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Degenerative Disk Disease


david walker

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David, I am rated for DDD and DJD of the cervical spine. It is rated under Ratigs of the spine. The VA rated mine toghether. The only thing they considered was the range of motion of the neck. However, if there are any radiating signs auch as weakness then the va is supposed to separately rate the effected nerve group.

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Well, Hopefully I'll find out soon. I just mailed my NOD claim off last week for my measely 10% rating I got for osteoarthropathy which is Arthritis I guess. A CT scan and MRI revealed DDD, Hernisted disc, partial herniated disc, and Spina Bifida. Hopefully I'll snaggle some more. I'll let you know when they decide to screw me B)

Sean

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men-is the newer IVS Invertebral Disk Syndrome C & P appropriate for these conditions?

http://www.vba.va.gov/bln/21/Benefits/exams/disexm53.htm and VA Training letter 02-04 on Invertebral disc syndrome-

It is my understanding- and I could be wrong -I am not a doctor- that the Oct 24,2002 revision of the worksheet for spine -that the newer version is more favorable to vets than any older ones that pre existed the new one-

The VBM (2005 ed) pages 407 to 419 states that IVS is a nonmenclature to include DDD, sciatica,discogenic pain syndrome, prolapse,rupture, herniated nucleus pulposus etc- terms that are often used interchangably-

It also states Lumbar IVS accounts for 62% of all disc disease, and that all but 10% lumbar is at the L-4, L-5 or L5-Si level

C6 and C & is most common yet IVS is much less common in the thoratic area.

I sure hope you guys are getting the right C & P-

and it does not hurt -if your last C & P was prior to 2002, if you feel you have additional disability from

DDD or IVS ,since then , to file a claim and get the more recent C & P exam.

I feel anyone with this type of claim needs to access a VBM 2005 edition as the NVLSP has a lot of excellent information in it for IVS or DDD, or radicular effects or any secondary affects from this condition to bladder , or bowels or sexual function.

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Berta

The reason the (relatively) new IVDS examination is considered more favorable to the Veteran, is that the revised rating schedule allows for two methods of determining the award level. The old system only alllowed doctor ordered bed rest - is now revised to allow ROM, pain, fatigue, weakness, etc for each affected area. It also specifies that the IVDS C&P should be done by both an Orthopedic specialist and a neurologist.

I had an IVDS C&P done by an internist, who didn't even know how to use a goniometer, back in October, and I'm still fightingwith Manila OPC over his incompetence. With no response yet, of course.

I'm waiting for our new VARO Director to arrive, before I elevate it to VARO.

Dabid,

Get a copy of the C&P ASAP, and if there are no comments about limitations caused by pain, fatigue, or weakness, then file a complaint for an inadequate C&P examination. You should also compare it to the worksheet and the Training letter, and cross reference any failures on the part of the examiner, to follow the provided guidance.

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What about when the C&P examiner:

1 ) States, As likely as not related to military in-service injury.

2 ) States, Muscle spasms with LOM due to pain. This is with consideration of pain, fatigue, repitition, etc...

Thanks,

carlie

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Carlie- that is a very positive statement of service connection-

it is the rating that the VA might play games with-

Walter- no goinometer?

I have seen that here at hadit too many times over the years-

You sure are right to question that C & P!

I printed out a blank C & P for something I forget for a local vet to bring to his C & P to make sure the doc goes by the book. It might not even matter-

I think C & Ps are getting the same amount of time and attetion that claims are getting-

5-10 minutes? Ridiculous.

Edited by Berta (see edit history)
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Berta, I just had a C and P fo r an increase for The Cervical Spine on Dec 19. The new system was used. Now the VA has the Instructions in the computer and it goes step by step. The DOc performed the C and P and entered the info in the computer as she went along.

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Get this my exam in Dec the doc determined my ROM without a goinometer (cervical & lumbar). I'm getting a little aggravated at all this. Not only that, I filed for migraines, submitted supporting documentation that they were related to my C-spine. The migraines were never addressed, except when I told the doc I had them. His diagnoses stated headaches of upper cervical occipital blending with daily neck pains. I have no idea what that means. I don't understand how someone with no residuals can end up with the same percentage of someone in constant pain.....Thanks for listening while I let off some steam.

