Degenerative Disc Disease - 'chronic' Defined?

[Vync]

In terms of degenerative disc disease, what would the VA constitute as 'chronic'?

Would one of these definitions suffice or do they look at more defined time periods?

1 a : marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness : not acute <chronic indigestion> <her hallucinations became chronic> b : suffering from a disease or ailment of long duration or frequent recurrence <a chronic arthritic> <chronic sufferers from asthma>

2 a : having a slow progressive course of indefinite duration—used especially of degenerative invasive diseases, some infections, psychoses, and inflammations <chronic heart disease> <chronic arthritis> <chronic tuberculosis>; compare acute 2b(1) b : infected with a disease-causing agent (as a virus) and remaining infectious over a long period of time but not necessarily expressing symptoms <chronic carriers may remain healthy but still transmit the virus causing hepatitis B>

[*Bergie*]

In terms of degenerative disc disease, what would the VA constitute as 'chronic'?

Would one of these definitions suffice or do they look at more defined time periods?

1 a : marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness : not acute <chronic indigestion> <her hallucinations became chronic> b : suffering from a disease or ailment of long duration or frequent recurrence <a chronic arthritic> <chronic sufferers from asthma>

2 a : having a slow progressive course of indefinite duration—used especially of degenerative invasive diseases, some infections, psychoses, and inflammations <chronic heart disease> <chronic arthritis> <chronic tuberculosis>; compare acute 2b(1) b : infected with a disease-causing agent (as a virus) and remaining infectious over a long period of time but not necessarily expressing symptoms <chronic carriers may remain healthy but still transmit the virus causing hepatitis B>

VYNC,

Good job, but let me add that in the medical field "chronic" is longer than 6 months in duration. But the rest of your info is correct.

JMO,

Bergie

[Pete53]

chronic means in plain English an injury that is not going to get better and probably will get worse over time.

Many on this Board are fighting or trying to fight the hammer of injuries that may remain static or slightly improve but will never go away and for many it means a shorter life with more suffering than most of our buddies who did not serve.

Treatment is usually a game plan to help mediate the injury.

God Bless all who have gained their earned benefits and the many who are still struggling. Every nigh part of my prayers is for grace for all on this Board to deal with their injury but also the affliction.

If you read my signature I hope that those who are fighting get some hope that not all of the VA is jacked up.

[vaf]

My opinion only, but for VA disability rating purposes, I think "chronic" only means what 38 CFR 3.303(b)says it means, which is:

(b)Chronicity and continuity. With chronic disease shown as such in service (or within the presumptive period under §3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim."

And a big find I often use in appeals -- evidence of chronic symptamotology, not to be confused with evidence of continuous treatment, is sufficient to prove service connection.

CONTINUITY OF SYMPTOMATOLOGY, NOT TREATMENT

“The Court notes that symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” See Savage v. Gober, 10 Vet.App. 488, 496 (1997) citing Wilson v. Derwinski, 2 Vet.App. 16, 19 (1991) (“regulation requires continuity of symptomatology, not continuity of treatment”).

The VA likes to cite little to no evidence of treatment for conditions as grounds for denial, even when the vet's service medical records and medical records after separation are replete with medical evidence that a condition does, in fact, exist.

Edited April 21, 2010 by vaf

[Vync]

Vaf,

That info was really good.

Here are the facts (all of this is documented)

- Entrance physical: No clinical findings. I checked 'no' on the 'recurrent back pain' box.

- 8 (or more) lumbar injuries (fall, car wreck, moving furniture, etc...) in 5 years of active duty

- One Army doc indicated recurring LBP x 1 year, worsened by moving heavy furniture.

- Other notes indicate strains, sprains, and lumbar flattening

- Exit physical: no clinical findings. Doc noted "Hx of recurrent low back pain"

- The Army did not diagnose DDD

- 19 months after I got out, the VA diagnosed DDD during my first C&P exam

- 8 years later, cervical bulges/osteophytes per MRI

- 2 years later, DDD advanced to the point of 2 herniations. Radiologist's reading of MRI included chronic DDD.

- 2 pain blocks in last six months

- C&P range of motion values are in the toilet

Additionally, I had other injuries not listed here (pugil stick injury to base of neck, shoulder, knees, feet, etc...), documented while I was on active duty.

Add this in too:

The Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005).

And this too ( http://www.hadit.com/forums/lofiversion/in...php/t34224.html )

(not sure if I snipped this right)

Washington v. Nicholson, 21

Vet.App. 191, 195 (2007) (holding that, "[a]s a layperson, an appellant is competent to provide information regarding visible, or otherwise observable, symptoms of disability"). Further, lay evidence maybe competent to show continuity of symptomatology under 38 C.F.R. § 3.303. See Davidson, ___F.3d at___, slip op. at 3 (rejecting the view that "competent medical evidence is required . . . [when] the determinative issue involves either medical

etiology or a medical diagnosis."

I love that last one, the underlined part. Does that mean that we don't need a doctor's nexus?

I can also cite this too:

http://www4.va.gov/vetapp10/files1/1002995.txt

- Very similar scenario. Veteran had a 20 year gap of treatment records, but they gave him benefit of the doubt,

I always have stated that the symptomatology (low back pain) was caused by active duty injuries and continued, even during periods where I have no treatment records.

Would all that be sufficient to counter the C&P examiner's statement (below) and indicate the problem was and is chronic?

- Treated intermittently for low back pain while in service

- Records are silent with regards to chronic low back pain until 2006 (disc herniations)

[calton]

My rating decision for Degenerative Disc Disease, cervical spine, dated April 7, 2010 states,

The rating criteria was revised Sept 23, 2002. Under the New criteria, "an evaluation higher than 40% must demonstrate incapacitating episodes of intervertebral disc syndrome haveing a total duration of at least 6 weks during the past 12 months; or unfavorable ankylosis of the entire spine with or without sumptoms such as pain(whether or not it ratiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease." If this is of any help!

[cannoncocker]

calton, I have a question for you or anyone who may have an answer to this but the definition for CDD is the 6 week incapacitation or unfavorable ankylosis of the entire spine. Do you have to be SC'ed for the entire spine or sc'ed for one portion but the entire spine in an unfavorable ankylosis condition? It would seem to be a high mark to have your entire spine SC given their natural tendency to deny any back related claim.

"(rejecting the view that "competent medical evidence is required . . . [when] the determinative issue involves either medical

etiology or a medical diagnosis."

I do not believe the VA is going to give any credence to an individuals diagnosis or medical testimony aside from symptomology without documented credentials indicating the necessary training/education to prove professional comptence. I would have to see that citation in action. The implications from that would be overwhelming. I am going to study that one!