Strong enough nexus

[Andyman73]

I was at my PCP for routine services and he pointed out that a VA doc had said my SI joint pain was most likely caused by DDD, DJD, and low back issues.  This doctor wrote this back in the spring.

so, my question is this...is this strong enough to file for SI joint pain secondary to those issues? I've been SC for my low back since late 1998, which is currently rated at 40%. If a VA dr gave this opinion rationale, is it good enough to base my claim off it? 

[silverdollar22]

Hey Andy,

                 I thought that it was next to impossible to get anything higher than 40% on the back weather on ROM or pain!  I'm at 30% and hope to get 40% when i go for my C&P Sept. 6.  Maybe i'm wrong?  I hope for both our sakes that i am but anything higher would have to come by IVDS and bedrest !

[armorer]

It sounds like to me, a rookie, you are counting on an indirect Nexus based on rater discretion without an exact rating proposed and the 13 required features of a Nexus. But it is from a MD PCP. My NP PCP opinions are only 'fully' valid if a MD references my NP PCP's opinion, so you may be good to go. From my understanding though, VA PCP's can't give IMO's, IME's, or Nexus' for the Vet. It may be worth a gamble of time invested for you, but I think they are waiting for NPH (spinal tap), dementia, and/or a successful suicide attempt from me before they do anything.

A Nexus means, as far as I understand, big bucks or several months in appointments in advance. Chart your 3 alternatives' critical paths with assumed probabilities, costs, and lead times: it should be a robust estimate for starters to use as a guide post for any decision you make (to know when maybe to switch or combine strategies too.) You need to reference something for time and cost comparisons, that you can continually adjust as you go.

Don't worry about being exact on any measure. The fact that you are estimating all of the parameters means by the Central Limit theorem that you will probably be very close in system estimates. Keep It Simple.

Edited August 23, 2016 by armorer

[Andyman73]

Silverdollar, No, just takes a pretty significant reduction in bend ability or ROM to get there.

armorer

Mu PCP showed it to me, I asked if there was a DX in there somewhere.  He showed me where the rheumatologist made that inference.   He is the one who sent me to the pain clinic for pain shots.   This all started with a C&P exam for my hips, at that time I didn't know about the SI joints, I went back to my PCP who sent me to physical therapy. After pt said no more due to increasing symptoms, or not helping. Then the rheumatologist, who checked me out said he recommends the injections. He is the one who said secondary to those other issues.  

Wouldnt the rheumatologist opinion be strong enough for a secondary claim? 

[armorer]

Yeah, it looks like you've been around the block before. Hips are bad news and I would not let a VA surgeon near me. Right after injections, surgery is the following week! Take the claim and go to an acupuncturist first. The needle with electronic stimulation is stronger than morphine. Then verify with a couple of good surgeons and get some good radiological imaging done. Go with the Choice program: that would be my top choice! Worry about your health in your trunk area and don't get too distracted by the claims end for now. Safety first. They can mess you up for good!

It sounds like you may have RA, and that's tough in the longterm. I hope your  rheumatologist is good. But its not that bad, except you have got a lot going on now.

 

Edited August 24, 2016 by armorer

[Andyman73]

According to them it is the sacroiliac joint/crest that is where I'm experiencing my pain and the SI joints is where I got the injections in. 

No surgery mentioned yet.

[triman8654]

Andyman73, yes in my opinion this would be helpful. I would grab ALL medical notes appointments pertaining to this issue. Submit docs with your new claim for secondary.. Keep getting treatment & records from that tx as you go and it will all fall into place. Just my opinion..