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Be careful. It appears the VA is attempting to relate headaches to your cervical spine. You stated you have migraines. I have the same condition. My migraines are also called hypertensive migraines. The migraine diagnosis needs to include the following. ( Aura) feeling the onset of the headache, Nausea. F;oaters in the eyes. Do you have a copy of the C and P. Are you treated by VA neuro department?.

Dont let headaches get wrapped into the cervical spine if the cause is not the C spine.

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Be careful. It appears the VA is attempting to relate headaches to your cervical spine. You stated you have migraines. I have the same condition. My migraines are also called hypertensive migraines. The migraine diagnosis needs to include the following. ( Aura) feeling the onset of the headache, Nausea. F;oaters in the eyes. Do you have a copy of the C and P. Are you treated by VA neuro department?.

Dont let headaches get wrapped into the cervical spine if the cause is not the C spine.

You need to have the migraines rated separately.

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I sent in my records from (2) civilian neurologist diagnosing my headaches as migraines (they started after my accident in service, and worsened after my C-spine problems. My civilain records described my feeling the onset of the headache, Nausea. Floaters and spinning when I lay down. The C&P doc said in the C&P report they were diagnosed as migraine, but he sure didn't say it in his diagnoses. I'm not treated at the VA neuro department, but I get my migraine meds from my primary care doc at the VA.

If they are wrapped into the cervical spine what happens, am I just left out in the cold. See why I'm upset. Someone with a successful surgery and the same ROM as me (has no residuals) gets the same percentage. Its not right. I lnow I'm jumping the gun since my claims not been decided. But the C&P report seemed to be little my problems.

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Do you mind me asking what the ranges of motion were in the C and P exam?

Foreward Flexion

Backward extension

bending left / right

turning left / right.

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C-spine

Foreward Flexion 20

Backward extension 25

bending left / right 15

turning left / right. 45

How can he tell this if he used no goinometer. Plus some days are better than other depending on my pain level.

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See below. It appears a 20 percent start. VA should rate neurological segments separatly.

D General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated

under the Formula for Rating Intervertebral Disc Syndrome Based

on Incapacitating Episodes):

With or without symptoms such as pain (whther or not it

radiates), stiffness, or aching in the area of the spine

affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine............... 100

Unfavorable ankylosis of the entire thoracolumbar spine. 50

Unfavorable ankylosis of the entire cervical spine; or, 40

forward flexion of the thoracolumbar spine 30 degrees

or less; or, favorable ankylosis of the entire

thoracolumbar spine....................................

Forward flexion of the cervical spine 15 degrees or 30

less; or, favorable ankylosis of the entire cervical

spine..................................................

Forward flexion of the thoracolumbar spine greater than 20

30 degrees but not greater than 60 degrees; or, forward

flexion of the cervical spine greater than 15 degrees

but not greater than 30 degrees; or, the combined range

of motion of the thoracolumbar spine not greater than

120 degrees; or, the combined range of motion of the

cervical spine not greater than 170 degrees; or, muscle

spasm or guarding severe enough to result in an

abnormal gait or abnormal spinal contour such as

scoliosis, reversed lordosis, or abnormal kyphosis.....

Forward flexion of the thoracolumbar spine greater than 10

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..........................................

Note (1): Evaluate any associated objective neurologic

abnormalities, including, but not limited to, bowel or bladder

impairment, separately, under an appropriate diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes,

normal forward flexion of the cervical spine is zero to 45

degrees, extension is zero to 45 degrees, left and right

lateral flexion are zero to 45 degrees, and left and right

lateral rotation are zero to 80 degrees. Normal forward flexion

of the thoracolumbar spine is zero to 90 degrees, extension is

zero to 30 degrees, left and right lateral flexion are zero to

30 degrees, and left and right lateral rotation are zero to 30

degrees. The combined range of motion refers to the sum of the

range of forward flexion, extension, left and right lateral

flexion, and left and right rotation. The normal combined range

of motion of the cervical spine is 340 degrees and of the

thoracolumbar spine is 240 degrees.The normal ranges of motion

for each component of spinal motion provided in this note are

the maximum that can be used for calculation of the combined

range of motion.

Note (3): In exceptional cases, an examiner may state that

because of age, body habitus, neurologic disease, or other

factors not the result of disease or injury of the spine, the

range of motion of the spine in a particular individual should

be considered normal for that individual, even though it does

not conform to the normal range of motion stated in Note (2).

