Lower back pain

C123

PEB Forum Regular Member
Hello,
I have had lower back pain for 4 years now. I have been seen for it several times through out the last 4 years, but more recently have been going much more. They took x-rays and and MRI. Both don't show anything objectionable, however I have a lot of pain in my lower back. I am currently in Physical Therapy and have been getting temporary profiles since Feb, 2010. The stretches that the physical therapist is having me do is not helping at. I feel worse after doing them. I am not able to wear my flak vest for very long without my back becoming very painful. What will happen? What can I do? I am not able to do my job and my MRI doesn't show anything objectionable, but my lower back hurts a lot when I have to do things like stand for more that a 10 min, wear all the gear, walk, etc. Any help would be nice. Thank you.
 

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
Dear C123:

Other more knowledgeable folks will chime in on this shortly. All I can do is share my experience with you.

I, too, had similar symptoms you are expressing. I, too, went into the military medical system and had an MRI done with similar results.

When I finally went to a non-military back and spine doctor(neurologist), he ordered a new MRI(s) on my entire spine and the MRIs came up with issues related to various parts of my spine. Issues that went undetected by Army military medicine.

Not saying what your health problems might be, but just letting you know you may have other options outside of military medicine that may help you figure out what your medical issue(s) may be.

Others more knowledgeable than myself will respond to you here. And the information you'll get here is some of the best you'll get anywhere on the web.

Hang in there and keep us posted!
v/r,
nwlivewire
 

NACnomore

PEB Forum Regular Member
PEB Forum Veteran
nwlivewire,

What did you have to do to get out side of mil-medicine? Did tricare cover it all? I went to the ortho-spine clinic a few weeks ago and asked for a new MRI, he said they don't give MRI's willy nilly and ordered x-rays. My last MRI showed Degenerative disk disease but they were only looking at my low back and I have lots of pain in my mid/upper back also.

I'm going to the pain management clinic this week and will find out what the new x-rays showed, I'll be asking them for a new MRI also.
 

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
Dear NACnomore:

I went into the Army CB-WTU program as I am a traditional National Guard Soldier on Active Duty at the time of injury. What this meant to me is that I could return to my home of record, seek medical care through Tri-Care, and maintain my AD status at the same time while undergoing medical diagnosis and treat of injuries sustained while on Active Duty. And because my home of record is over 50 miles from a military treatment facility, I am able to utilize Tricare Prime remote and seek medical diagnosis and treatment of military injuries through civilian medical care providers. But even this program has it's problems and hurdles. It seems that there are some issues that I still have had to fight tooth and toenail to get. The bureauracy creates more barriers than what they're worth sometimes (IMHO). And sometimes, it's a royal pain in the arse what a Soldier has to go through just to get to proper diagnosis and treatment - if granted. There are disconnects in this system, too, and they do not bode well to the Wounded Soldiers benefit and well-being, either.

I'm sure others will chime in here for those who are traditional AD and on post and not in my situation as a traditional National Guard Servicemember. Surely, there must be a way to get a proper diagnosis for those in traditional AD service who believe they are not being fully diagnosed, underdiagnosed, or just plain not being diagnosed at all.

v/r,
nwlivewire
 

greenne

PEB Forum Regular Member
PEB Forum Veteran
Registered Member
One of the first(and simplest) things you can do as a military member is request a second opinion thru TRICARE...for anything. It is a RIGHT, something they have to do if you request it...for PCM visits and also refferals. Now I think they can refer you to another Dr in the same clinic(esp if you ask for a PCM 2nd opinion) but unsure about refferals. I specifically requested a DIFFERENT hospital (I live in the DC region) for my 2nd opinion because I was unhappy with one of my specialists. TRICARE granted my request.

It may not work in all cases and I will agree Drs sometimes tend to "stick together"...but if you're in pain and the DR isn't listening, what have you got to lose?

