Posted on Jul 6, 2014
SPC Justin Phillips
15.4K
5
24
0
0
0
I was recently diagnosed by my PMR doctor of having this problem with my back. My Primary Care doctor then denies that I need a cane/wheelchair to get around even though I can not walk more than 3 feet without some form of support. The VA diagnosed me with this problem and then denied me of my claim on my back because of a lack of information. Has anyone else had this problem?
Posted in these groups: Chhhfnmfuj 1420036448753 VA ClaimImages 5 Compensation
Avatar feed
Responses: 7
CPL David Riopelle Spencer
2
2
0
I had the same problem. How I fixed it was this way; I went the civilian route and got the diagnosis that way. Then I waited 6 months before filing a claim. Later, the claim went through and I was compensated. Now I bring all my RX's to my PCP and the VA fill all my scripts. I tried the VA route with 3 different PCP's and failed every time. Remember, civilian sector diagnosis is equal to a VA diagnosis. Now the system works for me. No more frustration.
(2)
Comment
(0)
SPC Justin Phillips
SPC Justin Phillips
>1 y
However, affordability is the big issue... I am not able to work right now which means that my only income is from 20% va disability compensation and going to school fulltime online... That just barely allows me to pay rent and utilities while still being behind on payments from when I was out of work for 4 months and trying to get enrolled into school because of this back problem... As it is, I have a 4k er bill from my back spasming on me and the VA wont even look at it, but its a bill caused by this back problem that the VA wont acknowledge is a problem... ...
(0)
Reply
(0)
CPL David Riopelle Spencer
CPL David Riopelle Spencer
>1 y
I know you feel like your being kicked while your down bro. Hang in there, it will get better! One if the most difficult challenges is getting compensation from the VA. Breaking everything down for them to a 3rd grade level is the only way. Using their language is most important via IDC codes and wording. I realize that's not going to help immediately but it's all we can do. Breaks my heart the Dept of VA won't get you taken care of properly. As you realize your not the only one. You may consider contacting your Senators. I know of many that did and sending letters and documentation via the Senators fax really speeds things up. The pressure from the civilian ER visit I'm sure is intense but remember they can't really do more than that. Medical bill can't take your money or property. All they can do it threaten. When I was in that situation I mailed them a dollar a month and they finally quit bugging me. When I finally got money, I squared things away with them for a deducted amount. They will negotiate if you wait long enough. It's not right in the slightest what's happening to you via the VA. I wish I could help you more than just these words. You may consider writing a letter that you can mail out to different Veteran support originations. ie, chuck-e-cheese, I know for a fact that they help the ones who really need it. Sounds like you need it bro, it certainly can't hurt and costs a little time and a few stamps.
(0)
Reply
(0)
PO1 Disaster Survivor Assistance Specialist
PO1 (Join to see)
>1 y
May I suggest you contact your local DAV or VFW to see if their Service Officer(s) might have a suggestion for a doctor/specialist that would work with you regarding costs?
(0)
Reply
(0)
Avatar small
LTC Physician Assistant
1
1
0
Have you been to a Physical Therapist? What imaging have they done?
(1)
Comment
(0)
SPC Justin Phillips
SPC Justin Phillips
>1 y
I have been to a PT and they gave me a cane before my results of the MRI came in, had me see a PMR doctor who diagnosed me with this and then they told me that the only way I was able to continue using a cane or wheelchair was if I bought it out of pocket. This has been getting progressively worse and in 2012 when I went to my last IRR Muster duty and they did a full medical checkup they sent me a letter stating that I did not meet the medical retention standards because of my back pain, shoulder, and knee problems.

The first time I filed they had me scheduled to see a CMP evaluator before my MRI results were in. I was told they would include the MRI findings into the cmp however I do not believe that was the case because 2 days after my CMP and before the MRI results were in my claim was denied. Upon re-filling my claim they had me see the PMR doctor and he was the one who diagnosed my back.
(0)
Reply
(0)
SPC Justin Phillips
SPC Justin Phillips
>1 y
Also, I have the DAV as my representative up at the Wichita KS VA hospital. I have been informed to contact other personnel to get assistance with this problem but I was unsure of my next move.
(0)
Reply
(0)
PO1 Disaster Survivor Assistance Specialist
PO1 (Join to see)
>1 y
SPC Justin Phillips
I have some questions regarding that .... please contact me privately.
(0)
Reply
(0)
Avatar small
SPC Dennis Mullins
0
0
0
Get a MRI, don't give up!
(0)
Comment
(0)
Avatar small
Avatar feed
Multilevel Degenerative Disc Disease with multilevel disc desiccation
PVT Vance Hanna
0
0
0
My Advice, Keep on them, Keep getting all the documentation you can get, Also consider Filing for SSI and SSD at your local Social Security Office. I am fighting with VA right now as well because of a Knee injury in boot camp that ended my short Army career and they are trying to say there was nothing in my army medical records about it which i proved wrong in my Appeal. Also Contact a VA Attorney, one that only handles VA cases. Good Luck Man.
(0)
Comment
(0)
Avatar small
SSG David Joubert
0
0
0
SPC Justin Phillip,
Found my own experience with Same finding and also put out in Mar 06 With same condition Which the Department of Veterans Affairs calls it in there rate as DC 5237 Lumbosacral or cervical strain. Here are the DC codes for all these conditions 5235 Vertebral fracture or dislocation, 5236 Sacroiliac injury and weakness,5237 Lumbosacral or cervical strain, 5238 Spinal stenosis, 5239 Spondylolisthesis or segmental instability, 5240 Ankylosing spondylitis, 5241 Spinal fusion, 5242Degenerative arthritis of the spine (see also diagnostic code 5003), 5243 Intervertebral disc syndrome. No mater what they call it I have 6 out of 9 of these but they used 5237 for my rating. I waited 13 months for my first rating of 10% and after having back surgery Pre - POSTOPERATIVE DIAGNOSIS: Spinal stenosis with herniated disk at L5,S1 PROCEDURE:Decompressive lumbar laminectomy at L3-4-S and Sl
and diskectomy of LS-Sl and posterior spinal fusion of L5-S1 with pedicle screws and interbody cage. They move it to 20% and I was put out of work August 2012 and awarded SSI and put in for increase for this as well compensation based on unemployability and was denied for both and still fighting and filed NOD and have lawyer working it. For what I have gone though to get to this point was do to Doctors outside the VA. If you use the VA system this statement here is so true about the VA system.

