lumbosacral Lumbar Strain Vs. Sciatica

[yelloownumber5]

Another question.

Upon my retirement in 2004 I submitted my original claim. I did claim low back pain (sciatica). They denied the condition, then off the NOD they actually gave me "Lumbar strain" at 20 percent in 2006.

I do have in my active duty medical record signs of left leg tingling, + sciatica, left buttox pain and l4 l5 radiculopathy. I just had my VA PCM give me a Lumbar MRI in 2007 and it shows L4-5 broad based disc buldge with paracental left protrusion. L5-S1 Broad based disc bulge with mild paracentral left component extending into the inferior aspect of the left neural foramen may contact the nerve root as it exits at this level.

But the C&P Examiner did the exam and during the time I guess he did not feel I have these problems of sciatica which I was claiming. I do not want to lose my 20 percent for "lumbar strain", they did say in the notes

"This is a grant of the benefit sought and the NOD is considered satisfied in full as to the low back issue, previously claimed as sciatica. It is noted that the current VA Exam does not objectively confirm sciatica, so service connection for this aspect of the claimbed back condition has not been established. However, a low back condition characterized as lumbosacral strain as ben established as service connected." " A future VA Exam is not needed since improvement in the condition is not anticipated."

Should I leave this all alone and not try to claim something like Lumbar DDD with Sciatica?

Thanks.

Y#5

[rentalguy1]

Welcome to Hadit! Sam.

You need to get your diagnostic code changed to 5243: IVDS. The way to do that, at this point in your claim would be to request the change in a VA From 21-4138. Explain to them why you want the change to be made; because 5243 better explains the disability that you actually have. Read the VA Training letter listed below to get a better picture of how to explain your request. You'll want to do this quickly since you have aC&P coming up.

As to the C&P, you need to research the actual exam, which is also in the training letter below (it has changed a little, but the one below is fine). You also need to research the rating criteria for both the lumbar strain and IVDS. They are the same if rated under general diseases of the spine, but IVDS can also be rated on incapacitating episodes. You can find more information on the rating criteria here.

Good luck and keep us updated.

[hurryupnwait]

Hi can any one help me I have a hearing coming up.I am rated at 40% for lumbar strain but my MRI showed Osteoarthritis of the spine, Disc Herniation, Posterolareral disc herniation, Spondylolsis, Diffuse Spinal Canal Stenosis I was wondering what Diagnostic codes I can used in title 38CFR for my claim. Need to know any good help with my claim.Please help as soon a possible.Thanks Sam

Hi samH

Diffuse Spinal Canal Stenosis This causes neurological problems such as Sciatica.

This is from the post below about Sciatica.

f. Sciatic nerve functions.

• Made up of nerve roots L4, L5, S1, S2, and S3.

• Supplies the muscles of the back of the knee and lower leg and sensation to the back of the thigh, part of the lower leg, and the sole of the foot.

• Incomplete damage may appear identical to damage to one of its branches (tibial or common peroneal nerve).

• Sensory abnormalities may include sensory changes of the back of the calf or the sole of the foot, such as numbness, tingling, burning, pins and needles sensation, other abnormal sensations, and any level of pain up to excruciating pain.

• Motor loss may include weakness of the knee or foot leading to difficulty walking, weakness or loss of knee flexion, and weakness or loss of foot inversion and plantar flexion.

• Reflexes may be abnormal, with weak or absent ankle-jerk reflex.

Happy Trails

Paul

Edited March 2, 2008 by hurryupnwait

[samH]

Welcome to Hadit! Sam.

You need to get your diagnostic code changed to 5243: IVDS. The way to do that, at this point in your claim would be to request the change in a VA From 21-4138. Explain to them why you want the change to be made; because 5243 better explains the disability that you actually have. Read the VA Training letter listed below to get a better picture of how to explain your request. You'll want to do this quickly since you have aC&P coming up.

As to the C&P, you need to research the actual exam, which is also in the training letter below (it has changed a little, but the one below is fine). You also need to research the rating criteria for both the lumbar strain and IVDS. They are the same if rated under general diseases of the spine, but IVDS can also be rated on incapacitating episodes. You can find more information on the rating criteria here.

