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]

OIC  typical of the VA. 

That has happen to most of us, a lot of it depends on how they put the Initial paper work in the Dr's slot.....when you check in a print out is made and they put that in the appropriate D'rs Slot and the Dr comes in and takes it out of the slot  usually the first one in order  or sometimes the Dr's Nurse or CNA will grab the paper work with 4 or 5 veterans clinic appointments and they get mixed up...hence you probably got put in the back of the pile...I hate that when this happens...nobody seems to care one way or the other  or how bad were in pain & the wait.

You can request another Dr if you feel this one don't have your best interest at heart...or being  NP?....I prefer an MD with Internal Medicine  or a specialist.  most PCP are MD of internal Medicine(check with the hospital Director)

I would request Neurology Dept  Sounds like your having symptoms In that area? but I'm no Dr

But at least you got some Referrals so that's a good start..and weekly appointments   , hopefully someone can get to the bottom of your problems and get your pain under control.

 

 Pertaining to your claim a few pointer's!

What you may want to do is after you see any VA Dr  PCP or Specialty Clinics...wait 3 days and go to your'' MyhealthyVet'' site and click on the Blue button and check your Notes....and make copies of anything you feel is favorable.

Also if you see things in your notes the Dr Never mention at your exam ( which happens a lot unfortunately)...take a copy to your next Dr's visit and confront that Dr ...usually they will make an Amend to the note...you can wait 3 days to see what they say.

My Advise is= make you a Nice Organized Folder to keep the Notes in and any medical records and evidence for your claim, when you get ready to submit your claim send in all these records that you kept and feel is a favorable part of your claim.

These Notes can be used as evidence in your claim.

You can also go to ROI (release of Information) desk at your VAMC  & Request your Medical Records From any particular Date to Date.you will need to sign a ROI there.

It's always a good Ideal to keep up with your VA medical records while using the VA.& Your Private Medical records as well as you probably already know!

And remember your lay statements matters as evidence in your claim 

(statement in support of claim) From you & your hubby and members of your family and people you know and trust.

If you don't want to work your claim you can find a good VSO (Veterans Service Office) to help...I recommend to just stay here on Hadit and get the information you need..just simple ask your questions and most Hadit members will help you,  these people are better than most VSO you can find as for as helping you with your Claim. (in my humble opinion) and working your way through the VAMC maze of ''Excitement''

Some of Hadit Top Intelligent Members to help  you with your claim are:

 Ms T Bird (Hadit founder)  & Elder members like  Berta,Asknod, broncovet, Vync,Jbasser, and a lot of other members can give you information with what worked with there claims and their experience.

This information is Priceless and well worth your time.

I wish you the best and hope you get that pain under control and you find a Great VA Doc you like and  can click with.

Respectably 

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

 

[Andyman73]

CC,

I had my first chiropractic session yesterday, for my SI joints. Doc checked me out too to bottom. Was a real nice dude. He was rather surprised when I gave him the basic  run down. Said he's amazed I still work. Told him I don't have a choice, and besides I haven't had a pain  free day in 24 years.

He bent and cracked me pretty good, said he fixed my unequal leg length, we'll see. He barely touched my neck, was very concerned with my nerve issues, and didn't want to risk making it worse.

I asked him how much does my feet and knee problems effect my back and neck. He said they definitely play a big part. He cautioned me not to expect full relief since this is a decades long issue, and my lower extremities will be a constant negative force against my back and neck.

Yep, I agree with that. What relief I felt was gone by this morning. I only went because the VA sent me. You know, to keep playing the game. I think I'll get some permanent relief once they grant SC, if you know what I mean.

But still...I really don't like the way all this VA stonewalling bs makes me feel. My shrink seems to focus on how I feel and think. None of that matters because the pain and sleep apnea will always be with me.  Maybe I'm doing it wrong, but I mostly bs my sessions.  I just get a vibe that he won't really go to the past, where everything began.  

