ROM Results... Does this equal 20%?

T

trembly

PEB Forum Regular Member
PEB Forum Veteran
Here are the results from today's ROM testing. To me this is sad as I gave the military my back and they give me the boot. Can you guys confirm if this is 20% or am I miss reading this?

FF- 46
BB-20
LF
Left -27
Right-20
ROT
Left-30
Right-32

Best I can tell this looks like 20%- Good thing I only have four kids and a wife to support.

To make a long story short, I joined the Army Guard in 97, the Active Duty USAF in April 2001 as a Dirt Boy, (heavy equipment operator/concrete & asphalt) and have intermittent back pain, but nothing worth of even a profile. Until January 2009 at Combat Skill Training (CST) when I was pushing on the spare tire on the back of the up armored HMVV at 0500 in the morning. They redesigned the bracket from my "old" army days resulting in me pushing something that wouldn't move until my back Popped. X-rays showed nothing but lidocaine patches and pills helped me though until training ended. Next I went to Iraq in February 2009. My back kept getting worse going on missions OTW. Wearing the IBA/ force protection rounds didn't help, nor carrying the plywood and what not to construct buildings on the FOB's. I returned to Andersen AFB in August and was placed on a profile and gave an MRI to which no one agrees on.

So far they state Facet deterioration L-4 down to S1 and thickening of the tendon.
I have had three sets of Cortisone and nerve ablation and Cortisone in my SI (that shoot greatly reduced the numbness in my right thigh. I also have intermittent numbness in my right foot (big toe-> top of foot).

For pain I have been using Percocet, Mobic, Valium, Robaxin (its a joke), tramadol, and shots of toradol several times when I have to go to the ER for the pain. I try to limit the hard stuff as I don't not want to build a tolerance or dependance so I generally just suck it up. Only once have I had to use an ambulance as all I could do was lay on a couple chairs in the base clinic and drool (their next appointment wasn't for another 2 hours at least my drool stains are still on the chairs). This friday I have an appointment with my PCM to burn off some warts, at which time I will ask for a TENS to help with the pain. (Burning warts was the only way to be seen prior to my MEB appointment.)

I am to meet my PCM July 1st to put together my NARPSUM. Do I need to ensure the Combat training and Combat time is in my NAROSUM? If I am getting the boot it would at least help if I don't have to pay back all the severance pay prior to receiving VA pay.

I am also meeting with Mental Health to see how I am doing in that department. It's frustrating not being able to play with my kids, cycle, hike, swim...

Thanks for letting me vent and look over my numbers let me know what you think. This forum has been a great help in wrapping my head around this process and I am open to any help you guys can give me in this process.
 
Roger based on your forward flexion, you would be correct, 46 rounds up to 50 so you would fall between the 31-60 degrees ROM which equal 20%, Now you could also be rated for incapacitating episodes if you were ever prescribed bed rest by a doctor and its documented.
 
Trembly,
Sorry to hear of your back problems. Have you seen a neurosurgeon? Best of luck to you.
 
Yes, I have seen a neurosurgeon back in April, but based of my Aug 09 MRI he doesn't see anything to fix.

Just today, I was placed on quarters after maxing out on 10mg of Percocet, 10mg of Valium, 50mg of Tramadol, and 15mg of mobic. At the clinic they gave me Demerol, but that just helped enough to get me home. The doctor did not write Bed rest on the quarters statement. I did however get a consult for a TENS unit. The nurse kept apologize for the shots in the butt, all I could say is the military took my modesty, and my back my dignity.

Thanks guys for looking at my numbers and what not...
 
First off I posted this in the wrong thread... Please move it to the Spinal section if possible- Thanks

Monday Guam time I Was placed back on quarters for 48 hours (I was even probed to make sure things were working- isn't that what aliens do?) and given Prednisone for 5 days to stop the inflammation and started on a Neurontin at 300mg daily this week, 600 next, and maintain at 900 third week on. Upon quarters expiration this morning I went to my PT appointment, did one stretch and was done... I was placed on E-Stem (Fancy TENS) and ICE. My back reacted to that and I couldn't leave for an hour afterwards due to the pain. So far today I have taken 5mg Valium (after PT), 5mg percocet and 5 mg Vicodin and I will take a another 5mg of Valium if my pain doesn't start dropping... While these are low doses I don't feel safe to drive when I take 5 mg of two drugs at the same time... This pretty much screws me at work as I have to suck up the pain or have my wife and kids pick me up from work and bring me back to work the next morning. My wife is already doing everything I used to do I really hate making her do more- I am really blessed to have her! All in all this is one of my more painful days as the pain just hasn't let up much all day. How have you guys/gals dealt with this?

