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Recently separated - dealing with disc bulge issues & VA next

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aoneinsun

Question

Hi,

I’ve been recently separated as a USAF Captain from active duty due to reduction in force, and I am new to this realm. (I was not medically separated.) I’d sure appreciate some advice.

 

Background

While on active duty, I suffered a bulging disc and had a lot of left hip discomfort after some long runs at the unit’s physical training sessions. They called it piriformis syndrome and gave me physical therapy sessions at the base clinic, muscle relaxers, & some pain killers. I’ve long had an issue with my low back which have been well documented throughout my career, and have paid for a chiropractic care out of my own pocket (Tricare does not cover chiropractor) for 10 years to keep my back in decent shape. I was identified as having a mild curve (scoliosis) before joining the service in fact.

I suspected something more was wrong since I felt more discomfort in the back (in addition to the left hip), and so I asked for an MRI of my back. That is when they found a 5mm disc bulge at L4-L5, pushing into the nerve root there.

The base physical therapy sessions (and some off base message work) did help my left hip muscles loosen, but I was still having left hip pain and back pain. So I did just go through round two of physical therapy off base (about 14 PT sessions). I couldn’t straighten either leg during their straight leg exam. I’m slightly better afterwards but still having about the same issue with what I believe is a bulging disc that is the main culprit for the pain in the hip. I’ve never had any shooting pain down the leg thank goodness. But recently I’ve also had some feeling of pin pricks sticking me in the toes of my left foot while driving, which I think is a bit of sciatica. I’ve also recently had mild twitching episodes/muscle spams, which happen intermittently on my left side.

Since I limp and favor my right side, it has been taking all my weight. Recently, I have noticed my right knee has been hurting, and my right ankle too, with my right ankle hurting to lift up too far (angling the right ankle up to the right to far results in an interesting pop sound, which hurts).

My 6 months of Tricare benefits post-separation are over, and I’m meeting with the VA doctor for an initial exam in early December. I am wondering how this will unfold. Here are a few of my questions:

  • While standing I have very limited ability to step forward with my left foot (if keeping my left leg straight). I also cannot quite lift my right leg up fully (if keeping the right leg fully straight). I believe this is because of the bulging disc, and sciatic pain that results (felt in the left hip which prevents me from stepping forward very much without going into pain). If I have this issue with BOTH left and right legs, would bilateral factor come into play, or are they likely to say that is all because of the bulging disc (which is what I really think)? I researched and found that limited motion of the hip seems like the most applicable rating along with some radiculopathy (sciatica). Is that the most applicable for rating purposes?

  • They had done an MRI of my left hip, and the MRI came back normal. But I think something may be going on with the hip such as trochanteric bursitis (though I’m no Doctor), since the remaining pain is along the outside of the left hip, and not just the buttock. There is also constant ache deep in the left hip,

  • Should I ask the VA Doctor for examination of the left hip in particular?

  • I assume they will give me a cane to help take the pressure off my right side. I have full range of motion of the right knee, but it has a wired feeling (as though it has been twisted), and it hurts to flex while bearing weight, and it hurts with certain motions. Would this be ratable as secondary to (caused by) the back issue which has forced me to put all this extra weight on the right knee over 8 months? Since I still have full range of motion, is the pain with motion all that must be evident for the knee to be rated more than 0%? Or is pain AND limited motion required for the knee to be rated above 0%?

  • As to the right ankle, I cannot lift my toes up much (dorsiflexion). I think this falls under code 5271: If the ankle is not frozen, but limited in motion.  If I lift the ankle up too much it pops, and that hurts. It aches in general. Apparently, the ankle is considered a major joint. If it only has pain and nothing else in this major joint, would that result in a rating higher than 0%? Or is BOTH pain and limited motion required for the ankle to be rated above 0%?

  • I cannot bend down to touch my toes. In fact I cannot bend over much at all without feeling pain in the left hip. I think that will fall under 5237: Lumbosacral or cervical strain. (I certainly cannot bend over more than 30 degrees, which is certainly ratable.) Is 5237 the most applicable for rating purposes? 

  • For any of the tests the VA will ask me to do, must I go into pain to ascertain the maximum range that I can flex to? I intend to stop flexing before pain and let the VA examiner know of the pain.

With these various issues, should I consult an attorney up front? Are there good attorneys or really, really knowledgeable people about this unfolding process to really get good advice? Who would you recommend?

I appreciate any advice and thoughts for pointing me in the right direction for the best help.

