Cervical Back Problems

[Hogfan1978]

Okay, I am very new to the VA disability program and I have questions. First I'd like to give you the background of my situation:

I got out of the AF in 2007, I had been in for about 7 years. While in service, I had a 4-wheeler accident (while on duty). The 4-wheeler threw me back through the air and I landed on my rear end, the ATV then rolled on top of me and I was pinned under it for 25 minutes until help arrived. During the ordeal, the 4-wheeler was still running and being a 2-stroke engine, it was filling the ditch with exhaust making me nauseous and very dizzy. Also, while trying to push the running 4-wheeler off of me, I caught my finger in the drive chain which pulled my finger into the sprocket and cut my finger and tore off my nail, which the doc was able to sew back into place with a few stitches.

Last month (23 Sep 2011), I was awarded VA disability compensation of 20%:

- 10% for tinitus

- 10% for "lumbar spine strain (claimed as lower back pain and spasms)". On the lower back disability, the rating was based on range of motion. My combined range of motion was 230 degrees, which is right on the lower end of the 10% rating. On the decision report, the VA doctor said that it was as likely as not that the back problems were caused by the 4-wheeler accident mentioned above.

- 0% for hernia related pains

- Denied for knee pain because even though I experienced it while in service, I never went in to have it looked at.

- Denied for hearing loss. Even though the VA examiner opined that "it was as likely as not" that my hearing loss was due to military noise exposure, "the evidence does not show that you currently have a hearing loss for VA purposes"

So, having said that, I have some questions:

1) On 30 Sep 2011 (1 week after I received the disability decision report described above in the mail), I woke up with what felt like a crick in my neck. Expecting it to go away on it's own, I didn't worry too much about it. Besides, this crick was in my upper back and it was my lower back that had always bothered me. Anyway, after almost 2 weeks time, an MRI finding of cervical nerve narrowing in my spine due to discs, 4 prescriptions of Lyrica, Hydroconine, Valuum, and physical therapy (which starts Wednesday), I am still in pain, especially without the Hydrocodone. I called the VA and they "reopened" my lumbar (lower back) disability claim and said that they would send a letter asking for additional evidence. What should I send them on this new upper back problem and will it even apply since the existing disability claim was for lumbar (lower back) problems?

2) My civilian doctor also will write a letter addressing the problems I've been currently having. I want it to be thorough, but truthful. It will probably say something about the timeframe of the new back problem and something about the medications prescribed. During my initial visit, she also said that it was her opinion that the new disc problems could have been caused by the 4-wheeler accident mentioned above. She will probably state that in the letter as well. Will this letter even help my VA claim for back problems? I've already got 10%. Is it even worth my time to try? I saw that for disc problems I must prove that I've had X number of weeks of incapacitated episodes to get disabilities, which I have not had. I have not been able to go to work and have been pretty much laying in a recliner because of the medications and the pain, but I am not on bed rest.

3) I still have knee pain. As mentioned above, I did not have this in my medical records while in service. I have several coworkers that I have gotten in touch with that remember my knee pain and they have agreed to write a buddy letter about my knee problems. Will this even be worth it to appeal the knee decision and provide just 3 buddy letters to prove my knee pain? Not sure this will even work....

Any advice on my 3 questions above would be greatly appreciated.

Thanks,

Ryan Nelson

[COOL BREEZE]

I hope you get better as well. The VA used 3 MV whip lash accidents that occurred after I got out of the service. They denied my original claim for that reason even though I have experienced severe back and neck pain for over 25 years. Claim is on appeal.

[Hogfan1978]

cool b,

That's pretty messed up. Luckily, it's only been 4 years since my separation date and I haven't had any traumatic accidents, so they won't be able to blame anything else....

Again, what's the protocol about when to ask for the nexus letter? I've never seen this neurologist before, tomorrow's appointment will be the first. Not sure I want to just go bustin' up in there and say, "gimme a letter!" LOL.

[71M10]

Hogfan,

Many doctors like to explain why something is wrong. I think a good entry into the discussion is medical history mention that you had the 4 wheeler accident and no others(if that is true) and ask him do you think that accident is causing all this so many years later? Open the door and he may walk right through. If he says yes, ask if he could do a nexus letter, and stress the importance of being sure to get this documented properly. If he says he cant be sure about the accident then ask when he thinks the problem started. If he gives you a date prior to your active duty ETS ask him to provide a nexus letter that highlights the medical proof that your problems began before your ETS.

Best regards,

[Hogfan1978]

Thanks, great advice.

I'll play it by ear on asking for the letter.

I want to do this right, and I don't want to give the neurologist the impression that I'm just seeing him to get this letter. First and foremost, I want him to fix me....the letter is secondary.

