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Appeal To Split Combined Vagal Nerve Reflex And Benign Paroxismal Positional Vertigo
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FullTime
Hope I am am posting to the right place. I received 0% on Sensitive vagal parasympathetic nerve reflex and benign paroxysmal position vertigo. These two disabilities (claimed as pre syncope syndrome and vertigo) are evaluated together because the share etiology and symptoms.
I don't believe that these two disabilities should be lumped together. I don't believe that there should be 0% on either of these two disabilities.
I started my appeal with a rough draft and wonder if anyone could take a look at what I'm saying and see if my research and reasoning are on the right track. The rough draft follows:
Any feedback is appreciated.
Appeal to separate the benign paroxysmal position vertigo from the Sensitive Vagal parasympathetic nerve reflex.
Appeal: My appeal is to separate the benign
paroxysmal positional vertigo and the sensitive vagal parasympathetic nerve
reflex into two separate claims. The
first being rated as 6420 at 30% and the second being rated as 8210 at 30%. The
following is my argument and supporting medical history for the two ratings:
I experience dizziness frequently in several different
ways: The primary experience is the
momentary feeling of falling or tumbling that lasts for several seconds. It causes me to stumble when walking, or seek
firmer footing when standing and use my hands to stabilize when seated. The feeling comes when least expected and
happens on a frequent weekly basis.
I also experience is a sensation of having my environment
continue to move when I stop or change directions. For example I can be standing still and turn
myself to see or respond to someone calling out to me and the turning sensation
will continue after my body stops. This also happens when I am walking in a straight line and turn a corner. I will feel as if my body is still moving in the direction that I was going before turning the corner. (I am in the process of going through my 900 pages of medical records to show where I have complained to doctor and neurologist about this)
In _(Find date oftreatment)______ I experienced an incapacitating case of benign paroxysmal
positional vertigo where I was unable to move between laying down and sitting
up without incapacitating dizziness and nausea.
I went to the flight surgeon that was very familiar with this condition
and he treated me using a head movement method called “the Eply maneuver” where
the head is moved along various rotational planes for approximately 30
seconds. The Eply maneuver is used to help
usher out tiny crystals of calcium carbonate, which are a normal part of the
inner ear’s anatomy, that have detached from the otolithic membrane and settled
in one of the semi-circular canals. The
procedure worked, I was able to function normally after the procedure. This fact lends itself to a certain diagnosis
of BPPV.
Through my treatment of BPPV and discussion with the flight
surgeon, his estimation was that there are many different causes for BPPV and
unless the symptoms persist and are incapacitating, there is no reason for a
grounding status and there is no good explanation for why some people get it
and some don’t. The most common cause of
BPPV for persons under 50 is concussive force to the head. The flight surgeon explained that exposure to
explosions or noises so loud that one can feel them in their chest or head can
lead to these calcium carbonate crystals becoming weakened and dislodge over
time.
It is important to note that no two episodes of BPPV are
expected to be the same. The size of the
calcium crystal, the position of the crystal as gravity moves it within the
semi circular canal and the magnitude of the nerve receptor response will all
play a part in the intermittent pattern of symptoms. One common theme of BPPV is the symptoms
present themselves in relation to movement against gravity.
The rating for BPPV
should come under 6204
Peripheral vestibular disorders: I believe I should be rated at 30% for this
service connected dysfunction because of the occasional staggering, the need to
reposition when standing still and needing to find something to hold on to when
seated and having occasional dizziness.
Peripheral vestibular disorders
6204
Dizziness and occasional staggering......................................................................... 30
Occasional dizziness................................................................................................. 10
Note: Objective findings supporting the diagnosis of
vestibular disequilibrium are required before a compensable evaluation can be
assigned under this code. Hearing impairment or suppuration shall be separately
rated and combined.
The essential part of my argument to split the BPPV rating
apart from the Sensitive Vagal Parasympathetic nerve reflex is that the BPPV
was identified by an incapacitating episode of dizziness and treated
successfully using the Eply maneuver.
The second part of my argument is centered around a
well-documented conclusion that the vagal Parasympathetic nerve reflex (VPNR)
is caused by position of the neck specifically, it affects the 10th
cranial nerve as it travels down the right side of my neck and specifically
where the Vagal node is located where one would check for a pulse on the carotid
artery.
Background: Post
surgical fusion of my neck and subsequent physical therapy dated and documented
_date_ brought about a correlation
between executing the stretching exercises assigned and a feeling of fainting,
or the dizzying panic that comes with a rapidly lowering heart rate and blood
pressure. I had been assigned a stretch
to reach up with my left hand and pull my head directly to the side. This stretch caused the right side of my neck
to stretch out and subsequently allowed me to draw an undeniable relationship
between the position of my neck and the feeling of being ready to loose consciousness. Throughout the period from cervical surgery
to present day I have suffered from episodes that felt as if I was going to
faint. The symptoms could be grouped
into simple dizziness, but they are very different. The more frequent these episodes became the
more I was able to narrow down the position of my neck. The example I gave to the doctor, which
allowed me to see a cardiologist is one where I was driving down the road and
talking on my cell phone. I had the
cruise control on and was lazily laying on my right side, right elbow on the
center map case with my cell phone in my hand.
This was causing my neck to be flexed in such a way that the vagas nerve
was affected and it caused the vagal response.
I felt dizzy, flushed; panicked and thought I may loose consciousness. I immediately hung the phone up, sat up
straight and focused on driving. The
symptoms left me as quick as they came and I felt normal. During the same drive I resumed my phone
call. For the second phone call, I
placed my left elbow on the driver’s side window to hold my phone in the left
hand. I leaned my head to the left in
such a way that it stretched the right side of my neck and I quickly had the
same symptoms as before and I learned that this panicky dizziness with
impending feelings of loosing consciousness were brought on by the position of
my neck and held stationary in such a way that the vagas node on the right side
of my neck was affected. The range of
motion is quite small that brings about the vagas response. The physical therapy provided where I was
actively pulling my head to the left and inducing the response and the more
slight tilt of my head directly to the left allowed my cardiologist to draw the
conclusion that the Sensitive Vagal parasympathetic nerve reflex was caused by
some type of dysfunction on the right side of my neck where the Vagal node is
located.
The rating for sensitive vagal parasympathetic nerve reflex should come under 8210 Peripheral vestibular disorders: I
believe I should be rated at 30% for this service connected dysfunction because
of the extent of sensory and motor loss to my blood pressure, heart and
respiratory system. There is frequent
dysfunction, which can lend itself to distracting and dangerous situations.
Tenth (pneumogastric, vagus) cranial nerve
8210
Paralysis of:
Complete 50
Incomplete, severe..................................................................................................30
Incomplete, moderate..............................................................................................10
Note: Dependent upon extent of sensory and motor loss to organs of voice,
respiration, pharynx, stomach and heart.
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