jlrith

Vync is right: "if you give up, then they win"
If you feel like the local VSO's stink, find someone else or get a lawyer.
Having dealt with 2 regional offices and gone 3 times to the BVA:  The local office can be spotty.  Sometimes they get it right, but when they get it wrong, boy do they get it wrong.  
BVA is way better, more through and will provide a clear rational if they deny you.
At the least, let it ride to the BVA.  

The fibromyalgia rating should be separate from the secondary conditions of IBS, migraines, anxiety, Raynaud's, and your back problems.  
Since you already have separate ratings for the above conditions, it's pretty straight forward to me.
That said, make sure you submit the following information from the federal register blotter to the VA, otherwise they may decide to pack everything into the fibromyalgia rating, as you fear.  
From the federal register when the fibromyalgia rating was implemented (also see link below):
As the evaluation criteria indicate, there may be multi-system complaints in fibromyalgia. If signs and symptoms due to fibromyalgia are present that are not sufficient to warrant the diagnosis of a separate condition, they are evaluated together with the musculoskeletal pain and tender points under the criteria in diagnostic code 5025 to determine the overall evaluation. The maximum schedular evaluation for fibromyalgia in such cases is 40 percent. If, however, a separate disability is diagnosed, e.g., dysthymic disorder, that is determined to be secondary to fibromyalgia, the secondary condition can be separately evaluated (see 38 CFR 3.310(a)), as long as the same signs and symptoms are not used to evaluate both the primary and the secondary condition (see 38 CFR 4.14 (Avoidance of pyramiding)). In such cases, fibromyalgia and its complications may warrant a combined evaluation greater than 40 percent. Since these rules are for general application, they need not be specifically referred to under diagnostic code 5025.
http://www.myalgia.com/Disability/vah_disability.htm
 
Additional information:
https://www.tapatalk.com/groups/vets/fibromyalgia-this-his-a-good-write-up-i-took-this--t81499.html
 
 
 

Keep in mind that the appeal timer is still running since a reconsideration is not a process that is encoded in the VA regulations. 
If they don't get through your reconsideration in the year since the decision, file a Notice Of Disagreement.  

Not true in my experience.
I have had various claims in various stages be resolved at various times.
The important thing here is to file your new claims now!  All of your benefits are based on the date of claim.  It doesn't matter if the claim is then delayed, you get benefits back to the date you filed.
If you wait to file, you lose out!
I have heard that filing claims can slow down the overall process, but that was also back when there were paper claims files; they didn't like moving physical files around.  Now everything is electronic so that doesn't matter.  

You should consult with your VSO on the specifics of your case because you may qualify for Special Monthly Compensation (SMC) for loss of use.  
See 38 CFR 3.350
Since your condition has worsened since your last rating, it is extremely unlikely that your VA rating will be reduced.  
With politician talk about removing IU when you become eligible for Social Security, you might want to consider putting in for a higher rating even if you do not qualify for SMC.  100% schedular is superior to IU.  

I am rated for an almost idential problem; here is my 2 cents:

All spine problems are primarily rated under limitation of motion (look up "General Rating Formula for Diseases and Injuries of the Spine" in 38 CFR Vol 1, part 4)
or incapacitating episodes.
Since the incapacitating episodes are 'Dr prescribed bed rest' its unlikely that will apply.
That covers your bulging disk and arthritis, regardless of how many bits of your back are involved.
In my experience that rating is much lower than the impact the disability has.

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

I have a 40% rating for my sciatic nerve affecting my leg and a 20% rating for a voiding dysfunction - Urinary frequency (see 38 CFR Vol 1, 4.115a.)
Both of these started after I left the military and both are secondary to my DDD.
Take note of the areas that feel weird from your lower back on down; write it down if need be.
Some of the symptoms I get:
Numbness
Pins and needles
Areas that feel like hot water has been spilled on them
Muscle weakness
Pain, both dull and sharp(feels like a have a red hot steel rod in my leg)

Nerves show up in an MRI, so your Dr should be able to determine if you have a pinched or displaced nerve or if the bulge is abutting the nerve. Get him to write that down and you have your physical evidence for the neurological claim.
One thing I found out and would really help you if your doctor is willing to make note of it: The sciatic nerve exits the spine in something like 4 locations; the specifics of which signals go through which exit varies from person to person. This means there is no map showing that if a certain spinal disc is bulging it will cause these neurological symptoms.

Download 38 CFR vol 1, part 4 (the listing of ratings) and check your symptoms against it. Pay attention to 4.115a, 4.123, 4.124 and 4.124a "diseases of the peripheral nerves" specifically "Sciatic Nerve" and down.

Do your homework and match your symptoms and the symptoms listed in your medical records against the rating list (beware: the nerve names the VA uses aren't always the same as what the medical world uses so you need will have to cross reference.)

