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VA primary care will not refer to Rheumatologist or MRI

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  • HadIt.com Elder

Ain't that the truth 63SIERRA  

Btw   Welcome Back to Hadit

...............Buck

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  • Content Curator/HadIt.com Elder
On 6/10/2016 at 11:06 AM, seminoles said:

I don't think this is a systemic VA problem, I have had the absolute opposite experience.  Request a new PCP.  My podiatrist referred me to the rheumotologist.

The experience does vary between VAMC and even between doctors in the same VAMC.

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  • Content Curator/HadIt.com Elder
On 6/8/2016 at 3:52 PM, fiasco2g said:

Hello. I am new to this site and need a little info. I am trying to get my va primary care doctor to refer me for an MRI for my back and a Rheumatologist for the pain in my knees, hands, back, etc. He said he does not know why I am hurting but will not send me to a specialist. This was messaging response below:


I have reviewed your lumbar spine films and you have a mild L5-S1 disc disease.  Without radiculopathy, an MRI is not warranted. I understand that you are applying for benefits, but it is not the VA providers responsibility to order all tests and exams that you want done.
  I have to justify all consults and exams.  Your lab work is within normal limits so Rheumatology will not be consulted as they have rules as to who can be seen.  You do not meet the criteria for Rheumatology consult. 

Well I did not want every test in the world just something to diagnosis the problem. I sent him a reply asking what the next step for treatment and diagnosis is then since he told me that he does not know what is wrong with me. I thought 30% of the time

blood work will not tell you anything for Rheumatoid arthritis, fibromylagia, gulf war syndrom, etc. I just need help. I paid for an MRI myself on one knee and it is expensive.

I am not service connect yet but filed an intent to file in January 2016. So I need to get the ball rolling on diagnosis and will go the civilian route if required. But is the VA responsible for at least attempting to diagnosis the problem or just continuing to push me six months down

the road to the next appointment. Thank you for you help.

That VA primary care doctoc is among those who give the VA system a bad name.

 

Keep in mind that I am not an expert, but here is my opinion as a fellow disabled veteran with SC neck and back issues:

An x-ray showing "mild L5-S1 disc disease" is visible proof of a problem. The doctor is right that L5-S1 nerve issues are related to sciatica, but he is wrong to assume that sciatica is the only problem. When my L5-S1 acts up, it feels like someone hit my lower back with a baseball bat and causes problems walking. Additionally, it's pretty common for the neighboring muscles to spasm, which is your body's natural response to tighten up and protect the area from further injury, and this causes even more pain. Combine that with your knee and other issues and you start to feel like a ball made of rubber bands. By just relying on an x-ray alone, the doc also fails to identify any other factors which could be causing your problem, such as herniated discs, stenosis, osteophytes, etc...

Regarding fibromyalgia, there are some advanced blood tests (FM/a or ANA) which can help identify some factors. On top of that, to diagnose fibro, usually the rheumatologist runs a boatload of different blood tests, trigger point tests, etc... The goal is rule out everything else that could be contributing to your symptoms.

Regarding filing your claim, keep in mind you need these three things:
1. Event/injury in the military
2. Current diagnosis
3. Nexus/opinion from doc connecting 1 and 2

Keep in mind the VA is setup in two entities. The VBA handles benefits/claims, C&P exams, etc... The VHA is basically the hospital, clinic, medical, mental arm of the VA. Your VA doc will probably tell you it is not their job to write a nexus, but they are supposed to help diagnose.

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an x-ray showing mild DJD is an example that most people have a touch of arthritis in their back when they get older. my ortho doctor has preached this as long as i have known him (1988).

 

of course, its possible there are other issues going on not seen in a routine xray. but as a longtime back sufferer i don't know where there is a need for an mri. i'm 40 percent for my back, with a history of over a dozen mri's on my entire spine.

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iceturkee, to really get an accurate picture of a back disability, multiple diagnostic exams are the best approach.  I'm sure you know this as most of us have come to find this revelation is true.  The key to most is whether there was trauma in service, and whether the trauma caused an advance in a deteriorating condition.

I cannot for the life of me understand why the VA medical centers get away with this crap.  Institutions that practice this should be severely fined and not be allowed to practice.  A multi million claim settlement might cause enough waves to fix some of these issues.

63Sierra, it's great to read your posts again.  How have you been managing?  

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if you truly have a back problem, then yes. but many people just have a touch of arthritis and they don't need cat scans and/or mri's. even my civilian physican assistant friend who works at an ortho clinic will tell you that!!

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