Nate
 

C123

PEB Forum Regular Member
This is some good information. I am not able to do my job properly and keep going back to get temporary profiles. I just seem to be getting the run around. I have been in the Army for 9 years, I am not trying to get out of anything, I just don't want to cause more damage to my back and end up being more damaged later in life. I am the only one that is truly going to look out for myself. Like I stated in my first post I am currently in physical therapy, and it isn't doing anything for me. Should I just keep going back to the clinic? If I do this what will end up happening? Will they send me to the MEB eventually? If so, what will come out of that since my MRI didn't show anything objectionable and is considered "normal"? I have heard about some soldiers getting shots in their back to numb the nerves. I don't like the sound of that because if they kill the nerves then I won't know my limits and will end up causing more damage in the future. Well this is where I am now. Any answers would be wonderful.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
You can't have a temporary profile for more than 12 months for the same condition. Any temp. profile over 6 months requires referral to a specialist. Here is the quote from AR 40-501:

"7–4. Temporary vs. permanent profiles
a. Permanent profiles. A profile is considered permanent unless a modifier of “T” (temporary) is added as described
in b below. A permanent profile may only be awarded or changed by the authority designated in paragraph 7–6.
(1) If the profile is permanent the profiling officer must assess if the Soldier meets retention standards by chapter 3.
Those Soldiers on active duty who do not meet retention standards must be referred to an MEB as per chapter 3. (See
paras 9–10 and 10–26 for disposition of USAR and ARNG Soldiers not on active duty who do not meet medical
retention standards.)
(2) Those Soldiers (active duty and USAR/ARNG) who meet retention standards but have at least a 3 or 4 PULHES
serial will be referred to a Medical MOS Retention Board (MMRB) in accordance with AR 600–60, unless waived by
the MMRB convening authority.
(3) Permanent profiles may be amended at any time if clinically indicated and will automatically be reviewed at the
time of a Soldier’s periodic health assessment or other medical examination.
(4) The Soldier’s commander may also request a review of a permanent profile in accordance with paragraph 7–12.
b. Temporary profiles. A temporary profile is given if the condition is considered temporary, the correction or
treatment of the condition is medically advisable, and correction usually will result in a higher physical capacity.
Soldiers on active duty and RC Soldiers not on active duty with a temporary profile will be medically evaluated at least
once every 3 months at which time the profile may be extended for a maximum of 6 months from the initial profile
start date by the profiling officer.
(1) Temporary profiles exceeding 6 months duration, for the same medical condition, will be referred to a specialist
(for that medical condition) for management and consideration for one of the following actions:
(a) Continuation of a temporary profile for a maximum of 12 months from the initial profile start date;
(b) Change the temporary profile to a permanent profile;
(c) Determination if the Soldier meets the medical retention standards of Chapter 3 and if not, referral to a MEB.
(2) The profiling officer must review previous profiles before making a decision to extend a temporary profile and
refer the Soldier to a medical specialist for management if the temporary profile has been in effect for 6 month. Any
extension of a temporary profile must be recorded on DA Form 3349, and if renewed, item 10 on the DA Form 3349
must contain the following statement: "This temporary profile is an extension of a temporary profile first issued on
(date)."
(3) Temporary profiles should specify an expiration date. If no date is specified, the profile will automatically expire
at the end of 30 days from issuance of the profile. In no case will Soldiers carry a temporary profile that has been
extended for more than 12 months. If a profile is needed beyond the 12 months, the temporary profile will be changed
to a permanent profile."

I have seen many cases where the doctors either ignore this regulation or try to get around it by letting the temporary profile expire and then re-initiating it and treating as the first profile.

Only your doctors or other providers can give you any guidance on how to address your medical problems. Though, if you are not happy with the treatment you are getting, you may well want to consider getting a second opinion. As far as outcomes from the administrative side, well, you will either get referred to an MEB/PEB or return to duty without referral. If you get referred to the MEB/PEB, it will follow the course outlined in the regulations (you can find many posts on this, start with the Overview of MEB/PEB process thread). You will either be found fit or unfit (and given appropriate disability benefits).

Hope all goes well for you.
 

NACnomore

PEB Forum Regular Member
PEB Forum Veteran
This is some good information. I am not able to do my job properly and keep going back to get temporary profiles. I just seem to be getting the run around. I have been in the Army for 9 years, I am not trying to get out of anything, I just don't want to cause more damage to my back and end up being more damaged later in life. I am the only one that is truly going to look out for myself. Like I stated in my first post I am currently in physical therapy, and it isn't doing anything for me. Should I just keep going back to the clinic? If I do this what will end up happening? Will they send me to the MEB eventually? If so, what will come out of that since my MRI didn't show anything objectionable and is considered "normal"? I have heard about some soldiers getting shots in their back to numb the nerves. I don't like the sound of that because if they kill the nerves then I won't know my limits and will end up causing more damage in the future. Well this is where I am now. Any answers would be wonderful.

