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]

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]

CC,

MOP in the dark...no wonder you missed that step down.  Whew!

Hmm...started out with physical therapy, which was stopped after 3 sessions, no relief was found there. Next was shots in both SI joints, which worked for a week.  Next is chiropractic bend and snap. Go for that tomorrow, m first time ever.  Waiting to hear back from the acupuncturist to set up an appointment with her.

They showed me on film where my arthritic facet joints are and narrowed nerve openings and degenerate discs, too. 

Most of the time the pain is like fire here and there, with occaisional lightning bolts, mixed with deep dull pain that feels like yesterday's mule kick.

[Crabcake]

5 hours ago, Andyman73 said:

CC,

MOP in the dark...no wonder you missed that step down.  Whew!

Hmm...started out with physical therapy, which was stopped after 3 sessions, no relief was found there. Next was shots in both SI joints, which worked for a week.  Next is chiropractic bend and snap. Go for that tomorrow, m first time ever.  Waiting to hear back from the acupuncturist to set up an appointment with her.

They showed me on film where my arthritic facet joints are and narrowed nerve openings and degenerate discs, too. 

Most of the time the pain is like fire here and there, with occaisional lightning bolts, mixed with deep dull pain that feels like yesterday's mule kick.

Yikes! Good luck with the chiro. I wish you the best outcome for getting relief; SI joint pain is an unbearable bear. I have done all three at different points with decent results - injections for keeping inflammation at bay, PT for muscle strengthening, traction, and flexibility, and chiro for adjustment & alignment. What frustrates me about it is I KNOW my SI joints have a problem, but the VA Drs keep saying "si joints appear fine on X-ray" and then overlook them and my pain with them, except my private Drs. Did your SI joint problems show on X-ray or MRI? My MRI is Tuesday morning and I believe will cover cervical/spine through sacrum/SI, so I look fwd to reading that report and seeing what it reveals. 

One question I asked earlier in this thread and am still unclear on is if - when I refile my claim - would I claim the shooting pain/numbness problems with my legs & arms as separate conditions from my back & neck pain (disability for legs, disability for arms, etc), or is the pain in them factored into the back and neck ratings? I am not clear on the whole "grouping" of conditions factor. If anyone can clarify that or share a link that articulates the groupings matter, I would appreciate it. 

[Buck52]

crabcake

How was your visit today at VAMC?

 Did you get a good Dr?

AS for as your claim  you really need a Dr (specialist) to say how bad your disability is and say things like in his/her opinion I have examine this veteran (state your full name and last 4#) and have read her medical records & STR AND this veteran disability (discribe disability and a diagnoses)....is likey as not caused from military service. ( SOMETHING LIKE THIS)

This is called a Nexus letter....I'll go find one and post it under this post.

Being were not Dr's we can't diagnose our self or give opinions on our disability,other than say ''its sore as hell''  they (VA) say that's pure speculation on our part  which carries no weight.

And you can get a private Dr to give his/her opinion..you will find out the VA PCP don't like to help us to much with our claims  but ever now and then  they do  Just depends a lot on the VA PCP.

hope your feeling better btw?

[Buck52]

Example of a Nexus Letter

DATE ____________ 

Reference: (Veteran's name) ____________ 

SS# ____________________         VA File #____________________ 

To Whom It May Concern, 

I am Dr. ____________. I am board certified to practice in my specialty. My credentials are included. I have been asked to write a statement in support of the afore mentioned veterans claim. 

I have personally reviewed his medical history. (Name the Documents) I have also reviewed and have noted the circumstances and events of his military service in the years ____________ (Event or Events claimed as the cause of the condition) while he served during his military service. (List dates of service) 

Mr. ___________ is a patient under my care since (enter Date). His diagnosis is _____________ (Name the Condition). 

I am familiar with his history and have examined Mr.____________ often while he has been under my care. (Specify Lab Work, X-rays, Etc.) 

Mr.____________ has no other known risk factors that may have precipitated his current condition. 

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. ____________'s condition is a direct result of his (Event) as due to his military service. (Choose the degree of likelihood with which you can concur - "at least as likely as not", "more than likely", or "highly likely") 

In my personal experience and in the medical literature it is known (Give a rationale). 

Signed, 

Dr. ____________
(List credentials and contact information) 

Please understand that the VA often uses credentials to assign probative value to the nexus letter.
While the nexus letter must be brief as possible it should be as detailed and complete as the circumstances dictate. 


you need something like this when you submit your claim.

 

 

[Crabcake]

50 minutes ago, Buck52 said:

crabcake

How was your visit today at VAMC?

 Did you get a good Dr?

AS for as your claim  you really need a Dr (specialist) to say how bad your disability is and say things like in his/her opinion I have examine this veteran (state your full name and last 4#) and have read her medical records & STR AND this veteran disability (discribe disability and a diagnoses)....is likey as not caused from military service. ( SOMETHING LIKE THIS)

This is called a Nexus letter....I'll go find one and post it under this post.

Being were not Dr's we can't diagnose our self or give opinions on our disability,other than say ''its sore as hell''  they (VA) say that's pure speculation on our part  which carries no weight.

And you can get a private Dr to give his/her opinion..you will find out the VA PCP don't like to help us to much with our claims  but ever now and then  they do  Just depends a lot on the VA PCP.

hope your feeling better btw?

Thank you for the perspective Buck, as well as the template. I guess I am just trying to "think through as I go through", if that makes sense, so I can make sure I am asking the Drs the right questions, ensuring - where I need to - I make notes at appts, ask for the dr to document things where it may be necessary, etc.

Today's appt was ... okay. It was a rough start because they didn't check me in properly, so when my appt time passed by 15 mins with others coming in & going back while I waited, I politely asked the reception person if I was forgotten, and he said the other person didn't check me in right. So, by the time I actually got in with the PCM (a NP), half of my 60-min appt passed, and she curtly said "since you were late, we won't get to cover everything today ...". I arrived 20 mins early for my appt, checked into reception, and waited patiently for 30 mins, so I politely but firmly corrected her assumption about my "tardiness", and really did not appreciate feeling rushed. I was in a lot of pain, had already had one panic attack just driving there, and then two more while in her office just talking through my conditions. Her attitude made me feel like I did not matter or was impeding her from something - so, not a really good "first impression", and sadly a reminder of why I went with private Drs the last 10+ years. ?

Nevertheless, I did get some pain relief via a torodol shot (which I didn't even feel due to how numb my rear & legs are). I can move my neck a little better right now, the SI joint/lumbar area inflammation has eased up some, and I can walk with a little less pain, but my thighs are still half-numb/tingling with some shooting pain, and both my arms and legs still feel 'heavy', like it's a chore to move them. I don't know how long this shot will last (12 hrs, a couple days...). She reviewed my current meds and family medical history, but we didn't get to half of my list. She focused on the immediate issue of my current pain which makes sense, checked my ROM, and we have another appt next Thurs to hopefully finish my list and review MRI (Tues) results. She is putting in a few referrals to include mental health, physical therapy, and one other I cannot recall off hand, but I think she was waiting to do ortho referral pending the MRI results. I will see what shows in the notes when they are available to me.