Good luck and keep us updated.

Hi rentalguy1 you are absolutely right I am tring to get them to change the code to the right multi ones I have a DRO hearing in 3 days to do that. I am going to let them know that my MRI turn up diagnostic code 5243 IVDS, 5241 spinal fusion in my neck, 5239 Spodylolisthesis segment instability, 5238 Spinal Stenosis, 5236 Sacroiliac Injury and thank to your hadit article 8520 Sciatic nerve and impingement. I guess he will order a new C &P exam. I did have a IME by a doctor who link the injury to the service and wrote the whole spine up which VA only gave me compensation for just lumbar spine not the cervical or Thoracic part.The Sacroiliac which is S1 injury did show up in the X-ray done while on active duty boy did VA try to forget a lot of my injuries and low balled my rating.Hey if you have any more helpful hints or suggestions I am open for all. Thank so much Sam

[rentalguy1]

Sam...you won't be able to ask for all of those codes as that would be pyramiding. What you should ask for is:

5243 IVDS for all of the thorocolumbar disabilities

5241 Spinal Fusion for the cervical disability, and

5243-8520 for incomplete paralysis of the sciatic nerve [shoot for moderate effects on this (20%), but they only like to award 10% for minor effects.]

You can also ask for 5243-**** for whatever nerve paralysis codes most closely approximate the vascular psuedoclaudication. Are you sure that it's VP and not neuro intermittent claudication? Do you have a diagnosis? Just wondering because I have NIC due to central spinal stenosis at L5-S1. I actually also have the beginnings of cauda equina...boy, that's a blast...lol

[samH]

Sam...you won't be able to ask for all of those codes as that would be pyramiding. What you should ask for is:

5243 IVDS for all of the thorocolumbar disabilities

5241 Spinal Fusion for the cervical disability, and

5243-8520 for incomplete paralysis of the sciatic nerve [shoot for moderate effects on this (20%), but they only like to award 10% for minor effects.]

You can also ask for 5243-**** for whatever nerve paralysis codes most closely approximate the vascular psuedoclaudication. Are you sure that it's VP and not neuro intermittent claudication? Do you have a diagnosis? Just wondering because I have NIC due to central spinal stenosis at L5-S1. I actually also have the beginnings of cauda equina...boy, that's a blast...lol

Hey will that put me past 40 percent? What should I know about the C & P exam to make sure they are doing right. Yes My doctor said the dianostic was The pain in his legs restricts him for walking more than 20 feet he stated simply stopping and rest does not make all of the pain subside, The Cause of Pseudoclaudication is by severe pathology in the bony structures of the sacral spine and cauda equina.Then he tell VA they have not been properly treating me.Hope this helps you too.It is stupid VA does not have more in tile 38 subpart B about soft tissue damage and to treat it properly.Sam

[rentalguy1]

depending on the ROM of your C-spine, you could get anywhere from 10% - 40%. I am guessing that you still have some ROM in your neck, though, so 10% is probably where they would start out. So, if they didn't increase your lower back rating and they added 10% for the fusion, and 10% for the sciatic neuropathy, then you would have:

40% + 10% = 46% + 10% = 51.4% which rounds down to 50%.

If you could get 20% for the fusion, it would look like this:

40% + 20% = 52% + 10% = 56.8% which would round up to 60%

How many qualifying (bed rest prescribed by a physician) incapacitating episodes have your had in the last 12 months? What is your forward flexion ROM in your C-spine? What is your forward flexion ROM in your thoracolumbar spine? That's the things that you will be rated on.

Also, since you are already rated at 40% for a lumbar strain, it is appearant that you have a very limited thoracolumbar ROM. If you need help with daily living due to this, you can file a claim for special monthly compensation based upon the need for aid and attendance. My wife has to help me do everything now; dressing, bathing, etc.. We put this in our sworn statements in my last claim and the VARO picked up on the inferred claim for A&A, but that usually isn't the case.

Edited March 3, 2008 by rentalguy1