First, great to find this site. I had this posted elsewhere,but I didn't know if was in the right place.

My question is regarding my back. In 1989, while in the USAF (1987-1991), I had an L4-L5 diskectomy (right side) and 20 years later I am currently recovering post-op for a micro-laminectomy/diskectomy on the left side along with removal of a bone spur...the imaging (MRI, myleogram w/ C-T scan) also showed additional protrusion on the right at L4-L5 and mild protusion at L5-S1 with possible nerve displacement. The private neurosurgen was only concerned with the l4-l5 issue and only does micro. He said that it would add a couple of hours to the surgery to reconstruct the right side. The only current problem I have on the right side is sciatica flair ups if I sit for extended periods of time and my toes are always insensitive/numb. He didn't want to mess with it since most of my pain was on the left. Should I get a letter from him saying that additional work is probabily needed and that I have DDD or IVDS?

I never filed for a claim when I was discharged in 1991 (why? no idea I guess something you really don't think about when you are 22 and no guidance).

Do I have a chance for a claim? I really haven't missed much work or have seen the doctor for my back in the last 20 years, since it was something you live with until about 4 months ago when the pain became severe and familiar except on the left side this time.

Do they rate you on how you are feeling now (he had surgery and is fine) or do they look at the surgeries as an indication of degeneration (ROM)? I am pretty sure that within 5 to 10 years, I will have additional surgeries...fushion or reconstruction.

Should I wait to see how this surgery effects me i.e does the sciatica pain go away etc...before starting a claim?

Additionally, I had a broken bone removed in my left foot about 5 years ago. I am constantly running into things and ended up breaking a small bone in my left foot that would not heal and had to be removed. Could this be related to my back (balance-gait-foot drop-atrophy)? Is there a test for this?
After reading some of the back pain/spine posts and repository, I'll admit that I am still confused about what compensation I would be entilted to (10%-40%)? I guess

Any help would be appriciated.

81150CAFB,
Welcome to Hadit.
carlie

I am currently working on getting the OR report and the orginal surgery was on the same disk just a different side. Wouldn't this automatically be related -current condition vs old surgery or am I assuming to much. Luckily I didn't have a fusion in 1989 just a big cut diskectomy - I don't know much about traumatic arthritis, I would think it would be degenrative.

Thanks for the welcome.

The Correlation between in service and post service is not guaranteed. According to the regs you need a Nexus for the conditions as in a medical opinion.

Degenerative arthritis is rated as traumatic arthritis.

J

Yes you can file a claim for your back condition as it is shown in your smrs. You also can file a claim for the scar. You will need a nexus letter for your foot as secondary to the back condition.

Thank you all for the information. I talked to my doctors office today and they can write me a letter regarding/connecting the herniated disk(s).

I guess my biggest mistake was not filing for a claim when I got out the USAF.

Do I just put herniated disk, sciatica, scar, arthritis (whatever is applicable) on the VA Form and send to them with the SMR's and current medical records or just put back problems (something general) and they decide how to code after looking at records and C&P? I would have never thought of scar or arthritis and that makes me think that I would miss listing/showing something that I would be entitled to...make sense?

After looking around this great site and reading some of the other veterans problems with their backs, I would guess that my claim would be IVDS with range of motion as the rating factor and sciatica/numbness on the right side and who knows on the left, since I am still post-op (one week).

Regarding my left foot - I think it is related to foot drop (my foot drags/catches sometimes when I walk). The broken bone removed was just because when I walk I am "bumbly" and run into chairs, coffee tables etc... I am going to talk to my neurosurgen about foot drop when I see him.

Sorry if these are stupid questions - I just want to make sure that I do everything right before I submit the claim.

Since I am just over 1 week post -op, do I need to wait a couple of months to file the claim (still waiting on SMR's anyway and post op appointment with nuero) to see how the current sugery takes? I don't think the VA would want me to do a C&P so close to my surgery. Is there a time frame they prefer (6 weeks - 3 months post op)?

I will probably file for IVDS (herniated disk, stenosis, bone spur-arthritis) and sciatica (numbness, tingling & foot drop)

Thanks

81150 CAFB - both extinct

File the claim now. you should already be service conected since you had the surgury in service.
The latest surgury may increase the rating.

You are costing yourself Money by waiting. EED is the date claimis filed or Enitilement arose whichever is later.

J

Thank you. No problem if the schedule a C&P witin a month? I don't want them to discount the rating because I'm still recovering.

