I was blown up in Iraq by an IED in 2005 and wedge fractured my L4 and T11 vertebrae and compressed my discs. I survived an MEB and was MMRB'd under the old system in 2006 because ortho dropped the ball twice (exact words in my medical record) and never put the referral in for neurology and a CT/MRI. So, I failed to successfully get back to running but won the board over by being a motivated young soldier. Following my MMRB and MOS reclassification, I got proper imaging done, real physical therapy, RFA, and more and more treatment over the years as my back has continued to get worse.
I have had sciatica, but beyond transient numbness in my lower back and being brought to my knees by sudden flare ups, RFA has eliminated the persistent electric shocks from my back down through my legs. ROM is stiff in all directions. I can move but i use my knees and hips to get me forward and down or flop and deal with the pain. Pain is normally 5/10 with debilitating flare ups to 7-9/10 every 1-2 days that can take me out for minutes, hours, or days. Hip is tilted now with one leg shorter on most days unless by some miracle I can pop my hip back into place. I have managed to suffer through over the years.
I am now just over 19 years time in service, OCONUS, and at a location where I see a civilian provider. My last CONUS doc told me to MEB out instead of taking a 20 year regular retirement because I am so broke ( I have at least 4 issues that are MEB worthy as I read the reg) and my back has significantly worsened. What I need help with is your collective experience on IDES and the evaluation and rating for back issues. I have time to shape my treatment and evaluations with my current doctor to ensure the right language is used for VA and DoD rating purposes. I plan on reaching back to my military medical team this summer and waving the white flag to start the MEB based on the current 6 month IDES cycle goal to ensure I am safely at 20 years.
I am especially interested in if the back has separate ratings and if you have similar experiences to my above and below issues how did they get rated? The CFR is confusing on the issue. Do I need my doc to prescribe bed rest? Do doctors really do that? It sounds nice. I have been put on a treadmill by Army PTs and told to run while being treated for flare ups.... Is ROM based on where you feel a natural hard stop, where pain starts, or where you can force yourself to go?
I apologize for all the detail, there is so much going on and I am clueless as to what really matters. Is it my record or does it just boil down to the C&P?
My current back diagnoses in my medical record read as follows: Low back pain, SACROILIITIS, FACET SYNDROME LUMBAR, INTERVERTEBRAL DISC DEGENERATION, LUMBAR SPONDYLOSIS, CLOSED FRACTURE OF LUMBAR VERTEBRAL BODY L4 COMPRESSION and LUMBAGO.
My last English language radiology exam notes (2020 and 2019 respectively) have the following detailed impressions:
Findings:
There is a mild lumbar levocurvature with the apex at L1-2 (image 8, series 8). Lumbar lordosis is increased (55 degrees). Vertebral body height and bone marrow signal are normal. The conus terminates at a normal level at L2. There are no cord signal abnormalities. The visualized paravertebral soft tissues are unremarkable. Specific findings by vertebral level: T11-T12: Seen only on the sagittal sequences. Severe disc desiccation, disc height loss and endplate degenerative changes. There is no evidence of significant canal or neural foraminal stenosis as seen on the sagittal sequences. T12-L1: Normal. L1-L2: Normal. L2-L3: Mild disc desiccation. There is no significant canal or neural foraminal stenosis. L3-L4: Disc desiccation with severe disc height loss and a disc bulge. There are also extensive Modic type II endplate degenerative changes and a Schmorl's node along the superior anterior endplate of L4. There is also mild bilateral facet/ligamentum flavum hypertrophy. Findings result in minimal canal stenosis without significant neural foraminal narrowing. The exiting and traversing nerve roots appear unaffected. L4-L5: Minimal disc bulge with severe bilateral facet/ligamentum flavum hypertrophy. There is no significant canal or neural foraminal stenosis. L5-S1: Disc desiccation and severe disc height loss with a central disc herniation. There is also endplate hypertrophy with Modic type II endplate degenerative changes and bilateral facet/ligamentum flavum hypertrophy. Findings result in mild canal stenosis without significant neural foraminal narrowing. The exiting, L5 nerve roots appear unaffected. The traversing, left S1 nerve root may be lightly contacted in the left lateral recess (image 17, series 7). The visualized sacroiliac joints are unremarkable. Impression: 1. Multilevel thoracolumbar degenerative changes, as detailed above. Findings are most pronounced L3-L4 and L5-S1. 2. Lumbar levocurvature with increased lumbar lordosis.
Lumbar vertebral column demonstrates normal sagittal curvature and alignment. Normal vertebral body height. Mild reverse S-shaped scoliosis of approximate 10 degrees. Multilevel degenerative endplate osteophyte formation. Degenerative disc height loss most severe at L3-4 with vacuum phenomenon and deep L4 superior endplate Schmorl's node. Degenerative disc height loss left severe at L5-S1. Mild low lumbar degenerative facet sclerosis at the L3-4, L4-5, L5-S1 levels.
