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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey, guys. It's Leah b from Prestige Veteran Medical Consulting. I'm a US army veteran, physician assistant, and former compensation and pension examiner. So today, I wanna come on and discuss scoliosis and how that can be related to veteran's disability. So when people hear scoliosis, they generally think of, a childhood disease.
Leah Bucholz:So most of us, you know, at least in current times, kids get checked for scoliosis in school during the physical exam. In elementary school, generally, people will have the doctors will have them bend over, and they'll check their spine alignment and things like that. It's not necessarily always thought of as an adult onset, medical condition that can happen, but it it absolutely can. So let's talk about that. So the Mayo Clinic defines scoliosis as a sideways curvature of the spine that most often is diagnosed in adolescence.
Leah Bucholz:While it can occur in people with conditions such as cerebral palsy, muscular dystrophy, the cause of most, childhood scoliosis is unknown. Most cases of scoliosis are mild, but some curves can worsen as children grow. It can be very disabling. Usually, it's identified and and kind of managed with x rays over time. Symptoms of scoliosis can include uneven shoulders, a curvature of the spine just by looking at it.
Leah Bucholz:One shoulder blade that can appear more prominent than than another. One hip can be higher than another, and prominence on one side of the back when bending over. So the causes, again, we talked about certain neuromuscular disorders, like cerebral, palsy or muscular dystrophy, birth defects, affecting the development of the bones of the spine, previous surgeries on the chest wall as a baby, injuries or infections of the spine, and this is where this is gonna come in, spinal cord irregularities. Risk factors for developing the most common types of scoliosis include age. So, generally, beginning in adolescence, gender, both boys and girls can develop mild scoliosis.
Leah Bucholz:Some girls have much higher risk of the curve worsening, family history, a lot of complications like back pain, breathing problems, etcetera. So if a person enters service and you look at their entrance examination and there's no childhood history of scoliosis. There's no they've never complained about it, never been told that they had it. Their exam is normal, and then they've got multiple episodes of back pain and service, and an x-ray is performed, and you can see that there's a level of scoliosis, well, if there's a trauma that occurred, it could be a post traumatic occurrence of this. Okay?
Leah Bucholz:A lot of times I'll see that that people will say, oh, no. They've had they have scoliosis evidence post service. Right? Either post service or in service, it gets identified, and they'll say, oh, well, this is a genetic issue. This they they've had they must have had this since birth.
Leah Bucholz:So it's, you know, not service connected because it's, preexisting. Okay? Well, if there is an evidence that it was preexisting, how can we not say that it developed in service? So at at least that at least is likely as not standard should be able to be applied here. Even if someone was to say it preexisted service, how can you not say it was not aggravated beyond its natural progression from an aggravation standpoint if the person started having these symptoms while in service?
Leah Bucholz:Okay? So I think that the key element here is to outline that it's not always a, you know, from birth or adolescent issue. That's where we most commonly see it. But service members have a really rough time with with back injuries due to occupational stressors, and it is very plausible that a person can develop this unnatural curvature of the spine due to service related medical, you know, issues. Right?
Leah Bucholz:So I'm gonna discuss some of the literature that I talk about when I write reports for this. Mostly, I just talk about those injuries and service. Okay? And and, one of them is occupational back disability in US army personnel published in military medicine in 1999. It's an older article, but it is very specific to military members.
Leah Bucholz:A study published in the Army Public Health Center in 2018 titled army injuries causes risk factors and prevention overview discusses the common injuries and mechanisms. Musculoskeletal injuries, both acetic and chronic are caused by repeated stress or overuse and and is the largest health problem in the military. Nearly 50% of military members experience an injury each year requiring extended, limitations of duty, like profiles, removal from combat, etcetera. Low back pain during military service predicts low back pain later in life, published in PLOS 1 in March 2017, aim to assess associations between physician diagnosed, low back pain during compulsory military service and self reported low back pain after military service. So there's a lot of good literature in that one.
Leah Bucholz:Low back pain fact sheet published in the National Institute of Neurologic Disorders and Stroke, discusses development of chronic back pain and lists having a job that requires heavy lifting, pushing, pulling, particularly when it involves twisting or vibrating, at the level of the spine. Mechanical low back pain published in the American Family Physician, discusses discusses repetitive trauma and overuse, common causes of chronic mechanical low back pain. There's so many articles about back pain that we can use in radiculopathy. One really good one that I like to use for people that do not necessarily have, in service documentation is let me see if I can find this one. It's about under reporting.
Leah Bucholz:Oh, here's a good one. Post traumatic arthritis, overview of mechanisms and role of inflammation published in rheumatic and muscular this, musculoskeletal disease shows that post traumatic osteoarthritis is not clinically diagnosed until after the onset of symptomatic of the symptomatic phase. So So you can have post traumatic arthritis. You can have a post traumatic scoliosis. You can have a post traumatic lots of degeneration of the spine that can lead to shifting of that spine.
Leah Bucholz:K? Degenerative disc disease active component US Armed Forces, 2001 to 2011. This was published in medical surveillance monthly report in 2012. Let's see. One more good article for you guys, and then we'll wrap it up, for that underreporting.
Leah Bucholz:I gotta look it up in my database here. Let's see. Under reporting of musculoskeletal injuries in the US army published in sports health evaluated into reporting among US army soldiers to explore potential limitations of surveillance approaches. In the study, surveys were completed by soldiers assigned to an army infantry brigade combat team. Survey questions inquired about injuries sustained in the previous 12 months, injury onset, and whether injuries were reported to a medical provider.
Leah Bucholz:Study showed that a total of 138 soldiers reported 32 102 injuries that had occurred in the previous 12 months and included 1636, which was 51% that were reported and 49% were identified as not reported. So this article just goes to show that what we know from a cultural standpoint, veterans just don't often active duty service members do not report for fear of reprisal or for, you know, not wanting to appear weak or wanting to go to a school or whatever. Right? So some of this will help bridge that gap for those of you that may not have been seen on active duty. Maybe you have a buddy statement.
Leah Bucholz:Maybe you're leaning into your MOS. We have some great videos on, you know, 11 bravos and different MOSs in the, MOS SmartBook and how it shows that, you know, different occupational stressors for each MOS. Right? So I hope this was helpful mostly to shine a light that, scoliosis is not just an adolescent injury, and many veterans can be service connected for this. So thank you for watching and please drop some comments.
Leah Bucholz:Alright. Talk to you guys later. Bye.