Question: Last two times I Was placed on quarters I asked the Doctors (two different ones) to write bed rest on the sheet and they both replied to same way... thats what quarters means. Will the board look at this the same way? I have also kept a pain log since August will this help me and my case, or am I just waiting my time?
 
Don't forget about Deluca criteria - additional rating consideration if use of back causes pain, instability fatigue. Was your range of motion measured to point of pain or as far as you could (or someone else could make you) bend?

Mike
 
Good Morning,

I am going to find out more about the Deluca criteria... haven't heard of it. On the 1st I went in and reviewed my NARPSUM with my doctor. Overall its not bad, but their are a few thing I would like him to include that he states... Well, the board doesn't care about that." The main things I want included are the following:

1- 2000- The doc lists a hematoma on my lower back prior to entry in the USAF that is listed on the enlistment paper work, but does not incldue that I had an MRI preformed with negative findings.

2- 2007- In Iraq I was seen by a "Bone" Doc who happened to be the only doc in the clinic, as my back was hurting and sent me to PT for leg leg concern (came back normal). My doc does not list that he successfully adjusted my back and I received 100% relief.

3- He has not include the times were I have been placed on quarters (6 in the past year) due to my back flaring up. Says its not needed.

There are a few things were I don't like the wording but they are not that bad. How do I go about including them as my Doc is pretty certain I don't need them? IS this what the rebuttal is for and if so, does the Board review the rebuttal as well?

Another Issue:
This appointment My doc JUST noticed that when he would lightly Push on the L5/S1 Disk space I would literally jump off the table! I have been complaining about this for months but he has done nothing. I have a standing X-Ray from September 2009 that states my L5/S1 disk is wedged...What are my options? Can I push for treatment and have this included or just push forward with the current package.

To be honest at this point and time I am ready to get out and start a new life, my family concurs. When I look at Tricare Standard for retirement, it looks like it not much better than no insurance at all. PLEASE let me know what you all think!!!!!
 
Have you thought about getting a second opinion from a different neurosurgeon. That first neurosurgeon I saw said that i just had "a bad back" my PCM was smart enough to realize that the guy was quack since my first MRI clearly showed impingement of L5-S1 nerve root. Did the neurosurgeon you saw just read the report or did they actually look at the MRI films/pictures?
 
Got a printed copy of my Draft Copy of the NARSUM and it is not good..... Doc wouldn't give me a copy in his office, but the record folks were happy to!

First off- Batcheej, Great Question... No I have not had any second opinion.. Unfortunately, being on Guam means I would have to pay out of pocket to go anywhere as we do not have one that I am aware of local. The Doc did look at my MRI for about 5 min during the consultation. A flight to the states is a min of $1100 if you are lucky. I mentioned that I may need to go to Trippler AMC in HI with my wife and I asked if there are any additional testing/ what not that could be done if I am already there. My Doc made it clear that I am done.... IE: where done spending our money on you!!

maparker- You mentioned Deluca criteria... I had my ROM testing on 16 July after which I took a percocet, on 17 July I was in the clinic getting shots in the tush by a different doctor. He asked what brought this one and I replied I had my ROM testing yesterday. Now if only I can get my NARSUM to reflect this...

In my NARSUM it is tilted to make me look like I have a preexisting condition due to mildly intermittent back pain and the already mentioned incident in 2000. When I really hurt my back at Combat Skills Training for which he doesn't even call it that... he treats that as just another incident in a long line of them, nothing special. Doesn't even have the facts straight on what I did to injury my back. Iraq is briefly mentioned. He has an incorrect number or facet injections listed, and it still is not clear in my records if a nerve ablation was preformed at my L5-S1 or not. Nor was their any mention of the pain that occurred when they did my ROM's... I was in Tears when it was over and promptly took a perk.

He is kind enough to mention that I have:
"Moderate tenderness to palpation over intervertebral space between L4-L5 and L5-S1. Well-healed scar, midline L4-5 region from hematoma drainage"

My August MRI (the only one) does state Disk space narrowing at the L5-S1 area, and I have two sets of standing X-Rays (one taken today all of which I paid for as my Doc refused to order them) to confirm this, yet they do nothing to investigate. It doesn't take a Einstein to figure out that if your L5-S1 has a posterior wedge of course your facet joint is going to wear out. What I would like to know is what can be down about that wedged disk space?? Yet this is only briefly mentioned in the NARSUM.

