Chronic Pain Disorder/chronic Pain

[applejack]

is there a rating under cht35 for chronic pain/or chonic pain disorder anyone knows?

[carlie]

applejack,

Welcome to Hadit.

I think you are referring to 38 CFR.

Hope this helps a vet.

carlie

http://ecfr.gpoaccess.gov/cgi/t/text/text-....13&idno=38

§ 4.59 Painful motion.

With any form of arthritis, painful motion is an important factor of disability,

the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted

and definitely related to affected joints. Muscle spasm will greatly assist the identification.

Sciatic neuritis is not uncommonly caused by arthritis of the spine.

The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability.

It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.

Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased.

Flexion elicits such manifestations. The joints involved should be tested for pain on both active

and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.

[c&p man]

applejack,

Welcome to Hadit.

I think you are referring to 38 CFR.

Hope this helps a vet.

carlie

http://ecfr.gpoaccess.gov/cgi/t/text/text-....13&idno=38

§ 4.59 Painful motion.

With any form of arthritis, painful motion is an important factor of disability,

the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted

and definitely related to affected joints. Muscle spasm will greatly assist the identification.

Sciatic neuritis is not uncommonly caused by arthritis of the spine.

The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability.

It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.

Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased.

Flexion elicits such manifestations. The joints involved should be tested for pain on both active

and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.

With musculoskeletal ratings there is no rating for pain persay. Rating is weighted towards range of motion in which painful motion is supposed to be considered. Neurological deficits are rated seperately but again pain is used as one of the indicators of a problem and is not necessarily "rated". The long and short of it is the amount of pain you suffer from does not determine your rating. The limitation/s that you face from your disablility do. If you are on pain meds that interfere with your ability to work that can be considered under the category of individual unemployability. If a doctor has determined you have chronic depression due to service connected pain that is rateable. If you have pain issues I highly suggest meeting with a pain management specialist, however, they are not going to provide a "rating for pain".

As always, if someone with more knowledge notices a glaling error in this advice please chime in/correct. I hope this helps.

[allan]

Disability Examination Worksheets

Mental Disorders (Except initial PTSD and Eating Disorders) Examination

http://www.vba.va.gov/bln/21/Benefits/exams/disexm37.htm

************************************************************

9422 Pain disorder

Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name...100

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships...70

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships...50

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)...30

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication...10

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication...0

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DeLuca v. Brown, 8 Vet.App. 202 (1995) (No. 94-242) (With

respect to the question of whether 38 C.F.R. § 4.71a,

Diagnostic Code (DC) 5201 (limitation of motion of the arm)

subsumes 38 C.F.R. § 4.40, the Court observes that range of

motion undoubtedly can be affected by pain in certain

situations, and a limitation of motion due to pain might indeed

be reflected in a rating under that rating code. However,

section 4.40 specifically refers to disability due to lack of

normal "endurance", provides for a rating to be based on

"functional loss . . . due to . . . pain", and states that "a

part which becomes painful on use must be regarded as seriously

disabled." Furthermore, section 4.40 provides that "t is

essential that the [rating] examination . . . adequately

portray the . . . functional loss." Accordingly, because DC

5201 provides for a rating solely on the basis of loss of range

of motion, "[t]he Court holds that DC 5201 does not subsume 38

C.F.R. § 4.40, and that 38 C.F.R. § 4.14 [avoidance of

pyramiding] does not forbid consideration of a higher rating

based on a greater limitation of motion due to pain on use

including during flare-ups." The Court also holds that DC 5201

does not subsume 38 C.F.R. § 4.45.)

DeLuca v. Brown, 8 Vet.App. 202 (1995) (No. 94-242) (Because

the April 1990 VA examination relied upon by the Board in

denying the veteran's claim for an increased rating for his

left shoulder disability merely recorded the range of motion at

that time, and did not indicate consideration of the factors

cited in 38 C.F.R. § 4.40, and required by section 4.40 to be

considered and portrayed in the rating examination, as to

functional loss on use or due to flare-ups, the Court concluded

that a remand to the Board was required for the purpose of

obtaining a new medical examination which complies with the

requirements of section 4.40, and the medical examiner must be

asked to express an opinion on whether pain could significantly

limit functional ability during flare-ups or when the arm is

used repeatedly over a period of time. "Because DC 5201

provides for a rating solely on the basis of loss of range of

motion, these determinations should, if feasible, be

'portray[ed]' (§ 4.40) in terms of the degree of additional

range-of-motion loss due to pain on use or during flare-ups.")

