possible Secondary Condition

[lt4ds]

I have a question about service connected and secondary claims

I have had 2 previous C & P exams for my back, knees and shoulder

I am currently rated:

40% for Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease

20% Paralysis, incomplete, moderate, right sciatic nerve

10% tinnitis left ear

10% bilaterally knees for DJD

I have an appealable claim for left shoulder residuals from surgery post service for symptoms that manifested during service.

I recently had a 3rd C & P for a few other claims seemingly unrelated to any of the above listed claims. The examiner asked if I used my shoulders and arms more when lifting, sitting, raising from a sitting position, and other activities, and if I had headaches or tingling numbness in my hands. This C & P has resulted in numerous appointments, including an MRI for cervical spine that had a diagnosis of HNP (severe impingement) c5-c6, osteophytes(9mm), neuritis, and carpal tunnel. The MRI was listed as "STAT" on the appointment letter. I have an EMG/NVC scheduled for Upper Extremities. All of these have happened at a much faster pace than I have normally experienced with the VA.

I have a question about the cervical spine being considered secondary to the lumbar spine.

The original C & P specifically cited "no noted abnormalities of cervical or Thoracic spine".

The second C & P was dramtically different

Diagnosis:

Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease

Paralysis, incomplete, moderate, right sciatic nerve, as likely as not secondary to service connected lumbar spine condition.

impacts:

decreased mobility, problems with lifting and carrying, pain

prevents: exercise, sports, recreation

severe: chores

moderate: shopping, traveling, bathing, dressing,

mild: toileting, grooming

none: feeding

My activities are severely limited as a result of the problems with my back, so my question is:

1. Likeliness of a rating for the cervical spine as secondary to lumbar spine, even if the C & P was not for my cervical spine.

2. If I do not recieve a rating for the problems with my cervical spine, should I start a claim.

I have assumed the back pain was natural with the arthritis and DDD so my cervical spine has never been a specific complaint to a doctor. It seems apparent that I have progressive issues with my spine over the previous 3 years

Note: All appointments for my lumbar problems and cervical spine have been with VA doctors.

Thanks for any and all responses.

[lt4ds]

ok, I wasn't sure. It's hard to figure what they will do with limited experience dealing with them. I would assume the C & P notes will make a decent place to start for filing a claim for those things moving forward, although I am sure there will be some type of contention and a follow up C & P, even though they are noted in the notes. Thanks for the input John.

What I have seen is that if you don't claim it you don't get it.

[lt4ds]

Well, I recieved a decision, or at least a partial decision on this claim. I did recieve 2 ratings, 1 expected just lower than expected, and 1 that was not expected. Still quite a few that were either denied or deferred. Also several things that are part of an appeal that were covered in the C & P. The VA can be so frustrating.

They rated me as follows:

10% Irritable Bowel Syndrome as a presumptive illness from service in Southwest Asia. I thought with my symptoms it would rate as 30% but am happy with this, it can be appealed later. Symptoms as stated by the rating officer: Soft to loose stool with every episode of of food intake. eating reliably followed by fecal urgency with abdominal cramps. I am not sure I understand the difference, the explaniation of the rating decisions follows.

States an evaluation of 10 % is granted if the record shows frequent episodes of bowel disturbance with abdominal distress. A higher evaluation of 30 % is not warranted unless there are symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.

10 % Miagraines (claimed as headaches) This was a surprise. Went through the "Gulf War Syndrome" exam, of which headaches are part of, and I do have headaches. I also was diaginosed with migraines during my service time. not unhappy about this at all.

Deferred on the following:

increase for scar, left nose

aches/pains (associated with Gulf War Service)

Neuropathy bilateral upper and lower extremities

Skin disorder/acne

diabetes

several others that were denied.

I guess I am going to have to let the deferred claims work themselves out, but from my experience I will have to file an NOD and then an appeal.

I have a pending appeal for several items that were covered during the C & P, that have set for over a year and have not moved from the local office of jurisdiction. I am sure it's because I had another claim in process, hopefully they will begin working on the appeal since everything in the appeal was addressed in the original claim filed in 2008, and were identifed in the last C & P exam.

Right hip, included in original C & P and denied, NOD'd, and then appealed

Hip

Active Range on Motion for each type of motion of this joint :

Flexion: to 80 degrees

extension: to 0 degrees

adductions: to 25 degrees

abduction: to 45 degrees

internal rotation: to 40 degrees

external rotation: to 60 degrees

Note: pain is caused with active excursion and is due to back condition and not due to intrinsic hip joint disease: passive excursion is tolerated with normal flexion to 90 degrees.

Is there objective evidence of pain on active motion: yes

Is there pain on motion after at least 3 repetitions of ROM: unable to test

Additional limitations: no

reason unable to test: baseline pain with active excursion and baseline impairment makes testing an undue burden

Right foot part of original C & P denied, NOD'd, appealed

Foot exam

right/left

Abnormal findings: weakness, circulatory disturbance

dscription of abnormal findings:

unable to abduct, normally plantat flex toes at MTP joints

very cool to touch

absent ankle jerk

knee jerk hyperactive

Sensory exam:

sciatic nerve right/left lower

vibration: absent

pain/pinprick: decreased

location: entire limb, more severe anterior thigh, medial calf, and foot

light touch: decreased

dysesthesias: yes burning pain anterior thigh

description of other motorimpairment: unable to abduct, plantar flex toes either foot, marked weakness of right EHL; increased tone in both calves; mild atrophy distal quadriceps

effectson usual occupation and resulting work problems:

leg symptoms due to SC degenerative disc disease limit walking, standing, sitting and similar activities of the lower extremities.

hypertonicity of bilateral plantar flexor muscle groups with overuse related to pain; etiology is likely as not disuse due to severity o SC back and sciatic nerve conditions.

Left Shoulder part of original C & P, denied, NOD'd, appealed

Left shoulder ROM

forward flexion: 90 degrees

abduction: to 90 degrees

internal and external rotation: to 50 degrees

extention: to 30 degrees

objective evidence of pain on active motion: yes

pain on active motion after at least 3 repetitions of ROM: yes

ok, I wasn't sure. It's hard to figure what they will do with limited experience dealing with them. I would assume the C & P notes will make a decent place to start for filing a claim for those things moving forward, although I am sure there will be some type of contention and a follow up C & P, even though they are noted in the notes. Thanks for the input John.

kind