ROM Experience

H

Heli2015

PEB Forum Regular Member
Registered Member
I am finally going through the MEB process which started last week. I have 16 years of service and now the army decided that I am no longer needed. I had a failed micro discectomy in January 2015, which relieved the pain in my leg initially, but it came back two months ago. My back pain is still a huge problem, and the surgery did not help at all. I had an EMG done recently. The results were normal. So why am I having pain in my leg? The doc explained that the EMG only tests for nerve damage and does not address if the nerve is compressed or pinched. I also had MRIs and X-rays done about two weeks ago. MRI results show that the L5 nerve root is impinged on the right side. My right leg goes numb from prolonged standing, sitting, walking, or carrying light weight (my son weighs about 25 pounds). My ROM varies daily, but stays within very limited range. I can bend forward, but it almost immediately causes pain. Did anyone else experience this after micro discectomy? I know that forward flexion is about the only thing that determines the rating for lower back disability. My back pain is something I have to live with for the rest of my live and the neurosurgeon told me that another surgery will very likely happen in a few years. I refused his offer to do a fusion a this point, since there is only a 50% chance that it would help. Honestly, I just don't trust them. I am very frustrated with army doctors. It seems to me that they all have short-term memory problems and sometimes unethical practices. After my neurosurgery appointment, I got the copy of the record and I was blown away. I told him that the medication they put me on, helped me some, but I could not handle the side effects. So what does he put in the record? Significant improvement with medication. Really? He also stated that that my sensory exams were all normal. The problem is that he did not even do them!!! Pain management doc was not much better. I told him that the meds they put me on made me feel like a zombie. I was unable to drive, concentrate, or work. They made me depressed to the point that I was thinking about really weird and unsafe stuff. So, what does he do? Try taking half, he says. When I told him about a severe depression I am experiencing, he blew it off and told me that it's not a big deal. So he continued me on the medication. I tried taking half of the dose, but the side effects were still unbearable. I have decided that I will not be going back to see that doc. I will be going to physical therapy next week. Seem to me that those people actually care about the patient.
Well, while I am on this anti-army doctor rage, I will tell you about my dental experience. About six months ago, I came in to get a couple of fillings done. An army captain was a nice guy, until he started to work on me. He was trying to numb me, but it was not working. After 5 failed shots, he called another captain and she did 3 more shots. Still, I was not numb to start the work. Finally, they called their boss, and he did it right the first time. They hit my jaw bones with needles several times and I could not open my mouth fully for 3 months. I guess you get what you pay for.
Anyway, I have some important questions, and I hope I can get hep on this board.

1) I was referred to MEB for chronic back pain only. Can I add radiculopathy, even though my EMG says I have no nerve damage?
2) I am very worried about the ROM test. I have read a few horror stories, but is it really that dad?
3) My last question is about severance pay. If I do get less than 30%, and I want to get the taxes back, does the VA rating have to mirror DoD rating verbatim? What if the DoD says chronic back pain and VA says degenerative disk decease?

I would really appreciate everyones help. Thank you all in advance. This board is a life saver for many.
 
In my case, I was granted 10% for my Lumbar DDD and 10% in each leg for radiculopathy on the VA side. They did not combine any of Lumbar ratings. 20% for my Cervical issue and 10% for the Lumbar DDD for the combined 30% Army.
 
1) EMG tests the changes along a nerve. You'll remember they didn't stick a needle in your spine. The EMG has no idea what changes originate in the spine, it will only tell if the changes are starting or getting worse somewhere down the line. A normal EMG is expected if it starts in the spine. Neuropathy should definitely be claimed. If it can also be an unfit condition is the more interesting question. Often times this can be pretty key in reaching a retirement rating.

2) All my ROM tests were very straight forward. They are required to also account for how a flare-up effects you. Do the test as instructed, doing the full movement you can do. Just explain to the examiner where the pain would start on a bad day, how often a bad day happens, etc.

While I don't believe it accounts for all bad ROM experiences, there are some examiners who are on the look out for inconsistencies. If you have no pain taking off your boots, or otherwise are inconsistent about what hurts, they will tank the exam. Trying to game the system isn't needed IMO.

3) Yes, they will match up. There are some examples where this throws a wrench in things, the MEB referred for condition A, VA says its condition B, and things have to be hashed out. Chronic back pain vs DDD is pretty much potato/patato, the Army should just update to the VA name.
 
Thank you for the replies and I apologize for not getting back sooner. I have read many posts on ROM experience. Some say to stop when the pain starts and some say to continue going. I guess it all depends and many factors would come into play. I completely agree that there is no need to play the system, but it is imperative to protect yourself and get the deserved rating. I do not want anything extra, just a fair rating. C&P will only last a couple of hours and it is almost impossible to present the whole picture. Doctors are busy and may overlook something important. I still have a couple of months before my exam, so I am educating myself and reading as much as possible. My folder is getting thicker every day. The system is not perfect, especially when it comes to the spine.
 
