Download Michael Riordan

Michael Riordan
May 7, 2017
VA regional Office
555 Willard Avenue
Newington, CT 06111
Dear Sir or Madam:
I am writing you to formally request an increase for my service connected back and testicle groin
disability.
Back Disability:
Dating back to at least September 2005 my back has had pronounced impairment, with persistent
symptoms compatible with sciatic neuropathy, with characteristic pain, muscle spasm, and other
neurological findings appropriate to the site of diseased disc, with little intermittent relief per DC
5293. This would give me a rating of 60%.
The evidence to support this claim for in increase is as follows:
Letter from Craig Bash, M.D., M.B.A, Board Certified-Associate Professor of Radiology and
Nuclear Medicine dated 23 OCT. 2007 - …imaging findings on MRI of severe lumbar spine disc
disease (DDD, epidural adhesions, annular tear) out of proportion for his age, clinic notes that
document his sciatica, radiculopathy, transforaminal injections, leg fasiculations, neuropathy and
straight leg raise tests………limited range of motion in all directions…….absence from work over 12
weeks over about an 18 month time period………significant loss of work time, need for medications,
and sciatica….he cannot sit and stand for extended periods of time……has burning shooting
pain…..patients spine disease is not run of the mill as epidural adhesions are fairly rare and extremely
difficult to treat as they cause constant pain 10/10 unrelated to his superimposed disc disease.
Letter from Edward C. McGuire, D.C., DACBOH, CCSP, Board Certified Chiropractic
Occupational Health Specialist, Board Eligible Chiropractic Sports Physician Specialist –
……..Orthopedic, Neurologic, and functional capacities examinations 8/20/07, 10/8/07, and 11/7/07
show continued impairments to the lower back and lower extremities related to diminished L4, L5
and S1 neurologic function and spinal/disc conditions………Forward flexion to 40 degrees….post
surgical syndrome, Sciatica……….visual evaluation – wearing back brace, patient movements
restricted, slow, guarded………….Minor’s sign positive……..SLR (left) positive, SLR (right)
positive, Milgrams test positive………..
Open MRI of Connecticut Report – increasing back pain, at L3 – L4, some signal loss, small left
hemilaminotomy, at L3-L4 a mild disc bulge is present, some, granulation tissue, L5-S1 a small right
paracentral disc protrusion is present, post-surgical changes with central disc bulges at L3-L4 and L4L5 levels.
Letter from supervisor Brenda Jenkins – 12 weeks out of the office because of back from 9/05 to
03/07, unable to drive or sit, limping or being stiff, leave the office early many times because of the
pain.
Notes from Dr. Andrew Wakefield, M.D. (Neurosurgeon) – desiccated and collapsed disc spaces
at L3-4, L4-5, and L5-S1, slight endplate changes noted at L4-5 level as well, some central disc
bulge, possibly annular tear at L3-4, loss of cervical lordosis with straightening of the lumbar spine,
anterior thigh pain going down to the knee, positive SLR on right and left side, numbness is present
which is probably due to some involvement of the L4 nerve root likely due to scarring, spinal cord
stimulator, rather advanced degenerative changes present in the lumbar spine.
Notes from Dr. Huber (Primary care doctor) – testicle pain on right, pain down both legs, multiple
episodes of back flare, has been out of work 3 x weeks, pain in low back radiating to testicles, worse
with standing and sitting, was having fasciculations in the legs, then three days ago worse pain ever,
has neuropathy – dull ache down anterior legs to knees, has panic attacks related to chronic pain,
on buspar and ativan for this, lumbar radiculopathy progressing, chronic back pain, ultram 50mg tabs
prescribed.