Veterans Medical Advisor states; unfortunately, the C & P examination system is not designed in the veterans favor. Many times, the VA denies a veteran’s claim based on the medical evidence the VA itself has provided. The primary care and specialist providers at the VA clinics are restricted in what they can say about your condition. These doctors work for the VA; therefore, they must follow VA guidelines and internal policies. The C & P examiners are supposed to decide whether you are disabled. Further, they decide just how severe the disability is in your case. The problem is, the C&P doctors usually must see several veterans in one day and do not have time to completely review medical records and do a proper exam. A VA-ordered exam that disproves your claim means it is even more important to have an Independent Medical Examination (IME) that could offset that opinion. If the veteran presents evidence that raises an element of doubt, then, by law, the VA must rule in the veterans favor.

This is the same of what the news is saying right now about veterans Dying on these so called secret list. It the system and we can't change it. So you have to beat them at there own game and seek outside medical Doctors to prove this are the injuries and what to outcome is. Then when you go to your C&P show the doctors the reports from them and they have no choice but write what they see. Oh I served 18 1/2 year and was put out with severance and have a nice day with hardware coming out of my RT hand because the Army doctor screw it up and my command put me out. My rating was 20% of nothing and a severance pay from Active Duty. I use the severance pay up and had to wait 13 months for my VA rating. Oh they came back with a 40% rating and I had to pay back the severance pay as you can't double dip from both one is taxable and one is not. So as I got my things fixed outside the VA. I would put in for an increase for that and so on Now at 80% and still fight the system as the last 2 years I was using the VA for my medical and when I went for my 2 C&P exams they used my VA records against me. I had to go outside the VA system to get the same type of doctors to prove the records are wrong and that's my I have a lawyer now to prove they records are wrong and they will put thing in your records they didn't even do and it become a he she thing and you won't win as VA doctors did do it or it won't be written.
(0)
Comment
(0)
SSG David Joubert
SSG David Joubert
>1 y
Remember that If you are still active / or Drill status you do not meet the standards and will have to be put out. If you have treatments and your unit is ready to deploy you do not meet and they have to put you out. Yes it sucks I know as this is what they did to me after 18 1/2 yrs and also requesting med hold to get fixed before being put out which my chain of command denied. So yes it suck and live on and get stronger as The VA will lead you down the same path. You have to understand the DC code in the VA system for rating this without all the things they want you to do the last and I mean the very last thing is surgery which they do not want to pay for. Here is what you need to look at.
(0)
Reply
(0)
SSG David Joubert
SSG David Joubert
>1 y
THE SPINE
Rating
General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating
Intervertebral Disc Syndrome Based on Incapacitating Episodes):

With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine 100

Unfavorable ankylosis of the entire thoracolumbar spine 50

Unfavorable ankylosis of the entire cervical spine; or, forward flexion
of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of
the entire thoracolumbar spine 40

Forward flexion of the cervical spine 15 degrees or less; or, favorable
ankylosis of the entire cervical spine 30

Forward flexion of the thoracolumbar spine greater than 30 degrees but not
greater than 60 degrees; or, forward flexion of the cervical spine greater
than 15 degrees but not greater than 30 degrees; or, the combined range of
motion of the thoracolumbar spine not greater than 120 degrees; or, the
combined range of motion of the cervical spine not greater than 170 degrees;
or, muscle spasm or guarding severe enough to result in an abnormal gait
or abnormal spinal contour such as scoliosis, reversed lordosis, or
abnormal kyphosis 20

Forward flexion of the thoracolumbar spine greater than 60 degrees but not
greater than 85 degrees; or, forward flexion of the cervical spine greater than
30 degrees but not greater than 40 degrees; or, combined range of motion of
the thoracolumbar spine greater than 120 degrees but not greater than 235
degrees; or, combined range of motion of the cervical spine greater than
170 degrees but not greater than 335 degrees; or, muscle spasm, guarding,
or localized tenderness not resulting in abnormal gait or abnormal spinal
contour; or, vertebral body fracture with loss of 50 percent or more of the
height 10

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest five degrees.