DeLuca v. Brown, 8 Vet.App. 202 (1995) (No. 94-242) (With

respect to the Board's determination that 38 C.F.R. § 4.45 did

not provide for an increased rating above 20 percent for the

veteran's service-connected left shoulder disability because

"[w]eakened movement and excess fatigability usually are

associated with muscle injury"; because "ncoordination is

usually associated with disease or injury affecting the

peripheral nerves"; and because this veteran's disability was

not associated with "nerve injury" or "muscle injury, as such,

to the left shoulder girdle", the Court held that the Board's

reading of section 4.45 could not be sustained in that the

plain language of that provision indicates that "[w]eakened

movement", "[e]xcess fatigability", and "ncoordination" do

not refer solely to muscle and nerve conditions. Accordingly,

in the examination ordered on remand, the Court notes that the

medical examiner should be asked to determine whether the left

shoulder joint exhibits weakened movement, excess fatigability,

or incoordination, and, if feasible, these determinations

should be expressed in terms of the degree of additional

range-of-motion loss due to any weakened movement, excess

fatigability, or incoordination.)

DeLuca v. Brown, 8 Vet.App. 202 (1995) (No. 94-242) (In a case

involving a claim for an increased rating above 20 percent for

a service-connected left shoulder disability, it was held by

the Court that a remand was required because the Board's

statement of reasons or bases did not adequately explain how

pain on use was factored into its evaluation of the veteran's

disability in terms of limitation-of-motion equivalency under

38 C.F.R. § 4.71a, Diagnostic Code (DC) 5201 (limitation of

motion of the arm).)

Voyles v. Brown, 5 Vet.App. 451 (1993)

Hatlestad v. Derwinski, 3 Vet.App. 213 (1992)

Quarles v. Derwinski, 3 Vet.App. 129 (1992)

Schafrath v. Derwinski, 1 Vet.App. 589 (1991)

Lichtenfels v. Derwinski, 1 Vet.App. 484 (1991)

Bailey v. Derwinski, 1 Vet.App. 441 (1991)

Ferguson v. Derwinski, 1 Vet.App. 428 (1991) (No. 90-472)

(38 C.F.R. § 4.40--functional loss due to pain, and 38 C.F.R. § 4.59)Martin v. Derwinski, 1 Vet.App. 411 (1991) (No. 90-343) (38

C.F.R. § 4.59)

Ferraro v. Derwinski, 1 Vet.App. 326 (1991) (No. 90-444)

(functional loss due to pain)

[john999]

You have to remember that VA considers chronic pain disorder to be an emotional disorder like PTSD or depression. The physical parts of the pain disorder are so intertwined with psychological factors they treat it as if you have a mental disorder. I am SC for chronic pain and some emotional problems, but it all comes to 70%.

[LarryJ]

To answer your question, yes there is a recognized disability called Chronic Pain Syndrome, and it falls under the mental/psychiatric realm. I can't remember the Diagnostic Code number right off the top of my head.

And, it has nothing to do with "painful motion" as covered in a couple of the answers to your question. The "painful motion" that is referred to is considered a disability of the muscular/skeletal system and is covered in the ortho section of the diagnostic codes.

The Chronic Pain Syndrome can be caused by anything that can cause "chronic" pain, be it muscles, joints, migraines, cancer, etc.

[allan]

Im confused & trying to get a claim for Chronic Pain Syndrome set up for the VARO.

Am I to understand that pain with motion, can not be the cause or contribute to Chronic Pain Syndrome? If this is the case I doubt i'll get much of an award. My pain is chronic without moving, but made far worse when I do. So they wouldn't consider this than?