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I agree with Berta there are presumptives for "tropical diseases" as in 3.307, but those are not the ONLY presumptives for a Veteran who exited the service within the past 12 months.   Except as noted on the "entrance physical", Veterans who have developed a condition within 12 months after service are presumed to be service connected.  That is, the burden is on VA to prove that the Veterans conditions are NOT service connected.  

M21-1MR, Part IV, Subpart ii, Chapter 2, Section B   explains:

 

The presumption of soundness means that Veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at entrance into service.

 

Notes:

  • The presumption of soundness applies only when the Veteran underwent a physical examination at the time of entry into service on which the claim is based.

  • Only the conditions that are recorded in the examination report are to be considered as noted.

 

When no preexisting condition is noted at entrance into service, the burden falls on the VA to rebut the presumption of soundness by clear and unmistakable evidence showing that the disease or injury

 

  • existed prior to service, and

  • was not aggravated by service.

 

Reference: For more information on the presumption of soundness, see

 

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Hi,

 

I have indeed put in for VA disability well within the one year. I'll be going to some VA exams in the next few months for an ongoing lower back bulging disc issue, left hip issue (which I think is Trochanteric Bursitis) and also another issue with TMJ where my mouth will only open a certain width (opening any further has distinct pop/click sound and hurts/aches if going beyond that range of about 1.5 inches in my case). I had been treated for the TMJ issue while in service and given a mouth guard to reduce teeth grinding and told not to open my jaw "too far."

My VSO said that I do not have to pay for anything for the VA exams. I will need to attend the VA exams. I have a question though. They will likely see the maximum range I can open my jaw, and the maximum range I can bend over as I attempt to my touch toes, and the maximum amount I can step forward with my left foot. So I am wondering if the VA examiners will carefully measure the degrees exactly with high accuracy equipment such as with a goniometer to ensure a proper rating? I was reading that one may be well advised to have a private physician carefully make the measurements (presumably in concert with a VA attorney). Is it a common issue that during the VA exam they do not make the measurements with precision or overestimate your range of motion… resulting in lowered rating? I heard from a friend with back issues that he had a VA examiner just put in a write up that his back was just fine even though it was not (didn’t sound like the examining Doctor really thoroughly examined him at the exam). I was reading online that one attorney who works with workman’s compensation was saying those Doctors essentially work for the insurance company, and during the exam they are often going to end up reporting that you are just fine (essentially healthy). That workman's comp attorney was even recommending a “sandwich” approach, which is to be seen by your physician for your condition the day before a physical exam AND also be seen by your physician the day after your exam. This way you have a leg to stand on medically/legally when the exam results come back with eschewed results saying you are just fine (since then you can show proof from Doctors that shows the exact measurements of the limitation you were experiencing at the time... the day before and the day after). Of course that would be money I would have to pay out of my pocket, but I can do it if it would be worth it (vs having to go through a merry-go-round of appeals).

I’ve been hearing that the VA exam Doctors are not working on the side of the veteran by any means. What are your thoughts?

 

For example I was reading on: http://www.militarydisabilitymadeeasy.com/thespine.html

 

************************

 

NOTE: It is important that your physician records correct and thorough measurements for any back condition. The measurements should be measured with a goniometer. If possible, make sure your physician records the range of motion for EVERY direction. As shown in the above images, there should be 6 total measurements taken for both the cervical and thoracolumbar spines. THIS IS VITAL TO A PROPER AND FAIR RATING!!!!! Too often physicians do not record these important measurements properly, and then the service member’s condition is not appropriately rated.

 

************************

Your thoughts? Appreciate any insights.

 

Edited by aoneinsun
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aoneinsun,

Okay, first off, when ever you go through any exam where they are checking your physical mobility, you must stop at the point you FIRST feel pain or tightness.  Some lesser types may try to force you to move beyond that point, do not let them!

Also, describe everything based on your worsts symptoms, they will lowball or deny you otherwise.  Never tell them you are fine, tell them you are living. 

I went 15 years with a 10% for low back pain because I didn't follow the principle listed in my first line.  This past year I finally got bumped to 40%, for my back because I didn't bend or twist beyond the pain. 

For your sciatica symptoms caused by the  bulging disc, it's a separate claim from back, and is secondary to the back.  You can claim both at the same time.

It's better if you don't jump to the lawyer stage first, give the VA their chance.  Sometimes they do get it right.

Semper Fi.

Andyman

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