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!

[Crabcake]

Hi Andy. I agree - MRIs/X-Rays/etc. don't really tell the whole story (my PT guy said that very thing yesterday as well), and our pain thresholds definitely are different. I just find it baffling that my images and VA rad reports "say" my SI joints are 'unremarkable' yet Monday morning, I could barely get out of bed and could not walk unassisted (and even then, I was bent over like an 80-year-old); I felt like my sacrum was crumbling with every movement, and that is coupled with all the other issues (back/neck pain and nerve/numbness in legs & arms).  Also, in looking at my historical reports, there are conflicting 'findings' which leads me to believe the VA does not interpret the images completely or perhaps 'fairly', or perhaps they only report on what they see that could be related to the complaint, but I don't know. A 2013 lumbar x-ray I have notes "dextroconvex scoliosis, facet sclerosis of L4/L5 and L5/S1 and lumbar spondylosis".  And a 2008 Lumbar MRI I have notes "1) Bilateral sacroiliac joint dysfunction; 2) Central disc protrusion at L4/5; 3) Clinical impression of left L4 and L5 radicular pain." A 2013 cervical CT scan noted "mild cervical spondylosis". I guess when you put all of that together, it 'paints' a more thorough picture overall. I'm obviously not a doctor, but logically I can see some things perhaps 'improving' to some degree (e.g., a protruding disc that perhaps - with traction - moves back in place or muscle spasms that ease up with PT), but to have so many different 'interpretations' of the same patient/anatomy that - over time - experiences worsening pain levels of the same condition/s is kind of befuddling to me. I dropped the VA images & reports off at my private ortho's office yesterday after my PT consult. Private ortho will take about a week to review, then schedule my exam.

Yesterday's PT Consult (@ VA) resulted in: submitting an urgent referral for 16 PT sessions (I call the Choice people today to ID the PT clinic so they can get the ball rolling; and thankfully, the PT clinic attached to my private Ortho is on the list, so that is where I'm going); a cane to use when the SI Joint/Sacrum pain makes walking unbearable; a 4-pack of strap-on microwaveable heating pads which are helpful because I can move about while keeping the heat on; and a tens unit which historically has helped manage some of the pain, but obviously doesn't really 'correct' anything (neuro-brain games). He also said that if I don't see any improvement in 3 weeks, or if after 5/6 weeks only slight/minimal improvement, to let him know, and he will refer me to Neuro/Ortho, that I won't need to wait 4-6 months like the PCM said.

I also asked the PCM at both appts for referral to Mental Health for my anxiety (which is high - for me at least - while I'm dealing with all of this), and while she noted it both times in my record, I've yet to receive a call to schedule or an appt notification, so I'll call them today to see if she did submit the referral and if I can self-schedule. I'm having a hard time dealing with this - at each appointment, I end up in tears over my pain levels, not to mention the episodes of panic driving to these appts.

[Andyman73]

46 minutes ago, Crabcake said:

I also asked the PCM at both appts for referral to Mental Health for my anxiety (which is high - for me at least - while I'm dealing with all of this), and while she noted it both times in my record, I've yet to receive a call to schedule or an appt notification, so I'll call them today to see if she did submit the referral and if I can self-schedule. I'm having a hard time dealing with this - at each appointment, I end up in tears over my pain levels, not to mention the episodes of panic driving to these appts.

Hey, if you don't get no where with you PCP, in regards to a referral to MH, call the hot line...they will get you in PDQ!

May I ask how your back ended up in it's current state of affairs?  Me, I fell down a flight of stairs, which I may have mentioned previously on your thread.

One thing I recall my pain management dr telling me, is that issues with the SI region are hard to come by, without serious hip joint injury, usually. He has been quite intrigued by my case, since I don't have a direct injury to that part of my body. He said that compression injuries to the lower spine can do it, too, but mine was mild to moderate at best, at time of initial injury, which was nearly 24 years ago.

I tried to get an appointment with a local ortho group that takes my private insurance.  They told me that they don't do IMO/IMEs, so back to the drawing board for that idea.

Seems many of your symptoms mirror mine, some much worse, tho.  I actually do not have an radiology report for my SI joint region, they just went off the images already in the system without generating a separate report for that area.  Hmm....that may be my angle to use for a renewed request with that ortho group.

If you can't wait, call the hotline asap, even if you are in no danger of taking yourself out of the picture, give them a call anyway.  Don't be like me and wait till it's nearly too late to make that call.

[Crabcake]

Hi Andy. I quoted below what I shared earlier in the thread about one of my injuries; you and I had commiserated a few pages back about some of our condition similarities. ;)  In addition to below, I also had a hard fall square on my butt/tailbone area, and a rear-end car accident during active duty. I've read that injuring the SI joint is a very difficult thing given it's 'a very strong and practically immovable' joint (or something to that effect). But I've had multiple impacts/injuries to that area (both in service & out), but the SI joint problem is very documented in my service records. Nevertheless, that IS where one/some of my problem is, in addition to a fractured coccyx (from the fall) and the other lumbar & cervical issues from all this stuff. And when I saw my private ortho post-service, I shared that history with him, so he made sure to request the SI joint area & look closely at it on the images/rad report. So you might very well see about doing the same with your private ortho.