Notes from Dr. Boobol Connecticut Pain Care – tingling – thighs, buttocks, pins and needles –
legs, muscle spasm or tightness – back, thighs, after surgery in 2000 patient reports that he
experienced no symptomatic improvement and states in fact that his symptoms worsened, MRI
diagnosed epidural scar tissue, pain is constant, sharp, shooting, aching, and burning pain, presents
with LBP, buttock, thigh, testicle pain, constant burning sharp shooting pain radiating into L leg into
knee, Vicodin is not covering pain, pain also radiating into testicles, anxiety, panic attacks, Lyrica
samples did not help, chronic lumbar radicular pain, postlaminectomy syndrome, patient is
complaining of low back pain radiating down his right greater than left lower extremity in what
appears to be the L3 and L4 nerve root distribution, Right L3 and L4 transforaminal epidural steroid
injections, I explained to him that he certainly again now has a neuropathic component in the L3 and
L4 nerve roots, diagnosed with epidural scar tissue that has been there for some time, my hope is to
break up the scar tissue which is clearly entrapping the nerve roots causing his symptomatic
complaints, my concern, however is that the scar tissue has had many years to form and become more
solidified making it more difficult to destroy, pain returned to normal on 4 th day after injection,
Vicodin not helping, seems like he is in constant state of flare ups, patient is complaining of low
back pain with a right lower extremity radicular component what appears to be starting from the L3
and L4 nerve root distribution, right L3 and L4 transforaminal epidural steroid injections, injections
had little to no effect, on Perecet instead of Vicodin, SLR both sides, facet / medial branch block.
Billing Statements from Blue Cross / Blue Shield – This statements show I have been going to Dr.
McGuire for Chiropractic / physical therapy two to three times a week since August 2007. Each
appointment makes me miss approximately two hours of work. That is equivalent to four to six hours
a week.
Various RX records – These records show I have been on narcotics since 2006. As you can see I
have progressed from using Vicodin to Oxycodone. Oxycodone is sued to treat severe pain. Prior to
taking any narcotics I strictly used alcohol to try and get some pain relief. Since Ativan and Buspar
were introduced and then finally narcotics.
What current evidence shows is that since 2005 on average I have missed at least six weeks of work
per year. This needs to be taken into consideration of the rating. Since the ratings are based on
unemployablility I feel missing this much time from work shows I have a severe problem and not a
moderate or mild issue. This does not seem to be reflected in a 20 % rating. I have also received
steroid injections and nerve blocks on a regular basis since the beginning of 2007. A mild to
moderate condition does not constitute injections of the frequency I am receiving. Dr. Boobol states
that I have nerve entrapment at two disc levels. Dr. Bash states the epidural adhesions that Dr.
Boobol states as the entrapment source are extremely difficult to treat and cause constant pain. Then
the fact that I have been constantly in physical therapy since August 2007 needs to be taken into
consideration. A person who needs this much treatment does not have a mild or moderate symptoms
with their back. Dr McGuire also states that I have continued impairments to my lower back and
lower extremities related to diminished L4, L5, S1 neurologic function and spinal / disc conditions.
Then there is the issue of taken narcotics since 2006. The fact that I need to take these pills three
times a day and need increasing stronger drugs show again a severe problem not a mild or moderate
issue. I also experience anxiety / panic attacks two to three times a day because of the severe pain I
am in. I have been taking ativan and buspar or equivalent anxiety medications since 2002 for this
issue. I am service connected for adjustment disorder for this directly related to my back. The last
point I will raise is the fact all the VA examinations you have are outdated. I readily admit that since
2004 my back condition has increased in severity. I ask that a separate rating be considered for the
scar tissue from my back surgery and the neurologic symptoms from my back. The surgery was done
based on an injury deemed to be from active service. Therefore does the scar tissue deserve a
separate compensatable rating? I also ask that all these symptoms listed above are taken into
consideration with CR 4.25.
Chronic Testicular / Groin Pain Disability: My evidence does not only show locking and pain
from sexual activity but from daily life. The VA examiner who service connected by back and
testicle pain in 2001 made the opinion that my testicle pain was tied to my back. This opinion has
been collaborated over the years with many different doctors. If that is the overall opinion then it
would need to be considered in my back rating. This would only be more evidence for a higher rating
of my back.
I ask that the regional VA office consider DC 8530 as Dr. Bash has recommended. This diagnostic
code would be more fitting in this case since the pain is tied to the Ilio-inguinal nerve than any
urinary or prostate issue. I think the evidence of thirteen years has proven that. There have been
many other BVA cases that have been rated under this code for similar symptoms. I also experience
limping with the torsion of my testicle and experience severe pain that makes me drop to the floor. I
would consider this pain to be disabling and has cost me a great deal time off from work.
Sincerely,
Michael Riordan