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]

7 hours ago, broncovet said:

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.  

Thank you for your response, Broncovet. Yes, utilizing the VA for medical care has become a financial necessity for me due to increases in my private healthcare cost and deductible. For years, I've used my disability comp to help pay my copays, injections, meds, massage, chiro, etc. to manage my pain as well as help with things around the house as needed when I've been unable to tend to them (e.g., some housework, yardwork, etc.), but I just can't afford to do so anymore unless my ratings are increased, so in the mean time, while I pursue the rating increase, I am seeking SC condition-related care through VA.

Yes, I am seeking to increase my already SC'd conditions  - they all have increased in severity in the 18 years since initially rated. I believe I have my full c-file, except the notes from the 2005 C&P exam & increase for lumbar. When I dug out my service records, I didn't recall that I had requested it years ago after my initial claims. So I just need to get those 2005 notes, and I should have a sense for whether that increase included the sciatica or not, and would then exclude it from my forthcoming request; I don't believe it was.

I'm don't anticipate any issues with documentation of the secondary disabilities being clearly linked to the initial disabilities. It's been verbalized by every doctor I'd seen, and I will ask them to provide such in writing if their notes don't specifically call that out. On the anxiety linkage, I know that is very well documented by my doctor and psychologist as well.

What I'm unclear on is:

• if - in my claim - I should request the shooting pain/numbness in my legs and arms (resulting from the compressed nerves in my C- & L-spine) as separate/secondary items (rating for legs, rating for arms), or if they would be tied to the existing C- & L- spine ratings if they are the source of the problem;
• if the hearing would be a new SC claim, or secondary to the existing tinnitus rating;
• or, do I just request these as "service connected/secondary to ..." and let them decide? I feel like I need to be specific, but I'm afraid that - by doing so - perhaps I'm limiting the VA's realm of considerable options, and leaving them open to deny if it doesn't meet that exact 'standard'.

[broncovet]

Unless you plan on going to work for the VA, dont do their job for them.  Here is what I suggest:

"I (Veteran) would like to apply for an increase in my VA comp benefits, to include "shooting pain/numbness in my legs and arms" which may or may not be secondary to an already service connected compressed nerves in C and L spine.  I would like consideration for both primary and secondary service connection."  This is a claim for both new service connection for shooting pain/numbness in legs and arms, and an increase of same. 

Signed, IMa Vet. 

Ask for primary and secondary and dont limit yourself..let the va raters decide which, if any you qualify for, dont eliminate anything.  

[Buck52]

crabcake

you should't have any problems getting medical care and presciption medications from your local VAMC, the only obligation VA ask is that you see a VA PCP.

Your 40% S.C. rating will help with co-pays

You should use the Meds by mail program  that's very convenient option.

[Buck52]

Crabcake

As for as claims go, When a Veteran applies the correct laws of the U.S.C. & C.F.R.'s to his/her claim &

 has a well grounded claim with medical evidence Dr's Reports in his/her  favor  its very hard for the VA to deny,  but unfortunately some times they fail to read our evidence or lose it or shred it  and very quick to deny the veteran  and this causes the veteran to send a NOD and some times years of backlog drag!

so when you do file recheck every little detail and make copies of everything, go over your claim with a fine tooth comb and always mention in your claim that you ask for the highest rating allowed by Law According to your symptoms and severity of your disability.

[Crabcake]

Buck - I don't have "copays" with my private insurance; I pay out of pocket fully until I reach my max out of pocket/deductible. And that deductible is about to roll over and increase.  My only 'issue' with getting VA medical care right now is the wait to be assigned/see a PCM, but that ball IS at least rolling. My first appointment is this coming Thursday, thankfully.

Unfortunately, while I get that ball rolling for getting in the system and the necessary referrals, etc., I have been having a terrible time with my pain. I had to go back to the VA ER again today (since I am not yet assigned a PCM) because - after 4 days of recliner/bed rest & meds from Wednesday's ER visit - my legs and arms were going fully numb and my c-spine pain was worse than it was on Wednesday. Dr today listed the ER diagnosis as "nerve pain in legs and arms" while Wednesday it was degenerative disc disease & neck/back pain.  He also changed a couple of my meds, and ordered an MRI to be scheduled. I wish they had done the MRI while I was there today so we would have a better idea of what is going on come Thursday. Also, being in so much pain heightens my anxiety, and I had a couple panic episodes in the ER as a result, especially when the dr suggested surgery may be necessary. I wish there was more the ER could do such as ordering PT or injections for pain. I know I need PT (traction) to help open the vertebral spacing, and injections would help with pain relief in the mean time; but I don't want to rush under the knife, and just hearing that sent me over the edge today, and is a large part of why I saw private doctors with more conservative approaches to pain management.

I sent the letter into VA to link my medical records with the heathevet site so I can see more than just the ER diagnosis on my discharge document; the physician Wednesday said there was arthritis & degeneration in the SI joints while today, the ER dr said there was none. I don't understand that, but I guess I just need to be patient, get access to the records and see what they say, as well as my private ortho doctor's notes when I receive those. 

Till then, I will keep reading, reading, and reading some more. Thank you for the help & suggestions! I am keeping note of them for when I am ready to file my claim.

[Buck52]

Yes Mam I so understand

About all yuo can do is go the E.R.  which sucks b/c of the long wait.

Also I wanted to let you know  that when you do get in to see a PCP  before you go to your appointment  make every minute count big time...  write out all the things you need to talk to the NEW PCP about before your appointment...

and try to get most everything covered & all of every contention you maybe having  even the small ones.

  its good to bring all your health issues all up at once, so take a pad/pen with you and take notes of what the Dr is saying.

b/c this will let him/her know your on your toes about your well being and Health.

Its Unfortunate the PCP's tend to make statements in there clinical visits  that are not even brought up during the veterans visit  so check your Myhealthyvet Notes after 3 days  and you can see what all the PCP stated in his/her report.

but main thing is try to let the Dr Know about all your contention  service connected or not.  you will be glad you did later on down the road.

This is why the VA Dr's get paid so well, so make them earn it.

& never let a Dr hurry you up, some will try that but don't let them push you around , because it will be like 6 months before you may get in again  or 3 months at the soonest . 

Make this appointment like it was your last and try your best to get in every detail about all your contentions that you need to talk to the PCP about.

Remember to write everything down you need to ask the Dr about  no matter how bif or small that maybe..you need medical documention  and you will have it.

If by chance when you check the Dr's reports  after 3 days and there is things in it that the Dr never said or twist things around...you can confront that Dr about it later and request an appointment with him/her  take copies from Mthealthyvet Notes  and just confront the Dr about it  so they can make an Amendment and get it straighten out.

 Remember all these Dr'notes are placed in your C-FILE for VA RO to review.