Keep doing the physical therapy, ask your primary care for a referral to the pain management clinic. I went to the orthopedic spine clinic a few weeks back and they also refer out for coritizone or RFA but it would be faster to just get a referall straight to PMC if you can get it.

I've had multiple cortizone shots, and now an RFA(radiofrequency ablation - killing nerves ). I've had the same question as to knowing my limits w/ the nerves deadened? Maybe some one else can answer that. It has provided some relief but I need to go and get the right side and my neck done and hopefully that will provide the relief I need. If you go w/ RFA you have to have a test (lumbar medial branch block) done first, this is a test to see if the RFA will help you. If you ask them to test both sides at the same time they can then do the RFA for both at the same time. I didn't find this out until after, now I have to wait several months, I'm going to ask for a test when I see the pain management clinic tomorrow, but that will take another month, and then a month after that to get it done. Your clinic may have different waiting periods.

I'll ask about the "knowing limits" at my appointment tomorrow.
 

NACnomore

PEB Forum Regular Member
PEB Forum Veteran
I went to my appointment at the pain management clinic today. I got a TENS unit and will be getting RFA on the right side. I asked him about knowing your limits and RFA and he said it's nothing to worry about. He said you should already know your limit which is lower than it used to be. I avoid heavy lifting in general any way.
 

leon2325

PEB Forum Regular Member
PEB Forum Veteran
C123- I feel your pain, literally. I was injured 5 years ago and have had tons of up's and down's. Fortunately, I am lose to WRAMC and they will do any intervention/testing they care for. I have had multiple injections, including RF Ablation. That hurts like nothing you can imagine. They can't numb you up and have to stick a needle in your back. It does work, but is temporary. Have you been to a chiropractor? I had one who I really liked... until he got a little skeezy and I no longer felt comfortable with him. The chiropractor diagnosed me with laxed ligaments. It makes sense because my pain waxes and wanes. Just putting my socks on can be painful. All of my tests are essentially negative also. That doesn't take the pain away, though. Did you have some type of trauma? You could have a ligament problem too. My civi doctor diagnosed me with a "back sprain." I think it all depends on who you talk about. If you can, see as many different specialists. There has to be someone who can help you out. Physical Med & Rehab doctors can at least give you helpful meds. As for my personal limited experience with the MEB and VA rating, you are rated on ROM.
 

Hooah1002

PEB Forum Regular Member
Registered Member
C123 - have they checked your sacroiliac (SI) joint? I started having lower back pain a couple of years ago, feels like it is just below the waist to the right/left of my spine. Good video on YouTube discussing it
. I'm having the same issues, can't stand for more than 10-15 minutes, some days walking is impaired and causes a limp, carrying anything even moderately heavy causes pain to increase, etc. Sounds like that might be what you are experiencing.
 

cmckee494

New Member
Registered Member
I got out of the Army in 2001 as an MP. I had chronic lower back pain from 8 years of the duty belt, with handcuff cases in my back. I didn't notice that the VA classified it as degenerative disc disease which is hereditary and not caused by the constant trauma. I've now been fighting for 17 years to get the VA to acknowledge the actual cause. Any tips would help. The only issue is L5/S1 if it was degenerative disc disease it would be my whole spine.
 

Warrior644

Super Moderator
Staff Member
PEB Forum Veteran
Lifetime Supporter
Registered Member
I got out of the Army in 2001 as an MP. I had chronic lower back pain from 8 years of the duty belt, with handcuff cases in my back. I didn't notice that the VA classified it as degenerative disc disease which is hereditary and not caused by the constant trauma. I've now been fighting for 17 years to get the VA to acknowledge the actual cause. Any tips would help. The only issue is L5/S1 if it was degenerative disc disease it would be my whole spine.
Welcome to the PEB Forum! :)

Hmm, why is it so important to have your lower back not categorized as DDD? Did the DoVA Rating Agency issue a military service connected finding with corresponding rating on your lower back at this particular point in time? Take care!

