Getting A Chiari Malformations

[epierce1389]

Hello,

I am wondering how I would go about getting a Chiari Malformation rating?  I have a service rating of 30% for headaches which I've had multiple doctors believe it is caused by a Chiari malformation.  I've had a CT and MRI done.

 

16Dec2014 (Brain CT)

FINDINGS:Cerebellar tonsils are protruding slightly inferiorly to theopening of the foramen magnum suggestive for   tonsillar ectopiaor very minimal Chiari 1 malformation.  The ventricles and sulciare normal in size for the patient's age. No abnormal intra-axialfluid collections are identified.  The brain parenchyma appearsintact, with normal gray-white differentiation. No evidence oflarge territory vascular infarct, acute intracranial hemorrhage,mass, or mass-effect. Paranasal sinuses are well aerated withoutevidence for acute sinusitis.

Impression: Low position of the cerebellar tonsils most consistent withtonsillar ectopia. Consider MRI to further assess and rule outpossibility of a mild Chiari 1 malformation.DIAGNOSIS CODE:  4 - ABNORMALITY, ATTENTION NEEDED

 

So they decided to do a brain MRI:

 

01Oct2015(Brain MRI)

 

FINDINGS:The images are slightly degraded by motion artifact.Stable slight asymmetry of the lateral ventricles, the left beingslightly larger in caliber than the right, likely representingdevelopmental variant. The ventricular system is otherwise normalin size for age. Slightly prominent bilateral frontoparietalcortical sulci and adjacent extra-axial spaces again noted. Thebasal cisterns are patent. There are no extra-axial fluidcollections, mass effect or midline shift. No areas of restricteddiffusion are identified to suggest acute infarct. No foci of abnormal magnetic susceptibility are noted on the B0 images tosuggest intracranial hemorrhage.No significant parenchymal signal abnormality detected. Scattereddilated perivascular spaces are incidentally noted bilaterallywithin the supratentorial white matter and gangliocapsularregions. The pituitary gland is normal in size for age. Rightcerebellar tonsillar ectopia again identified, 5 mm below thelevel of the foramen magnum. Borderline low-lying left cerebellartonsil, 2 mm below the level of the foramen magnum.Right parieto-occipital plagiocephaly noted. The calvarium, skullbase and visualized upper cervical spine demonstrate preservedfatty bone marrow signal. Diminutive intracranial right vertebralartery, possibly terminating in the right posterior inferiorcerebellar artery, likely representing developmental variant.Flow voids are present within the remaining major vessels of thecircle of Willis, indicating their patency. The dural sinusesappear grossly unremarkable.Trace mucosal thickening within bilateral inferior frontalsinuses, ethmoid air cells and maxillary sinuses. The paranasalsinuses are otherwise well-aerated. Underpneumatized left greaterthan right inferior mastoids. The remaining right mastoid aircells appear well-aerated. Small amount of fluid noted in theleft lateral mastoid air cells. The intraorbital contents appearwithin normal limits.

 

Impression: 1. No acute infarct, intracranial hemorrhage, mass effect ormidline shift identified. 

2. Right cerebellar tonsillar ectopia,5 mm below the level of the foramen magnum, and borderlinelow-lying left cerebellar tonsil, 2 mm below the level of theforamen magnum

 

 

 

Those are the only two things I have related to it.  I was told by a pain management doctor from the VA he believes that these are the reason I am having my bad headaches and even affecting my memory.  I can hardly remember last week and sometimes even what I've done that day. 

 

Next week I am seeing my civilian doctor and asking him to do another ct/mri on my brain see if it has gotten worse.  I recently went to the eye doctor and my eyes are in pretty bad shape for a 29 year old, but he believes this issue is also causing my eye problems.

Last question, how would I go about filing this as a fully developed claim?

 

Any advice would be greatly appreciated!

Edited February 27, 2019 by epierce1389

[Berta]

There are many decisions at the BVA on this disability:

This is a long, but recent  very medical interpretation:

https://www.va.gov/vetapp18/files6/18112273.txt

Unfortunately the BVA remanded the claim

 There is rating info in the decision as well as what other disabilities might be secondary to the Chiari malformation : “Readjudicate the symptoms on appeal to determine whether they are residuals of service connected Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord or whether disorders manifested by those symptoms were caused or aggravated by the service-connected Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response before the case is returned to the Board.”

It seems to me that the VA is conceeding (due to the SC headaches) that the Chiari is also a service connected disability....which seems to be a normal manifestation of Chiari.

However: the decision starts out with:

"ORDER
A 70 percent rating for dysthymic disorder associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A 30 percent rating for a disfiguring scar of the neck associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A rating in excess of 10 percent for two stable, but painful, scars associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is denied since May 17, 2010.
A 60 percent rating for right upper extremity radiculitis associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A rating in excess of 30 percent under 38 C.F.R. § 4.124a, Diagnostic Code 8024, for Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord since May 17, 2010, is denied."

 

Some grants,some denials , but on remand perhaps the veteran can turn those denials around.

