lumbosacral Back Pain Worsening, denied increase?

[jwesley]

lumbosacral spine strain with mild thoracic scoliosis

20%

Service Connected

^^^ My current diagnosis... this was proven with an x-ray. My pain scale is at a 7, I went to the Examination for an increase and she seen how much pain I was in and how bad my muscles were swollen on the one side and she called it a "Flare up" even though I have this pain constantly and consistently every day all day. I can't even bench press half my weight with out it pinching and hurting enough to make me about drop the weight. They denied my increase, what more can I do to receive proper diagnosis and care? The doctors seem to brush me off, I seen a chiro for approximately six months and I am unable to receive a MRI because I have an AICD implant. I don't even know where to begin to try and get this fixed.

Any input is appreciated!

[pwrslm]

All of the spine disabilities are rated on ROM, not pain.  Pain, in essence, would have to be documented and a request for extra scheduler consideration need be put into the claim.

That part where they said bend over, they measure your ability to move your back, range of motion (ROM) and its over if you don't scream out in pain.  In your condition, the CT Scan is the way to find how bad your back is, with injections.  Lots of radiation, so you don't want that but once or twice in your life.  They also do injections into the disc with some kind of dye before they take x rays, regular x rays don't show the disc or soft tissue problems.  This also tells them how your disc is, but when they inject into the disc, it can damage it more.

With back pain problems, they consider it chronic if its over 6 weeks.  Sounds like you have run the conservative treatment route through and through, might be time to look at finding a good surgeon and get evaluated for back surgery.  These days they can do a lot of good stuff with just small incisions.  You get up and about the next day, back to work pretty fast.  If its bad, its months.  I'm looking at a laminectomy w/decompression and fusion from S1 to L3 in the next month.  I know the pain, so I sympathize with you.  Educate yourself on this issue, you are your best advocate.

[iceturkee]

lumbosacral spine strain with mild thoracic scoliosis

20%

Service Connected

^^^ My current diagnosis... this was proven with an x-ray. My pain scale is at a 7, I went to the Examination for an increase and she seen how much pain I was in and how bad my muscles were swollen on the one side and she called it a "Flare up" even though I have this pain constantly and consistently every day all day. I can't even bench press half my weight with out it pinching and hurting enough to make me about drop the weight. They denied my increase, what more can I do to receive proper diagnosis and care? The doctors seem to brush me off, I seen a chiro for approximately six months and I am unable to receive a MRI because I have an AICD implant. I don't even know where to begin to try and get this fixed.

Any input is appreciated!

i am currently 40 percent for my back although it should be higher. but the va has quirky requirements for evaluating back problems. my last lumbar mri (taken in may of 2014) showed 5 herniated discs, a slipped vertebrae, foraminal and spinal stenosis, an abnormal upper lordatic curve, 2 torn disc and lots of arthritis.

[Vync]

If you can post the text of the C&P exam (with personal identifying info omitted), it can be helpful for us to help you.

I'm not sure if the number changed, but this part is worth looking at:

3. Flare-ups
------------
Does the Veteran report that flare-ups impact the function of the
thoracolumbar spine (back)?
[X] Yes [ ] No

If yes, document the Veteran's description of the impact of flare-ups in
his or her own words:

I am curious if the doc accurately noted what you said

[bigmuny]

jwesley...

I would say this for anyone going to a C&P examination and that is to research the BVA Appeals both those that have been denied and those that have been granted regarding the same thing you have applied for, back, legs arms whatever and see how they made their determinations.  PSRSLM gave the correct response in that they measure everything by ROM  (Range of Motion).  It's pretty much all done mathematically.   When you first enter the exam area the Doctor immediately sizes you up and makes notes on how you appear, look etc.  If he shakes your hand he notices whether or not you have a firm grip or weak one and whether you can lift your arm to even shake the hand.  He watches you sit, get up and perhaps lay on the gurney.  Then they ask you to do certain motions like bend over, not if you bend over and touch the floor without making a painful noise then in his eye's you are ok and have 100% ROM, but if you say bend 10% and it hurts like hell tell him you can't go any more and make disgusting looking faces of pain, same way with everything they ask you to do, can you walk??? How far?? Did you tell him "Oh about a mile"...well guess what you flunked your exam but if you walk and after a few steps you start to hurt, stop and say you cannot go anymore than a couple of feet, he will put that down in the review.  Now when leaving be extremely careful..he may watch you leave or send someone to watch you get in your car and if you hop outside and bounce into your car like you don't hurt then he will make note of that.  A lot of Doctors are skeptical to say the least and some want to catch a Veteran faking it or lying about their disability.  If it hurts when leaving show them it hurts all the way to your car or else have someone get you a wheelchair and push you.  Now do your research and look up BVA Appeals and start with 2015 and work your way back to 2014 etc. and put in the keywords C&P back exams or whatever it is you are researching.   http://www.index.va.gov/search/va/bva.jsp                                      

Check this one out.  http://www.va.gov/vetapp15/Files1/1500074.txt

Disability Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4 (2014).  The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations.  38 U.S.C.A. § 1155 (West 2014); 38 C.F.R. § 4.1 (2014).

Here, the question for consideration is the propriety of the initial disability rating assigned, evaluation of the medical evidence since the grant of service connection, and consideration of the appropriateness of "staged ratings" are required.  See Fenderson v. West, 12 Vet. App. 119, 126 (1999).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7 (2014).  Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor.  38 C.F.R. § 4.3 (2014).

Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine, (for DCs 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes).  Under the General Rating Formula for Diseases and Injuries of the Spine, 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:

A 10 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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.  38 C.F.R. § 4.71a (2014).

A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 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.  Id.

A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.  Id.

A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine.  Id.

A 100 percent rating is warranted for unfavorable ankylosis of the entire spine.  Id.

Hope this helps somewhat....
 

[Navy04]

MRIs and X rays are what tell the story bud. I was denied the first round cause VA did not order them. Second time around there it was, whole in spine near L3, DDD, DJD and nerve damage, and I only get 20% for back and 10% for nerve damage. I was due to have back surgery in summer 2014, but VA Ortho Surgeon said to high of a risk of being paralyzed, so I just live with it. Cant take pain meds either due to Crohns Disease and 2 blood transfusions. What I am trying to say is your word is not enough for the VA to warrant an increase. You either need an IMO or MRIs, to link and warrant an Increase for you back issues. Good luck and keep us posted

[iceturkee]

the op should definitely have an mri. routine xrays basically show nothing other than fractures and arthritis. mrs's will provide much more detail!