@Heli2015

1) I was referred to MEB for chronic back pain only. Can I add radiculopathy, even though my EMG says I have no nerve damage?

Yes, you can add radiculopathy or neuropathy if you are exeriencing symptoms, an EMG is not necessary, but it can help. They do not use a EMG in your C&P evlauation to test for radiculopathy, it is old school pin prick method.

2) I am very worried about the ROM test. I have read a few horror stories, but is it really that dad?

The test in itself is not too difficult, in my opinion, the majority of the horror stories are due ot the patient, not the doctor. The patient over performs during the test(s) (we are soldiers, it is our mission to perform well). Once the results come back, then the patient blames the doctor for mis-interpreting how the patient feels, not how the patient performed. It is a best practice for a doctor to use a goniometer, however it is not mandatory.

3) My last question is about severance pay. If I do get less than 30%, and I want to get the taxes back, does the VA rating have to mirror DoD rating verbatim? What if the DoD says chronic back pain and VA says degenerative disk decease?

If you are going through the IDES, it is very likely that you will have the same rating code for your unfitting condition and claimed condition. To get the taxes back, you must file a claim with DFAS in the same calendar year in which you receive the pay (sooner is better than later), or you will have to file the claim with the IRS in the following years tax filing (refund).
 
gsfowler, thank you. My EMG came back normal, so I am not sure how this will affect the outcome. Time will tell. I still have a long road ahead.
 
Heli2015 said:
gsfowler, thank you. My EMG came back normal, so I am not sure how this will affect the outcome. Time will tell. I still have a long road ahead.
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I had several abnormal EMG tests and the Army performed one as part of my MEB, which they claimed was normal.

When it cam time to my rating, the impressions from the "pin-prick method" in my C&P was used. The doctor in my C&P did not even use a "pin-prick" kit like physical therapy and chiropractic used on my but rather a "tounge depressor" that he broke into a sharp splinter.
 
VA regulations provide that "use of
a goniometer in the measurement of limitation of motion is
indispensable in examination conducted within the Department
of Veterans Affairs." See 38 C.F.R. § 4.46.
 
Hello.

Was you able to get radiculopathy as unfit? I had 2 micro discectomies and my rom is shot to hell. My nuero surgeon says that I need to get an interbody fusion on L5-S1. I said no. I'm tired of being cut open. I talked a lawyer in San Diego at Balboa hospital, he basically said that radiculopathy would be categorized as class 2. Meaning that it's connected to your back injury and that the PEB will most likely say that it's not unfitting. I was referred to MEB for post laminectomy syndrome and chronic back pain. I asked if my radiculopathy could be added and they said no. So this does not make sense to me as I keep reading that radiculopathy can be an unfitting condition. I walk with a cane constantly because of the pain and also take lyrica for nerve pain with Percocet. Any advice on how to add radiculopathy to my unfitting conditions after I receive my findings from IPEB?

Thanks for all help I have already received!

Killakx3
 
Killakx3 said:
Hello.

Was you able to get radiculopathy as unfit? I had 2 micro discectomies and my rom is shot to hell. My nuero surgeon says that I need to get an interbody fusion on L5-S1. I said no. I'm tired of being cut open. I talked a lawyer in San Diego at Balboa hospital, he basically said that radiculopathy would be categorized as class 2. Meaning that it's connected to your back injury and that the PEB will most likely say that it's not unfitting. I was referred to MEB for post laminectomy syndrome and chronic back pain. I asked if my radiculopathy could be added and they said no. So this does not make sense to me as I keep reading that radiculopathy can be an unfitting condition. I walk with a cane constantly because of the pain and also take lyrica for nerve pain with Percocet. Any advice on how to add radiculopathy to my unfitting conditions after I receive my findings from IPEB?

Thanks for all help I have already received!

Killakx3
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From an U.S. Army perspective when in the DoD IDES MEB/PEB process, upon the receipt of your IPEB findings, you shall have an opportunity to request a Formal PEB (FPEB) hearing in order to address any medical impairments for a PEB-referred unfit for duty determination (supportable via medical evidence and/or medical documentation) if you believe they are affecting your ability to "reasonably perform duties of his or her office, grade, rank or rating." Take care! :cool:

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer!"

Best Wishes!
 
Killakx3 said:
Hello.

Was you able to get radiculopathy as unfit? I had 2 micro discectomies and my rom is shot to hell. My nuero surgeon says that I need to get an interbody fusion on L5-S1. I said no. I'm tired of being cut open. I talked a lawyer in San Diego at Balboa hospital, he basically said that radiculopathy would be categorized as class 2. Meaning that it's connected to your back injury and that the PEB will most likely say that it's not unfitting. I was referred to MEB for post laminectomy syndrome and chronic back pain. I asked if my radiculopathy could be added and they said no. So this does not make sense to me as I keep reading that radiculopathy can be an unfitting condition. I walk with a cane constantly because of the pain and also take lyrica for nerve pain with Percocet. Any advice on how to add radiculopathy to my unfitting conditions after I receive my findings from IPEB?

