lumbosacral Filing for Increase in S/C disabilities - just getting started

[Crabcake]

Greetings all! I thank you all - in advance - for the wealth of information available on this site to help vets. I stumbled upon it while researching what to do, where to start, etc. on filing for an increase for my S/C rated disabilities. At this point, what I have is: a full copy of my service records, and I have filed a notice of intent this week with VA. I am going to chronologically organize & flag my service records this weekend so I can identify where these things are noted in them.

This will be long, but I want to lay out as complete a starting picture as possible to help understand my situation in hopes of getting advice on how to proceed. I've been fortunate to have had good health insurance through my employer for years, and have used it for treatment as needed vs. the VA because of how cumbersome getting to & through the VA system can be. In the last two years, my insurance is now an HDHP, which means until I pay out of pocket $3500, insurance doesn't kick in, so I need to start utilizing the VA for these issues because I cannot afford to pay for the injections, films, treatment, etc. anymore.

The neck, shoulder and low back issues stemmed from a combination of a fall I took during a training exercise carrying way more gear on my back than I should have; a fall during a squadron event; and, a motor vehicle accident. What I feel may complicate things is that I have also been in a few car accidents since being S/C rated; none were my fault; I'm sadly just a crash magnet for inattentive drivers. The last one caused a minor rotator cuff tear in my left shoulder, further aggravated my cervical spine pain (to include shooting pain down my arms and fingers) and lumbar area & SI joints (to include severe shooting pain down both legs to the ankles). Following each accident, I've gone through ortho treatment, MRIs/x-rays, PT, injections in the SI joints and left shoulder, etc. And in 'settling' each accident, the insurance companies cite my 'pre-existing conditions' as reasons for low settlements.

I had a bad flare-up of both the neck & low back problems earlier this week with the shooting pain down arms & legs, and went to the Durham, NC VA hospital ER because I'm not assigned a VA PCM yet (that appt is next week). The ER did x-rays which - according to the ER doc - showed: loss of disc space and degenerative changes in cervical & lumbar spine and SI joints and my cervical spine is too straight vs. curved - all of which is resulting in the nerves from cervical & lumbar areas being pinched causing my shoulders/arms/fingers to go numb, as well as the shooting pain down my legs. She also noted arthritis in my spine, but I didn't catch the specific locations. Her discharge diagnosis reads: neck/back pain; degenerative disc disease. I was prescribed cyclobenzaprine, prednisone, 800mg iburprofen, and hydrocodone/acet.

What I currently have S/C per eBenefits (all from 2000, retroactive to end of service in 1998, except the lumbosacral strain which was increased in 2005 from 10%)

• Lumbosacral strain to include coccyx condition (previously claimed as coccyx fracture)(VCAA)  20% Service Connected 

• Refractive error (claimed as astigmatism) Not Service Connected                             

• Degenerative joint disease and rheumatoid arthritis, secondary to a coccyx fracture -Not Service Connected                     

• Bursitis, right shoulder   0%          Service Connected

• Bursitis, left shoulder     10%        Service Connected                         

• Allergic rhinitis   0%          Service Connected

• Cervical strain    0%          Service Connected                         

• Tinnitus                10%        Service Connected

What has arisen/increased in severity (why I'm seeking an increase/file new claim/s):

• Sacroiliac joint pain - I know I verbalized this repeatedly in my C&P exams, but not sure it was factored into or as part of the lumbosacral strain rating or not, but this pain is noted in my service records with the word "sciatica", and it is excruciating. I remember describing it to the C&P examiner as someone smashing my tailbone area with a baseball bat. If you have this, you understand. I get injections about every other year for them, and take 500 mg naproxen to ease flare-ups in between injections.
• Shooting pain (sciatica, radiculopathy ... I've been told both and not sure what the difference is) in both legs to my feet and arms to include my fingers.
• Anxiety - I believe this is secondary to my injuries. I barely drive because I have panic attacks as a result of the pain I'm in and the fear of yet another potential accident worsening my injuries. I had a panic attack in my ortho's office when he suggested I might need surgery on my shoulder. I cannot sit in the dentist's chair without Xanax because the sounds and feeling have me clenching my jaw and fists (never had this problem before the injuries).  I saw a psychologist after my last accident about the panic attacks, and my private PCM put me on anxiety meds, but I don't attend regular counseling, as there isn't much we can do except understand the triggers, perform exercises when they come on, and take my meds when it happens. Consequently, I work full time from home, barely drive anywhere, and take Xanax whenever I go to the doctor for anything other than a routine exam.
• Hearing - I was rated for tinnitus; however, I believe I mentioned to C&P examiner that I also had (at that time) some hearing loss/challenges. This has - over time - gotten far worse. I cannot differentiate conversations from background noises (e.g., music, tv, etc.), and I strain to hear people who speak in normal tones. I also experience a severe 'crackling' sound in my left ear if there is any loud noise (e.g., firetruck passing, in church if sitting too close to speakers, music being played too loudly - for me). The cause for the tinnitus (and I suspect the hearing loss) was from escorting media on the flightline during deployments as well as through other high-noise areas on base where - because of the need for interaction with the media and those they interviewed (make sure they weren't saying things they shouldn't) - it wasn't conducive to wear any sort of hearing protection.