[Crabcake]

Andy - I'm sorry that you're feeling like you're getting the run around. That's so frustrating, and the whole reason I avoided VA care over the years, and I'm being reminded of it now as I go through this. I hope you get a course of treatment that leads to some relief soon.

Buck - As always, great advise; thank you! So, a few updates:

I had the MRIs of C & L spines last Tuesday. As soon as my MRI (both C & L spines) was completed, I went to Release of Information and requested a copy of my images & reports on CD. I received them in the mail (no lie) 2 days after my MRI. I was SHOCKED - fastest response I ever had from VA, so kudos to them there.

Here is what the Rad reports say:

Quote

 

Lumbar:

FINDINGS: There is transitional thoracolumbar anatomy, treated for the purposes of this report as hypoplastic ribs at T12 with 5 nonrib-bearing lumbar-type vertebral bodies, to remain consistent with 10/26/2016 spine radiograph report.

Lumbar vertebral body heights are maintained. Normal lumbar alignment. There are scattered benign fat-containing osseous hemangioma is with bone marrow signal otherwise preserved. Conus medullaris terminates at approximately L1. Cauda equine normal in morphology.

T11-T12: Seen on sagittal images only. No spinal canal or neuroforaminal narrowing. T12-L1: Serial sagittal images only. Minimal disc bulge. No spinal canal or neuroforaminal narrowing. L1-L2: Seen on sagittal images only. No spinal canal or neuroforaminal narrowing. L2-L3: Mild degenerative facet changes. No spinal canal or neuroforaminal narrowing. L3-L4: Mild degenerative facet changes. No spinal canal or neuroforaminal narrowing. L4-L5: Small disc bulge with small central annular fissure. Mild degenerative facet changes. No spinal canal narrowing. Mild bilateral neuroforaminal narrowing. L5-S1: Minimal disc bulge asymmetric to the left. No spinal canal or neuroforaminal narrowing. Visualized retroperitoneal structures, sacral elements, and superficial soft tissues are unremarkable.

Impression:  Overall mild degenerative disc and facet changes with mild bilateral neuroforaminal narrowing at L4-L5.

Cervical:

FINDINGS: Cervical vertebral body heights and bone marrow signal are normal. There is straightening of the normal cervical lordosis.

Visualized base of brain is unremarkable. Cervical spinal cord is normal in morphology and without abnormal signal. Craniocervical junction: Unremarkable. C1-C2: Unremarkable. C2-C3: No spinal canal or neuroforaminal narrowing. C3-C4: Mild bilateral uncovertebral joint hypertrophy. No spinal canal or neuroforaminal narrowing. C4-C5: No spinal canal or neuroforaminal narrowing. C5-C6: Mild right uncovertebral joint hypertrophy and small central disc protrusion. No spinal canal or neuroforaminal narrowing. C6-C7: No spinal canal or neuroforaminal narrowing. C7-T1: Minimal central disc protrusion. No spinal canal or neuroforaminal narrowing. Visualized cervical soft tissues are unremarkable.

Impression:  Mild degenerative disc and uncovertebral joint changes with no significant spinal canal or neuroforaminal narrowing.

 

I don't know what a lot of that is/means, but I did note the disc bulges, and asked the PCM about those. She said "those are probably what is pinching the nerves going down my legs & arms."  *Probably* ... and that is why I would rather see a specialist. At the PCM follow-up last week, she noted in my records that (per MRI) that I have "degenerative changes to spine" and "radiculopathy (c-spine & l-spine)"; as well as "anxiety". She said these degenerative changes are consistent with age progression (I am 42 years old!), and is referring me to PT (consult tomorrow morning), and Mental Health (to be scheduled) for the pain-related anxiety.  I asked the PCM if/when I would be referred to an orthopedic specialist for the issues with my back & neck, and she said that until we exhaust the conservative options (PT, injections/pain mgmt, etc.) and she feels surgery is necessary, there is no reason for me to see an ortho. This is kind of concerning to me - no disrespect to her (and I told her such) - because she is not a specialist. Nevertheless, that is her recommended course of action. She said if PT and Pain Mgmt (after PT) doesn't yield any results in 4-6 months, then she'll refer me to ortho. Four to Six Months ... to see an ortho!!! I did get a second Toradol shot, which helps for a short-time with the immediate pain, but doesn't do anything to reduce the numbness and shooting pain down the arms & legs (which makes sense if the disc is bulged and putting pressure on or pinching the nerves). This morning, I could barely get out of bed or walk because my sacrum/SI joint area was excruciating (as usual when I wake up, but this morning it was probably the worst it's ever been), and I'm baffled how the MRI & X-rays appear to see no problem with that part of my back unless I'm missing something.

