lumbosacral I Have Two Diagnosis But One Rating?

[nyc-vet]

I was needing some help. When I submitted a claim 2 years ago for increase on low back and sciatica in leg, it came back as Lumbosacral Radiapathy.... I noticed in the award letter sciatica was not addressed or was it combined into Lumbo Rad...? Also I put in for anxiety and on my physical, I was diagnosed with Anxiety and Major Depression but still only one rating of general anxiety (9400). How can I get these separated into four different rating. Lumbar strain, sciatica, anxiety and depression? Or is this the way that it is?

[WHOLESALE]

You can only get rated for one mental disorder from what I have read on other posts here. I believe they combine them into one rating if you have multiple symptoms.

Someone correct me if i'm wrong though.

Jay

I was needing some help. When I submitted a claim 2 years ago for increase on low back and sciatica in leg, it came back as Lumbosacral Radiapathy.... I noticed in the award letter sciatica was not addressed or was it combined into Lumbo Rad...? Also I put in for anxiety and on my physical, I was diagnosed with Anxiety and Major Depression but still only one rating of general anxiety (9400). How can I get these separated into four different rating. Lumbar strain, sciatica, anxiety and depression? Or is this the way that it is?

[nyc-vet]

I agree from what I've seen they combine the mental issues. The medical description for my back is "Lumbosacral strain with myofascial and facet related pain and lumbosacral radiculopathy" I wonder if they are combining low back and sciatica?

[broncovet]

Dont give up. Tho some of them are combined, another possibility is that the RO just plain secretly denied one of your claims. They dont use the word secretly denied, instead they use the word "deemed denied". It is a giant ripoff to Vets. Here is how it works. You apply for two or more unrelated benefits..say, hearing loss, and loss of use of your leg. They deny (or award) hearing loss and dont mention loss of use of your leg. Loss of use of your leg is "deemed denied" and YOU MUST appeal it within a year even when it is not addressed. Since most Vets do not appeal this, the VA pulls a fast one on you. After a year passes, it is extremelely difficult to appeal, you now have to prove "Cue". You are going to have a big fight on your hands if you dont appeal a claim that the Regional Office messed up and never addressed it.

There are hundreds of "deemed denied" cases..that means the RO never addressed your claim so it was, therefore denied.

It is one of many "dirty tricks" the VA pulls on unsuspecting Veteran claimants.

Dont believe the VA would do this? Do a search using "deemed denied" and you will find many, many instances this happened.

Edited June 18, 2009 by broncovet (see edit history)

[nyc-vet]

That exactly what has happened. For the past two years I've been trying to get them to address all my original claims. They missed the anxiety (9400) issue totally the first time around. So i wrote a letter last year and they CUE themselves and gave 30 percent. But now I thinking Depression is a different code (9434) and should be separate. I guess I write another letter to get it addressed but now like you said it is beyond the one year. They pulled a dirty trick.

[purple]

Anxiety & Depression wont' be rated separately. Mental Health issues are always rated together no matter how many you have. Strange but true.

I don't know about the other things.

[broncovet]

I personally think a deemed denied claim is, in fact, CUE, as the VA has a mandataroy obligation to consider all claims and evidence before rendering a decision. Look it up, if you like. I recommend filing a CUE NOD, based on a deemed denial. I would also ask for a copy of your c file, to make sure the VA didnt shred stuff on the deeemed denial part. YOu have a long fight coming.

[nyc-vet]

Thanks for the replies, Broncovet I requested my c-file the other day.

[jbasser]

I was needing some help. When I submitted a claim 2 years ago for increase on low back and sciatica in leg, it came back as Lumbosacral Radiapathy.... I noticed in the award letter sciatica was not addressed or was it combined into Lumbo Rad...? Also I put in for anxiety and on my physical, I was diagnosed with Anxiety and Major Depression but still only one rating of general anxiety (9400). How can I get these separated into four different rating. Lumbar strain, sciatica, anxiety and depression? Or is this the way that it is?

