New C&p Today For Lower Back

[jessie0054]

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 ;)

[vmo]

After review of the recent helpful posts--I'm somewhat in limbo. The lumbar spine L5-S1 is fused with 12 mm of anterior subluxation of the L5 on S1 (overlap). This type fusion appears to be the gray area somewhere between unfavorable ankylosis and and favorable ankylosis. The fusion was accomplished in the "neutral" position not being flexed or extended. However, the question still remains that if one disc is fused overlapping the one below it (a fusion which is not flexed or extended) is this "unfavorable". The veteran in question suffers neurological left leg foot/sciatica problems. Maybe it is acceptable (favorable) to the VA Rating if if discs are fused overlapping even with continuing neurological problems(?). I just have to question that an overlapping fusion--why it would not be an "unfavorable ankylosis". The rating percentages for favorable vrs. unfavorable are well worth the question. I would expect nothing positive from the DRO and probably should expect another lengthy appeal to BVA.

[rentalguy1]

It's all going to depend on the deviation from anatomical neurtral. If the tc spine is fused at 0*, and the veteran is capable of 0 ROM, then it is favorable ankylosis and the rating is 40%. If the tc spine is fused in any position other than anatomical neutral, and the veteran meets the other unfavorable ankylosis criteria in 4.71a, then the rating would be higher. The fusion and degree of ankylosis don't really matter as far as the neurological deficits/sciatica are concerned. The rating criteria allows for seperate ratings on these issues even without any ankylosis.

[jessie0054]

Hello all.

Just got the results of the 2nd C&P it is as follows, Need some insite rather an increase is due.

Medical History: the patient is a 37 year old veteran here for evaluation of his low back. The claims file has been reviewed. He underwent an L4-L5-S1 fusion in May 2006. He has had no pain relief, but is now ambulatory. He continues to have pain all day every day going into his posterior right leg down to the calf with numbness. No Bowel or bladder incontinence. He does occasionally use a girdle.No cane or crutch. no medications

{ my note} The Va recently took him off all his medications except those that he has to take for Gerd, They said that he had been on them longer that they were surpposed to be perscribed. He can't take any narcotics since he was treated for an addiction to his pain medications}

No Physician directed bedrest. He is unable to sit for more than 15 mins, unable to stand more than 30, unable to walk more than 30 mins. He was a diesel mechanic . He last worked in 2006 because he was unable to do the lifting and manual labor required as well as bending.

He went in to become a service manager which he is now working at. At this posion his only job restiction is when he has to change position from sit to stand to walk frequently. The back pain flares every day during which he has to minimize his activities and attemp to avoid weightbearing until it passes.

Physical Examination: On examination, he is well developed well nourished male siting and arising stiffly but no limp. No assistive devices.

Thoracolumbosacral spine revels a 16 X 1 cm well healed surgical scar with flattening. No spasm, No tenderness. He does have paresthesias over the scar.

He has right lateral bending of 0 to 40, left lateral bending 0 to 35, extension of 0 to 10, flexion 0 to 70 that diminishes to 40 with repetition, right rotation 0 to 30, left rotation 0 to 60 with pain on all ranges of motion.

He has positive bilateral straight leg raising, normal senation, 2+ deep tendon reflexes, no atrophy, and 5/5 motor strenght throughout both lower extremities.

He has DeLuca criteria only as specified above. { What is DeLuca???}

I have available for my review the report of an x-ray from 3/10/2007 that shows a posterior fusion L4 through S1 with diskectomy at L4-L5, L5-S1: Also an MRI from 10/2007 that shows surgical changes and Multilevel Spondylosis.

My Impression is that the patient is a 37 year old veteran who has spinal fusion but continues to have spondylosis and rght lower extemity radiculopathy.

Addendum: no pain on range of motion or flare ups on any of the above joints except as stated above. { what does this mean???}

All above joints have no additional limitations by pain, fatique, weakness, or lack of endurance following repetive use.

My note: he is currently at a 10 % rate of disabliity. Base on the exam does it sould like he will get and increase???

And should he also get a rate for the raiculopathy??

Thanks for helping me understand this!!

Jessie

Oh The examiner didn't mention that he fell when he had him bend backward, I thought that would be in the report!!! guess it happens everyday!!

[john999]

You should get your own opinion that you pay for yourself and not rely on the VA. If you are in constant pain I don't know how you only rate 10%. Who decided you were an addict? There is a hell of a difference between developing a dependence and addiction to opiates. Anyone who takes opiates has a tolerance. That is not the same thing as addiction. Addiction is a pyschological condition and a disease in and of itself. Does the VA claim they cured your addiction since they caused it?

[carlie]

jessie,

I think the Deluca Decision relates to Pain.

jmho,

carlie

[rentalguy1]

jessie: The rating will remain at 10% based upon the criteria in 38 CFR 4.71a:

Forward flexion of the thoracolumbar spine greater than 60 degrees but not

greater than 85 degrees; or, forward flexion of the cervical spine greater than

30 degrees but not greater than 40 degrees; or, combined range of motion of

the thoracolumbar spine greater than 120 degrees but not greater than 235

degrees; or, combined range of motion of the cervical spine greater than

170 degrees but not greater than 335 degrees; or, muscle spasm, guarding,

or localized tenderness not resulting in abnormal gait or abnormal spinal

contour; or, vertebral body fracture with loss of 50 percent or more of the

height 10

They may be kind and increase it to 20% based on functional loss upon repetative motion, but don't look for it. Constant pain is not one of the current ratable criteria, even though it should be. Wish I had better news.