Questions I have to get started:

1) What is the most effective way to request my C&P exam documents and any films/x-rays/to see how earlier decisions were reached and what they considered for each S/C disability? I was initially evaluated at the VA in Wilmington, DE, and the low back strain (originally 10%) was increased in Winston Salem, NC.

2) How (if at all) does my having been in the car accidents (since being rated) impact my claim for increased pain/problems/aggravation of these injuries? Will the VA say 'too bad, not our fault', or are they considered aggravations/worsening of conditions and therefore 'rate-able' or able to be considered for increase?

3) Would the shooting pain in my arms & legs due to the pinched nerves be separate claims from the cervical and lumbosacral strains, or would those items include these items? I keep reading about 'secondary' ailments, but I'm not clear on what that means in regards to the VA process.

4) I used to have a DAV rep helping with my claim, and they still have a POA on record with VA. Is it better to keep working through/with them, or can/should I go it alone?

I'm sure I'll have more questions but for now, hopefully that is enough to get started. And please, feel free to ask any questions to clarify anything I noted and/or make any suggestions/recommendations/etc. It's been so long since I went through this all that I don't know where to start, where to go, what to do, etc. Thanks again!

[Buck52]

Crabcake

it depends if they catch it or not ???which they will you can bet on that!   about the auto accidents.

 if a Dr mention it the ''auto accidents'' aggravated your Back and tail bone /shoulder  then they probably will give you hell over it .

They can even reduce your rating saying the Auto Accident caused the S.C. disability to get worse and non military related.

 so this is kinda walking on shallow waters here so  be careful!

and it don't matter who is at fault in the Auto Accident's

but it also can be INCREASED too  just have to go about it the correct way  and that is get all the medical evidence you can and  your lay statements and opinions from specialist Dr's in this field of medicine to read most of your medical records and in service medical records   so they can give there medical opinion rather or not its ''likely as not'' your .S.C. Disability's has increase/aggravated over time/years from when you were first S.C And rated.

you might be better off to seek an experienced Veterans Attorney  to help you!

 or contact Alex Graham (AKA Asknod here on Hadit   He is an excellent Adjudicator for veterans and also Accredited with the VA to help Veterans win their claims.

Here at hadit we can recommend some great Attorney's Dr' combination.  they work on 20% of retro that you may get.

AND SOME HAVE THEIR OWN FEES!

As for as how secondary claims work  here a link that may help you shine a light on.

( link at the bottom of this post.)

because I just have a feeling VA will fight you tooth and nail on this  because of the Auto Accidents...but maybe not?

, File for the increase and  the other contentions at the same time and see what happens. 21-526 EZ  I would not recommend a FDC.

I may add this

 To use an attorney you will need to be denied and then you send in your NOD (Notice of Disagreement) and find a good prompt intelligent VA Attorney TO LET YOU KNOW WHAT TO DO KEEPING YOUR BEST INTEREST IN MIND.

You can get help here at hadit too  but since this is going to be a Difficult claim to win If the medical don't jive between the auto accidents and the S.C. Disability  this is why I would suggest an Attorney to put a nexus together and have a good plan. 

So file your claim and submit any favorable probative evidence that you can  and just see what happens?

 The auto accidents will be in your files  and the medical records are there  the main thing is for you or your Rep to find these records and see what they say??

Here's link to secondary /aggravated /caused by for bases of claims.

how they work.

https://www.nap.edu/read/11885/chapter/11#273

Other Members please chime in

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

Edited October 29, 2016 by Buck52
forgot to put the link in..eh!

[Crabcake]

Thank you - Buck-  for your thoughtful observations. It's surely a complicated situation. I went through all my records tonight, put them in chronological order, flagged the records where the issues are noted (to include the sciatica, numbness, etc. in my legs) when I was on active duty, etc. I am still baffled that they ignored that in my initial claim as well as the NODs that were done back then. I still have that problem (but there were different labels put on it between the VA & the docs I saw on active duty); it's just worse now. The only 'new' things I believe are tied to my S/C items are the numbness & shooting pain in my arms from my neck, and the anxiety due to all of the pain. I will definitely read through the link you kindly shared with coffee in the morning. My brain is fried from reading all of those records; tiring for the eyes!

In going through the records, I realized that I do actually have my 'c-file', except fo those from the increase in 2005, so hopefully that makes the process of getting those records easier/faster once I understand how to request them.

Also, just to clarify, I did not receive any care from the VA following the accidents; does the VA somehow have access to my other (private) doctors' records if I have not signed a release? I'm not trying to hide anything; just not clear on how they would have them. I seem to think (and need the records to confirm) that the L/S strain increase in 2005 was due to the sciatica, but without the C&P docs, I can't be sure. If it was, then I would think it'd be harder for the VA to deny, but I don't know.