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

Best Wishes!
 

fred801

PEB Forum Regular Member
PEB Forum Veteran
Registered Member
C123 - have they checked your sacroiliac (SI) joint? I started having lower back pain a couple of years ago, feels like it is just below the waist to the right/left of my spine. Good video on YouTube discussing it
. I'm having the same issues, can't stand for more than 10-15 minutes, some days walking is impaired and causes a limp, carrying anything even moderately heavy causes pain to increase, etc. Sounds like that might be what you are experiencing.

Sounds like what I'm experiencing to a T. Standing up from sitting, especially from the toilet is excruciating and coughing sometimes puts me on the ground. My pain started around 10 years ago and I have gone through the ringer to get to where i'm at.

I am a physical therapy "failure" twice over.
Stretching exercises did nothing.
Chiropractor made it worse.
Did 5 spinal epidurals in several spots and none of them helped.
Did an SI injection which didn't help.
The doctor referred me to a spinal surgeon and I am awaiting authorization for a discogram.

The last reading on my latest MRI shows a lot of things, most notable bulged disks from L3-S1 and DDD from L3-S1 also. Only advice I can give is to document everything and keep at it. Unfortunately results from an MRI don't always translate over to the amount of pain you are feeling. I'm in the final stages of my board and i'll let you know what my results are when I find out.
 

lesco431

PEB Forum Regular Member
Registered Member
VA question:
- My neck has a service connected rating of 10% (Its called a cervical strain and i believe the rating was based on a slight lack of ROM and some pain) however, it has progressively gotten worse over time (also I made the mistake of being on pain medication during exam so it temporarily reduced my symptoms during exam: I realise that was a poor decision)
- Anyways, my question is that since this condition has worsened (meaning, I believe the ROM is worse) can I file for an increase even though I haven’t sought treatment and have no additional medical records and just expect that I will be granted a C&P exam since it is service connected? Also, assuming I am granted an exam, if the ROM is worse, can it be assumed it would result in a rating increase?
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
VA question:
- My neck has a service connected rating of 10% (Its called a cervical strain and i believe the rating was based on a slight lack of ROM and some pain) however, it has progressively gotten worse over time (also I made the mistake of being on pain medication during exam so it temporarily reduced my symptoms during exam: I realise that was a poor decision)
You don't have a specific question here, I just note that you didn't provide much in the way of time or chronological events in your statement and that makes it harder to provide input.

- Anyways, my question is that since this condition has worsened (meaning, I believe the ROM is worse) can I file for an increase even though I haven’t sought treatment and have no additional medical records and just expect that I will be granted a C&P exam since it is service connected?

Yes, you can always file for an increase.

Normally, an exam is required if necessary to make a rating determination. So, absent other information or evidence submitted that would allow for an increase or rating determination, you may well be able to expect a new C&P exam.


Also, assuming I am granted an exam, if the ROM is worse, can it be assumed it would result in a rating increase?
I don't know that I can say you can "assume" anything. I don't necessarily have a disagreement with what you "assume." However, an increase would be warranted (and perhaps be due as a matter of law) if your worsened ROM meets the requirement for an increase. What I am getting at here is that you can have decreased ROM, but it still falls within the same criteria for your current rating based on ROM. Your decreased ROM would have to meet the criteria for the higher rating.

Hope this helped. Best of luck to you! If you have any other questions, please let us know.
 

lesco431

PEB Forum Regular Member
Registered Member
Thanks for the input,
In the event that I were to file for an increase on a rated condition, if I include an updated DBQ from a physician with the increase claim, would it be considered a “fully developed claim”?
 

browntown12

New Member
Registered Member
Sounds like what I'm experiencing to a T. Standing up from sitting, especially from the toilet is excruciating and coughing sometimes puts me on the ground. My pain started around 10 years ago and I have gone through the ringer to get to where i'm at.

I am a physical therapy "failure" twice over.
Stretching exercises did nothing.
Chiropractor made it worse.
Did 5 spinal epidurals in several spots and none of them helped.
Did an SI injection which didn't help.
The doctor referred me to a spinal surgeon and I am awaiting authorization for a discogram.

The last reading on my latest MRI shows a lot of things, most notable bulged disks from L3-S1 and DDD from L3-S1 also. Only advice I can give is to document everything and keep at it. Unfortunately results from an MRI don't always translate over to the amount of pain you are feeling. I'm in the final stages of my board and i'll let you know what my results are when I find out.
Do you mind if I ask what your DOD rating ended up being for the bulging discs and DDD?
 
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