I appreciate all of the info on this site. I learn something evertime I look around.

You should be rated on residuals. Post surgury.
It will depend on your range of motion, and any effected nerve issues.

If you have sciatica then file for your back and also file for the sciatic nerve.

J

Thanks for the help!

81150 CAFB

Does anyone know where I can find a full listing of the ratings based on code? For example scitica code xxxx, IVDS, scar, muscle spasm, hemerroids, etc...? I am trying to figure out what the percentages are based on. I know I have seen it somewhere on the site but can not find it again. Additionally, does the VA automatically rate you as IVDS after looking at your history or do I need my neuro to specifically state in the connection letter with current diagnosis?

Finally got my op report and it looks like they did a little more work then I thought for a micro surgery (large bone spur at S-1 with "generous formontomy(?)" Know wonder why I had a 2-inch+ scar directly over the same one 20 years ago and still in a lot of pain two weeks post-op. Oh well.

Thanks for all of the help.

38 CFR 38 4.71 schedule of ratings muscoskeletal system. Scroll down to Spine.

Look the other stuff up from the Same page. The Body segements are listed under each heading.



J

You could be eligible for 100% Temp Comp for convalescence. Those regs too are here at hadit- But this depends on getting it all service connected first-

I believe there is a time limit on temp convalescent appls- maybe best to claim that with your formal SC claim.

Make sure you access the topic I wrote called Getting an Independent Medical Opinion. Available under search.

If a IMO doctor doesnt follow this criteria- as to making the nexus statement with full medical rationale based on referrals to your SMRs and also your clinical records, the VA will reject the IMO.

IMo docs should also have any C & P results too in order to shape their opinion well.

You dont need the IMOs to file the claim- also claim the scar too.

I think scar ratings have changed- will post that info after I check it.

Scar ratings changed as of Oct 23 2008. All I have is 73 Fed Reg 428-this is in the new VBM 2009 edition page 300 and might not have been in 38 CFR yet due to their publication date-

The new change states that all scars must be rated separately.

Also this change is discussed in the Veterans Advocate 2008.

The Schedule of Ratings here should have the updated scar criteria.

http://www.warms.vba.va.gov/bookc.html#d

4.40 - 4.73 - The Musculoskeletal System

Thank you for all of your assistance. I have all the documents printed out and only need the nexus from my neuro (appointment in a couple of weeks). I should have enough ammo and by well prepared.

Thanks

81150 CAFB

I have a question regarding my recent myleogram that maybe some one can help me with. Reading the report it states that at L4-L5 there is a relatively prominent anterolateral defect on the right with a truncated apperance of the right L5 nerve root. This is the same side as my surgery in 1989 ..showing a herniated disc on the right that isn't bothering me to much (few sciatica spasms - right butt and insensativity in the foot, etc...). I am just wondering what the heck is a truncated apperance of the right L5 nerve root. I still don't have the op report from the NRPC, but it sounds weird to me.

I have my neuro appointment in a couple of days - maybe he will fill me in, but he has zero bedside manor and an ego to match.

Thanks

Means cut short or covered by something like a plate. For exmple a perfect circle missing an edge.
J

Do you think it means anything (physically) to have it truncated. Sounds like cut to me.

no plate(s)added. Just a discectomy in 1989 on that side.

I also called the 1-800 number last week to get my claim started (informally) and received a letter yesterday from the VARO with VA form 21-526 attached along with VA form 21-4138 along with the letter (no mention of 4138 in letter). Do I need to do anything with this? I have never made a claim before and I looked up 21-4138 and it doesn't seem to apply for my first claim.

Correct?

The form is just a statement in support of claim. Make plenty of copies of that as you may need a bunch of them.
Any evidence or document sent to the VA should be based on that form.
The application is the Key to rolling the ball down the lane of claims adjudication.
The 21-4138 picks up the spares.

Also, part of a disk may be missing.

J

Sorry but I need to vent. I know most of the people on this site are in a lot more pain/discomfort and more disabled, but I need to blow off some steam. Forgive me for my crankiness.

I had my neuro appointment today (private doctor) and I am very fustrated and angry at what is going on. It has been exactly one month since my surgery and the pain is worse now then when I went in.

