Incapacitating Episodes For Low Back Pain

[kluender]

I know this is long, but can someone please read VA's “Reason for Decision” for an “evaluation of mechanical low back pain with arthritis and herniated disk, L5-S1, with radicular symptoms which is currently evaluated as 10 percent disabling.”

"(Place where I work) medical certification form completed by your treating physician notes no work for approximately six to eight weeks with no severe postoperative residuals reported.

Addendum to VA spinal examination in February 2004 notes that it is at least as likely as not that your low back pain and arthritis in the findings of your MRI are directly related to your low back injury during service.

The evaluation of mechanical low back pain with arthritis and herniated disk,

L5-S1, with radicular symptoms is increased to 40 percent disabling based on VA examination which revealed forward flexion of the lumbar spine limited from 0 to 20 degrees with radicular symptoms. It is noted that current non-compensable radicular symptoms are included in the evaluation of your low back condition. Neurological abnormalities due to intervertebral disc syndrome may be assigned a separate evaluation under the appropriate diagnostic code. A compensable neurological evaluation due to intervertebral disc syndrome would include definitive clinical findings which demonstrate mild paralysis of the involved nerve root. The criteria for rating diseases and injuries of the spine apply 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 40 percent evaluation is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A higher

evaluation is not assigned unless there is unfavorable ankylosis of the entire thoracolumbar spine or evidence shows incapacitating episodes having a total duration of at least 6 weeks during the past 12 months due to intervertebral disc syndrome. The effective date of the increased evaluation is February 28, 2004, the earliest date clinical evidence shows objective findings of a worsening of your low back condition. An evaluation of 100 percent has been assigned effective March 1, 2004 based on the need for surgical or other treatment necessitating convalescence. A 40 percent evaluation is assigned from May 1, 2004, the first of the month following a period of convalescence."

This has been nagging me for a long time. I’m wandering if I should put in a claim since I had surgery 2 times in 2004. Both times after surgery the doctor who treated me noted no work for 6 weeks which would be a total of 12 weeks. The second time was 6 months after the above decision. Also, I was given 100% temporary disability both times.

[jbasser]

Incapacitating episodes actually means off of your feet, Bed Rest.

Another member here is actually fighting for the same thing and he has Doctors notes stating he was prescribed bed rest.

[Ricky]

OK I give up. Is your rating 10 percent or 40 percent? Looks like based upon your symptoms and the evidence quoted the rating is correct.

JB is correct in that you would have to have episodes yearly of complete bed rest in order to qualify for a higher rating.

[rentalguy1]

It would be of no use to file for an increase since this occurred in 2004. If the doctor prescribed "incapacitating epsisodes" occurred during the last year, I would say go for it.