How Is Degenerative Disc Disease Rated?

[oldman273]

Hello to everybody, I need to know how the Degenerative disc disease is rated and on my last C/P I was rated @ 10% My thoughts are if all they used were x-rays how acurate would the rating be? I have some mri of my spine from 2006 that I am going to present for evidence in a claim. The MRI was doen at my local hospital I have had a dsicectomy where they cleaned out the disc that was falling apart. I am no nuerologist but I have Disc Disease in L3, L4, L5 and L5 S1 I knwo that it hurts me everyday. Any advice from those of you cursed as I am with a bad back let em know. Should I wait a period of time before putting this or right now since the claim just came back? I told the fellow I woud post it and find out. I look forward to anyone one who has been down this road. Thanks again....

[iceturkee]

On 6/2/2008 at 7:26 PM, yoggie2 said:

oldman273, I my self am presently rated at 40% DDD/IVDS and over the last 13 years and filed for an increase and was denied even with years of constant monthly medical treatment and therapy. 3 years ago I finally give in to the pain and unable to work due to incapacitating pain and 3 MD's stating so, and one Doctor stating I was unable to return to work scripts due to being incapacitated, and another stated he had treated me for years, I was disabled and wouldn't be able to seek any gainfully activity and that he thought that surgical intervention may be needed, the 3rd doctor stated about the same. I still made medical exams through the years with the VA. I turned in my independent medical records to the VA with my claim, yeeeeears worth. I was denied because the doctors did not state specifically I was proscribed bed rest, just that I was "totally incapacitated" with pain. So I had to go back to my doctor for a specification of my condition and treatment that has left me house bound.

The only problem I have with this is when you have years of medical evidence and stating your totally incapacitated is there another kind "incapacitated"?

 

incapacitated - lacking in or deprived of strength or power; "lying ill and helpless"

The VA has there own definishion and it adds "prescribed more than 6 wks of bed rest out of a year. Now do you go to the VA to get this script miles away? when you can't sit or stand at all?

the va generally doesn't prescribe bed rest unless you are in bed. you can't get up and do anything. you have to be in bed. and to be in bed for over 6 weeks, you need to be so helpless you can't do anything. nascar driver tony stewart recently suffered an L1 burst fracture (very serious). he either needs to be lying in bed all day or walking the treadmill. not anything else.

[oldvet]

You need to get a neurologist to look at you as you have nerve damage.  This damage is related to your spinal injury of DJD and it will be rated accordingly in addition to what you have now.  For example your sciatic nerve is affected.

[71M10]

Hello to everybody, I need to know how the Degenerative disc disease is rated and on my last C/P I was rated @ 10% My thoughts are if all they used were x-rays how acurate would the rating be? I have some mri of my spine from 2006 that I am going to present for evidence in a claim. The MRI was doen at my local hospital I have had a dsicectomy where they cleaned out the disc that was falling apart. I am no nuerologist but I have Disc Disease in L3, L4, L5 and L5 S1 I knwo that it hurts me everyday. Any advice from those of you cursed as I am with a bad back let em know. Should I wait a period of time before putting this or right now since the claim just came back? I told the fellow I woud post it and find out. I look forward to anyone one who has been down this road. Thanks again....

It will be rated on Range of Motion (limitations of) with separate ratings for objective neurological impairments or based on incapacitating episodes requiring bed rest perscribed by your doctor. To be rated on incapacitating episodes you have to be SC for IVDS Intervertrebal Disk Syndrome.

General Rating Formula for Diseases and Injuries of the Spine(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or diseaseUnfavorable ankylosis of the entire spine100Unfavorable ankylosis of the entire thoracolumbar spine50Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine40Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine30Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis20Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height10Note (1):Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.Note (2):(See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.Note (3):In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.Note (4):Round each range of motion measurement to the nearest five degrees.Note (5):For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.Note (6):Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 5235 Vertebral fracture or dislocation 5236 Sacroiliac injury and weakness 5237 Lumbosacral or cervical strain 5238 Spinal stenosis 5239 Spondylolisthesis or segmental instability 5240 Ankylosing spondylitis 5241 Spinal fusion 5242 Degenerative arthritis of the spine (see also diagnostic code 5003) 5243 Intervertebral disc syndromeEvaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating EpisodesWith incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months40With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months20With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months10Note(1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.Note(2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

If all they used were x-rays and they did not test your ranges of motion I would be very skeptical about this rating. All ratings for the spine require assesment and measurment of ROM.