When making the claim I use form 4138 and say:
I hereby claim the following disabilities as secondary to my service connected degenerative disc disease:
1- Sciatic: Code 8520: 80%
Justification: Medical exam dated 4/3/21 shows that I have complete paralysis of my sciatic nerve.

2- And so on...

Use the verbage in 38 CFR section 4 whenever possible.

One test the VA may subject you to is an EMG. The put electrodes in your body to stimulate the nerves and read their responses. Its not bad.
If it shows a nerve issue, thats basically iron clad proof you have something wrong. If it shows nothing, don't allow the VA to use that against you: EMGs routinely miss nerve problems; it has been proven that the nerves can be severed and an EMG won't pick up the problems until months later.

It does not matter if you claim it as a new injury or a condition that has gotten worse. It is treated the same way.

These claims suck; it took me about 4 claims and 3 remanded appeals over 7 years plus a different regional office for them to finally get it right.

When you get your decision make sure you keep an eye on what they actually considered, both the disabilities and the evidence they list.
It took me a number of claims for the VA to even acknowledge what I was claiming and they also forgot to look at pertinent evidence.
If the disability is not listed in your decision letter, it has not been adjudicated ( I received 7 years of retro because of that.)
If the evidence is not listed in your decision letter, it was not considered; you can appeal on that basis alone.

I have claimed depression as secondary to my back problem. Its in the "Rating Phase" right now. Who knows, they might decide before Christmas.
I also made the mistake of taking my pain medication when going for a neurological C&P exam.
Low and behold, it ended up being a full neurological and lower back workup. Wouldn't you know it, my range of motion was pretty good, so they bumped my DDD from 40% to 20%...Thats on appeal.

Feel free to ask if you have additional questions.
Good luck.

Hello all,

I am interested in opinions concerning a disability that could be rated under 2 separate codes.

I am rated 40% for Raynaud's, with my previous symptoms matching that rating spot on.
Over the last 2 years the Raynaud's has started to manifest with other problems such as nail abnormalities, hyperhidrosis, fungal infections, chilblains, loss of hair...
I submitted a claim for a rating increase based on the chilblains being a type of ulcer.
The VA came back with a C&P exam for cold injury residuals as secondary to Raynaud's.
I only recently had my C&P exam for this, so although I know what was discussed and the notes the doctor made, I do not know the content of the final report.
Depending on how the C&P report is written there is the possibility that I will fall into a gray area, namely that including Raynaud's could be rated under code 7117 as Raynaud's, or included in code 7122 as color changes. Since a 30 percent rating under 7122 requires 2 of the listed symptoms, of which color changes is one, the way this is rated could make a huge difference in the final outcome.

My question is this:
Would Raynaud's be automatically rated separately since the cold injury residuals are secondary to it, or would it be rolled into the 7122 code (analagous rating) which would result in a higher combined rating?

My ratings for this, based on my understanding:

Cold injury residuals only rating:
Hands, bilateral - 30% each
Feet, bilateral - 30% each
ears, bilateral - 20% each
Combined = 94%

Raynaud's rated separately:
Hands, bilateral - 20% each
Feet, bilateral - 20% each
ears, bilateral - 10% each
Raynaud's - 40%
Combined = 84%


For reference:

7117 Raynaud’s syndrome:
With two or more digital ulcers plus autoamputation of one or more digits and
history of characteristic attacks .................100

With two or more digital ulcers and history
of characteristic attacks .............................60

Characteristic attacks occurring at least
daily ...........................................................40

Characteristic attacks occurring four to six
times a week .............................................20

Characteristic attacks occurring one to three
times a week .............................................10

NOTE: For purposes of this section, characteristic at- tacks consist of sequential color changes of
the digits of one or more extremities lasting minutes to hours, sometimes with pain and
paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are
for the disease as a whole, regardless of the number of extremities in- volved or whether the nose
and ears are involved.


7122 Cold injury residuals:
With the following in affected parts:
Arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following:
tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray
abnormali- ties (osteoporosis, subarticular punched out lesions, or osteo-
arthritis) .......................................30

Arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail
abnormalities, color changes, locally impaired sensa- tion, hyperhidrosis, or X-ray ab- normalities
(osteoporosis, sub- articular punched out lesions, or
osteoarthritis) ...............................20

Arthralgia or other pain, numbness,
or cold sensitivity .........................10

NOTE (1): Separately evaluate amputations of fingers or toes, and complications such as squamous
cell carcinoma at the site of a cold injury scar or pe- ripheral neuropathy, under other diagnostic
codes. Separately evaluate other disabilities that have been diagnosed as the residual effects
of cold in- jury, such as Raynaud’s phenomenon, muscle at- rophy, etc., unless they are used to
support an evaluation under diagnostic code 7122.

NOTE (2): Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine
the ratings in accordance with §§ 4.25 and 4.26.