What is good about this decision is that it shows how many secondary conditions can result from Chiari Malformations.

You have 90 % now- can you tell us what those ratings are for?

Also, can you still work with this disability?

If not, do you get SSDI and is it solely for the headaches or the chiari disability?

I am thinking that to file a fully developed claim, you need to make sure that the Chiari is a SC disability- perhaps they did award it but as a "0" SC yet they did award the headaches as SC...

and then you might want to invest in an IME ( Independent Medical Evaluation) that will not only support a rating for the Chiari, but also will support ratings for anything else you might have as secondary to it.Perghaps your civilian doctor would beable to prepare an IME for you= the IMO-IME forum here will reveal what he/she needs to consider , with the proper wording , (" as likely as not" and a full medical rational.

You stated:

 

"Those are the only two things I have related to it.  I was told by a pain management doctor from the VA he believes that these are the reason I am having my bad headaches and even affecting my memory.  I can hardly remember last week and sometimes even what I've done that day. "

But a good doctor might well find you have other ratable problems due to this.

The MRI states:

"tonsillar ectopiaor very minimal Chiari 1 malformation", which could mean a minimal rating from the VA....

then you stated:

"Next week I am seeing my civilian doctor and asking him to do another ct/mri on my brain see if it has gotten worse."

I think that is an excellent idea and will be able to hopefully support a FDC.

 

https://www.index.va.gov/search/va/bva.jsp This search feature might help you-= we also have had in the past other vets here with this disability.

 

 

 

[Vync]

I also found one where SC was denied because they considered it a congenital defect. As Berta indicated, this could go either way. Advise caution.

https://www.va.gov/vetapp16/Files2/1615691.txt

Quote

FINDING OF FACT

Arnold Chiari malformation is a congenital defect and is not a disability for VA purposes; no other disability is superimposed upon this defect.

 

[Berta]

Thanks Vync- very good info--- the odd thing is that in this more recent BVA decision they state:

"The Veteran also seeks a compensable evaluation for his service-connected Arnold Chiari I Malformation with Syringomyelia which has been rated pursuant to 38 C.F.R. ง 4.124a, Diagnostic Codes 8099-8024. Arnold Chiari malformation does not have a specific diagnostic code. When a Veteran is diagnosed with an unlisted condition, it must be rated under an analogous diagnostic code. 38 C.F.R. งง 4.20, 4.27. The diagnostic code is "built-up" by assigning the first two digits from that part of the schedule most closely identifying the part of the body involved and then assigning "99" for the last two digits for all unlisted conditions. Then, the disease is rated by analogy under a diagnostic code for a closely related disease that affects the same anatomical functions and has closely analogous symptomatology. Therefore, the Veteran's service-connected Arnold Chiari malformation with syringomyelia is rated according to the analogous condition of syringomyelia under Diagnostic Code 8024, which provides for a minimum rating is 30 percent. Higher ratings are assigned by analogy to other Diagnostic Codes. "

https://www.va.gov/vetapp18/files1/1805015.txt

It is something to watch out for- because here we have two separate BVA decisions that have opposite results.

[Berta]

I just read the BVA Arnold chiari denial- aint that the craps? The veteran shot himself in the foot!

-- what I mean is he sent to the VA some internet printouts , in which  the Arnold type of chiari was often deemed congenital- and the VA was more than happy to run with those print outs....that denied the claim.

He should have sent the BVA some of their own  Arnold Chiari decisions! But that does not help much either.

He should have gotten an IME.!!!

I cannot imagine why vets and survivors think something from an internet site will really help their claims.This is a good example of how these internet articles hurt this vet's claim.

A good medical printout ,however, can certainly support the established medical facts of a claim.

I have used internet print outs - specifically from Merck ,in one case because VA used Merck for years and the print out completely knocked down some dumb C & P examiner's statement in a past claim I had.

Example- I was trying to prove my husband had DMII and found a diagnosis that had been crossed but but I still could read it. Then I found an entry for DVD. Diabetic Vascular Disease. per Merck.

The C & P endocrinologist said DVD did not mean mean Diabetic Vascular disease, it meant the veteran Denied having  Venereal Disease ( DVD)-I knocked that down with the print out of the medical abbreviation from Merck and what it meant -diabetic vascular disease, DVD and also pointed out to the VA that my husband never denied having VD at all and it was clearly noted he got it in Vietnam and was within his SMRs and noted in all of his treatment records and rating sheets.

Also internet printouts ( of a 1997 VA training Letter) made me realise that I could be confident that my costly IMOs would make the DMII claim succeed. 

And if you get an IMO/IME from a real doctor  they can bolster their opinions with their own access to medical info,that may or may not appear on the net.

C & P doctors use Google a lot- and will use any search feature that can support a denial of the claim- a search excerpt that,however,  might be outweighed by multiple other medical studies, abstracts etc-which pop up in the same search list- that would have supported the claim.

