Lower Back Claim - Epidurals

[Conrad G]

Hello community,

This is my first post, so hopefully, I'm posting it correctly!

I have a service-connected disability in my lower back for 'Lumbar Strain' at 10% in 2012. (L4/L5) - I'm also currently 34 years old.

Since then, I received ~4 or 5 epidurals through the VA and then 1 nerve blocker procedure through the VA as well in 2013/2014. Also, here it showed the beginning sign of DDD on L4 only.

I moved abroad in 2015, and from 2015-2017 I would take hydrocodone either 5 or 10mg very often for the lower back pain.

Through the Foreign Medical Program abroad in 2018, I was seen twice for my lower back and recommended for more back injections, but then moved to another country and had to start the process over again.

In November 2018, I went to the ER room because I was unable to get out of bed by myself. I was in the hospital for 6 days on a pain medicine drip and finally ended with another nerve block injections on both sides of the spine. Here the doctor also stated that the DDD is now on L4/L5/S1.

My questions:

1) I'll want to get seen for the 'Range of Motion' as I think I fit the criteria for an increase to 20%. If I live abroad how can I get this evaluated by the VA? I assume having a doctor where I'm at currently do the exam and provide notes to file with my claim?

2) Epidurals - Because I've received these injections and nerve block procedures, what should I be claiming for these? I don't know how to properly claim this and what disability I believe should be associated with the information I've provided.

3) DDD - Same as #2. What should I be claiming for this?

Also, if there's any other information you need, please let me know and I'll answer to the best of my knowledge. Thank you in advance for your help.

 

-Conrad

[broncovet]

1.  You did not specify "what country" you are in, and this probably makes all the difference.  We have no idea if your doc even speaks (or writes) English, and its fruitless to speculate on "what VA will do" in your circumstance.  We dont even know "what VA will do" in America, much less in foreign countries.  Im not sure its VA's fault/responsibility to provide you with an American c and p exam, when it was your choice to live abroad.  While its true that "travel mileage" is paid to Vets attending a c and p exam, i have no idea if that applies to Vets who choose to live overseas.  The obvious answer is for you to relocate to the USA, at least, for long enough to attend your own c and p exam.  I would not expect VA to pay for that, but stranger things could happen.  

2 and 3.  Have you checked the criteria for DDD?   I think "epidurals" are a treatment, not a symptom, and VA does not compensate Vets for "treatments", but symptoms, since there are a wide variety of methods of treatments.  You can look up the criteria, here:  https://www.benefits.va.gov/warms/bookc.asp

     My advice is for you to apply for an increase, using the applicable form, and, maybe a new claim for ddd if not so rated already.  Remember, tho, being rated for a "new diagnosis" such as DDD may or may not result in an overall increase, in part, because pyramiding is prohibited.  

     In regard to where/how/who pays for travel overseas to a c and p exam, my guess is you should apply for an increase, and see what VA says.  After you hear their response, you can decide what to do from there amongst your options.  You have many options, for example, withdrawing your claim for increase, travel at your own expense to c and p exam, or, there may not necessarily be a c and p exam needed.  Remember, there is no rule that a c and p exam is "required".  VA orders c and p exams, pretty much, only when they want to.  

[Conrad G]

1 minute ago, broncovet said:

1.  You did not specify "what country" you are in, and this probably makes all the difference.  We have no idea if your doc even speaks (or writes) English, and its fruitless to speculate on "what VA will do" in your circumstance.  We dont even know "what VA will do" in America, much less in foreign countries.  Im not sure its VA's fault/responsibility to provide you with an American c and p exam, when it was your choice to live abroad.  While its true that "travel mileage" is paid to Vets attending a c and p exam, i have no idea if that applies to Vets who choose to live overseas.  The obvious answer is for you to relocate to the USA, at least, for long enough to attend your own c and p exam.  I would not expect VA to pay for that, but stranger things could happen.  

2 and 3.  Have you checked the criteria for DDD?   I think "epidurals" are a treatment, not a symptom, and VA does not compensate Vets for "treatments", but symptoms, since there are a wide variety of methods of treatments.  You can look up the criteria, here:  https://www.benefits.va.gov/warms/bookc.asp

     My advice is for you to apply for an increase, using the applicable form, and, maybe a new claim for ddd if not so rated already.  Remember, tho, being rated for a "new diagnosis" such as DDD may or may not result in an overall increase, in part, because pyramiding is prohibited.  

     In regard to where/how/who pays for travel overseas to a c and p exam, my guess is you should apply for an increase, and see what VA says.  After you hear their response, you can decide what to do from there amongst your options.  You have many options, for example, withdrawing your claim for increase, travel at your own expense to c and p exam, or, there may not necessarily be a c and p exam needed.  Remember, there is no rule that a c and p exam is "required".  VA orders c and p exams, pretty much, only when they want to.  

10

Thank you for your response. To clarify, I live abroad in Colombia, South America. Here, they generally speak Spanish, so all the documents would be in Spanish. The ones that also speak English, do their medical reports in Spanish.

With regards to what is covered by the VA/not covered, it's what is covered by the Foreign Medical Program (FMP). Travel is not covered in this. Only medical treatments/procedures/etc. associated with VA disability covered items.

