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Please Explain - I Need An Expert On Degenerative Arthritis

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carlie

Question

After reading the regs below will someone try to explain to me how it's possible for VA to grant diagnostic code 5019 - Bursitis at 0 %.

The way I understand this reg. it would have to award a 10 % minimum, even if the LOM is noncompensable.

Thanks, carlie

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):

Degenerative arthritis established by X-ray findings will be

rated on the basis of limitation of motion under the

appropriate diagnostic codes for the specific joint or joints

involved (DC 5200 etc.). When however, the limitation of

motion of the specific joint or joints involved is

noncompensable under the appropriate diagnostic codes, a

rating of 10 pct 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 5003. Limitation

of motion must be objectively confirmed by findings such as

swelling, muscle spasm, or satisfactory evidence of painful

motion. In the absence of limitation of motion, rate as

below:

With X-ray evidence of involvement of 2 or more major joints 20

or 2 or more minor joint groups, with occasional

incapacitating exacerbations...............................

With X-ray evidence of involvement of 2 or more major joints 10

or 2 or more minor joint groups............................

Note (1): The 20 pct and 10 pct ratings based on X-ray

findings, above, will not be combined with ratings based on

limitation of motion.

Note (2): The 20 pct and 10 pct ratings based on X-ray

findings, above, will not be utilized in rating conditions

listed under diagnostic codes 5013 to 5024, inclusive.

5004 Arthritis, gonorrheal.

5005 Arthritis, pneumococcic.

5006 Arthritis, typhoid.

5007 Arthritis, syphilitic.

5008 Arthritis, streptococcic.

5009 Arthritis, other types (specify).

With the types of arthritis, diagnostic codes 5004 through

5009, rate the disability as rheumatoid arthritis.

5010 Arthritis, due to trauma, substantiated by X-ray findings:

Rate as arthritis, degenerative.

5011 Bones, caisson disease of: Rate as arthritis, cord

involvement, or deafness, depending on the severity of

disabling manifestations.

5012 Bones, new growths of, malignant 100

Note: The 100 percent rating will be continued for 1 year

following the cessation of surgical, X-ray, antineoplastic

chemotherapy or other therapeutic procedure. At this point,

if there has been no local recurrence or metastases, the

rating will be made on residuals.

5013 Osteoporosis, with joint manifestations.

5014 Osteomalacia.

5015 Bones, new growths of, benign.

5016 Osteitis deformans.

5017 Gout.

5018 Hydrarthrosis, intermittent.

5019 Bursitis.

5020 Synovitis.

5021 Myositis.

5022 Periostitis.

5023 Myositis ossificans.

5024 Tenosynovitis.

The diseases under diagnostic codes 5013 through 5024 will be

rated on limitation of motion of affected parts, as

arthritis, degenerative, except gout which will be rated

under diagnostic code 5002.

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Carlie- I see this a little differently-

I guess I read it as -if no LOM affected then 0%.

I sure could be wrong-

Would these claims help you:

http://www.va.gov/vetapp98/files4/9837390.txt

this vet gets 20% for bursitis in each shoulder but was denied increase-

http://www.va.gov/vetapp97/files3/9721173.txt

The decision however reflects how they are looking at diagnostic codes for bursitis:

"According to 38 C.F.R. Part 4, Code 5019 (1996), bursitis is

rated as degenerative arthritis on the basis of limitation of

motion of the affected parts. Under the applicable criteria,

limitation of motion of the arm (major or minor) to

approximately shoulder level (90 degrees) warrants a 20

percent disability evaluation; a 30 (major arm) or 20 (minor

arm) percent evaluation is applicable for motion of the arm

limited to midway between the side and shoulder level. 38

C.F.R. Part 4, Code 5201 (1996)."

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Berta, This is the sentence that confuses me.

carlie

When however, the limitation of

motion of the specific joint or joints involved is

noncompensable under the appropriate diagnostic codes, a

rating of 10 pct 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 5003

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Guest fla_viking

Dear Carlie

I read it several times. I cant understand it either. but it seems like they are trying to limit the way you add up there ratings. Maybe take the 0% and try to up it. The VA low balls everyone.

Terry higgins

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Carlie

That comment in 4.71a refers only to 5003, to which it is attached. Bursitis is one of those areas where the VA can do whatever it wants, as there is NO definition and no award criteria.

Your lucky you got it SC, I've been trying for 5 years. Now that you are SC, you should NOD it for an increase. Your best bet is for LOM.

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Mr. Walter,

So good to see you are still with us. Are you ever going to be able to begin your blog ?

As to this post - I remain confused, as the regs. state 5019 - Bursitis is to be rated as Arthritis Degenerative

which IS 5003. FYI, I did not even actually apply for Bursitis, I applied for a shoulder injury from active duty

on my original claim in 1978 - they awarded it as Bursitis - direct SC at zero %, in 2003 -- go figure.

thanks for sticking around,

carlie

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Dear Carlie

I read it several times. I cant understand it either. but it seems like they are trying to limit the way you add up there ratings. Maybe take the 0% and try to up it. The VA low balls everyone.

Terry higgins

I may be mistaken, But this looks like it is interperted as to the Spine and each vertebrate is a joint so the VA is getting out of paying for each separate issue if a person has more than 1 Vertabrate effected by arthritis.

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