"lower back condition" denial

[th175]

I was rated 20% for my shoulder due to many dislocations and 10% for cervical strain. I applied for lower back condition thru the DAV. It was denied because they stated the scoliosis I have is not service related. I appealed and asked for a hearing.

 

Since I didn't mention scoliosis in the claim I'm not sure why that is all that they looked at. I've had a back Xray which showed

"2. Mild anterior endplate spurring, with disc heights maintained. 
 
3. Thoracic dextroscoliosis, measuring 22 degrees"

 

Which I'm told is indicative of degenerative disc disease and/or arthritis. However, I don't have any in service medical treatment records for my back because I never complained due to fear of losing my flight status as a pilot.

 

I'm being seen by a private sector doctor and getting facet joint injections and medial branch block. How should I appeal this?

 

Should I get a nexus letter stating the arthritis was caused by my service on active duty as a pilot? Or should I ask the doctor to tie my lower back condition in as a secondary condition to cervical strain or shoulder problems?

[GBArmy]

th175 Welcome to Hadit. The best advise I think you could get is to ask your doc what does he think has caused your back condition. I am not a doctor and am willing to bet you aren't one either. So the VA doesn't really care what we think about what caused your disability. Only thing that they care about is the medical opinion and reasoning of a doctor. It is called an IMO. They state the cause, "x' has caused the s-c condition. Why it happened and a statement that states that in their professional opinion, based on years of medical practice, study et. etc. it is at least as likely as not that it was caused by your service doing ...If your doc can't or won't provide such a statement, then you either can either get o new IMO from another doc or expect to lose appeal.

 

 

[th175]

13 minutes ago, GBArmy said:

th175 Welcome to Hadit. The best advise I think you could get is to ask your doc what does he think has caused your back condition. I am not a doctor and am willing to bet you aren't one either. So the VA doesn't really care what we think about what caused your disability. Only thing that they care about is the medical opinion and reasoning of a doctor. It is called an IMO. They state the cause, "x' has caused the s-c condition. Why it happened and a statement that states that in their professional opinion, based on years of medical practice, study et. etc. it is at least as likely as not that it was caused by your service doing ...If your doc can't or won't provide such a statement, then you either can either get o new IMO from another doc or expect to lose appeal.

 

 

Thanks for the reply. Is an IMO the same thing as a nexus letter? The DAV only sent me the nexus letter template and told me to have the doctor explain why it is secondary to one of my service connected disabilities. This led me to think that having the doctor give his opinion that my injury was caused by service would not be good enough for an appeal. Can just a doctor's opinion with no in service treatment records be enough?

[brokensoldier244th]

Yes, basically, but it has to be more than "I Dr. So and So, think this is service connected....." It needs his name, specialty, years of practice helps, and lots of rationale not just based on his personal opinion only, if they can get it (literature, personal observances, studies they've been a part of). It doesn't need to be flowery, but it needs to be more than a doctors note to school, too.

 

Scoliosis would have been inextricably mentioned somewhere in exams on your shoulders and back, and it would appear in your medical history summary that would be in your STRs and also in a lot of your VAMC clinical notes along with information from prior back ratings and or shoulder. The scoliosis could be contributing to the lumbar strain you are trying to claim- depending on where the deviation is and to what degree. If your scoliosis was in your entry physical you will have a difficult time- just because they waived you in doesn't necessarily mean that it will count as 'disabled in service' down the road-at least as far as I can surmise from the ratings I have seen.

CAS

Edited September 17, 2020 by brokensoldier244th

[GBArmy]

An IMO, Independent Medical Opinion, is the same. You don't have to have in-service med records if you're claiming a secondary condition to an alreadys-c condition. But as Broken just said, your  doc's letter has to have rationale with back up details why his opinion is correct. Search Hadit (and elsewhere) on what you need for a good IMO.,He has to be board certified for the most impact, provide his biography on work experience, education, published work, etc.and discuss medical studies, journals, technical stuff as back up. Just a letter from a GP on an IMO on a denial usually doesn't cut it. So you probably have to pay up front for the IMO.

