lower back strain C&P exam

[PACBRED]

Hello everyone...

I recently had a C&P exam for my lower back and was awarded 40%. I then filed for IU and they of course set me up for another C&P exam and had my previous employer send in forms needed for IU. I went to my C&P exam and it was a certified registered nurse practitioner who I saw. She started off interrogating me about who is controlling the pain is it pain management or primary care? Then she proceeded to ask me to show her how far I could bend. I should her how far I could bend and she wasn't even looking she was already asking me to twist my body and I was confused as to what she meant by that and so she proceeded to grab by arms and started to twist me. She asked if that hurt I told her no. Then she started typing away on her computer. So when I went to get a copy of my C&P exam she lied on they exam and checked the box that stated condition has improved and she also went as far as stating that after reviewing my xrays from 2003 it was normal and in 2005 it showed degenerative changes. First off they never sent me to do an Mri or ct scan. So when they finally decided to do an Mri and CT scan it was in 2016 it should herniated disk , etc. They also have me taking 1800 mg of gababetin for lower back pain. They did do steroid injections for my back and that didn't help. So I get a letter from Department of Veterans Affair stating that they plan to take my 40% away due to improved back condition. I was so upset seeing that this individual who isn't a doctor giving her medical opinion and they agreed. I went to my service rep and told him that how can my lower back improved after seeing all the medications that Ive been on and the MRI and CT Scan says something different. Can anyone please shed some light on this situation because my lower back is still killing me and I stopped working for a couple of years. My Social security disability was approved but my IU was denied due to my 40% being striped based on c&p exam. I am going from 80% down to 60%. Anyone please help.

[Vync]

I've been though a situation like this, but first there is something very important here. The VA sent you a letter proposing reduction of your rating. You only have like 30 or 60 days to get back to them (check the letter) to contest this. Whatever you do, don't let that timeframe lapse. If you do, the reduction will go into effect and you'll have to take the NOD/appeal route to fight it. It's easier to contest it before the window expires, but you'll need to do some work.

Look for avenues to challenge the C&P.

Did the NP use a goinometer (protractor) to measure your ROM? If not, then you could qualify for an inadequate exam.

Some CRNP's are really good at what they do, but the VA uses them to help address the claims backlog. The key word here is "weight". An MD carries more weight than a NP. A neurologist or orthopedic doc is a specialist and carries more weight than an MD.

The part about her not even looking at you makes me smack my own head. You could probably challenge it on those grounds alone. You can try to ask for a specialist who has and knows how to use a goinometer.

Additionally, look up the effects of the medication you take. Gabapentin can help with the nerve pain, which can allow you to move more than normal.

Flare ups are important. If you have any medical evidence showing limited ROM during a flare up, make sure the VA is aware of it. Those are supposed to be key factors. With back pain, you may not be in agony at all times, but when you are it is supposed to count toward your limitations.

Look up the rating criteria for 40% and become familiar with the rating criteria and ROM tiers. Look up the DBQ so you are familiar with what they are supposed to perform the exam.

How long has your 40% been in effect? If it is less than five years, then they can propose to reduce based on an exam. If it has been more than five years, they have to be able to show sustained improvement, which tends to mean more than one exam.

If you hurt when you move on a certain axis, tell them when the pain begins. Painful motion is considered limited motion.

Keep in mind that if you do get another C&P, they the 40% spine ratings are based on the ROM limitation. There is a chance you could still be reduced though, but perhaps not as bad. You could always file for an increase when it gets worse.

Havind SSDI approved is a plus. Request consideration for extraschedular IU if your SC disabilities are responsible for being on SSDI. It's worth a shot.

[pwrslm]

40% is about as high as you can get in spine ratings unless your entire spine is frozen/cant move. Then its 50%, and if your neck is the same, it can get 100%. the 40% is 30 deg or less bending forward. Thats it. If you were bending to 45 deg, its 20% and beyone that its 10%, or 0 if you can bend all the way over and touch your toes without pain. Pain is a big player in this. Doctors dont prescribe weeks of bed rest for the pain anymore, that ended in the 90s, so the only real way they rate spine injury is how far you bend forward now. Min rating is 10% is they say its painful.

I would rush to get a MD to fill out a new C&P exam for you to counter the other one if you can afford it. Generally most non-VA docs will do it or have thier PA do it for them, either way you would have an accurate exam to counter the flunkee that did your orig C&P. That's what I do when they give me the flunkee, I have a secondary insurance now (CHAMPVA) because my spouse is 100% P&T so a $150 exam and report costs only $38 which makes it better. I had a 4 lvl fusion from L3 to S1 in 2015, nerve damage to both legs because of it. I have 40% on spine, Left leg is 60% and right is 10. I fell several times and injured both shoulders (20% bilateral) now. Secondary conditions are service connectable. If your toes are numb, its 10% per leg. If you have much worse pain (sciatica) and numbness, its 20% each leg affected. Weakness pushes it up to moderately severe, which is 40%, and with atrophy noted in medical exams it goes to 60%.  Loss of use or total paralysis is 80%, which is max for each leg no matter the cause. Legs are bilateral so you do the VA math and add 10%, just like shoulders and arms. Another issue is knee and hip arthritis, which may be tied to spine injuries as well.

If you have any of these secondary conditions, put them in as a new claim, and get a new C&P done ASAP to counter the reduction if u can. The VA will likely combine them all and you could end up with an increase when its all done. Like Vync said, dont wait, your time is limited. Ask for a hearing also. If they compare previous exams, or you have new exam by the VA PCP that contradicts the C&P they are using, they may just drop the whole thing. Drop in and ask you VA PCP to check your spine, and while you are there, see if they have a goniometer to verify your condition.

[Guest L]

Also - don't focus on this as much as your medical issues ....

 

but check the nurse pract. credentials against the state board and see if there are any malpractice issue...or complaints... 

google state board for nurses in your state and  locate the license number of her license off of your medical note. or her Medicare number if she is allowed to write prescriptions..... 

 

[paulcolrain]

THIS IS A FANTASTIC WEBSITE TO FOLLOW HOW SPECIFIC DISK BULGES AFFECT NERVE ROUTE INTO SENSORY...

https://www.spineuniverse.com/conditions/back-pain/low-back-pain/lumbar-radiculopathy-low-back-leg-pain

 

IF YOU CAN GET DR TO DO A SENSORY TEST PER NERVE ROUTE YOU WIN EACH NERVE....

[Guest L]

Sensory nerve test : called an ENG - overcoming the approval for the cost at the va is an obstacle.. I ran into... "Dermatomes" is what paulocolrain is referring to... 

https://www.webmd.com/brain/emg-and-nerve-conduction-study#1

[paulcolrain]

the doc can do a hands on test as did in my case.. can tell where the dullness is coming from just from a chart after the test.