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

[Hogfan1978]

Berta, thanks for the response. My responses to your comments/questions are in BOLD:

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? No, she didn't. This was my general practitioner. She has stated that she will write a letter though. I will try to write it for her with all the correct verbiage and see if she'll sign it.

Does the VA have that info? No, it just happened on 1 Oct. The only thing that the VA knows about is the 10%SC lower lumbar spine injury.

"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? NO

Is the Neuro a VA doctor? No

Was the MRI report favorable to your claim? Not as written, that's why I want it corrected. If correct, it would support my claim. I, myself, can look at the MRI pic and see the herniated discs...

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. I will bring him my pertinent service records.

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." Yeah, I know. Nothing like this will be sent to the VA.

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 was under the impression that it would be best to claim this new c-spine injury as a new claim, independent of the lumbar spine strain 10% that I've got. That's why I wanted to get this nexus letter, to link the upper spine injury to the ATV accident (not to the lower back injury). If this is a bad idea, or I just don't know what I'm talking about, please, let me know....

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. I don't know him well, but other trusted doctors have recommended him to me. My original statements about him may have been written incorrectly, I think he's good. Just when I asked "what could've caused this?" he basically said "anything really"

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? NO, I have never seen, not talked to, this radiologist.

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

[Berta]

. "I was under the impression that it would be best to claim this new c-spine injury as a new claim, independent of the lumbar spine strain 10% that I've got. That's why I wanted to get this nexus letter, to link the upper spine injury to the ATV accident (not to the lower back injury). If this is a bad idea, or I just don't know what I'm talking about, please, let me know.... "

You could raise both potentials- direct SC for the c spine problem and also claim it as secondary to the established SC.

A claimant can raise as many potentials scenarios they want- to attain SC. VA will only award under one scenario but many raise more than one issue.

I raised a secondary issue many years ago that was denied in 1995.I also succeeded however on another claim pending for the same award I sought.

Now that older denied issue is at rating board under the new AO regs.

So it pays to claim you have disability due to more then one cause if possible.

[Hogfan1978]

Berta,

So I can chase this as a new claim submitted and also try the route of secondary to my lumbar SC disability? If so, can you step by step the process of getting a secondary claim? I will also search the forums, but you seem to know a lot about it.

Thanks

Ryan

[Berta]

I agree with what Sharon said in this thread.

Since you are still accumulating evidence you could , when you submit it, say it is in support of the secondary claim you filed (I think you filed it as secondary?) and that you also request a determination based on direct service connection as well -due to the enclosed evidence.(if you have documented medical evidence that warrants direct SC.)

"If so, can you step by step the process of getting a secondary claim? I will also search the forums, but you seem to know a lot about it."

I described secondary SC here:

Basically it means the VA as established a SC rating for something you have.

You get medical evidence that you have an additional ratable disability directly due to or caused by the SC disability.

If you are attempting to get an independent medical opinion, please use our IMO criteria in our IMO forum here.

I developed this criteria from the IMOs I got.

The VA does not give us any format for IMOs.

The IMOs I got were from a former VA doctor so he knew exactly what wording should be in them.

He also sent me his 10--12 page Curriculum Vitae whch I sent to VA with his IMOs to show is level of expertise.

In another situation I helped a local vet but he did not advise the doctor the way I told him to prepare the IMO.

Also his doc got mad when he found out I accessed healthgrades for a print out on his expertise. The doc is well known in his field but the RO in Buffalo never heard of him down here in Southern part of NY.

The doc reluctantly prepared a new IMO. The vet won his claim.

The IMO doctor should state their currculum vitae or at least enough info to show VA they have expertise in the field.

In my case I had a NeuroRadiologist IMO for a diabetes claim.

Dr Bash stated that in his neuroradiological experience he as assessed the MRIs of thousands of patients with the same type of diabetic brain trauma as my husband had.

Many of those thousands had been Pts of is when he worked at VA.

This fully supported his ability to opine on my claim. He even said a VA's Endocrinologist's C & P was medically inaccurate and told them why.

This is what the "medical rationale" part of the IMO criteria means.

The IMO doc has to state why, medically, the claimed disability should be service connected and refer directly to specific SMRs and/or med recs.

I did a SVR radio show on secondarys but cant remember when- it might still be in our SVR archives here.

There is plenty more info on secondarys here under a search.

[Hogfan1978]

Okay, so I found the "Dr. Quack/John Doe" sample nexus letter that has circulated around this site. I basically pasted that sample letter into a Word document and inserted my info and several notes for my general practitioner to put her own words in it. In a nutshell, it's got the following items in it:

-the fact that she has reviewed my service medical records and the medical records that she has on me since I separated (which is not much)

-her diagnosis of my problems

-specific references to pertinent medical records (the ones that complain about back problem (although they are all complaints about my lower back) and the record of my ATV accident)

-the fact that I have not had any traumatic injuries since my ATV accident that would have caused or worsened my accident

-medical terminology that links my ATV injury to my current condition

-I gave her a choice that if she feels that there's a 50/50 chance that my ATV injury is linked to my current condition to say that "it is as least as likely as not" and if she feels that the chance is greater than 50% that they are linked, to say, "it is more likely than not" that they are linked.

I gave her the sample and explained that all of the above info must be in the letter or the VA would disregard it. I also gave her copies of any service records about my back and the ATV accident. I also included the neurologist's diagnosis that my C6-7 showed an "impressive herniation".

Once I have my general practitioner's nexus letter (assuming she does write it), I will include her letter in a similar package to my neurologist to get a nexus letter from him. The reason I'm doing this is because my neurologist's nurse told me that he would probably be glad to sign such a letter, but it would be advantageous if my general practitioner signed one first and he could follow up with a similar letter....

So, what do you think about how my nexus letter will be written? My only concern is that I wasn't able to give the nexus letter request package (as described above) directly to the doc. In fact, I had to give it to the receptionist who looked like she was about 18....so we'll see what happens.....*fingers crossed*

[Hogfan1978]

So, I used the below nexus letter format, wrote a "sample" letter, and scheduled an appointment with my General Practitioner. I gave my doc the choice to write "as likely as not" if she thought it was 50/50 chance of service connection, or "more likely than not" if she thought it could be more than 50/50 chance that my current herniated disc was caused by my ATV accident back in 2002.

She said, and I quote, "I can't really say either way, so I can't sign the letter". I told her that she didn't have to be 100% on her decision. I told her that if she thought it was just a 50/50 chance, then she could say "as least likely as not" on the letter....she still wouldn't sign the nexus, and apparently no explanation of mine would change her mind.

I thought that it was kinda strange that back during my first doctor visit after this herniated disc started causing problems, her exact words were "have you had an accident in the past? If so, that accident could have caused it...."

HOW THE HECK DO YOU GET THE DOC TO SIGN A NEXUS?!!

Maybe it just wasn't meant to be. I have yet to ask my neurologist to sign a nexus, afraid he might reject me like my general practitioner did...

Any ideas before the neuro says the same thing she said???