Thoughts on This Nexus Letter..To Much, Not Enough?

[bm7388]

August 13, 2019 RE: Brian Morrison DOB: 10/2/1973 To whom it may concern, My name Dr. James Lohse; I am certified to practice in my specialty. I have been asked by Mr. Morrison to write this letter in support of his veteran’s claim with the Department of Veteran Affairs. I have reviewed his VA C-File, medical history both military service records and private medical records, initial PTSD disability evaluations, sleep studies, compliance with CPAP records and psychiatric evaluations. I have also reviewed and have noted the circumstances and events of his military service to include his occupation of Airborne Infantryman. During his time as an Infantry Paratrooper, Mr. Morrison conducted over 80 parachute jumps, numerous forced road marches and patrols, along with typical physical fitness activities of typical soldiers. Mr. Morrison was required to carry extremely heavy loads compressing on the lumbar area of his lower back, at times exceeding hundreds of pounds in gear, weapons and ammunition, see below for more explanations of weight carried. Mr. Morrison is a patient under my care since 8/13/2019. His diagnoses are Spinal Stenosis, Diabetes Type 2, Obstructive Sleep Apnea (OSA), Post-Traumatic Stress Disorder, Hypertension, Anxiety, and Plantar Fasciitis. I am familiar with his history and have examined Mr. Morrison while he has been under my care. Mr. Morrison has no other known risk factors that may have precipitated his current conditions. I have reviewed pertinent records to include military service and medical records, along with private medical records. At this point in Mr. Morrison’s military carrier, he weighed approx. 150lbs in body weight. Infantrymen are required to carry their equipment where they go, which consist of (rucksacks (large Alice Pack (3lbs.) with Alice Frame (3.10 lbs.) , Load Bearing Equipment (LBE 2lbs.), Chemical Protective Mask (3.5lbs.), 4 quarts of water (8lbs.), personal items to include extra uniforms, socks and underwear, personal hygiene items and food (Ruck sack weight without ammunition is approx. 40 lbs. per Army Field Manual FM 221-18)). These men are also required to carry combat loads of ammunition (100 rounds of 7.62millimeter ammunition weighs 6.6 lbs. X 1000 rounds per combat load= 10 boxes / 2 men per M60 Gun team= 33lbs of ammunition per man). Mr. Morrison was a M60 Machine Gunner, required to carry the M60 Machine Gun that weighs 23.15lbs. Mr. Morrison was required to wear a Kevlar helmet (3.25lbs.) and a Flak Jacket (9.5lbs) with ballistic plate carrier (additional 8lbs.) with ballistic plates (additional 15lbs.) The total weight for this equipment that is carried on the back is 172lbs. Mr. Morrison was required to conduct forced Road Marches of 12 miles regularly carrying this amount of weight, along with patrols while conducting field training exercises. Mr. Morrison was also an Airborne Paratrooper, required to wear 1 T-10c Parachute (31lbs. with Reserve Parachute (8lbs.)), 1 Airborne Weapons Case (5lbs.) During Airborne operations, Mr. Morrison’s total weight carried was 196lbs. spread out between his upper and lumbar back area. While rigged up to jump, the ruck sack is attached to the lower part of the parachute harness at the lumbar area, pulling that weight down onto the lower L4, L5 lumbar spine area. Mr. Morrison was also required to conduct daily physical fitness activities that consisted of running three to six miles 3-4 times daily, along with weight training. Spinal Stenosis is can be caused if your job involves lifting and carrying heavy objects, spending a lot of time standing in one position or bending over and impacts that compress the spinal cord. Symptoms include pain in back and legs, stiffness and limited motion, numbness or tingling in arms or legs, difficulty moving legs and loss of bladder or bowel control. The pain maybe continuous or occur only in certain positions. Taking Mr. Morrison’s military history being an Airborne Infantryman into account and it being a known medical fact that parachuting puts abnormal, traumatic pressure on joints, especially knees, feet, ankles, hips and spine, and as a result, chronic joint disabilities usually follow; and the images taken of Mr. Morrison’s lower back and flexion examination. I opine more likely than not, Mr. Morrison’s current diagnoses of Spinal Stenosis is a result of duties performed during his military service. Sincerely, ___________________________ James Loshe, MD FAAFP CAQSM

[GBArmy]

Well, for starters, the doc has to have his resume with his "petagree" noted. If he is board certified, in what? What articles has he published, or books?, Schools, degrees. Why is he qualified to make this opinion. I am assuming that he is a back doc; doesn't say but is appears that he is mainly talking about the weight causing the back issues. Do you have other medical opinions on the other claimed disabilities? If he is trying to cover those issues in this letter, it is inadequate. If he is not trying to talk to those other issues why is he doing it and why is he qualified to talk to them ex. Sleep apnea: why would he be qualified. If he is a GP, for an example, he could talk to the others, but he hasn't done much in facts for the as they relate to you. It is great that you have a doc that is willing to do this, but you have work to do.

[vetquest]

I agree with everything GBArmy sates.

I am going on the assumption that the disabilities he listed are already assigned. But you only list 10% service connected.  If you are not recognized for these disabilities his mentioning the disabilities without explanations and diagnoses may hurt you.  IE, only a VA doctor can diagnosis PTSD.  As for the others, he must make a decision on whether they are service connected.  As for the lumbar spine disability he makes a great case but must say that it is more likely than not that the lumbar spine issue is related to your military service.  

 

[Buck52]

BG Army is correct

This Dr needs to add his medical credentials and expertise/experience ?

'' James Loshe, MD FAAFP CAQSM''  ( needs to be more in detail.)

 this Dr stated

''My name Dr. James Lohse; I am certified to practice in my specialty. ''

but he failed to mention what his specialty is?

is he certified in Sleep Apnea Medcine? is he certified to give his professional opinion on other medical matters? such as PTSD or mental problems?

they  (VA)will certainly look into this.

[broncovet]

In my recent IMO, the practioner enclosed his CV (cirriculum Vitae).  You need to establish that this doctor is "competent" to render a valid medical nexus opinion by virtue of his (medical) experience and medical training.  

Interestingly, when VA sends you to a c and p exam, the examiner is "presumed competent", absent your challenge to his competency.  However, when you submit an IMO, you have to demonstate the competency of the examiner..its not presumed.