I wouldn't say though that my pain/injuries are 'worse' than yours or someone else's; we're all suffering with and impacted by our conditions, and my pain threshold perhaps is less than yours. I think I used to have a higher tolerance for pain, and would push through it and do what I needed to do, but that tolerance gets less and less as I get older and the episodes are more intense/severe and frequent. But admittedly, when I talk to my local vet friends who sustained injuries/conditions (some obviously far worse than mine) in combat/overseas, it makes me feel a sort of 'guilt' or shame about having service conditions that impact me the way they do, but were sustained during peacetime in comparison to theirs. 

Re: MH, I sent my PCM a message this afternoon. If I don't hear back from them by mid-day tomorrow, I'll do exactly as you suggested; thank you!

 

On 11/2/2016 at 3:01 PM, Crabcake said:

Wow Andy, it does sound similar (minus the flight stairs); I'm sorry you're suffering with it as well. I had a duffle bag full of equipment (printer, laptop, etc) on my back during a training exercise, and since we were in full MOP gear walking in the dark, I didn't see a step down, and I went down with it all.

Do you mind sharing what sort of treatments they have you undergoing for the SI joint pain? Just curious what I might expect them to offer in terms of pain management (I like to research things when I can). SI joint pain SUCKS! I've told the drs for years that when I get up from bed in the morning or if I walk/step 'wrong' (e.g., uneven surface), it feels like someone taking a baseball bat to my sacrum and it sends lightning down my legs, yet I keep seeing mixed 'reports' on films when they look at it (that they look fine); yet, when I've had injections in the joints over the years, they have seemed to help cut down the frequency & severity of the pain.

 

[Andyman73]

Good evening Crabcake! I must admit, I am enjoying comparing and sharing our back/spine notes, especially since they are so similar. 

Forgive my memory, it is a revolving door, most of the stuff doesn't stay in it. Been tested on that, no joke! I do recall that you had written that, after reading your re-quote. You probably wouldn't believe how much trouble it causes me at home.

I don't have anything in my record in regards to my SI joint.  Mine would be secondary to the other stuff. 

As for sharing, I really only talk to a young Marine at work. He was in kindergarten when I joined the Marines. He's been to both Iraq and Afghanistan and has some IED related injuries. So I tread lightly when comparing notes with him.  But he's cool about every thing. He actually holds me in high regard, which just blows me away, cuz nobody else I know thinks that of me. I'm sure some of it is the Marine connection. It's quite surreal to me. 

I know all about the guilt/shame that you speak of, that specifically is what kept me from seeking MH help for 23 years.  That and the fact it was highly frowned upon and discouraged back then. Going to Africa was quite an experience I wasn't prepared for. Not the going, physically, but the mental impact.

I will contact the Ortho  tomorrow about my SI joint pain. I didn't mention that to them before. I'll post what I learn from that contact.

[Andyman73]

CC,

Onto the next thing, I just emailed the ortho's office requesting an appointment, as a new patient, for my neck and back.  I think this will be my best and most affordable option, especially since they do take my insurance.  Should hear back in the next day or two.

I'm sorry if I implied that you had said your pain was worse. Or maybe I'm just confused inside my own head(not lost in thought, just lost).  I try to be very sympathetic to others pain, when my wife complains of her issues, I err on the side of caution and over do it.  She was hit by a female driver who was reaching for a ciggy, at least that's what her 9yr old daughter said(she was in the back seat when it happened). More so than that, I NEVER EVER complain about my own aches and pains. But sometimes you just can't help making a pain face or keep a moan or groan of pain from escaping your lips.

I know I mostly just limp when I walk, and it comes and goes, so I don't look like how my body hurts.  And I know exactly how I got this way, not on deployment, not in combat or a combat zone, or anything worth talking about...more of that guilt and shame mentioned earlier.

[Crabcake]

Andy - no worries at all. I try not to take online comments personally because it's hard to convey someone's intent or meaning, and it's usually not meant that way anyway, so it's all good my friend. ;) And I know exactly what you mean about your body not 'looking like how it feels'; you're not alone in feeling that way. On the outside and on a 'good' day, I'm sure I look like the average 42 year old. But if someone saw the 'routine' I need to go through just to get out of bed every morning, or when my pain flares up throughout the day inhibiting my ability to walk, they would have a clue; but I am pretty closed off about letting people in or see me in that way, so I tend to lay low, don't go places, etc.

I hope your appt with the Ortho proves helpful for you. One thing I think - and perhaps this is obvious to everyone else and I'm just slow grasping it - is this: each time I have had an x-ray or MRI over the years, the 'findings' are always only specific as to what the complaint is at that time, and are silent to anything else that may be 'visible' even if perhaps 'unrelated' to what is currently going on. And I'm wondering if that's why (for example) my recent images' findings don't mention the things earlier images' findings note (e.g., about my SI joints, because they weren't the specific complaint when I went to the ER, rather the neck & lumbar pain, and shooting pain & numbness down my legs). The radiology report only commented on things he saw that could be causing my nerve issues. That's why I am asking my private ortho to look at it ALL and provide a complete diagnosis based on what he sees (via images and exam). I don't know if my perception is correct or not, but just a thought about how you might ask your doctor for your appt; I do plan to ask my dr when I see him.

All the best to you with your appt; do let me know as I'm curious what your dr says about your SI joint issues. I hope you get some answers that lead down a path for effective treatment to help minimize the pain. And I hope you & yours enjoy a happy Thanksgiving.