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

5235 Vertebral fracture or dislocation

5236 Sacroiliac injury and weakness

5237 Lumbosacral or cervical strain

5238 Spinal stenosis

5239 Spondylolisthesis or segmental instability

5240 Ankylosing spondylitis

5241 Spinal fusion

5242 Degenerative arthritis of the spine (see also diagnostic code 5003)

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.
(0)
Reply
(0)
SSG David Joubert
SSG David Joubert
>1 y
Any Veteran in need of advise for this please feel free to contact me I have not used the DAV or any other so called help out there. I know first hand how the treat us Veterans and the so call test that they perform and you do not follow the book so there nothing wrong with you well I have proven them wrong time and time again on this.
(0)
Reply
(0)
SSG David Joubert
SSG David Joubert
>1 y
Yes the DAV is there for you but remember this my fellow Veteran's they are not there for you. They are there to Rest easy and put their time in until they can retire. The old saying have they forgotten where they came from. Yes I have heard it right from Medical student that there is a standard that you must follow and if you make other look bad you will be told in a nice way first and be harassed over and over till you get it. As for long lines at VA clinic and Hospital see how many patients a private MD see in one day and then compare that same Gov't MD sees in that same day.

Also remember all bonus that these Gov't MD get the Private Doctors don't get. No it's a choice that all Doctors make on where they want to help. I dare you to ask a VA MD the same question that you would ask you Private MD and see the response you get. You will get more help from your PMD then the VA MD. The VA MD gets paid weather they see one or 8 patients in that day. That's right 8 now look at that PMD needs to see 24 Patients that same day to pay they office staff and build and so on. That's the system that Gov't has set up for you.
(0)
Reply
(0)
Avatar small
PO1 Disaster Survivor Assistance Specialist
0
0
0
SPC Justin Phillips

It's never easy dealing with the VA - especially if you're in pain.

I deliberately re-read your missive 4 times before I opted to chime in. Several have spoken up so I won't repeat what has been asked.

Here's what I see / suggest:

1. You've said your Rep is with the DAV at the Kansas VA hospital. Since you have apparently started your VA claim with them you should go back to them. If the distance to travel is too great - try a local DAV and see if they can't get their Service Officer to work with you.
2. Are you in the VA healthcare network? (do you have a VA ID card?) If so, contact your DAV rep and find out what process the VA hospital there has for requesting Release of Information (ROI) and request your entire VA file. You can still get the ROI even if you don't have the VA healthcare ID... While you're at the VA Hospital get a copy of all x-rays, MRI's, etc.
3. Do you have ALL of your military Dental, Health and personnel files? If you have the VA ID - you can go to the VA website and pull them up electronically - shouldn't take long at all.
4. Once you have all of this data assembled go back to your primary care giver (aka civilian doctor) and talk to them about seeing a specialist. Once you sit down with the civilian specialist (it's not clear in my mind what you've seen for what) talk to them about your VA claim - and tell them you wish for them to look at all available data (your military personnel + health and VA health files) relating to your situation in order to provide information to aid in either your appeal or re-open your VA case.
5. SFC A.M. Drake and LTC (Join to see) are each trying to head you in the right direction. While it seems perfectly clear to you that you have provided all the information necessary - trust me when I say it's always the little details that these two gentlemen are trying to discover that make the difference...work with them.
6. As for the cane - talk to your local VFW/DAV and see if they can't find some way to help you with that.
(0)
Comment
(0)
Avatar small
SPC Justin Phillips
0
0
0
just wondering if anyone has any advice for me.
(0)
Comment
(0)
SFC A.M. Drake
SFC A.M. Drake
>1 y
Spc Phillips,

Please answer CPT LaFlame question the best you can. Here on RP we all want to assist you the best we can, so the more information the better here are some questions for you.

1. Did you contact a DAV/PVA/State Vet Rep to see if they can assist?

2. Do you have any more information to give the physician of whomever is asking? Other than what you already gave? i.e. All supporting documentation before your diagnosis and after such as treatment records from MTF or personal physician?

3. Was this a one-time incident, or a progression of your back getting worse?

4. I know this can be a frustrating time, however the VA or any govt agency is not going to release any type of benefits without proof.


Hopes this helps.
(1)
Reply
(0)
SPC Justin Phillips
SPC Justin Phillips
>1 y
I understand SFC Drake. How do you mean MTF? I have included every bit of information I have about my back and related problems in my medical file when I gave them a copy of everything.
(0)
Reply
(0)
PO1 Disaster Survivor Assistance Specialist
PO1 (Join to see)
>1 y
MTF = Military Treatment Facility
(1)
Reply
(0)
SPC Justin Phillips
SPC Justin Phillips
>1 y
and I have every bit of file and diagnosis that is available. I have been double checking to ensure that I have everything I could need
(0)
Reply
(0)
Avatar small

Join nearly 2 million former and current members of the US military, just like you.

close