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Spine - Secondary Conditions


ken1939

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I am: 10% SC for degenerative disease, cervical spine; 10% degenerative disease, lumbar spine amd 10% tinnitus. I am appealing the ratings for the spine conditions and am asking for additional benefits for secondary conditions i.e. headaches and lower extremity pain. The secondary conditions have already been denied and I will appeal that decision as soon as my other appeal has cleared.

How do I know what codes the VA used when rating my case? There is no mention of codes in the decision documentation other than a reference to title 38. I read a lot in the forums about trying to get a case rated under certain codes. How, for example, can I present my case for the secondary nerve pain for the lower extremities? On the one hand, I have a report from the VA neurologist examiner where he does not give an actual diagnosis but opines that the pain is secondary to my SC lumbar condition. The claim was denied on the basis of no diagnosis. On the other hand, I do have a diagnosis from another VA examiner, an orthopedic surgeon, who says: " The veteran has lumbar degenerative disk disease, spondylosis, and spondylolisthesis with partial left foot drop. there is additional functional loss due to pain and weakness after repetitive use. The major impact is from the pain. There is additional functional loss of 5 degrees due to pain after repetitive use X 3. The straight leg raising causes low back pain on the left at 70 degrees. It is at least as likely as not that the nerve pain in the lower extremity is secondary to the lumbar spine condition." This examination was done 2 days before the neurologist's examination but was not included as evidence when deciding this case.

I also have an examination report from a private neurologist that I have not submitted yet. He says: " The study (his examination) shows electrophysiologic evidence consistent with a left L5 radiculopathy." He goes on to say " the MRI scan of the lumbosacral spine shows anterolisthesis of L5 on S1 with moderate bilateral L5 neural foraminal narrowing as well as degenerative disk disease elsewhere."

I will include the Dr. reports along with my summary when I submit my appeal. I have been studying the forum and the table of codes but for the life of me I cannot see a way to guide them to the right codes. The more I read the more I become bogged down with information overload. Thank you.

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Ken,

Thanks for your service and I am not in the position to answer your question.

However, I'm sure one of the experienced members on the site will chime in to assist you; good luck to you.

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  • HadIt.com Elder

I hear ya on the information overload-

The claims process can be miserable and confusing.

I am not sure what you mean about the codes-the diagnostic codes should be part of the decision-

on a rating sheet-

What stage are you in- I mean was this a recent denial?

If so I feel you should send them a Request for Reconsideration and expand on and attach any of the recent medical evidence that they did not have when they made this decision.

This will not stop the year NOD clock but could produce a faster and proper decision.

You could add to the reconsideration request any argument that your medical evidence reveals would warrant a higher rating. They should have sent to you the criteria for higher ratings.

Unfortunately we ften have t hold their hands and guide them to how the medical evidence supports a higher rating.

I dont kow what you mean as to the codes-

The MRI- do you have a copy of it and does the VA?

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Thanks Berta,

The diagnostic codes I am talking about are those in Title 38 part 4, schedule for rating disabilities. I reviewed my documentation for the 3 SC conditions I have and find no mention of diagnostic codes. There is no rating sheet.

Currently I have 2 issues:

Issue 1) On 4/29/08 I filed a Notice of Disagreement (NOD) where I appealed the rating of 10% for my cervical spine condition and the 10% for my lumbar spine condition. I had a VA examination on 8/18/08 resulting in a range of motion (ROM) assesment that should give me a 20% rating for each of of these disabilities. However, I was told 2 days ago that VA has no record of the 4/29/08 NOD. I spent yesterday getting my records together and resubmitting the NOD (via certified mail as I have always done).

Issue 2) On 4/29/08 I also filed for additional benefits for conditions secondary to the cervical spine and lumbar spine SC disabilities i. e. headaches and lower extremity pain. I have a decision on this claim dated 11/28/08. The headaches are SC but 0% rated (for lack of characteristic prostrating attacks averaging 1 in 2 months). The claim for lower extremity pain was denied for no diagnosis. There were two diagnosis but they were not considered. I will appeal these decisions in due time but first I want to settle issue 1. I don't want 2 claims in the hopper again unless I need to protect a filing date. What I am doing now is getting my ducks in a row for appealing issue 2 when the time comes.

Looking at the schedule of ratings it appears that headaches might be code 8100 or possibly somewhere in the 8200s to 8400s. The lower extremity pain might be in the 8500s or 8600s. I can't find where my diagnosis fits in any catagory. It has been my experience that every doctor uses different terminology to describe the same thing. I turned to this forum hoping that someone with similar circumstances might shed some light on how I can point the VA in the right direction for me to receive the best rating possible. There can be quite a difference in the rating percentage depending on which code is used. And, by the way, does anyone know what a "characteristic prostrating attack" is? I found numerous definitions that a "characteristic prostrating attack" is a "characteristic prostrating attack".

Thank you, Ken1939

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