ptsd results of cp exam do I have ankylosis favorable or unfavorable

[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.

 

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

Will they take in consideration less movement due to ankylosis as mentioned above in this note?

or will they base my disability on rom?

I have looked up and if they base it on my rom it will be 20%, but who is to say if they will take into consideration ankylosis, and nerve injury?

Any advice will help

 

[brokensoldier244th]

Its "at least as likely as not" that your humvee flight lesson caused your injury-weight of determination should go to the veteran, so I would say yes, service connected. 

 

Nerve pain/sciatic is rateable, usually as 'radiculopathy' or as neuropathy. Most of the time its 10% unless you have foot/ankle drop or partial paralysis. I had 'mild' rated at 10% but over the years it graduated to 'moderate' and I had a few falls. Its now 20% bilateral.

 

Radiculopathy doesn't have anything to do with depression- not sure what you are asking there. I am rated for depression, anxiety, intervertebral disc syndrome, and neuropathy (secondary to IVDS). Nerve compression is what it is- a straight leg test, EMG, or sensation test should sort that out. 

My depression is secondary to my pain caused by my back and legs, so even if they wrap pain up in 'mental' you still should have it at least as a contributing factor and so your depression rating may go up as well, depending on how it affects your daily life. Pain is weird- and when you are depressed and anxious it certainly compounds your sensation of pain. 

Motion is what is used as the basis for most back injury claims- so you may get a 20% for your IVDS, but your nerve issues would be rated separately. 

Edited May 14, 2016 by brokensoldier244th

[gass278th]

but the doctor put this in here

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

 

ankylosis

 

[gass278th]

so does that mean they will base it off of ankylosis? i am so confused if they did it will warrant a higher rating than 20%

[brokensoldier244th]

It looks like 20%. The ankylosis is a contributing factor to your reduced motion, but your forward flexion is 40* so that falls into 20% category. The nerve roots will be rated under code 8520 for sciatic nerve, most likely. 

 

Being out of work for 5 months may be an extraschedular contributing factor, based on some VA Court of Appeals citations that I have read, but I am not familiar with how that part works in personal experience. I did not file for IU until I had already been out of work for 6 months and it was determined on its own, separate from my already rated back injury since it was more tied to MH issues. 

 

Edited May 14, 2016 by brokensoldier244th