I'll have to give some thought to the lawyer if it comes to that. I hope it doesn't. Does your suggestion for such mean that having a DAV or Legion rep assist would not be as 'reliable' or helpful? I hope I'm wording that okay; I don't mean it to offend those individuals in the least. I just feel like I can do a lot of the 'leg work' and draft the claim if I understand the process, what the current laws/regs are, etc.

Thanks again! I'm off to rest my eyes to do more reading in the a.m.

[Buck52]

If you have not sign a ROI (release of information) with VA  no they can't request your private records.

You can go to your VAMC and go to the VBA (Veterans Benefits Administration) Office and request  copies of all your C&P Exams  dating back to the dates you need,but you need to sign the ROI.

As for as a VSO to represent you, you can check out a DAV Rep  or any VSO.

 just do a back ground check on his reputation & how many cases and how long his/her  experienced is in VA Claims.

  This is your decision to make..I have lost all hope with the DAV but that's just me, you may find a great DAV Rep that will represent you tooth and nail..I just never had any luck with'em

but no matter who you chose to help you  just make sure they have a lot of years experience and Know the VA Laws and how the VA Claims process works. (the do's and dont's  ( so- to -speak)  and one that will keep you informed of what he /she is doing with your claim, make this a point when you hire them as your POA.

You can get great advise her eon HADIT and its all free we have a lot of experienced members that can help you , So feel free to ask any question you need or want.

 also if you feel you need more privacy  you can PM a member and ask a question  but some of our members do not do PM's.

Unless you can come up with all the medical records that support your Claim,  you will probably need to sign the ROI form to the VA.

Its better to be up front and honest with the VA and just tell about the Auto Accidents  b/c they will find out sooner or later and if they know you been holding this information  it will definitely  go against you.

It all depends on a Medical Specialist of Dr's Opine stated ''least likely as not'' to what caused/aggravated  your S.C. disability's to increase ''stated least as likely as not'' That's the whole point.

jmo

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

Edited October 29, 2016 by Buck52

[Crabcake]

Thanks Buck; good points on the VSO experience & qualifications, and good things to consider & think about for sure.After thinking about it last night, I believe - when I went back for the Lumbar increase in 2005 - I shared the one bad one (was t-boned by my neighbor) with the C&P physician. Since then, there was only one other 'major' one - 3 years ago - where I was hit head-on while I was stopped at a traffic light. I don't have any problem sharing the accident history with the VA and don't intend to hide it, and I definitely don't mean to imply anything unethical; I'm on a lot of pain meds right now because of this latest flare-up of pain, so I'm probably not articulating myself too well.

I'm making a list of the doctors/clinics where I received treatment since my last visit to the VA so I can request all the records for review and as evidence.

In your first message, you recommended against an "FDC"; what is that please? I didn't see it on the acronym list.

Thank you again!

[broncovet]

There are 2 issues that are apparently important to you.  The first is VA medical care, and you should be able to get that without further ado.   Depending on your income, and levels of service connected disabilities, you may/may not have any prescription co pays.  

Next, is you are seeking an increase in service connection.  While SMR's are important, you need to order a copy of your Cfile if you have not already done so.  

About your increase in service connection:  To increase a service connected disability, you need a docs statement that your condition worsened since your C and P exam that granted the service connection.  Most of these are about symptoms, and if your symptoms worsened you should be able to increase that disability. 

Now, on to "new" disabilities and disabilities secondary to existing ones.  

To get a new disability, you still need the Caluza triange of 1) Current diagnosis, 2) in service event or aggravation and 3) Nexus, or doctors statement that your (diagnois) is at least as likely as not due to an event in service.  

Lastly, if you are seeking secondary service connection, such as depression secondary to SC Pain, then you need only 2 of the 3 caluza triangles:  1.  Current diagnosis of secondary condtion and 2, Nexus between this diagnosis and your primary condition.  You need not establish an "in service event" (2d leg of Caluza triangle) for a secondary condition since the in service event was already established for your original condition.  

Edited October 29, 2016 by broncovet

[Buck52]

We had a Veterans spouse on here not long ago  (unfortunately she is a widow now) her hubby had a claim in for his S.C. PTSD increase  at the time of his death,2010 (I think?)

 He had a motorcycle accident that killed him.

5 1/2 years Ago  this is how much time had past & she came here for help.

However this veterans spouse filed a claim or requested a reopen claim to her hubby's pending claim years later.. the VA AGREED. (if I remember right?)

 and her evidence/testimony  was that his S.C.PTSD was very bad  and he would have convolution and jerks at any  ungiven time.

she used this as her hubby's defense about the Accident  that killed him.

   Even though in the police reports  a witness testified he was doing wheelies  and driving in a reckless manner!

After intoxication was ruled out

  The decision was he must have had  some type of CIA or Seizure seconds before the accident that was  Caused or Aggravated by his  S.C. PTSD

she won the claim  based on his S.C. Condition of PTSD and prior medical evidence that it is very possible he did have a episode out of his control at the time of the accident that caused his untimely death.

I am leaving a lot of the details out I'm sure but to make this short this is what happen.

I was thinking this is a very rare and interesting unique case.

So anything is possible with the VA...WE JUST NEED to know how to word things and be positive and back up what we say.

Edited October 29, 2016 by Buck52