During the first part of the appointment today, the doctor looks at my operation record and as he is reading it crosses out the S-1 bone spur removal and replaces it with L-5 (was to quick for me to question why I have a two inch+ scar for a micro - one of those things you just think of right after you leave). He also said directly after surgery (8/27/09) that he removed the bone spur from S-1 and then said it was L5 a couple of minutes later. Additionally, he kept mixing up L4-L5 and L5-S1 discectomy that he performed at my appointment today, my wife and I had to correct him a couple of times. This is making me nervous and I don't feel very confident with him - he also wote yes on the right side of my initial scar just prior to surgery - the surgical nurse and I had to tell him that it was the left side. He is probably in his mid to upper 60's and is just really immune to peoples concerns and is just not a people person at all.


At one point during the appointment, he has me try and flex my back backwards - 0% and alot of pain, doesn't tell me anyting same with forward <30% with pain. He then has me standing up and lifting my left leg up - very painful in lower left back and left buttock that shoots down to my heel via my calf. He then looks at his notes and says that previously my pain extended to my big toe = L4-L5 (which it did) and says I now probably have a L5-S1 issue. He says he wants to give me a shot to deaden/block this nerve to see if it is the area causing my current pain and to give it time to see if it gets any better (his assistant will make an appointment) and he starts to leave and I had to stop him ("wait") three times to answer some additional questions. I told him that it is too painful to sit for more than an hour or two (with no relief when standing back up) and the only somewhat comfortable thing I can manage is my walking. I have been walking about two miles every day and during my walks my wife and I noted that my foot (both left and right) occasionally scraps the sidewalk like it is lazy or falling behind. The doctor then comes back in the room after standing at the door ready to leave and has me lay on the gurney and pushes on my legs and I resist and he says they are fine (maybe they are?). I also ask him if I have arthritis - he tells me basically of course you do. The funny thing - no MRI or C-T or mylegram picked up the "large" bone spur that he remove with no mention in any of the radiologist reports of arthritis or ostephyte(sp?). Additionally, the radiologist read the images and dictated his notes and was finished a few minutes after he performed the myleogram. I really am disappointed in the speed that all off the images were read and reported. I was in line with a dozen or so other patients for my myleogram and they just speed you through the process. I am wondering if they missed anything?

He then tries to leave again and I bring up the VA nexus letter and explain to him what I need it for (he is actually a veteran) and what the wording is like and how it ties everything together. He then looks at me like I am crazy and says "how am I supposed to know if they are related - I wasn't there in 1989 when it happend". I try to explain it to him again and he says he will not write this since he can not tell if they are related - he tries to be somewhat helpful and said he could write up what he has done so far (hopefully I can get a good letter with all of the diagnosis). I even brought an example nexus letter and my available SMR's - didn't care. He then leaves to dicate his notes.

His assistant (who told me three weeks ago that he would do a VA letter) comes in and tells me that the nerve block shot appointment will be after the the 5th of October - the Doctor acted like it would be early next week. I will now be off of work for another two weeks (luckily I have good short term disability) and it is driving me crazy - the pain, being stuck at home, missing work, etc... to bad I can't claim depression because this is certainly depressing (already on Lexapro and Clonanzepam for anexity/attacks - works great).

It seems that there is no end in site. I actually had my surgery on a Thursday and told my work I would be back on the next Tuesday since it was micro (little did I know). I did go to work part-time (starting the next Wednesday) for two weeks (sitting behind a desk), but the pain kept getting worse and I had to stop going.

Oh well - as soon as i got home I called an ortho/sports center and got an appontment with a spine specialist for a consultation and second opinion - they also asked me to bring all of my tests - CD's of my MRI/C-T/Myleogram. Maybe they could connect the DISCECTOMIES THAT ARE ON THE SAME DISK with a nexus letter - how a neurosurgen can say what he said is just mind boggling.

Just had to gripe.

J - you were right about the truncation - they did have in one on the reports that there may be a fragment of disk.

81150 Carswell AFB

Just an update:

I had the nerve block shot last week at the l5-s1 nerve and it appears to have worked to some degree (main butt pain is gone). I have an appointment with ortho spine specialist in a couple of days. Hopefully we can figure out what to do with the l5-s1 problem. My biggest concern right now is that the amount of lower back pain has really increased and it is still very difficult to sit (still on short term disability) and even if I take it easy my back is trash by the end of the day . I don't know if this is from the shot or if my back is worse after having two suguries/disk removals on the same disk. I hope the Orto takes an x-ray to look for arthritis and bone spurs. I need some answers.

I think I will also add depression to my claim. I don' t know if it will work since I am already on lexapro for panic attacks/anexity, but I will talk to my physchiatrist (visit coming up).


Thanks for all of the advice and information on this site.