Thanks for all help I have already received!

Killakx3
Click to expand...


I feel positive that radiculopathy in my right leg will be an unfitting condition. During my NARSUM telephonic interview, my radiculopathy was added. I am currently waiting to receive my NARSUM. Will provide an update, once I receive it. On the other note, my C&P went very well. I am very optimistic that I will get correct ratings. The doc was very helpful and even suggested that I add two other conditions. I was able to take a quick glance at the numbers he put down. It is still too early to celebrate and time will tell what I will end up with. I did my C&P on a army base. Another Soldier, who had his C&P off-base had a very negative experience. So I guess it all depends who you get.
 
Heli2015,

I'm on a MEB for exactly the same thing. I had a failed microdiscectomy and now have significant ROM issues, radiculopathy, etc. Im in the USMC and probably under a different program, but on my referral sheet I have Lumbar radiculopathy, IVDS L4-L5, L5-S1, and some other stuff not related to the back. I think I've talked to the same lawyer in San Diego as KillaKx3 who keeps talking about CAT 2 vs CAT 1. Bottom line, get it in your file. You can always write a personal statement indicating how this pain affects you.

Send me a PM if you need to commiserate. I think we're going through very similar situations.
 
A-5,

1. Hello and all who reads this. Thank you for your advice. My PEBLO in Hawaii says that I am "unofficially unfit" according to the IDES in Washington navy shipyard. She also said that my package was sent to the VA site located in Rhode Island Providence for ratings. All I can do now is to wait for the ratings to come back and rebuttal stating that I want to have the radiculopathy as a unfitting condition. My neurosurgeon wants to do a TLIF fusion on the L5-S1 region and the Pain Clinic wants to do a spinal cord stimulator trial. Unfortunately my PEBLO is really demanding that I don't get any surgeries as it will stop the PEB!! I am trying to prepare my self for this rebuttal but I am kind of lost in the sauce. Do I go through navy Jag here located in Hawaii for rebuttals of findings or do I go to the PEB Lawyers located in San Diego?

2. Also since its been a very long time since my medical record has been updated (Nov 2, 2015) that was sent to IDES in Washington navy shipyard how do I send them my new and updated info? Or do I just wait til I do the rebuttal?

3. VA-ratings- the package that was sent to PEB did not have the new updated info so I uploaded my updated medical records on Ebenefits. Will the VA raters see the new updated Medical records for the rating proposals decisions?

4. Mental health records was not included with the updated medical record that I requested from medical. I can get a copy of it, but my main concern is that- Do I need to upload the mental health records to the VA for them decide or is it just the C&P exams that they will base it all of?

thanks all,
Killakx3
 
I'm in the same boat as you.. I noticed after my C&P exam I had 120+ pages of documentation missing... I re uploaded them as well
 
A quick update. I received my C&P, NARSUM, and DA 3947 this morning. Out of all the conditions I claimed, only 2 failed retention standards:

1. Lumber DDD
2. Status post lumber microdiscectomy surgical procedure with persistent pain and reduction in range of motion.

C&P Forward flexion 30 degrees

My right leg radiculopathy met retention standards, according to the NARSUM. It sites that my C&P neurological exam was largely intact. It also says that my EMG was normal.

But looking closely at the NARSUM, I noticed a huge mistake. My sensory, reflex, and leg raise test clearly show radiculopathy. But section 8D says that my right leg is not affected. Here is the kicker. It says that my left leg has moderate radiculopathy. Unreal. Is this why my right leg radiculopathy met retention standards? Would it make a difference in retention, if the correction is made? Any feedback would be greatly appreciated.
 
It likely won't make a difference in retention either way. Likely the back is alone enough for the unfit. It will make a difference in the % offered. 30 degrees should result in a 40%, so retirement should be in the cards either way, but I'd probably rebut the NARSUM and/or ask for an IMR to correct an error as simple as the wrong leg being considered.
 
scoutCC said:
It likely won't make a difference in retention either way. Likely the back is alone enough for the unfit. It will make a difference in the % offered. 30 degrees should result in a 40%, so retirement should be in the cards either way, but I'd probably rebut the NARSUM and/or ask for an IMR to correct an error as simple as the wrong leg being considered.
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I'm meeting with an attorney tomorrow to discuss the course of action. I have a feeling that without a positive EMG, I will be just wasting my and my attorney's time. It is an obvious error they made on my C&P, but I would hope the docs are much smarter to understand that it is just an error when they were looking at fit or unfit determination. I will update tomorrow.
 
Interesting. I'm about to go through something similar. Do you have to do an EMG in order for radiculopathy to be recognized in your % awarded?
 
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