What VASRD codes they have SC your disabilities will guide how the schedule is to be used.

unfortunately you will not get a rating based on your pain level. However, it is important to be clear with any examiner on the side effects and limitations that your medicines/treatment imposes on you.

The rating sounds low but their are many people with intense back pain that have fairly preserved ranges of motion.

Best regards,

Tyler

[Teac]

Hello to everybody, I need to know how the Degenerative disc disease is rated and on my last C/P I was rated @ 10% My thoughts are if all they used were x-rays how acurate would the rating be? I have some mri of my spine from 2006 that I am going to present for evidence in a claim. The MRI was doen at my local hospital I have had a dsicectomy where they cleaned out the disc that was falling apart. I am no nuerologist but I have Disc Disease in L3, L4, L5 and L5 S1 I knwo that it hurts me everyday. Any advice from those of you cursed as I am with a bad back let em know. Should I wait a period of time before putting this or right now since the claim just came back? I told the fellow I woud post it and find out. I look forward to anyone one who has been down this road. Thanks again....

Someone has already indicated that it is rated based on range of motion and incapacating incapacitating episodes that require bed rest.

here is the rating schedule for the spine. It is hard to say if you have been low balled or not. When I was rated for my back injury, I was rated undet the old schedule. Todays rating requirements make it harder to get a higher rating. This is because most people with IDS do not seek treatment everytime the back goes out, if there are no medical records then there can be no rating.

The Spine

General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating

Intervertebral Disc Syndrome Based on Incapacitating Episodes):

With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine................................................................... 100

Unfavorable ankylosis of the entire thoracolumbar spine............................................... 50

Unfavorable ankylosis of the entire cervical spine; or, forward flexion

of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of

the entire thoracolumbar spine...........................................................................

..... 40

Forward flexion of the cervical spine 15 degrees or less; or, favorable

ankylosis of the entire cervical spine........................................................................ 30

Forward flexion of the thoracolumbar spine greater than 30 degrees but not

greater than 60 degrees; or, forward flexion of the cervical spine greater

than 15 degrees but not greater than 30 degrees; or, the combined range of

motion of the thoracolumbar spine not greater than 120 degrees; or, the

combined range of motion of the cervical spine not greater than 170 degrees;

or, muscle spasm or guarding severe enough to result in an abnormal gait

or abnormal spinal contour such as scoliosis, reversed lordosis, or

abnormal kyphosis........................................................................

......................... 20

Forward flexion of the thoracolumbar spine greater than 60 degrees but not

greater than 85 degrees; or, forward flexion of the cervical spine greater than

30 degrees but not greater than 40 degrees; or, combined range of motion of

the thoracolumbar spine greater than 120 degrees but not greater than 235

degrees; or, combined range of motion of the cervical spine greater than

170 degrees but not greater than 335 degrees; or, muscle spasm, guarding,

or localized tenderness not resulting in abnormal gait or abnormal spinal

contour; or, vertebral body fracture with loss of 50 percent or more of the

height..........................................................................

........................................... 10

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest five degrees.

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the

past 12 months..........................................................................

....................................... 60

With incapacitating episodes having a total duration of at least 4 weeks but less than

6 weeks during the past 12 months..........................................................................

.......... 40

With incapacitating episodes having a total duration of at least 2 weeks but less than

4 weeks during the past 12 months..........................................................................

.......... 20

With incapacitating episodes having a total duration of at least one week but less than

2 weeks during the past 12 months..........................................................................

.......... 10

Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

[oldman273]

Yes I do agree with you the way they rate you seems like as usal the law is on thier side how ever if I start going to the VA everytime my back goes out and there is evidence that my back is getting worse by evidenc of the most recent MRI I wonder how that will go. I have in the past always laid around and kind of nursed my back to get going again. I am now going to my Civialian Doctor or to the Vetrans urgent care.....

[william n]

as i have severe documented back disease and am on opiates + for it as well as a SC claim pending...my question is if you tell the Dr. u couldnt get out of bed for 4-5 days and he does'nt note it ....What do you do????

Edited June 2, 2008 by williamn