You wont. there is no rating for Sciatica as it is the sciatic nerve associated with Lumbar problems. The regs state to rate the nerves separate. If the IVDS rating you have is separated then you are OK.

The mental anxiety and depression may be considered pyramiding if both are rated.

Find and post your Codes. That will help a lot.

J

[sharon]

Dont give up. Tho some of them are combined, another possibility is that the RO just plain secretly denied one of your claims. They dont use the word secretly denied, instead they use the word "deemed denied". It is a giant ripoff to Vets. Here is how it works. You apply for two or more unrelated benefits..say, hearing loss, and loss of use of your leg. They deny (or award) hearing loss and dont mention loss of use of your leg. Loss of use of your leg is "deemed denied" and YOU MUST appeal it within a year even when it is not addressed. Since most Vets do not appeal this, the VA pulls a fast one on you. After a year passes, it is extremelely difficult to appeal, you now have to prove "Cue". You are going to have a big fight on your hands if you dont appeal a claim that the Regional Office messed up and never addressed it.

There are hundreds of "deemed denied" cases..that means the RO never addressed your claim so it was, therefore denied.

It is one of many "dirty tricks" the VA pulls on unsuspecting Veteran claimants.

Dont believe the VA would do this? Do a search using "deemed denied" and you will find many, many instances this happened.

http://www.fedcir.gov/opinions/05-7155.pdf

[nyc-vet]

One of my back issues is 5003/5242 and the other is 5237 Lumbosacral or cervical strain

5242, 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

or 2 or more minor joint groups, with occasional incapacitating

exacerbations...................................................................

................................. 20

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

or 2 or more minor joint groups...................................................................... 10

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 code 5013 to 5024, inclusive.

The rater didn't even address the nerve issue. I looked at my physical exam it clearly falls under the periphial never section. I don't know how they missed this?

My anxiety code is 9400 I was never rated or denied for depression so I don't have a code to give. But reading the CFR book it would fall under code 9434

[WHOLESALE]

I agree.......They will probably come at you with something like "DEPRESSION WITH ANXIETY." Something to that effect. Or they may rate you with depression and use anxiety as a symptom to conclude a rating percentage.

Jay

Anxiety & Depression wont' be rated separately. Mental Health issues are always rated together no matter how many you have. Strange but true.

I don't know about the other things.

[mags1023]

[broncovet]

To fight against "deemed denials" you have to go all out. It is the VA declaring war on you. I am convinced the regs do not allow it, but they get away with it time after time.

This is why the VA cant get away with it:

Moody states:

"The appellant argues that the Court of Appeals for Veterans Claims erred in construing our decision in Roberson. In Roberson we held that the VA has a duty to “fully and sympathetically develop a veteran’s claim to its optimum,” 251 F.3d at 1384 (quoting Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1998)), and that this requires the VA to “determine all potential claims raised by the evidence, applying all relevant laws and regulations.”

When the VA "blows off" a Veterans claim, they have violated the above regulations in Moody, and Roberson.

When you do your appeal, be it a DRO or BVA CAVC etc, I suggest you quote Moody and Roberson, above. Moody is available here:

http://www.ll.georgetown.edu/federal/judic...ns/03-7119.html

[nyc-vet]

From what I can see they blew off the nerve issue down my left leg even though I was clearly examined for it. Then later on that day the examined my back and neck.

back is 40%

neck is 20%

nothing for nerve issue. There is nothing in my award letter even addressing it. My only guess is they combined the back and the nerve issue. In the letter cover sheet they describe my back conditon as "Lumbosacral strain with myofascial and facet related pain and lumbosacral radiculopathy"

It got 30% for Anxiety disorder, they didn't describe it as "depression with anxiety" or "Anxiety with depression"

That is why I am wondering should I at least seek clarification on what happened with the radiculopathy and depression diagnosis.

I know for sure radiculopathy should be a seperate rating. I will just have to deal with the anxiety/depression as one it appears.

[mags1023]