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    • When i'm asked to do a C&P i call and make sure it's scheduled with a VA doc and not an outside contractor. I'm still young and healthy enough to not to need constant care. I don't use my Choice, because that isn't in the "system". I didn't serve long enough to qualify for Healthcare until after i received my 50% SC
    • ADodge, I am picturing you as the frog that choking the Heron that is trying to eat it! You just keep that death grip on the "Heron's" throat and don't let go!!! Semper Fi
    • Hi Everyone! First, thank you to everyone through March and April that helped me through the TKR and temp 100% process! At the advice of many here, my doctors, and my VSO I filed for 2 claims secondary to my right knee. I filed SC for my left knee because the doctors expressed concern over my left knee for a TKR before the right, at that time my right knee was the only condition that was SC'd so I did the right knee and currently I am on temp 100. At the end of April I filed for SC for my left knee and for my lower back, which are the conditions that have been noted by the VA doctor. I had my C&P at the end of May, my VSO says that the C&P notes are favorable to me (good news right)? Today I checked the claim to see where it was at and it says, Pending decision approval, and then in the information needed is says VA medical center by 8/29/16, I looked at upcoming appointments and it shows that there was one appointment requested today 7/30/16. There is no doubt that my left knee is connected to my right, I have compensated on my left for years due to the pain and awkward gait of my right to the point that I have a really bad gait on my left now, and very limited movement without alot of pain, which the examiner was very concerned about. My lower back, my back hurts in what I assume is due to walking so funny because of knees and limits my ability for bending and picking up items. I filed for my dependents to be added and that was completed in May, however at that time the didnt pay me for one month because my son (who's a college student) was on spring break, my VSO went back and forth and finally the rater agreed it should of been paid, so that does show as a pending disability. Could the pending decision approval be for that one month? Although when they were approved and added  as a dependents they were not a claim for disability it was a dependent claim and didnt really show up underclaims, and there wasnt away to see the status of that the way there is to see the claim for disability. SO there was no pending decision approval or notification status for dependents at all??? How can I possibly be at pending decision approval with another request for what I am assuming is a C&P? Does this mean that they have decided on one of the conditions and wants more info for another? Is it possible that it will stay in pending decision approval until they receive the 2nd C&P results? Or is it probably in approval for the 1 month they didnt pay me on my dependent?
    • ADodge, i am keeping you in my prayers!  I pray your cancer goes into remission permanently! what have you heard regarding your appeal for an earlier eed for asthma?      
    • Part of      M21-1, Part III, Subpart iii states: To create a new Block e with guidance for submitting requests to the Joint Services Records Research Center (JSRRC). To specify that follow-up requests to JSRRC must be completed by a Military Records Specialist (MRS).   This makes me think it might be their second request (follow up) or that they never requested the info in the first place. http://community.hadit.com/topic/48901-jsrrc-contact-info/   I strongly suggest that you contact JSRRC yourself and it might be possible to even contact the person who the VA sent the request to. I do not trust VA to properly make these JSRRC requests sometimes. I just read a BVA remand whereby the VA forgot to put the veteran's unit into the request, holding up that claim, AGAIN. "how can they deny my first claim of they didn't already review them?" If they didnt review them ( and they dont appear as Evidence on the denial,) there could possibly be a CUE in that denial , possibly ...the main problem is getting the pending claim resolved favorably first.                    



19 posts in this topic

It is my understanding that the VA rates the Thoracolumbar as one segment. Basically this means if one part of the Thoracic spine is messed up and later on in life the lumbar starts to mess up then it is suppose to be rated as the same as if it was the thoracic spine because there is no Thoracic and lumbar separation in the diagnostic codes...Correct?

I've been looking at all my stuff and I think I missed something and so has the VA of course. After the accident in service it was my thoracic spine area that gave me huge problems. Then within a year all the pain progressed to my lower back and cervical spine. While in service the XRays showed degenerative changes in my thoracic spine. I was medically discharged for mechanical lower back pain (trust me if I knew then what I knew now, they should have retired me because of my cervical spine also)....

Fast forward to today. I currently have Osteoarthritis in CSpine, Thoracic Spine and Lumbar Spine. But in my Thoracic Spine you can see the vertebrae basically deteriorating, I think its called Schmorl's nodes which are small protrusions of vertebral disk tissue that bulge through the ends of weakened vertebrae.