I'm doing better this morning, still nerve tinglings up and down my arm into my fingers, but it's better.

Thanks,

Ryan

[Hogfan1978]

Well it was a very interesting afternoon,

First, I went to the hospital where I had the MRI done and got a copy of the written results from the radiologist. I also wanted to get the actual MRI pictures to show the neurologist, so I made a visit to x-ray and they burned me a cd with the pics. Then it was off to the neurologist appointment.

I gave the written MRI results to the neurologist. He looked at them and said, "I'm not impressed with this". He then gave me a physical exam, part of which was poking my fingers with a needle. I could NOT feel a thing. Looking surprised, he took the CD into his office to look at the pics, came back in about 5 minutes and said "follow me". In he office, he showed me pics of 2 herniated discs - between C5 and C7. He then told me that the written MRI report was not worth the paper it was printed on. He looked at the name of the radiologist on the report and said, "I'm not sure what she was thinking, she normally does a better job at the reports." Anyway, I asked the neurologist if I should have them correct the report and he said, "no, it will all be correct in my report and notes."

Anyway, after clearing that up, I asked him what would have caused this problem (earlier in the appointment he had asked me if I had ever had any trauma or anything like that). He said it could have been anything. He also said that sometimes these things can just happen to people. Bottom line, I didn't feel like today was the day to ask about any nexus letter or anything. I did, however, bring it to his attention that I have a VA disability with my lower back.

In conclusion, he gave me another prescription for hydrocodone and he also had me get this water-bag neck-stretcher contraption to use over the weekend. He said to call him Monday to give him an update on how I was feeling and we'd go to the next step of steroid shots at that point.

What do ya'll think (spoken like a true southern gentleman)? Should I go ahead and have the radiologist correct the MRI report? Seems like that would be the smart thing to do, otherwise I won't send it to the VA written incorrectly.

About the nexus letter, I am going to ask the neurologist. I'm so nervous that he won't agree to sign it....

Edited October 14, 2011 by Hogfan1978

[Berta]

In your past reply to JBasser:

"No sir, this recent c-spine injury is the first problem I've had from my neck/upper back. However, my civilian doc attributes it to my on duty vehicular accident."

Did this doctor document that statement?

Does the VA have that info?

"looked at the name of the radiologist on the report and said, "I'm not sure what she was thinking, she normally does a better job at the reports." Anyway, I asked the neurologist if I should have them correct the report and he said, "no, it will all be correct in my report and notes."

Was the MRI radiologist report done by a VA doctor?

Is the Neuro a VA doctor?

Was the MRI report favorable to your claim?

If so why change it?

Personal experience- often Neuros compete with Radiologists to be 'right'.And vice versa.

"About the nexus letter, I am going to ask the neurologist. I'm so nervous that he won't agree to sign it."

If not it is time to consider an independent medical opinion.

Unless this neuro is a non VA doctor- but one also has to consider he would need to understand how your SC disabilty is relevant to this claim.

The IMO criteria is here in our IMO forum.

His statements here wont help you:

"Anyway, after clearing that up, I asked him what would have caused this problem (earlier in the appointment he had asked me if I had ever had any trauma or anything like that). He said it could have been anything. He also said that sometimes these things can just happen to people."

I have prepared cover letters and evidence for 4 separate IMOs I obtained for my last claim.

Even though 2 of them came from Dr. Bash (Neuro-Radiologist) and former VA doctor who knows exactly what an IMO should contain,

in any event I laid out the probative evidence they needed to consider in the cover letter and why and then gave them all medical and legal records available to support my position .

My point here is you have a SC disability that this could be found as secondary to.

But an IMO doc needs to access the SMRs and/or the past VA SC decision as to the nature of the back injury as to being relevant to causing you this additional disability.

I had an experience years ago with a VA cardio and two VA Neuros who all thought they were stating the word of God to me and that I would buy what they were selling.

It was funny in a way because they all wanted me to think they each were in charge of the situation.Which meant they wanted to be in charge of a cluster XXXX.In my opinion.

Unbelievable situation.

This was on the heels of a CT scan as well as MRI. The VA doctor who read the CT scan was wrong and I challenged her.

I had past experience of a Neuro nature and knew her interpretation of the scan was wrong and I got her to call a Neuro at another VA to read it, and his interpretation was correct and exactly my 'diagnosis' too.

When I read this it hit me that this neuro seems pretty pompous.

BUT he might be a great doctor and give you a strong IMO.

IMOs can be expensive but a private doc might do one for free or low cost.

Did the radiologist's MRI narrative refer to the SC back injury at all?

It probably didn't but if it did-what did the narrative say as to that?