When I had the nerve ablation completed the pain management doc did state that if this did not relieve my systems that I more than likely have Myofascial Pain Syndrome. However when I read over the symptoms it doesn't fit at all.

The Doc's Final Diagnosis is : Chronic Low Back Pain/Myofascial Pain Syndrome

Good News! I met my PEBLO (Did I type it right?) today. I found her, otherwise I don't they would have said anything to me until the NARSUM was signed. She wants me to type everything that is bothering me about the NARSUM and she will approach the Doc. I am not sure how much I can expect, but she said if we don't get anywhere, we will go over him to his commander. See seemed surprised how much I knew about this process and that is solely THANKS to you guys on this forum.

One thing that concerns me... She mentioned that I am being Fast Tracked and once my package is submitted I should have a response back in two weeks to two months at the longest. Have you guys heard anything about this?

I'm not sure what to expect in typing this out expect taking about 5 minutes of your lives that you will never get back, but if anyone has suggestions I'm all ears. I would love for them to explore my L5-S1 disk issue though.
 
-Doc refuses to modify NARSUM draft

Well, I supplied my remarks on the draft Narsum to my PEBLO and she forwarded to my Dr. He replied to her that he has no intentions to change anything. He was not very friendly toward her, it seems that he doesn’t treat his staff very well.

My PEBLO is going to take this to the SGO (my Doc's Boss) and let him look at everything. After that I assume it rebuttal and independent review. For the rebuttal is this were I would request JAG’s help in drafting it, or is that only for the one back from Texas (AFPC)? Although I must admit that Jason would do a far better job than Jag as the time he devotes to this forum is proof of that.

Time frame wise, I am being Fast Tracked- They expect to have everything wrapped up by September. Of course if this Narsum goes to the board unaltered I will have no choice but to Formally Appeal.

I must say I am sorry is I don't make must sense but I'm on my forth Vicodin, this Doc wants me to lay off the Perks for a while so I have to take twice as much Vicodin as perk. I am also going to see what I can do about changing him as my PCM. I have no desire to be treated by him again. Should anyone what to review his draft and my reply I don’t mind just PM me. Any pointers would be great.
 
Trembly ,
Sorry to hear about your back .I am replying becuase i am also a dirt boy and went thru the meb process they tried to fasttrack my case (ASTHMA I was in desert storm in the army in the oil fields) but i was told that besause of our MOS 3e5x that i could not be fasttracked ,wich I am probably better off because i got 30 % but you might check into that.
 
Good Point I will check into the us not being able to be fast tracked... But at this point I'm ready to get out and be done with it, but not before I fight. Today I went and had my PCM changed. Surprisingly it was approved even though I'm in the start of an MEB. I'm done with my old Doc.
 
Trembly,

Sorry that I missed some of your earlier posts.

I would suspect that they have not evaluated your back correctly. The Deluca criteria can be summed up as a Court of Appeals for Veterans Claims case (which is binding on the military) that says they have to take into account functional limitations (read as ROM) due to pain, fatigue, incoordination, flares, etc. They almost always get his wrong.

As for your MEB, if you are not satisfied, request an impartial review and rebut. Very often, the impartial review does not come back with any useful advice, but what is important is that the MEB Approval Authority (usually the Deputy Commander for Clinical Services, who is normally the MTF/hospital Exec. Officer) has to reply in writing to your concerns and all matters submitted have to be included in your MEB.

I hope you get a good outcome. Good luck!
 
Jason, I will do as you have suggested. This week we are having an ORE (operational readiness inspection) as such most everything thing has been put on hold until its over. I will be following up tomorrow to see what is being done. I did change my PCM, I am not sure what impact if any that will have.
 
I just got my results back on ROM test, and I would also like to know where I stand. I had L5 surgury and i have 4 screws with hardware. I have just over 15 yrs and getting paid for 19 yrs of service as E-6. I have permanent bending and lifting restriction of which no lifting greater than 40lbs and no running. It goes as follows:

LX F 45A/55P Muscle guarding prevents further F
LX E 5A/10P Muscle guarding prevents further E
L LX SB 25A/P
R LX SB 15A/P
CX conpression neg
No hypersensitivity noted LX region

A=active P=passive

My commanders letter says (summed up) if member is to be retained in the USAF his profile will need to be changed.

