Resident Pyramding Expert

[ruby]

Reactive arthritis is rated under rheumatoid. If my claim is approved, can I apply for bilateral heel spurs, knee spurs, thoracic spurs, elbow spurs and hands.

I doubt it is approved but I am trying to find my best avenue in filing other claims.

[ruby]

Bump for Rental--My heading meant to say resident expert on pyramiding.

[carlie]

ruby,

I'll second that bump and raise you 3.

carlie

[john999]

Since the disease affects different body parts you should be able to get individual ratings depending on the level of disability. I got individual ratings on hands and feet due to PN. 10% for each foot and hand.

[rentalguy1]

I looked at it earlier Ruby, but didn't respond because I wanted to thin it over and read up more on the symptomology of RA. I haven't had a chance to look at it yet, but I do know that rheumatoid (sp.) arthritis is a systemic disease. It eventually corrupts the whole body, making all of the spurs due to a single eitology. Section 4.14 states "The evaluation of the same disability under various diagnoses is to be avoided." It does not say that it can't be done, but it suggests that it shouldn't be done if at all possible. But, dx code 5002 states "For chronic residuals:

For residuals such as limitation of motion or ankylosis, favorable or unfavor­able, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion."

So, that means that it is allowable to rate seperate joints in addition to the rating for dx code 5002. This is based upon limitation of motion of each major joint, with a minimum rating of 10% assigned when the actual ROM produces a non-compensable rating. Then, all of these ratings are combined into a single rating, and that rating is not added to the rating for dx code 5002. In other words, if you get 10% for each heel, and each knee, and each elbow, that would give you an additional rating of 50.5086329% (after the bilateral factor is added to each group of joints) that can be added to whatever your RA rating is.

In short....yes, file for this because it would be very beneficial for you. You will HAVE TO spell out the regulations that I stated above, and also spell out the regulation concerning the bilateral factor (4.26) in your request of service connection. You should also have a nexus form for every spur signed by a physician before you file for it.

[ruby]

Thanks Rental,

The spurs are all documented by xray and mri results, except for my ribs, they haven't been addressed yet in the notes but they agree the pain in my chest is due to spurs.

I need to work on getting the proper wording for my doc to write in my notes, without overwhelming him.

From my observation if you make to many complaints or request they tend to get overwhelmed and only concentrate on one to two areas per visit.

Pain management kicked me out of the program due to too much pain--did they document this no, but that's what they told me. We can't help you, you have too much pain in too many different areas. See your primary for pain meds.

Thanks again

Ruby

Duh, I have arthritis severe, yeah I have pain everywhere.