 

Edited February 28, 2019 by Berta
added more

[epierce1389]

3 hours ago, Berta said:

There are many decisions at the BVA on this disability:

This is a long, but recent  very medical interpretation:

https://www.va.gov/vetapp18/files6/18112273.txt

Unfortunately the BVA remanded the claim

 There is rating info in the decision as well as what other disabilities might be secondary to the Chiari malformation : “Readjudicate the symptoms on appeal to determine whether they are residuals of service connected Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord or whether disorders manifested by those symptoms were caused or aggravated by the service-connected Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response before the case is returned to the Board.”

It seems to me that the VA is conceeding (due to the SC headaches) that the Chiari is also a service connected disability....which seems to be a normal manifestation of Chiari.

However: the decision starts out with:

"ORDER
A 70 percent rating for dysthymic disorder associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A 30 percent rating for a disfiguring scar of the neck associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A rating in excess of 10 percent for two stable, but painful, scars associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is denied since May 17, 2010.
A 60 percent rating for right upper extremity radiculitis associated with Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord is granted since May 17, 2010.
A rating in excess of 30 percent under 38 C.F.R. § 4.124a, Diagnostic Code 8024, for Chiari malformation with syringomyelia and residuals of a posterior fossa decompression and syringo subarachnoid shunt of the spinal cord since May 17, 2010, is denied."

 

Some grants,some denials , but on remand perhaps the veteran can turn those denials around.

What is good about this decision is that it shows how many secondary conditions can result from Chiari Malformations.

You have 90 % now- can you tell us what those ratings are for?

Also, can you still work with this disability?

If not, do you get SSDI and is it solely for the headaches or the chiari disability?

I am thinking that to file a fully developed claim, you need to make sure that the Chiari is a SC disability- perhaps they did award it but as a "0" SC yet they did award the headaches as SC...

and then you might want to invest in an IME ( Independent Medical Evaluation) that will not only support a rating for the Chiari, but also will support ratings for anything else you might have as secondary to it.Perghaps your civilian doctor would beable to prepare an IME for you= the IMO-IME forum here will reveal what he/she needs to consider , with the proper wording , (" as likely as not" and a full medical rational.

You stated:

 

"Those are the only two things I have related to it.  I was told by a pain management doctor from the VA he believes that these are the reason I am having my bad headaches and even affecting my memory.  I can hardly remember last week and sometimes even what I've done that day. "

But a good doctor might well find you have other ratable problems due to this.

The MRI states:

"tonsillar ectopiaor very minimal Chiari 1 malformation", which could mean a minimal rating from the VA....

then you stated:

"Next week I am seeing my civilian doctor and asking him to do another ct/mri on my brain see if it has gotten worse."

I think that is an excellent idea and will be able to hopefully support a FDC.

 

https://www.index.va.gov/search/va/bva.jsp This search feature might help you-= we also have had in the past other vets here with this disability.

 

 

 

My ratings for 90% are:

surgical scars; left inferior rectus abdominus muscle, aponeurosis 0% Service Connected Disability Evaluation System (DES) 05/31/2013 posttraumatic stress disorder due to personal trauma and bipolar disorder   Not Service Connected PTSD - Personal Trauma   left ilioinguinal neuropathy (also claimed as hip joint pain, left) 10% Service Connected Disability Evaluation System (DES) 10/01/2015 erectile dysfunction 0% Service Connected Disability Evaluation System (DES) 05/31/2013 headaches 30% Service Connected   09/04/2015 dyspnea   Not Service Connected Disability Evaluation System (DES)   patellofemoral syndrome, left 0% Service Connected Disability Evaluation System (DES) 08/17/2017 limitation of extension left knee (Painful motion) 10% Service Connected   11/05/2014 right knee strain 10% Service Connected   09/04/2015 degenerative facet arthropathy (previously rated as bilateral lumbar paraspinal muscle strain with mild degenerative disc disease at L5-S1 (also claimed as low back pain)) 20% Service Connected Disability Evaluation System (DES) 07/08/2017 adjustment disorder with depressed mood secondary to a medical condition (also claimed as insomnia associated with pain) now diagnosed as unspecified depressive disorder 50% Service Connected Disability Evaluation System (DES) 07/01/2014 left hip strain claimed as left hip condition 10% Service Connected   07/08/2017 left sciatic radiculopathy 10% Service Connected   07/08/2017 limitation of extension, left thigh claimed as left hip condition 0% Service Connected   07/08/2017     I am on disability.  Judge looked at my medical file and award it to me within 5 minutes of the hearing.  Didn't even say one word.

[epierce1389]

3 hours ago, Vync said:

I also found one where SC was denied because they considered it a congenital defect. As Berta indicated, this could go either way. Advise caution.

https://www.va.gov/vetapp16/Files2/1615691.txt

 

That is what I have read before.  I have read where people were awarded it and others denied.  I am hopping I have a case to make based on the fact they didn't know why I was having headaches, rated my headaches then a pain management doctor at the VA did the brain CT and MRI.  He was very worried that those findings are why I am getting headaches.  Now a eye doctor believes its also making my eyes worse to the point I now have to wear glasses.