So, I gathered up all my records from the VA (ER notes and PCM) and my private records from the last 10 years and the disk with the MRI & X-Ray images & reports, and I'm dropping them off at my private ortho tomorrow after my PT consult. He is going to look everything over and have me come in for an exam once he reviews everything. I am going to ask him to clearly document the applicable diagnoses and reference the leg & arm nerve issues, noting if they are related to the neck & low back issues (I recall the verbiage that needs to be used being along the lines of "is at least as likely as not" etc. Should I ask him to complete the DBQ forms as well for the neck & back? Or are those only to be completed by VA C&P doctors, and I should just ask for a letter from dr w/diagnoses and 'nexus' comment re: 'at least as likely as' sufficient?

Thanks all for your ongoing input, guidance & suggestions. These last several days have continued to be an ongoing battle of pain management, which certainly didn't have me feeling all that 'appreciated' this Veterans Day. And being on all of these meds has me feeling like I don't even know who I am half the time which is why I don't like taking them. :( 

[Crabcake]

In re-reading the DBQ page again just now, I found that private physicians can complete those forms, so that question is answered.

I guess what I'm curious about is would I be better off to have my private dr complete them, or - assuming my private dr confirms (with more specificity) what the rad reports & PCM said (about the radiculopathy in my legs & arms being due to my neck & lumbar) - is that 'enough' evidence to submit my C&P claim, and have the VA drs schedule exams and complete the forms or whatever they do?

I just want to get an idea of whether I should mention this to my private ortho when I do meet with him.

Thanks!

[Andyman73]

CC, 

Quick response, as I am manning the grill right now. Yes,  most definitely have your ortho fill out the DBQs and write a IMO as to why they think this is service connected.

I'll write a longer response soon,  probably tomorrow.

Andy

[Andyman73]

CC,

I find it quite fascinating reading your image reports and comparing what was revealed and what you described as your symptoms. 

And here's why, my x-ray and MRI image and reports show more damage and wear than yours do, well, based on what they told us, and we all know how they sometimes can't "see" what is plain as day on the images.  But your nerve damage symptoms as you describe them, seem much more severe than mine.

I do realize that we each feel our own pain   the way we do, my own twin brother has a pain threshold far different than my own.  And here's where I am once again fascinated, I've had the super fun EMG test done on both sets of my extremities, and know what the results are. Of course the results were negligible at best for the lowers and found carpal tunnel on both uppers. 

Bad thing about those results is they were done while I was laying down. Most of my symptoms are enjoyed while upright, not laying down.  I'm sure most of us feel our pain more when we are in every position but laying down.

Oh, before I forget, my radiology reports state mild to moderate degeneration at L2-3, and more moderate at 3-4, and moderate to severe at L5-S1. Also correlating narrowing of the neural foramins getting worse along the way down the spine. With severe narrowing at L5-S1, also central disc bulge with a line indicating a possible fissure.

And that doesn't even begin to cover the SI joint issues that have developed over the past year or two. 

Now don't go telling folks, but I've lost about a half inch of vertical appearance. Shhhhh, it'll be our little secret! Lol! Who'da think it, to start losing height before I turned 43! Guess I will have start using my step stool more often.