IMPRESSION: 1. Mild degenerative reverse S-shaped scoliosis curvature. 2. Multilevel end and osteophyte formation. L4 superior endplate prominent Schmorl's node. 3. Low lumbar degenerative disc disease, greatest at L3-4, less severe at L5-S1 level. 4. Low lumbar multilevel L3-4 through L5S1 moderate degenerative facet spondylosis.
I have had sciatica, but beyond transient numbness in my lower back and being brought to my knees by sudden flare ups, RFA has eliminated the persistent electric shocks from my back down through my legs. ROM is stiff in all directions. I can move but i use my knees and hips to get me forward and down or flop and deal with the pain. Pain is normally 5/10 with debilitating flare ups to 7-9/10 every 1-2 days that can take me out for minutes, hours, or days. Hip is tilted now with one leg shorter on most days unless by some miracle I can pop my hip back into place. I have managed to suffer through over the years.
I am now just over 19 years time in service, OCONUS, and at a location where I see a civilian provider. My last CONUS doc told me to MEB out instead of taking a 20 year regular retirement because I am so broke ( I have at least 4 issues that are MEB worthy as I read the reg) and my back has significantly worsened. What I need help with is your collective experience on IDES and the evaluation and rating for back issues. I have time to shape my treatment and evaluations with my current doctor to ensure the right language is used for VA and DoD rating purposes. I plan on reaching back to my military medical team this summer and waving the white flag to start the MEB based on the current 6 month IDES cycle goal to ensure I am safely at 20 years.
I am especially interested in if the back has separate ratings and if you have similar experiences to my above and below issues how did they get rated? The CFR is confusing on the issue. Do I need my doc to prescribe bed rest? Do doctors really do that? It sounds nice. I have been put on a treadmill by Army PTs and told to run while being treated for flare ups.... Is ROM based on where you feel a natural hard stop, where pain starts, or where you can force yourself to go?
I apologize for all the detail, there is so much going on and I am clueless as to what really matters. Is it my record or does it just boil down to the C&P?
My current back diagnoses in my medical record read as follows: Low back pain, SACROILIITIS, FACET SYNDROME LUMBAR, INTERVERTEBRAL DISC DEGENERATION, LUMBAR SPONDYLOSIS, CLOSED FRACTURE OF LUMBAR VERTEBRAL BODY L4 COMPRESSION and LUMBAGO.
My last English language radiology exam notes (2020 and 2019 respectively) have the following detailed impressions:
Findings:
There is a mild lumbar levocurvature with the apex at L1-2 (image 8, series 8). Lumbar lordosis is increased (55 degrees). Vertebral body height and bone marrow signal are normal. The conus terminates at a normal level at L2. There are no cord signal abnormalities. The visualized paravertebral soft tissues are unremarkable. Specific findings by vertebral level: T11-T12: Seen only on the sagittal sequences. Severe disc desiccation, disc height loss and endplate degenerative changes. There is no evidence of significant canal or neural foraminal stenosis as seen on the sagittal sequences. T12-L1: Normal. L1-L2: Normal. L2-L3: Mild disc desiccation. There is no significant canal or neural foraminal stenosis. L3-L4: Disc desiccation with severe disc height loss and a disc bulge. There are also extensive Modic type II endplate degenerative changes and a Schmorl's node along the superior anterior endplate of L4. There is also mild bilateral facet/ligamentum flavum hypertrophy. Findings result in minimal canal stenosis without significant neural foraminal narrowing. The exiting and traversing nerve roots appear unaffected. L4-L5: Minimal disc bulge with severe bilateral facet/ligamentum flavum hypertrophy. There is no significant canal or neural foraminal stenosis. L5-S1: Disc desiccation and severe disc height loss with a central disc herniation. There is also endplate hypertrophy with Modic type II endplate degenerative changes and bilateral facet/ligamentum flavum hypertrophy. Findings result in mild canal stenosis without significant neural foraminal narrowing. The exiting, L5 nerve roots appear unaffected. The traversing, left S1 nerve root may be lightly contacted in the left lateral recess (image 17, series 7). The visualized sacroiliac joints are unremarkable. Impression: 1. Multilevel thoracolumbar degenerative changes, as detailed above. Findings are most pronounced L3-L4 and L5-S1. 2. Lumbar levocurvature with increased lumbar lordosis.
Lumbar vertebral column demonstrates normal sagittal curvature and alignment. Normal vertebral body height. Mild reverse S-shaped scoliosis of approximate 10 degrees. Multilevel degenerative endplate osteophyte formation. Degenerative disc height loss most severe at L3-4 with vacuum phenomenon and deep L4 superior endplate Schmorl's node. Degenerative disc height loss left severe at L5-S1. Mild low lumbar degenerative facet sclerosis at the L3-4, L4-5, L5-S1 levels.
IMPRESSION: 1. Mild degenerative reverse S-shaped scoliosis curvature. 2. Multilevel end and osteophyte formation. L4 superior endplate prominent Schmorl's node. 3. Low lumbar degenerative disc disease, greatest at L3-4, less severe at L5-S1 level. 4. Low lumbar multilevel L3-4 through L5S1 moderate degenerative facet spondylosis.
