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Suggest treatment for myofascial pain syndrome and coccydynia

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Posted on Tue, 21 Oct 2014
Question: In the United States do Doctors give any type of Disability Permanency Rating for Myofascial Pain Syndrome, Degenerative Disc Disease and Coccydynia?

I have been injured several times at work but after my last fall (fell off of a box 2-3 feet high and landed on my back) my doctor was originally telling me that the results of my MRI of my lower spine and Coccyx area didn't match the level of pain i was reporting. This went on for almost 2 years back and forth between me and my Doctor. He then gave me a Functional Capacity Test that lasted almost 6 hours. When my Doc got the results back he then started believing me because the FCE i guess has hidden aspects to it so the evaluators can tell if your malingering but the report said i put forth maximum effort on a consistent basis and then they put it in a percentage saying the FCE was 94% sure i was not trying to lie.

My Doctor then changed his whole attitude towards me and i could tell he was now trying very hard to diagnose my low back pain.

I have a job that if the doctor says you are not 100% ready to come back to full duty then after 2 years you must retire or be fired. My two years is up and i have to go see my doctor this week and ask him for a disability rating and i need him to tell Workers Comp if my injuries are work related and if they are compensable.

So, my question is (I know every state is different, I'm only asking what you would do) In your opinion could my Doctors Assessment of my injuries be Compensable in relation to Workers Comp coverage
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Answered by Dr. Dariush Saghafi (5 hours later)
Brief Answer:
I believe the FCE is considered by WC adjudicators

Detailed Answer:
Good morning. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX OH region of the country. I am both an examiner for the State of OH as well as one for the Veterans Administration Hospital. I've read your other questions on this topic to colleagues as well as their responses.

I believe I'm correct when I say that no matter whether at the State or Federal levels, doctors are not the ones to ASSIGN any form of disability, permanent or otherwise, to a patient's claim. We are asked to evaluate circumstances, obtain examination data, and synthesize a report which suggests (within the bounds of medical probability) cause and effect.

In your case, an FCE was performed and you state that the examining physician did a thorough evaluation for your condition of back pain due to degenerative disc disease and coccydynia. You further state that the examining physician felt the results of the FCE were highly in favor of an organic substrate for your symptoms and that you believe the doctor has ruled out any form of malingering.

You also state that with respect to your work status you are in a job where the description of duties requires 100% full capacitation to perform them and that the limit to achieving that level of capacity is 2 years otherwise, you must be terminated one way or the other. It does not appear that you are able to claim 100% rehabilitated status to baseline prior to your injuries and/or fall(s).

Therefore, in my opinion the WC board would have to take all this into account when deciding upon the merits of compensable disability for work related injuries or incapacity. And I believe they likely will, however, I can tell you that the doctor sometimes in a case such as this can be as supportive as you wish of the circumstance but the board decides differently. In other words, doctors do not make the assignment of compensable disability though they may make the diagnosis of cause/effect with respect to work related injuries, symptoms, and degree of incapacity. Often times doctors are not made entirely privy to other facets of a case which the board does not consider relevant to the medical officer's direct "need to know" to evaluate a case medically. And some times it is precisely those factors that tilts a case away from what would otherwise, appear to be a medically sound judgement call for some type of work related disability compensation. The doctor is not involved in that final step of the decision making process rather that's the board. And so, there's where the appeals process begins.

I hope that makes sense.

Bottom line is that it is not uncommon for all the ducks to be lined up in what one thinks to be the "right row" but to not get the most favorable response. You'll simply have to wait to see how the board decides once they've reviewed all the information. I don't know that YOU in particular have to DO anything in particular any more unless it's to go for another examination with another physician from the State, from the WC bureau, or perhaps from the Police Force where you work. If so, you simply need to do your best to cooperate during the exam, relate the symptoms you are having as well as any improvements or not which have occurred over the past 2 years and what you believe your current capacity for the job description of your duties since doing the FCE.

The rest is up to the board. Good luck.

If this information has been helpful and I've answered your questions would you do me the favor of some written feedback and a STAR RATING to the answer?

Also, if you have no further questions or comments to place could you also be helpful by CLOSING THE QUERY which will alert the network to process, archive, and credit this question appropriately for future reference.

I'm happy to answer your questions personally through the following website:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This query required 29 minutes of physician specific review, research, and final draft documentation for envoy.


Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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Suggest treatment for myofascial pain syndrome and coccydynia

Brief Answer: I believe the FCE is considered by WC adjudicators Detailed Answer: Good morning. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX OH region of the country. I am both an examiner for the State of OH as well as one for the Veterans Administration Hospital. I've read your other questions on this topic to colleagues as well as their responses. I believe I'm correct when I say that no matter whether at the State or Federal levels, doctors are not the ones to ASSIGN any form of disability, permanent or otherwise, to a patient's claim. We are asked to evaluate circumstances, obtain examination data, and synthesize a report which suggests (within the bounds of medical probability) cause and effect. In your case, an FCE was performed and you state that the examining physician did a thorough evaluation for your condition of back pain due to degenerative disc disease and coccydynia. You further state that the examining physician felt the results of the FCE were highly in favor of an organic substrate for your symptoms and that you believe the doctor has ruled out any form of malingering. You also state that with respect to your work status you are in a job where the description of duties requires 100% full capacitation to perform them and that the limit to achieving that level of capacity is 2 years otherwise, you must be terminated one way or the other. It does not appear that you are able to claim 100% rehabilitated status to baseline prior to your injuries and/or fall(s). Therefore, in my opinion the WC board would have to take all this into account when deciding upon the merits of compensable disability for work related injuries or incapacity. And I believe they likely will, however, I can tell you that the doctor sometimes in a case such as this can be as supportive as you wish of the circumstance but the board decides differently. In other words, doctors do not make the assignment of compensable disability though they may make the diagnosis of cause/effect with respect to work related injuries, symptoms, and degree of incapacity. Often times doctors are not made entirely privy to other facets of a case which the board does not consider relevant to the medical officer's direct "need to know" to evaluate a case medically. And some times it is precisely those factors that tilts a case away from what would otherwise, appear to be a medically sound judgement call for some type of work related disability compensation. The doctor is not involved in that final step of the decision making process rather that's the board. And so, there's where the appeals process begins. I hope that makes sense. Bottom line is that it is not uncommon for all the ducks to be lined up in what one thinks to be the "right row" but to not get the most favorable response. You'll simply have to wait to see how the board decides once they've reviewed all the information. I don't know that YOU in particular have to DO anything in particular any more unless it's to go for another examination with another physician from the State, from the WC bureau, or perhaps from the Police Force where you work. If so, you simply need to do your best to cooperate during the exam, relate the symptoms you are having as well as any improvements or not which have occurred over the past 2 years and what you believe your current capacity for the job description of your duties since doing the FCE. The rest is up to the board. Good luck. If this information has been helpful and I've answered your questions would you do me the favor of some written feedback and a STAR RATING to the answer? Also, if you have no further questions or comments to place could you also be helpful by CLOSING THE QUERY which will alert the network to process, archive, and credit this question appropriately for future reference. I'm happy to answer your questions personally through the following website: http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474 This query required 29 minutes of physician specific review, research, and final draft documentation for envoy.