Getting the VA to pay for a civilian surgeon?

[HES]

DISCLAIMER: This is not a thread asking for pity. Just need advice. The majority of the text is meant to give some background.

Uncle Sam got his mileage out of my body. One of the consequences are messed up shoulders. Along the way the tendons securing the clavicle were damaged. The end result is that the tendons are not holding the clavicle in place, so its grinding bone to bone against the acromion (top of the shoulder). The only practical procedure is called a mumford. Basically they go in orthoscopically with a dremmel and grind the bones down to create space. Back in December of 08, when I had private health insurance, I had the left shoulder done. I'd have to say that I don't regret it. My surgeon does the shoulders of the areas professional sports teams and several shooters. He was great. I got my full range of motion back and could shoot with out a problem. The big restrictions are on load bearing. So when it comes to back packing I have to be very careful and my days of carrying heavy weights are over.

Then about 6 months ago we lost our awesome private health insurance for some mysterious reason (three guesses). So off the the VA I went. At about the same time the right shoulder started to let me know that it wanted some attention. It took 6 months to get an MRI. Well in those 6 months my right shoulder made it loud and clear that it felt left out. After the MRI I had an appointment in about a week to see the orthopedist. Spoke to him this Monday. The shoulder is now screaming and he said he could believe it based on what the MRI showed him. Other than that I have absolutely zero confidence in him. He didn't prescribe me anything for the pain. He did everything he could to talk me out of surgery. I told him that this wasn't my first rodeo and he insisted that all I needed to do was just ice it for 20 minutes a night.

I insisted on and now have referral to see the shoulder surgeon, but if she is like the orthopedist I'm not feeling too confident.

So with that in mind, is there anyway I could convince the VA to allow, and pay for, my original surgeon to do the right shoulder? I know I'm probably more likely to win the lottery but I figure it can't hurt to ask.

Double Bonus Points Round. Since its taken me so long to get this far, and since I've been favoring the right shoulder, the left is now starting to act up and remind me it may be better, but not like it originally was.

[T2C]

If you live near a large VA facility, try to locate a DAV advocate and ask what they can do for you. The DAV has helped people work their way through the VA maze quite a few times and are experienced at getting things done if it can be done. They also have a pretty good idea what cannot be done.

I have been dealing with the VA since 1985 and it is not an easy task.

[HES]

Yes I go to the #2 (I think) facility in the US. DAV advocate? Never even knew about them. I'll have to check it out. Thanks

[ABNAK]

Are you service-connected for your shoulders? That is a big question. Even if you are I'll bet the VA would try to not fee-base it out to your original doc; if you're not service-connected then no way will they do it. Can't hurt to inquire about it if you are service-connected though.

I've had 5 shoulder surgeries (3 on the left, 2 on the right) since 2003. I feel your pain. Can make lifting weights or sleeping on it a bitch until the surgery relieves the pain (basically cuts out bone spurs and inflammatory scar tissue) and gives me more space inside the shoulder. Then time goes by, and well, rinse and repeat. I'm used to it by now.

[HES]

I haven't applied yet. The wife keeps yelling at me to take care of that.

How often are you having your surgeries? Every 5 years? 10 years? Sounds like we've got the same thing going on. You're right, sleeping is a bitch.

[Irish]

My shoulders are jacked too and I've been going to physical therapy for about 6 months… End result, they're a heck of a lot better than what they were and I don't think I'm going to need surgery after all.

My R shoulder is service connected and the physical therapist I have at the VA is outstanding in every way! I credit her with successfully keeping me from going under the knife.

Have you looked into any type of sports related physical therapy? Might just be the ticket you need.

Also, if you plan on applying for a service-connected disability I would suggest starting on it yesterday. The wait times for the VA can be pretty darn long.

[HES]

With the left shoulder I did 6 months of PT and it was sports related. No luck. I only did the initial surgery because all other options were exhausted. After the results of that surgery I'm now of the mind set of saying "screw PT, just cut me and get the right done." As for filing, I've got a couple of days open next week.

[ABNAK]

I haven't applied yet. The wife keeps yelling at me to take care of that.

How often are you having your surgeries? Every 5 years? 10 years? Sounds like we've got the same thing going on. You're right, sleeping is a bitch.

Well, in 11 years I've had 5 surgeries. Granted they may not be mathematically spaced apart but it averages , what, every 14-15 months or so? They do it laproscopically so the "cutting" is minimal. The very first one was an "open" acromioplasty and they had to detach/reattach the deltoid in the process......it was a bitch. The last 4 have been with the 'scope. Like I said I'm a crusty shoulder-surgery veteran so it only sets me back a few weeks. Had one last June and was only off a week from work (would've milked it for longer being summer and all but my current job is tight on sick leave....if I'd had more time accrued I would've gone for two weeks!). Skipped lifting for a week altogether, then a light week or two, then ramped back up to normal. I go by how it feels.

I keep on lifting, which I'm sure doesn't help, but I'll be damned if I'll quit. That's why I get 'em fixed, so I can keep on keepin' on! Ortho guy doesn't even try to lecture me anymore. He's a year younger than me and is amazed that I stay in such good shape.



As stated above, the VA service-connection is a L-O-N-G drawn-out process. You will undoubtedly be denied and will have to appeal. That will drag it out even longer. Start yesterday as was already advised.

[ramairthree]

Sorry about your wear and tear.
Chronic ortho stuff is a seesaw and crap shoot and a hamster wheel many do not get off of.
Best of luck.

VA is hard to get in your favor for wear and tear your job put on you.

Chronic pelvic pain from uterine fibroids, sleep apnea, and other weird stuff is usually a cinch.

[HES]

I got the pelvic pain and damage down pat. Ditto the hyper extended cervical and compressed lumbar with herniated disk. But those are manageable by now.