ptsd cp exam for back

[gass278th]

question # 1 Does the veteran have a diagnosis of a back injury that is at least as likely as not 50 percent or greater probability incured in or caused by the back injury following being thrown from a humvee during service?

answer #1 yes, the veterans diagnosis of a back injury is at least as likely as not 50 percent or greater probability incurred in or caused by the back injury following being thrown from a humvee during service.

Rationale: It is more likely than not that this veterans service connected injury has resulted in progressive disabilty of the back.

Impression allowing for some variability in spinous processes alignment of the thoracic and lumbar spine is normal.

no evidence of fracture or traumatic subluxation.

few minor thoracic and lumbar degenerative features include the following t10 t12 l1 lower endplate schmorls nodes, mild loss of disc height at l1, l2 with small anterior ostephyte.

There is also a lower cervical spine level with mild loss of disc height and small ostephytes.

Thoracic and lumbar spine series are otherwise normal.

Some straightening of the thoracic spine which could be positional and secondary to muscle spasm.

Thoraco lumbar spine

thoracic degen joint and disc disease.

lumbar degen joint and disc disease.

Lumbar intervertebral disc disease with no prescribed bed rest.

analog pain severity scale is 4-7 and 8-10

the pain quality includes as follows aching throbbing burning dull grinding popping sharp and soreness

forward flexion 0-40

extension 0-15

right and left lateral flexion 0-15

right and left lateral rotation 0-30

veteran has radicular pain

right and left lower extremity= moderate

intermittent pain= moderate

paresthesias and dysesthesias = mild

numbness= moderate

Indicate nervce roots involved l4/l5/s1/s2/s3

indicate severity of radiculopathy and side affected moderate

Note: the veterans assertion of increased pain and loss of function are creditable. However, the probable etiology of the current additional intensity of pain and disability are more than might be expected with the current diagnosis. Therefore, the significant increase in intensity of pain from the anticipated level may suggest that it may be more likely than not attributable to these non anatomic causes. These non anatomic causes can increase patient perception of pain and loss of function. The current chief complaints of increased pain and loss of function are more likely than not the result of confounding factors.

Confounding factors are defined as those factors that may intensify the veterans perception of physical musclo skeletal pain, but from various etiologies unrelated to the service related physical injury.

Note: possible confounding factors identified in this veterans history include the following depression, ptsd, anxiety.

Note: Evaluating the possible impact of these multiple complex confounding factors effecting the veterans perception of musclo skeletal pain are beyond the technical expertise scope of the practice of the general medical provider. (I.e. Clinicans not specialized in psychological issues.)

Questions I have

Will these issues likely to be service connected, and if so how much?

What all problems are rateable, and is my nerve pain rateable or will they deny me because of confounding factors?

Also will my radiculpathy be denied because I have depression and ptsd and anxiety?

The cp exam said I did straight leg raises and the doctor checked the negative box. I did not perform this test. Also I told him I have muscle spasms, and the va prescribes me tizandine for them. The doctor did not check the muscle spasm box and check no. I did this test in Johnson city, tn. I have a feeling they are trying to screw me, and it seems like it.

 

[gass278th]

Help please

[jbasser]

IVDS with no bed rest. You have a positive C and P exam You also have Traumatic Arthritis. It will be interesting to see what road the VA will take on this one. I will guess it will be IVDS. If it were Traumatic Arthritis the nerves would be rated separately. 

 

[gass278th]

At what percentage 20% is what I thought it's a shame to think I cannot perform my duties as a diesel mechanic ne more and have been out of work for 5 months. Any feedback will help I think they should rate the nerve pain plz reply

[gass278th]

Also note in addition to those addressed above are there additional contributing factors of disability. Less movement  than normal due to ankylosis, adhesions, weakened movement due to muscle or peripheral nerve injury, instability of station, disturbance of locomotion, interference with sitting and standing

Would these add to contributing factors to increase my disability been out of work for 5 months

I am so scaredI can't work as a diesel mechanic and house is going into foreclosure. I have lost my health and bout to loose my house. I am only 28

I am worried that I will only get 20% any suggestions would help this is a complex injury

[gass278th]

Bump

 

[gass278th]

Also note in addition to those addressed above are there additional contributing factors of disability. Less movement  than normal due to ankylosis, adhesions, weakened movement due to muscle or peripheral nerve injury, instability of station, disturbance of locomotion, interference with sitting and standing

Would these add to contributing factors to increase my disability been out of work for 5 months

I am so scared I can't work as a diesel mechanic and house is going into foreclosure. I have lost my health and bout to loose my house. I am only 28

I am worried that I will only get 20%

any suggestions on what rating will be