But as you see earlier they are permanent restrictions not temp. So the profile will never change.
 
Hammer time now.... Jason I hope your have your internet working... Took them a while but I just signed my Local Boards Report, although I was loaded up on Percocet as I was having a bad flair-up at the time. Currently I'm at home on quarters because of the flair up. I have no idea what caused this flair-up as I have really done nothing. At least half of every day at work I have my feet on my desk while I reclined back in my chair with my keyboard in my lap. Anyway lets get to the... well interesting part.

When asked to fill out my AF618 I was repetitively told I should appeal the next board not this one... and several additional reasons were give but I persisted that I wanted an impartial review. I don't remember everything as I Was trembling with pain while we were talking by that point I had taking 15mg of percocet in the last 6 hours or so w/o much relief and just came out of the doctors office. She had me look at the AF618 briefly and then sign some forms... It took me a while as I was try to make sure I understood everything prior to signing. I was told by the PEBLO that due to the PACAF inspection next week they don't foresee completing my Impartial Review with in the 5 day limit. They also stated that the three days for me to sign the Impartial review were inclusive in the seven days to write my Rebuttal. After I was done with that I went to the pharmacy and picked up my Valium and took it, had my boss bring me home and passed out for the next several hours.

Now today when I look back though my paper work I see several problems and yet again I am unable to reach my PEBLO.

1. AF618
a. Block 12. MY separation date is not correct- they placed the expiration date of my ID card of June 2012, my DOS is Dec 2014
b. Block 17. Active Military Service is listed at 9Y/9M -It should be 10Y 4M / My Inactive is listed as blank...Should my Guard Time that is not included in my Active time be listed?
c. Block 23. It is listed that my Conic back pain began prior to Active Duty... This right here burns me, while I did have a back injury their is nothing conclusive that it is related to my current problem. I even have a neurosurgeon placed comments in my record that he failed to notice any sensitivity or anything in that region. Additionally I still have my MRI films that showed no damage, however the AF doc's have had zero interest in reviewing those films.

2. Attachment 5- Impartial Review
a. In my drugged state I signed the bottom of this from and dated it as the same day as I received the results of my Impartial review. --This is not correct... if push comes to shove what actions can I take?

So Far this is what I have done.
a. I called my PEPLO but she is out at a meeting
b. I left a message with the ADC (Area Defense Council) to call me back.

Right now I am starting to prepare my rebuttal as which about 90% of it is completed. I turned in this in as an unofficial rebuttal in when I received a copy of my Draft Narsum. MY questions are as follows.

1. How do I go about correcting the AF 618
2. What information do I need to include in my Rebuttal and what do I not include.
3. Are the 3 days part of the 7 days to turn in my Rebuttal
4. What am I missing here guys/gals please help me to cover all my bases as my clinic is not helping in the lease bit... in fact they have never had anyone request an impartial review before.
 
New Update...

The only doctor that can do my impartial review is my new PCM... currently he is off island for Emergency leave so AFPC has granted my case an extra 30 days. This is good as we are trying to figure out a medical issue affecting my wife. God is good!

On my AF618 the PEBLO is going to change the items requested on the original form and initial beside it... sounds like an easy fix as long as it is legit.
 
Whats with the valium? I've never heard of anyone being prescribed that for back pain (including me). I almost feel like someone wants you to be doped up through all of this so you take whatever they dish out.

There's a lot going on here. You need to keep your wits about you throughout the WHOLE process. Assume nothing.

You need to look into this whole second opinion matter. What surgical options has anyone given you? You need to talk to some civilian back ortho's that do this all the time and not some AF doc with an attitude. They're some great ones back in CONUS who work wonders with fusions etc.
 
I just got my results back on ROM test, and I would also like to know where I stand. I had L5 surgury and i have 4 screws with hardware. I have just over 15 yrs and getting paid for 19 yrs of service as E-6. I have permanent bending and lifting restriction of which no lifting greater than 40lbs and no running. It goes as follows:

LX F 45A/55P Muscle guarding prevents further F
LX E 5A/10P Muscle guarding prevents further E
L LX SB 25A/P
R LX SB 15A/P
CX conpression neg
No hypersensitivity noted LX region

A=active P=passive

My commanders letter says (summed up) if member is to be retained in the USAF his profile will need to be changed.

But as you see earlier they are permanent restrictions not temp. So the profile will never change.
 
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