carlie Posted January 26, 2006 Share Posted January 26, 2006 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. Carlie passed away in November 2015 she is missed. Link to comment Share on other sites More sharing options...
Guest Berta Posted January 26, 2006 Share Posted January 26, 2006 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)." Link to comment Share on other sites More sharing options...
carlie Posted January 27, 2006 Author Share Posted January 27, 2006 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 Carlie passed away in November 2015 she is missed. Link to comment Share on other sites More sharing options...
Guest fla_viking Posted January 27, 2006 Share Posted January 27, 2006 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 Link to comment Share on other sites More sharing options...
HadIt.com Elder wallyg Posted January 27, 2006 HadIt.com Elder Share Posted January 27, 2006 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. Fight the VA as if they are the enemy; for they are! Erin go Bragh Link to comment Share on other sites More sharing options...
carlie Posted January 28, 2006 Author Share Posted January 28, 2006 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 Carlie passed away in November 2015 she is missed. Link to comment Share on other sites More sharing options...
Guest jstacy Posted January 28, 2006 Share Posted January 28, 2006 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. Link to comment Share on other sites More sharing options...
Question
carlie
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.
Carlie passed away in November 2015 she is missed.
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