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New C&p Today For Lower Back

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My son had his C&P today for his NOD for his lower back. We filed a NOD last November due to an the last Examiner failing to do a ROM testing at all let alone with the goniometer and not giving a true picture of his disability. A lot of false statements.

To refresh my son had back surgery for 2 herniated disk with a large chunk of the disk had embedded into the L5-S1 nerve. He has a 2 level Fusion with stabilitation rods and screws and has Ankylosis of the spine fixed in a netural position and continued Radicular pain.

For this was was givin a 10& rating.

I think he failed the ROM testing today because he couldn't bend forward from the waist at all, Only bending was from the chest forward. He also could turn side to side and when he tried to bend backwards he fell and the examiner catch him before he hit the ground. I think the examiner felt there was no need to finish because he told my son, Oh, That's not good.

So i wonder how the rater will rate him now??

Jessie ;)

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  • HadIt.com Elder

I'm glad that he was able to get a new C&P based on the last one that was faulty. According to what you are telling us, he should get a rating of 40%, based on the criteria listed in 38 CFR 4.71a, due to favorable ankylosis of the t/c spine:

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

If it were fixed in any other position besides neutral, that would represent unfavorable ankylosis, and he would have gotten a 60% rating. Be sure to NOD for the original effective date if the rater tries to say that the date of the new C&P is the effective date of claim. Also, be sure that he files for any and all secondary conditions, such as bladder/bowel problems and nueropathy.

Can't wait to hear the outcome of this one!

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Thanks Rental:

I thought he should have gotten the 40% to start with But!!!!!!! I'm not the rater, Just Mom!!!


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Question pertaining to "Spinal fusion" surgery. During surgery: if the spine is fused in a "neutral" position--What exactly is meant by neutral?? The disc(s) are aligned directly above each other when fused with clamps and pedicle screws? The reason I ask is that some conditions (such as spondylolisthesis: where upper disc slips past lower) the vertebrae(disc) must be fused as positioned from previous healing or arthritis prior to surgery--the disc can't be moved when fused without the risk of further neurological complications. In other words the disc is fused as is one over lapping the other. Would this be considered as fused in a position other than "neutral"?? *Or does "neutral" simply mean the disc are fused together and can't move??

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  • HadIt.com Elder

The term for fusion of a joint is "ankylosis." The neutral position is 0*, or the position from where all movement is measured. Favorable ankylosis of a spinal segment, or the entire spine would mean that the spine is fused in the neutral position. Unfavorable ankylosis would mean that the spine is fused in any position other than the neutral position. For example, if a vet had spondylolisthesis (where a vertebrea slides over anteriorly over another, typically causing damage to the intervertebral disc that lies between them) at L5-S1, and had a fusion to relieve pressure from the S1 nerve root, and the L5 vertebrea was fused in the position of 10* forward flexion, that would be considered unfavorable ankylosis of the thoracolumbar spine. This would result in a VA disability rating of 50%, even though this postion would hardly be noticable. It could also be argued that the entire spine is ankylosed at this point, which would be a rating of 100%

If, however, the 10* fusion was at T1-2, for instance, the entire thoracolumbar spine could not be considered to be unfavorably ankylosed, and the rating would most likely be based on ROM of the TC spine. You could argue for ankylosis (favorable or unfavorable) of the entire c-spine at this point, for a rating of 30% - 40%.

If the fusion is at the lower end of the C-spine then the entire c-spine could be considered unfavorably ankylosed, and result in a rating of 40%.

Hope that made sense...

I can't tell if I'm starting to sound like a doctor, a lawyer, or a rater... :P

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  • HadIt.com Elder

Thought I should add this, as there is a bit more to the rating criteria than just unfavorable ankylosis:

From 38 CFR 4.71a, General Rating Formula for Diseases and Injuries of the Spine\

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.

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Makes a lot of sense--thank you for the clarification, hopefully I can turn this into some "cents". Great job, thanks again rental guy1.

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