In 2011, after realizing the VA never connected nor even mentioned my Thoracic Spine issues I file a claim on that particular issue. Well the C&P examiner said that it was an inservice diagnosis and that it was 100% service connected.

So, if my thoracic spine is serviced connected with current Osteoarthritis should the VA have SC'd my Osteoarthritis/DDD in my Lumbar with the same claim when in fact they knew I had DDD back then and I had a similar active claim and since they are ONE segment? This is like saying we if a person had two breaks in one bone and they SC'd one break but not the other.

Here is the definition of Thoracolumbar:

1. Of or relating to the thoracic and lumbar parts of the spinal column.
2. Of or relating to the thoracic and lumbar nerves.
3. Of or relating to the sympathetic division of the autonomic nervous system.
I could be wrong but the VA should have rated both as one?
They are Preparing a Decision on my current claims but I do have a NOD by DRO actively in with them. I did submit a Dr. Bash IMO for the NOD and the active claims. I am hoping they will combine both of them together on making a decision, I can just hope.
If they don't couldn't this argument be one of the many arguments that I have I can use if I have to or when I go see the DRO for the NOD if I have to go that far?

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Let me add one more to that and extend the question. I have radiculopathy in both my legs and feet. Since the Thoracolumbar is considered one as written by definition: Of or relating to the thoracic and lumbar nerves, should they also have had rated the radiculopathy as part of the Thoracolumbar. It is my understanding by all the BVA case I have read the RO's and C&P examiners are NOT suppose to pick and chose and separate the Thoracolumbar....

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You can chime in on this but I think JBasser answered my question:

"Sharon, the c spine is rated separate. The Thoracic and lumbar spine are combined. The VA uses the term thoracolumbar that is a combination of the two.

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 height."

So it seems the RO raters are doing their own thing instead of going by the Diagnostic Codes. Its okay I am ready for them at the NOD by DRO if I have to go that far....

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There is ambiguity in the regulation (suprised?).

§ 4.45 The joints.

[redacted to save space]

(f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

This part of 38 CFR clearly indicates they are seperate segements. for ratings based on arthritis only they would be rated seperately. For IVDS you could generate seperate ratings for each segement provided that the incapacitating episodes were distinct and seperate for each segment.

If you have khyposis or scoliosis in your thoracic spine segment you should be able to get service connection for the lumbar segment and cervical segment under:

§ 4.59 Painful motion.

With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.

I forced my cervical SC with this citation since my throracic spine has khyposcoliosis (kyphosis and scoliosis). Next time my file is open I will push for seperate SC for my lumbar spine(no ratings increase) since a C&P physician when discussing radiculopathy indicated my lumbar spine wasn't SC therfore radiculopathy was a mute point. Because my evidence was weak I didn't push it, but I am gathering evidence and we will be putting this in the stack if they ever try to reduce or open up my ratings again.

Best regards,

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The problem I have had was that they VA serviced connected me with "Cervical Spine Pain" and Mechanical Lower Back Pain"....So, I had to get Dr. Bash on the case and look at everything. He basically quoted word for word from medical journals that linked the trauma/injury and that I had DDD/Osteoarthritus/DJD throughout my whole spine.

I actually have a NOD by DRO in whenever they denied my DDD/Osteoarthritis, basically trying to get them to change the Diagnostic Code to the next level in my spine but they denied it even though one C&P examiner said I had degenerative changes in my thoracic spine on XRay while in the military.

They don't seem to understand that since 1. The Xrays showed degernative changes and 2. The C&P Examiner said I had Degenerative Changes in my Thoracic Spine that it was in fact service connected I have them by these two things.

You can separate the Thoracic and Lumbar even for being rated. So this means that if I now have DDD/Osteoarthritis in my lumbar like I do in my thoracic spine then they MUST service connect the radiculopathy in my legs, feet and toes.

Its all good, I can't wait to have my NOD by DRO, unless the decide to take the NOD by DRO and combine it with my current claims because of Dr. Bash's letter.

Finger crossed and I have actually started to write up a huge report for the NOD. And I am writing up my rebuttal to the current C&P exam along with witness statement from my wife.

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Eventually someone (DRO, BVA, CAVC) will understand that they are entitled to form their own opinions, but not facts.

It sounds like you have some good strong facts on your side. Eventually the VA will have to deal with them. What they hope to do is stall, demoralize, confuse with the goal of you not filing a timely appeal or accepting their lowball rating. They are hoping you make a mistake!

Hang in there and best regards,

Edited by 71M10

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