Provided that the examiner supplies an explanation, the

examiner's assessment that the range of motion is normal for

that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest

five degrees.

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.

Note (6): Separately evaluate disability of the thoracolumbar

and cervical spine segments, except when there is unfavorable

ankylosis of both segments, which will be rated as a single

disability.

5235 Vertebral fracture or dislocation

5236 Sacroiliac injury and weakness

5237 Lumbosacral or cervical strain

5238 Spinal stenosis

5239 Spondylolisthesis or segmental instability

5240 Ankylosing spondylitis

5241 Spinal fusion

5242 Degenerative arthritis of the spine (see also diagnostic

code 5003)

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or

postoperatively) either under the General Rating Formula for

Diseases and Injuries of the Spine or under the Formula for

Rating Intervertebral Disc Syndrome Based on Incapacitating

Episodes, whichever method results in the higher evaluation

when all disabilities are combined under § 4.25.

Formula for Rating Intervertebral Disc Syndrome Based on

Incapacitating Episodes

With incapacitating episodes having a total duration of at least 60

6 weeks during the past 12 months..............................

With incapacitating episodes having a total duration of at least 40

4 weeks but less than 6 weeks during the past 12 months........

With incapacitating episodes having a total duration of at least 20

2 weeks but less than 4 weeks during the past 12 months........

With incapacitating episodes having a total duration of at least 10

one week but less than 2 weeks during the past 12 months.......

Note (1): For purposes of evaluations under diagnostic code

5243, an incapacitating episode is a period of acute signs and

symptoms due to intervertebral disc syndrome that requires bed

rest prescribed by a physician and treatment by a physician.

Note (2): If intervertebral disc syndrome is present in more

than one spinal segment, provided that the effects in each

spinal segment are clearly distinct, evaluate each segment on

the basis of incapacitating episodes or under the General

Rating Formula for Diseases and Injuries of the Spine,

whichever method results in a higher evaluation for that

segment.

avid based on the range the range, If it is rated it looks like a 20 percent.

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"a spinal segment is composed of two vertebrae attached together by ligaments, with a soft disc separating them. The facet joints fit between the two vertebrae, allowing for movement, and the foramen between the vertebrae allows space for the nerve roots to travel freely from the spinal cord to the body."

from :http://www.spineuniversity.com/public/print.asp?id=91

This is an excellent link from med school info on the net re: spinal diseases.

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David,

I'm also confused about this. I have DDD and DJD among other things in my spine. My original diagnosis at retirement in 1992 was back strain and has continued since. Now I have severe spinal stenosis with nerve root compression, herniated disk. The max rating for back strain is 40% which I do have.

It seems almost every diagnostic code for the spine pertains to limitation of motion. The RO will give you a percentage and when you ask about pain it's always, Oh, thats included. Which we all know is BS.

I asked about pain and was told exactly that. I'm maxed at 40% so where is the 10% for pain? Trying to get simple mistakes like this corrected is another reason for delays with processing. In fact this is one of the reasons my appeal has been bounced around for the last six years and counting.

I've never seen seperate ratings for DDD and DJD. If this is possible seems i've got more work to do. (lol)

I'll try and research this and post any positive findings.

WAYNE

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  • In Memoriam

VA, in my case, is trying to say that my back problem is vascular (Possibly Atherosclerosis) and not neurogenic (Service Related Accident). I waited until my initial examination was written up; then presented pictures of before accident; after accident to present. I recently found this page, which explains why the NS (Neurosurgeon) ask only certain questions. I have DDD. After I presented these pictures the NS had to fall back and regroup by moving my follow-up exam back by two months.

DDD can cause stenosis. (Is it neurogenic or Vascular)

http://www.aafp.org/afp/980415ap/alvarez.html

Lateral recess stenosis. (Very good study)

http://www.uqtr.ca/~cardina/vbo1/ced/ced00065.htm

Some of the comments in his report were ridiculous.

He said that I had two children by a previous marriage.

My wife, of 28 years, was at the exam with me. My oldest child, son, is 25. When my wife read the report she could not believe what was written, and she said that my X owes us 25 years of back child support.

He also said that I worked with mercury and was exposed to toxins in the trade.

I never worked with mercury in my life.

He said that diabetes runs in my family.

No one in my family has had or has diabetes.

He also said that I was a welder.

I have never welded in my life.

Many many more statements that were from out of nowhere. Where do they get the crap? :P

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