lumbosacral Had Degenerative Disc Disease Changed To Lumbosacral Sprain

[hawkcrewchief]

This is what I got for SC Aircraft accident which hurt my back

The evaluation of chronic lumbosacral sprain, previously diagnosed as degenerative disc disease is increased from 0 to 10% disabling.

Va exam results dated Dec 08, from the VAMC noted your medical history relating to your low back disability. The examiner noted your current subjective complaints of increased low back pain with radicular pain toy your left lower extremity and decreased motion. The physical examination your gait and posture were normal. The examiner noted range of motion testing of your thoracolumbar spine was normal with flexion to 90 degrees, extension to 30 degrees, right lateral flexion to 30 deg left lateral flexion to 30 deg right lateral rotation to 30 deg and left lateral rotation to 30 deg. The report noted objective evidence of painful motion and tenderness. The examiner noted there was no additional range of motion loss due to pain, fatigue, weakness, lack of endurance, or incoordination following repetive use. The neurological portion of the exam was normal. X-ray was normal. The provided was chronic lumbosacral sprain.

----That was fine I guess untill I noticed that I am really in pain doing regular things at work, so my PC doc at the VA went ahead and ordered an MRI to see whats going on...? And here it is...

Findings: The alignment of the lumbar spine appears normal. Vertebral bodies are normal in height. Loss of normal disc signal seen at T11/T12 and L4/L5 levels, where mild disc space reduction is also noted.

There is a mild broad-based disc ostephyte complex seen at the T11/T12 level, indenting the ventral aspect of the cord, without any obvious cord compression.

On the axial images, at the L4/L5 level, a mild broad-based disc bulge with a posterior annular tear is noted (sounds bad?) causing mild central canal stenosis w/out significant exiting nerve root compression. Remainder of the levels are unremarkable.

-Have I just claimed the wrong thing???

-Would this new evidence prove there is more than a strain there and require an increase?

-Do I file an NOD, and if I do what do I state?

-Im a bit confused, is my back ok?

Thanks in advance!

Edited March 29, 2009 by hawkcrewchief

[rentalguy1]

nothing to worry about. All of the spine dx codes are rated under the same criteria based on range of motion. The only difference is that the dx you had (DDD) falls under the rating criteria for IVDS and you can actually achieve a 60% maximum rating under that dx code (5243) if you have doctor prescribed bed rest in excess of 6 weeks in a year. That is almost impossible to obtain. Otherwise, 40% is the max rating under all the other dx codes for the spine. If you have not had a MRI, I would get one to confirm a diagnosis so that you can receive proper medical treatment and know exactly what to expect in the future. They told be lumbosacral strain for over a decade, and I never question it. In fact I had DDD the whole time and it went untreated and I was hard on my body on top of it. I ended up with DDD, spinal stenosis, and facet joint arthritis. All of that arthritic damage has led to pinched nerves which cause severe sciatica, severe urinary inconitance, a weak leg and a foot drop. If I had known it was DDD from the beginning, I could have gotten proper care and instruction on how to take care of myself. It would have had no impact on my service connection whatsoever, though.

[hawkcrewchief]

I had an MRI its right here.

Findings: The alignment of the lumbar spine appears normal. Vertebral bodies are normal in height. Loss of normal disc signal seen at T11/T12 and L4/L5 levels, where mild disc space reduction is also noted.

There is a mild broad-based disc ostephyte complex seen at the T11/T12 level, indenting the ventral aspect of the cord, without any obvious cord compression.

On the axial images, at the L4/L5 level, a mild broad-based disc bulge with a posterior annular tear is noted (sounds bad?) causing mild central canal stenosis w/out significant exiting nerve root compression. Remainder of the levels are unremarkable.

What do you make of it? Should I NOD with this new evidence? Because the C&P doctor only had an X-ray.

Also what is all the talk of bulging and tears...?

[rentalguy1]

MRI vs X-ray won't make a difference on the rating. Only range of motion measurements will matter on that. It would make a difference on the dx code used. The findings of the MRI make your condition Intervertabral Disc Syndrome, not a lumbosacral strain. Unless you can get lots of prescribed bed rest, though, it would only be semantics. Your rating percentage would remain the same under either code.

Where it says loss of normal disc signal at T11-12 and L4-5, that means disc dessication. The disc has dehydrated, in other words. This is part of Degenerative Disc Disease. It also says there is mild disc space reduction at these levels. This is also DDD. The discs at these levels have lost their elasticity and now are performing like a worn out shock absorber.

At L4-5 you have a herniated disc that covers a broad area of the disc space. At the back portion of the disc, toward the spinal canal, the annular material is torn allowing the disc material to spill out into the spinal canal. This is a true ruptured disc. This is causing central canal stenosis; your spinal canal has been made smaller by the disc material that now fills it. This leaves less room for the spinal cord to function, and can cause all kinds of radiculopathies in your hips, legs and feet.

I don't think I would NOD based on this evidence. It would not make a difference in your claim, other than make you wait on pins and needles for months on end only to end up with a denial. What I would do with this is go to your PCP and start a managing care plan. Pain meds, muscle relaxers, and whatever physical therapy you can stand. These things have the ability to heal themselves some times if you have taken it easy, but if you have worked hard for a while, it is most likely permanent. Whatever you do, from this point on, take it easy on your back. The damage has already been done. The level of physical stress you put on your back from this point on will determine how bad it will eventually get, and how fast it will get there.

[luvHIM]

I'm just going to piggyback off of rentalguy here. One of the operative words used throughout the report is "MILD" which is an indication that from a radiographic view point your condition is not severe. Although the pain might be, the overall picture is not enough to warrant a rating higher than 10%.

I, like rentalguy, was served a diagnosis for decades of chronic lumbosacral strain. The word "chronic" played out in my favor in the end. But my true condition is ankylosing spondylitis. The point being that when it comes to diagnoses...it is all about physician interpretation. You can always get a second opinion.

I am currently rated for both conditions because both conditions are in fact the problem and one's chronicity is due to the other. That may be the case for you. I agree with rentalguy's suggestion, however, in the meantime. Best regards.

[hawkcrewchief]

Oh man thanks!!!!! At this point I am really concerned about the pain... I am glad you were able to translate this to english, I am a hard worker and my poor back does take a beating. I will watch how I use it, I will definantly focus on pain management and minimizing the damage. The rating is ok where it is right now I just wanted to be sure I did it right. Thanks a million you really put my pain into words I had no idea what was going on, and the docs never tell me anything!!! thanks rentalguy/ luvHIM thanks hadit!!! :)

Edited March 30, 2009 by hawkcrewchief