Epidural Injections and Nerve Root Blocks

Pain management has rapidly become a growing specialty area of medicine. So many of us suffer from lower back (lumbar) and upper back and neck (cervical) disk issues. The nerve pain associated with these degenerative issues are frequently treated with epidural steroid injections and nerve blocking techniques.  Although these procedures provide welcome relief, they come with risks.  One of the risks are “Missed Target” where the injection misses its mark and can traumatize the nerve roots causing traumatic neuropathy, a painful lifelong condition all its own. Even worse, a missed target on nerve root blocks can end up injecting a “cain” such as Lidocaine directly into an artery such as a vertebral artery. This type of missed target can have devastating consequence as the sending the agent directly to the brain resulting in paralysis and mental incapacity.

HOA’s and the SRL Project

The SRL program is very thorough about taking care of all of the approvals necessary for a turnkey project. There is one exception that can fall through the cracks and that is dealing with the local homeowners association.

Homeowners associations in Texas are not an official governmental entity and they lack authority of building codes that legitimate governments enjoy. That is not to say that they can’t or won’t make trouble in their attempts to enforce their deed restrictions nor does it mean that they do not serve a useful purpose. Granted there are bona fide interests in keeping the community well kept, and maintaining the standards established for that particular neighborhood.  The homeowners association or HOA’s get their power from the deed restrictions that are recorded in the deed records of the respective county courthouse. When a buyer purchases a home within such a community, they are usually buying into the HOA as long as the deed restrictions for that community have not expired. These deed restrictions are usually renewed prior to expiration and if not, they lapse. Deed restrictions are especially useful in communities where there are no zoning laws. A very good example of this scenario is the Heights neighborhood found in Houston. When parts of that neighborhood allowed the deed restrictions to lapse, neighborhoods found commercial operations opening up next door to residences and that adversely affected the property values.

The SRL program qualified contractors take care of the permits required for the elevation or other flood mitigation work for the homes but usually do not have to deal with HOA’s. After all, these are government projects funded by FEMA through the Texas State Water Development Board, the County Office of Emergency Management, down to the local municipality.  In some instances, these projects are outside of a municipality and subject only to the County building codes. This sets the stage for the local home owners association to exercise the power that so often finds HOA directors salivating.  In the hands of an overzealous HOA director, the Architecture Control Committee Chairman tries to assert authority where they are wanting. There are many reasons for this including envy that their home did not qualify for the program and the ever present opportunity to endear themselves to their friends, and cut the legs out from under those outside of their circles.

HOAs do have a legitimate purpose but in the hands of an opportunist, the power can be abused. If you fight your HOA to some extent you are fighting yourself. A lawsuit against your HOA that results in expensive litigation and a significant judgment will be paid out of the dues or special assessment that comes in part from your own pocket. If you choose not to pay you HOA dues, they can and will sue and foreclose your property.

FEMA Flood Map revisions

FEMA (Federal Emergency Management Administration) revises the flood maps from time to time and establishes the BFE (Base Flood Elevation) that directly establishes the premiums for flood insurance. The BFE for a particular property will determine whether a mortgage lender will require that the property must carry flood insurance coverage for any improvements on the premises. Following Hurricane IKE, the flood hazard maps (known as Flood Insurance Rate Maps, or FIRMs) for the Gulf Coast of Texas and other states underwent major revisions that continue to be reevaluated from time to time. These updated flood hazard maps (known as Flood Insurance Rate Maps, or FIRMs) and studies will allow communities and property owners to make more informed decisions about reducing their coastal flood risk. To help communities and individuals to understand their coastal flood risk even more, a new informational layer—the Limit of Moderate Wave Action (LiMWA)— are now be depicted on the FIRMs.

The effect of being in one zone verses another on the FIRMs can have a profound impact. It is not just a matter of how high above the BFE the living area of a house may be but if you are in a VE zone your property can not have reinforced concrete underneath it nor can there be enclosed space greater than 299 square feet (approximately enough for a one car garage.)  Your home may even carry a deed restriction recorded in the county deed records that precludes modifications in violation of such deed restriction. Although this change is still being considered in the Galveston County / Galveston Bay area, it has not yet been adopted.

SRL Grant Program

The SRL (Severe Repetitive Loss) grant program is a FEMA flood mitigation initiative that affects many Gulf Coast residents affected by Hurricane Ike, Katrina, and Rita. For those of us who have suffered repetitive losses resulting in flood insurance claims, FEMA implemented the grant program to mitigate future claims by either elevating flood prone homes or acquisition of properties from the insured claimants so they can rebuild elsewhere out of the reach of potential flood claims.  SRL is an acronym for Severe Repetitive Loss which is exactly that – it applies to residential property that is covered under an NFIP flood insurance policy and:

  • That has at least four NFIP claim payments (including building and contents) over $5,000 each, and the cumulative amount of such claims payments exceeds $20,000; or
  • For which at least two separate claims payments (building payments only) have been made with the cumulative amount of the building portion of such claims exceeding the market value of the building.
  • For both (a) and (b) above, at least two of the referenced claims must have occurred within any ten-year period, and must be greater than 10 days apart.

Each county enrolls in various federal grant programs that are managed through the Texas Water Development Board (TWDB) at the state level, administered through the Counties Office of Emergency Management (OEM), and then through the municipal engineering or building permit departments.

As a result of global warming and frequent flooding, the flood maps are being redrawn and revisions to the flood insurance programs are changing faster than we can implement them.  This affects how the SRL programs are being administered. Part of the new costal flood analysis and mapping include flood phenomenon’s such as overland wave modeling which are affected by wave action in various degrees depending on the property’s proximity to the title surge such as a “LiMWA” (Limit of Moderate Wave Action) area. Though the LiMWA is only proposed at this time in the future these areas may result in elevations in excess of the Base Flood Elevation (BFE) being required. During the execution of a SRL project the TWDB is requesting that homes are elevated  to meet these requirements and FEMA defines the LiMWA amount for each area to ensure that a property is elevated as high as necessary to be compliant once the new maps and LiMWA areas become effective.

The SRL grant programs are a moving target and NEWSLETTER posts will be updated from time to time with developments.