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    • How to get your questions answered.

      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ http://www.hadit.com/forums/index.php?/topic/40963-va-fl-10-34/ http://www.hadit.com/forums/index.php?/topic/40964-va-fl-10-32/ http://www.hadit.com/forums/index.php?/topic/40966-va-fl-10-30/ http://www.hadit.com/forums/index.php?/topic/40967-va-fl-10-26/ http://www.hadit.com/forums/index.php?/topic/40968-va-fl-10-25/ http://www.hadit.com/forums/index.php?/topic/40819-va-fl-10-24e1/ http://www.hadit.com/forums/index.php?/topic/40818-va-fl-10-24/ http://www.hadit.com/forums/index.php?/topic/40817-va-fl-10-22/ http://www.hadit.com/forums/index.php?/topic/40814-va-fl-10-04/ http://www.hadit.com/forums/index.php?/topic/40969-va-fl-10-03/ http://www.hadit.com/forums/index.php?/topic/40812-va-fl-10-02/ http://www.hadit.com/forums/index.php?/topic/40808-va-fl-09-52/ http://www.hadit.com/forums/index.php?/topic/40806-va-fl-09-50/ http://www.hadit.com/forums/index.php?/topic/40970-va-fl-09-41/ http://www.hadit.com/forums/index.php?/topic/40971-va-fl-09-38/ 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Va Eaminations And Rating For Back Injury

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First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

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5 answers to this question

Posted · Report post

Yea, I know what you mean about the Neurotin. Pharm. says that the Gabapentin (Neurotin), I am taking, will cause seizures if you stop suddenly. This is a concern.

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Posted · Report post

I am glad that you won your claim.

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Bob thanks for the the info. I've been suffering with my back since early 2000. I've had numerous x-rays, MRI's, CT scans and C&P exams. All the VA has done is watch my condition get worse. I've got DJD, spinal stenosis, ruptured disk and nerve impengment both sides of my lower spine. I was sent fee basis for a evaluation of my condition. The doctor looked at all my test and wrote that since the stenosis is to the point where sugery probably wouldn't help. He did recommend the spinal steroid shot, which the VA did about a week ago.

I've heard horror stories about this shot but I must be one of the lucky ones. This is the first time in six years I haven't been in severe pain. I don't know how long it's going to last but I thank God for the relief. I was told you could only get six shots per year. I also have DJD in both knees. I take 240mg of Morphine daily to help with this pain.

I applied for TDIU in jan 2000 and haven't received and answer yet. My appeal is in DC and I'm hoping there's not another remand. I have to deal with the RO Columbia, SC. I don't know if you've heard any horror stories about them, but if you have it's all true. All I can do now is wait. I've been waiting for six years.

WAYNE

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I am one of the lucky ones with severe osteoarthritis - for me Glucosamine sulfate/Chondroitin sulfate supplement works. According to the research done outside the AMA, it helps 72% of those who take it, sometimes as quickly as one month after start; although 6 months is a more realistic figure if you decide to try it.

Talk to your doctor about it, research it on the Internet, after more than 5 years, the AMA has finally decided to fund some studies on it.

Doctors who look at my X-Rays, MRIs and EMG/NCVs wonder how I am still able to walk, and mostly have intermittent pain, which is only occasionally severe enough to keep me at home.

The VA gave me neck and spinal braces, a wheel chair and Lofstrand crutches three years ago, and about a year ago, knee braces and ankle wraps. I also have from the VA, a hot pack and a TENS unit.

Some of this I use all the time, but most is only used intermittently.

Why?

Well, I prescribed Gluc/Chon for myself 4 years ago, after I spent a year trying to get the VA to give me something besides acetomeniphen and Indomethacin.

It took about three months for me to see noticeable difference, and I took it for two years. Then, because of cost, I stopped taking it for a year. After about 6 months, I started looking for a cheaper source, as my problems were returning. I started mail order from the US, and even with Philippines Customs Dues, it is worth while. One month back on it, and I was able to regain some more mobility and freedom from pain.

The dosage depends upon your weight, at 200+ I take 2000/1600mg per day in two doses. Below 200lbs I believe it is 1600/1200mg recommended. It is not cheap, but compared to US medicine prices these days, it is quite reasonable.

If you are one of the lucky 72%, you should know within 6 months of starting.

Good Luck

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WOW GREAT POST!!! YOU KNOW YOUR STUFF.

First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

B) B)

WOW GREAT POST!!! YOU KNOW YOUR STUFF.

First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do.

Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis.

The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI.

Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons.

The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first.

Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater.

A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation.

The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram.

The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation.

By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order.

A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc.

OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle)

Bob Smith

B) B)

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