Ivds/ddd And Spinal Fusion? Post-op

[Quint7]

Hi all, I'm almost 3 weeks post-op for a L4-5 spinal fusion (feel better than in 10 years!) and I am about 5 weeks post DRO hearing seeking SC for IVDS/DDD.

My question is, if I ever get another exam (as the DRO hearing officer said she wanted me to have), should I make a point of the fact that although I NOW have a spinal fusion at one level (L4-5), I STILL have IVDS/DDD at the next level down (L5-S1) and therefore should be service connected for BOTH. Not compensated, but SC. I don't think that now I will have any ratable issues from the IVDS/DDD in the short term other than surgery induced limited range of motion, and I'm pretty sure that a spinal fusion is an automatic 40%.

My issue is that the effects of IVDS/DDD don't go away, the fusion will put stress on the next level higher and therefore I want the VA to list me as SC for BOTH IVDS/DDD and the Fusion that resulted from it.

Any thoughts? I know seeking comp. for both at this time would be pyramiding..... or at least I think it would.

Thanks!

[rentalguy1]

you can still be rated for IVDS post op, and I believe it will still be on ROM, which would be in your favor due to "favorable ankylosis" of the thoracolumbar spine (which is in essence what the fusion has done to you).

[Quint7]

Rental thats what I thought. I'm gonna copy & paste the Title 38 portion and highlight what Im thinking.

The Spine

RatingGeneral 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 diseaseUnfavorable ankylosis of the entire spine100Unfavorable ankylosis of the entire thoracolumbar spine50Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine40Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine30Forward flexion of the thoracolumbar spine greater than 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 kyphosis20Forward flexion of the thoracolumbar spine greater than 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 height10Note (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 syndromeEvaluate 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 EpisodesWith incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months40With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months20With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months10Note(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.

It lists 5241 for Spinal Fusion and 5243 for IVDS/DDD. So since I have both, Im wondering how they will classify me. I agree that it says 0 degree fixation is ALWAYS favorable ankylosis and from what I read, that is an automatic 40%.

Range of motion or not, can they assign 2 different codes to one body part? My concern is that they will give me 5241 for SPinal Fusion and WHEN (as we both know) I start having problems with oher levels I will have to fight to get 5243 for IVDS/DDD. ALso, since my claim goes back well over a year BEFORE the fusion, can they rate me for IVDS for the time of the claim til the fusion and then state that from the fusion date on my DX Code will only reflect the fusion.

I don't expect much from the DRO as she was very non-participative compared to what others have experienced. She didn't ask a single question......

I just can't wait to leave the house! With the weather and not being able to drive or walk on ice, I have been cooped up since the 9th!!!!!!

[Quint7]

Well that didn't come out like I planned!

Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40% rating.

5241 Spinal fusion

5243 Intervertebral disc syndrome

Not quite what I planned but better than below.

[john999]

Quint

My doctor mentioned fusion to me as a resort for my back pain. Describe the surgery and recovery if you don't mind. I am scared of this type of surgery since I have had other failed surgeries. I have a disc that is going bad and my back in constantly in a knot.

[rentalguy1]

Well that didn't come out like I planned!

Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40% rating.

5241 Spinal fusion

5243 Intervertebral disc syndrome

Not quite what I planned but better than below.

That's what I was thinking.

[jbasser]

Quint, They will only assign 1 code for your condition. Before surgury IVDS and after Surgury most likely it will be post Fusion 5241.

They will base the rating on the ROM and then rate the Effected nerves. That is what they did to me.

As far as other levels, The only thing a person can do is ask for an increase when the problems occurr as it is a well known fact that the more fused a Back or neck becomes the less the ROM.

To be rated for Anlylosis there are 2 conditions that come into play. Each segement must be fused. Entire C spine, or T spine L spine before they will rate it as complete. There is another condition known as Dish that is a form of Osteoarthritis or forestiers disease whwere the tendons actually calcify. This should also qualify as fusing.

Pay close attention to the effected nerves. The damage caused can be major.

J

Edited January 26, 2009 by jbasser