[brokensoldier244th]

But, also KIM that a paid for IMO is still just an opinion- and whether you win your claim or not your Doc that you paid already has your money, and some of the more popular doctors that I see people referred to from the internet can charge from 500 to well over 1000 dollars or more and are not the ones actually reviewing your records. How could they? They supposedly do IMOs for thousands of cases a year with their name on them, which, if you want a good IMO with time spent on it, is a statistical impossibility. They need to be impeccable, specialized or at least very proficient in that area, to trump an actual in person physical exam. IF your examiner in person is an NP and your remote IMO opinion is from a doctor or a specialist, though, if they write a good one, it will generally bear out. 

Also, if you have a doctor use a DBQ form as part of your IMO- there is a spot on that form that asks if they saw your medical records and C file- if you don't have that, then they can't check the box. They also can't do a C and P per-se because if you live in TX and they live in Seattle and they DIDNT see you, its going to make a lot of what they say carry less weight than a C and P , no matter if they are the head of Orthopedic surgery at Seattle Grace. They can remark  in their opinion or on the DBQ (both, preferably) if you brought in part of it, though, or all of it up to year XXXX if you have it. Thats still okay, but the question is specific to them reviewing your C file records in real time as they are now. IF they remark to specific events in your records they should provide dates not page numbers- your page 193 is not MY page 193 when I pull your records from the VAMC, whatever your private doctor sends, or your STRs. 

C and Ps can only be done remotely by VAMCs and contractors (not my rules). An exam done via record review and no physical visit is going to have a more difficult time and will face more scrutiny. There are some doctors that will IMO remotely for a fee literally anything you send them. Their rationale is usually weak, and their track record is not that good- yet, they still have your money. 

FYI

If you have a remote IMO done and use a DBQ as a guide (they are still legally accepted forms at VA, they just removed the public link access to them-not my monkeys) the doctor MUST write up a separate opinion of some kind, not just do some remarks on the DBQ. For an actual C and P for service connection if a VA doc or contractor just does the DBQ and no actual opinion, we kick it back to them and make them redo it because its an insufficient exam. 

Edited September 17, 2020 by brokensoldier244th

[th175]

13 hours ago, brokensoldier244th said:

But, also KIM that a paid for IMO is still just an opinion- and whether you win your claim or not your Doc that you paid already has your money, and some of the more popular doctors that I see people referred to from the internet can charge from 500 to well over 1000 dollars or more and are not the ones actually reviewing your records. How could they? They supposedly do IMOs for thousands of cases a year with their name on them, which, if you want a good IMO with time spent on it, is a statistical impossibility. They need to be impeccable, specialized or at least very proficient in that area, to trump an actual in person physical exam. IF your examiner in person is an NP and your remote IMO opinion is from a doctor or a specialist, though, if they write a good one, it will generally bear out. 

Also, if you have a doctor use a DBQ form as part of your IMO- there is a spot on that form that asks if they saw your medical records and C file- if you don't have that, then they can't check the box. They also can't do a C and P per-se because if you live in TX and they live in Seattle and they DIDNT see you, its going to make a lot of what they say carry less weight than a C and P , no matter if they are the head of Orthopedic surgery at Seattle Grace. They can remark  in their opinion or on the DBQ (both, preferably) if you brought in part of it, though, or all of it up to year XXXX if you have it. Thats still okay, but the question is specific to them reviewing your C file records in real time as they are now. IF they remark to specific events in your records they should provide dates not page numbers- your page 193 is not MY page 193 when I pull your records from the VAMC, whatever your private doctor sends, or your STRs. 

C and Ps can only be done remotely by VAMCs and contractors (not my rules). An exam done via record review and no physical visit is going to have a more difficult time and will face more scrutiny. There are some doctors that will IMO remotely for a fee literally anything you send them. Their rationale is usually weak, and their track record is not that good- yet, they still have your money. 

FYI

If you have a remote IMO done and use a DBQ as a guide (they are still legally accepted forms at VA, they just removed the public link access to them-not my monkeys) the doctor MUST write up a separate opinion of some kind, not just do some remarks on the DBQ. For an actual C and P for service connection if a VA doc or contractor just does the DBQ and no actual opinion, we kick it back to them and make them redo it because its an insufficient exam. 

Thanks. Does the IMO/nexus letter have to include a C+P performed by the doctor? Will the VA schedule me for another C+P?

 

The scoliosis was mentioned somewhere in my MEPS exam but I can not find it anywhere and I have my medical records. The VA must have a document I don't have. Therefore I think I will be just trying to prove the arthritis was caused by service.

Edited September 17, 2020 by th175