I have a 20 year old lower back injury that I sustained in the military. I ruptured the L5 disc and now it is arthritic. I am in the process of getting a disability from the VA so that I can be treated for my injury. I had a MRI, and they would like me to get an opinion from a doctor regarding my MRI that will say that the injury is from the 20 year old time frame and not something like a car accident that happened ten years ago. The problem that I am having is that it appears that doctors cannot tell from a soft tissue injury approximately how long ago the injury took place. Is there any way to tell based on a MRI how long ago an injury may have occurred? Wouldn’t the fact that I now have arthritis indicate that the trauma happened a long time ago?
Sorry, but the MRI is just a static picture of what the anatomy looks like at the time the MRI is done. There is no way of telling if a degenerative condition started three years ago, or thirty.
The degenerative changes do progress in a fairly typical manner, but the rate at which this occurs is extremely variable. One person may develop significant degenerative changes in just a few years, while another patient may take decades to show the same changes.
How was the herniated disc diagnosed while you were in the military? Did you have a x-rays, CT scan, discogram, myelogram, or was it just based on physical findings? It should be documented in your military health records, as to how it was diagnosed. Essentially for the VA, you need to have documentation that the herniation existed while you were on active duty, or that you sustained an injury of significant magnitude that you would be expected develop degenerative changes from it in the future.
Unfortunately, it was just a physical finding. The Hospital Corpsman that treated me told me that I herniated the L5 disc in my lower back and treated me with heat and Motrin. He also advised me that based on the trauma that my back sustained that I would suffer back pain for the rest of my life. Additionally, he advised me that the Navy did not treat lower back injuries and that if I returned to sick call with my back injury that I would be medically discharged from the Navy. When we pulled into port the medical department never sent me to the hospital so that I could be x-rayed so that they could determine the extent of my injury. To complicate this further the injury and treatment were never recorded in my medical record.
I was able to locate the Hospital Corpsman after not talking to him for over twenty years, and he remembered my injury and wrote me a letter that my back was injured on the job and that he treated me and that they did not send me to the hospital for further diagnosis or treatment.
The VA had a doctor examine me and the exam took a whole seven minutes and he was of the opinion after looking at my x-ray that my injury was natural degeneration due to the aging process which is not true because prior to my injury I never suffered from any back pain prior to the injury occurring. So instead of the VA considering the letter from the attending medical person and making a decision that I did hurt my back on active duty and the degenerative changes are due to the trauma I sustained on active duty, they denied my claim and now I have to prove with a doctor evaluation that the herniated disc happened during that time frame.
I cannot find a doctor that is willing to raise the question of doubt and write me an evaluation that says that based on what I am saying that the injury is or could be consistent with my story.
All I am trying to do is get the VA to recognize that I was injured on active duty so that I can be treated for the chronic pain that I am in.
Am I not saying or asking the doctor the right way to write me an evaluation? What advice can you give me to ask the correct way? Is there a code that I need to know, or just like lawyer speak to I need to know doctor speak? I mean a doctor is not going to lose their medical license if they raise the doubt here or say that the injury and degeneration is consistent with what I have described.
Unfortunately, you are probably going to have problems with this one. Basically, for the diagnosis of a disc herniation by physical examination, you will have to have documented neurological symptoms. Back pain, unfortunately, does not make a diagnosis of a herniated disc. If you had objective decreased sensation (numbness, tingling), decreased tendon reflexes, weakness in the muscles innervated by the nerve which is being compressed, etc, then you could say that the annulus is torn and you have a herniated nucleus pulposus.
Problem is that you did not go see any one above the most basic of medical personnel. Often, the VA feels that if was not significant enough for you to see a specialist, then it wasn't that bad. Not that I agree with that. They are also probably wanting documentation by some type of study.
Back in the days before MRI or CT, if a patient came in with symptoms of a herniated disc, they would usually have been referred to the orthopedic surgery or neurosurgery service. If the surgeons were considering surgery, then usually a myelogram would have been done. However, MRI has been around since at least the 80's (Walter Reed, I know, had one in 1986), and CT is probably 10 years before that. So, the VA may also be looking for some type of study to confirm the diagnosis.
I just hate to say that you may really have a problem with this one. Having done more medical boards than I care to think about, I still don't understand the VA system completely. The military does their disability ratings based on regulation (such as AR 40-501 in the Army) and as to whether or not a service member can do his/her military job. The VA disability ratings are based on civilian standards, such as the AMA Guidelines for Disabilities. They go more on workman compensation type standards.
You can actually obtain the AMA Guidelines and look up what the standards are for the specific percentages of disabilities. That way you may be able to figure out what they are looking for.