lumbosacral Question On Ratings Of The Spine And 4.45 The Joints

[71M10]

Greetings all:

Have a nod filed on a 40% rating for spine. Trying to get unfavorable ankylosis rating and VA is stuck on complete/vs partial even though the last revision to ratings of the spine removed the terminology "complete bony fixation"

CFR 38 part 4 B 4.45 (f) (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.

CFR 38 part 4 B 4.71a

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

PORTIONS OMITTED TO SAVE SPACE

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.

Under 4.45 it says for arthritis the cervical vertebrea, dorsal vertebbrea, and lumbar vertebrea, are groups of minor joints that are rated seperatley.

May range of motion is 20 flexion of thoracolumbar spine, The doctor also stated I have DJD lumbar spine more likely than not from my SC kyphoscoliosis and I am SC for Arthritis of Thoracic spine. Can I recieve a rating of 40% for arthritis based on limitation of motion for my Thoracic Spine and a 40% rating for DJD of lumbar spine since these are two distinct segements?

Best regards,

Tyler

[jbasser]

They will rate the T spine and L spine together. The Cervical spine is another.

They will rate under the spine ratings of Spondylosis or arthritis based on limitation of motion.

To get a higher rating one must prove that there is neurologic conditions caused by the spine. The Neurologic conditions are to be rated separatly.

The BVA is full of denials for claims of th espine. It may pay one to research files.

J

[71M10]

Yes, NOD has been filled. I am trying to line up some contingency positions and have a series of statements ready to show how they have ignored parts of CFR38 the support a higher rating for me based on the evidence of record.

Thanks for the input.

Best regards,

Tyler

[71M10]

They will rate the T spine and L spine together. The Cervical spine is another.

They will rate under the spine ratings of Spondylosis or arthritis based on limitation of motion.

To get a higher rating one must prove that there is neurologic conditions caused by the spine. The Neurologic conditions are to be rated separatly.

The BVA is full of denials for claims of th espine. It may pay one to research files.

J

Yes the New ratings for the spine (2003) say to evaluate the Thoracic and Lumbar segments as one. They have not Changed 38CFR 4, b 4.45 that states Lumbar, Dorsal and Cervical Vertebrea are considered groups of minor joints and should be rated on par with major joints. One section of CFR 38 says Thoraco lumbar one articulation another says they are separate. I should be entitled to the more favorable rating if there is a conflict in the regs right?

Best regards,

Tyler

[jbasser]

Tyler, you shpuld be rated on the criteria that is highest in favor of the Veteran. Now The VA likes to word denials with the word pyramiding.

It would be better to prove some neurological defectis as a result of the spine problem.

[71M10]

Tyler, you shpuld be rated on the criteria that is highest in favor of the Veteran. Now The VA likes to word denials with the word pyramiding.

It would be better to prove some neurological defectis as a result of the spine problem.

Yes, I have those and they are part of the NOD just didn't mention them since its not anything I am unsure of the rating process for.