Back Claim

[goose_716]

During original exam I was given 10% for lumbar strain but It states that there is no evidence of ankylosis or intervertebral disc syndrome. Recently this condition has become much worse and an X-ray was completed along with an MRI. In the X-ray results it states that there is a mild L5-S1 facet sclerosis and Mild convex right curvature of the lumbar spine. From what I have learned the mild facet Sclerosis is a degenerative condition of the spine. From the MRI it states that on the L5-S1 level there is a Central and mildly leftward small disc protrusion at the L5-S1 level may be impinging on the left exiting nerve root and Mild dehydrative changes of the L4-5 and L5-S1 disc spaces. It also states left side leg radiculopathy 4-6 months, it still continues. This would indicate evidence of an intervertebral disc syndrome that includes a bulging disc and a herniated disc. It also states in records that unable to assess lumbar A/P joint mobility secondary to pain and muscle guarding. ROM lumbar ROM was within normal limits in all planes but lumbar extension excerbrated his central LBP and return from forward flexion caused some muscular LBP. Couple things that stand out for me other then it is Intervertebral Disc syndrome so I assume it needs to be reclassified but will still remain 10%. I have seen from Rentalguy that Radiculopathy is rated at 10%. Is this seperate or is it just grouped into this in general. Was hoping to find out trying to keep things focused and not just throw a bunch of things at them

[rentalguy1]

Welcome to Hadit.

You should try to get them to change the dx code to 5243 (IVDS) just because that is what you actually have now. It has degenerated into that condition, which is the normal path of the degenerative process. Just remember that (almost) all spine conditions are rated solely on range of motion. The less movement that remains in the spine, the higher the rating. If you have lost some range of motion since your last rating, then you should file for a increase. For the radiculopathy, it is rated seperately, under the appropriate dx code for the effected nerve(s). Sometimes the rater will hyphenate the dx code to show that the radiculopathy is related to the IVDS (5243-XXXX), other times they don't. That's not really a big deal,, just worry about getting it sc'd. If you don't have a diagnosis from a doctor of radiculopathy or sciatica, I would highly suggest getting one prior to filing the claim. You should not need it, but the rater pulled that card on me. If you have the dx up front that's one less trick they can play. If you haven't already, click on the Spine Claim Repository link in my signature for a lot more info. Good luck!

EDIT: radiculopathy can actually be rated much higher than 10%, especially for the sciatic nerve. What I have referred to in other posts is a note in the VA Training Letter on IVDS that states (paraphrasing) that raters should try to keep the radiculopathy rating to 10% except in the most severe cases. The actual highest rating listed in the criteria for sciatica is 60%.

Edited December 30, 2008 by rentalguy1

[Pete53]

Goose:

Welcome to Hadit. Rentalguy gave some good advice.

[goose_716]

Thanks for the information. I appreciate the help I will try and get them to change it to code 5243 and then in addition add radiculopathy for an additional 10%. It is diagnoased in my records as radiculopathy but what is that code or how do I find it I think if I remember it falls under 4.124a not sure how to relate it to a specific condition it states that it travels from back down buttocks to the left leg anyhelp would be greatly appreciated.

[rentalguy1]

That would be the sciatic nerve.

[john999]

Rentalguy

Considering your experience with back problems do you think it possible that if you have SC foot problems that might cause back problems as a result. I had the foot problems first and then developed the back problems. I have become more sedentary because of my feet and now my back hurts all the time.

[rentalguy1]

The way it was told to me by my PCP(s), ortho docs, and neuro docs is that "the foot bone is connected to the leg bone, the leg bone is connected to the hip bone, and the hip bone is connected to the back bone."

In other words, yes, foot disorders can lead to knee, hip and back disorders, and vice versa. You just have to get a ortho doc who looks the record over and agrees. My left foot plantar fasciitis is sc's secondary to both my sc'd knees and sc'd spine. My C&P examiner scathingly told the VARO that it is "common medical knowledge that orthopedic problems will always beget more orthopedic problems."