About the relocation solely for a C&P exam, according to what I've read is that the VA goes off of what the foreign documents show or they have someone fly out solely for the purpose of the exam. Relocating to the US is not currently an option as I'm a resident of a foreign country and here for the foreseeable future.

About the Epidurals being a treatment, I can understand this. I am trying to clarify if it's a secondary condition or not, as they are 'burning the nerve' in order to relieve pain.

DDD - I'll just have to apply for this and see what happens.

Thank you again for your quick response.

 

-Conrad

[broncovet]

It sounds like you know more about the Foreign Medical Program than I do.  As far as whether to apply for this secondary, or primary, I dont recommend you overthink this.  You need not make that choice..let VA raters do their job and decide what type of service connection.  So, apply for DDD both primary and/or secondary to sc conditions.  Dont choose between one or the other..why it could be neither and be a presumptive!!!  VA should know what is on the presumptive list or not, and you dont need to be a doctor.   If you insist, you could ask the doc whether or not "this condition" was caused by service or whether it was secondary to an already sc condition, and let the evidence determine your choice.  

I have seen Vets delay their claim by getting "too" specific.  For example, "I want to apply for osteoarthritis of C4-C5 secondary to blah, blah, blah."   Instead, tell them "it hurts in your back" and you want to apply for all benefits related to it.  You dont have to self diagnose your condition, but, if you do, the VA could deny that and you would have to re apply with the new diagnosis.  Of course, that is not supposed to happen either, but if you dont count of VA raters to do their job, you usually wont regret it, as far as connecting the dots to your "claimed" condition and the condition the doc diagnosed you with.  Just apply for an increase and new condition of DDD (if so diagnosed) both primary and secondary to your current SC conditions to cover all your bases.  

Please permit me an explanation:

A "diagnosis" by a doctor is required for SC.  (Element 1 of Caluza elements).  However, VA benefits are based on "symptoms", not diagnosis.  For example, if you had a diagnosis of DDD but had "no symptoms", the max rating you would get would be zero percent.  The VA requires a diagnosis, but compensates you based on symptoms of that diagnosis.  (such as pain, loss of range of motion, functional impairment.  "Functional impairment" would mean stuff like your ddd was so severe you could not walk.  "Inability to walk" is a functional impairment that would likely decrease your ability to earn a living.   The compensation rating tables are designed to compensate you for your loss of earning capacity due to that disability.) . 

[Conrad G]

30 minutes ago, broncovet said:

It sounds like you know more about the Foreign Medical Program than I do.  As far as whether to apply for this secondary, or primary, I dont recommend you overthink this.  You need not make that choice..let VA raters do their job and decide what type of service connection.  So, apply for DDD both primary and/or secondary to sc conditions.  Dont choose between one or the other..why it could be neither and be a presumptive!!!  VA should know what is on the presumptive list or not, and you dont need to be a doctor.   If you insist, you could ask the doc whether or not "this condition" was caused by service or whether it was secondary to an already sc condition, and let the evidence determine your choice.  

I have seen Vets delay their claim by getting "too" specific.  For example, "I want to apply for osteoarthritis of C4-C5 secondary to blah, blah, blah."   Instead, tell them "it hurts in your back" and you want to apply for all benefits related to it.  You dont have to self diagnose your condition, but, if you do, the VA could deny that and you would have to re apply with the new diagnosis.  Of course, that is not supposed to happen either, but if you dont count of VA raters to do their job, you usually wont regret it, as far as connecting the dots to your "claimed" condition and the condition the doc diagnosed you with.  Just apply for an increase and new condition of DDD (if so diagnosed) both primary and secondary to your current SC conditions to cover all your bases.  

Please permit me an explanation:

A "diagnosis" by a doctor is required for SC.  (Element 1 of Caluza elements).  However, VA benefits are based on "symptoms", not diagnosis.  For example, if you had a diagnosis of DDD but had "no symptoms", the max rating you would get would be zero percent.  The VA requires a diagnosis, but compensates you based on symptoms of that diagnosis.  (such as pain, loss of range of motion, functional impairment.  "Functional impairment" would mean stuff like your ddd was so severe you could not walk.  "Inability to walk" is a functional impairment that would likely decrease your ability to earn a living.   The compensation rating tables are designed to compensate you for your loss of earning capacity due to that disability.) . 

Thank you for your help and information. I will see what I can do when applying for the increase and give you an update when I've received word from the VA. Happy New Year!

[Vync]

Welcome to Hadit!

When getting your limited ROM checked, you can have your regular doc fill out the DBQ. You do not need to wait for a C&P exam to do this. Just be sure you tell them where pain begins (i.e. Delucca rule) and ask them to note that down.

https://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp

21-0960M-13	Neck (Cervical Spine) Conditions
21-0960M-14	Back (Thoracolumbar Spine) Conditions

 

Additionally, if you have any limited ROM measurements in your records from the past 12 months, bounce the ROM degrees off the rating criteria and see if they warrant an increase. You can request an increase in the manner, often without the need for another examination (depending on disability).