Question Concerning Possible Secondary Condition

[lt4ds]

I have a question about service connected and secondary claims

I have had 2 previous C & P exams for my back, knees and shoulder

I am currently rated:

40% for Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease

20% Paralysis, incomplete, moderate, right sciatic nerve

10% tinnitis left ear

10% bilaterally knees for DJD

I have an appealable claim for left shoulder residuals from surgery post service for symptoms that manifested during service.

I recently had a 3rd C & P for a few other claims seemingly unrelated to any of the above listed claims. The examiner asked if I used my shoulders and arms more when lifting, sitting, raising from a sitting position, and other activities, and if I had headaches or tingling numbness in my hands. This C & P has resulted in numerous appointments, including an MRI for cervical spine that had a diagnosis of HNP (severe impingement) c5-c6, osteophytes(9mm), neuritis, and carpal tunnel. The MRI was listed as "STAT" on the appointment letter. I have an EMG/NVC scheduled for Upper Extremities. All of these have happened at a much faster pace than I have normally experienced with the VA.

I have a question about the cervical spine being considered secondary to the lumbar spine.

The original C & P specifically cited "no noted abnormalities of cervical or Thoracic spine".

The second C & P was dramtically different

Diagnosis:

Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease

Paralysis, incomplete, moderate, right sciatic nerve, as likely as not secondary to service connected lumbar spine condition.

impacts:

decreased mobility, problems with lifting and carrying, pain

prevents: exercise, sports, recreation

severe: chores

moderate: shopping, traveling, bathing, dressing,

mild: toileting, grooming

none: feeding

My activities are severely limited as a result of the problems with my back, so my question is:

1. Likeliness of a rating for the cervical spine as secondary to lumbar spine, even if the C & P was not for my cervical spine.

2. If I do not recieve a rating for the problems with my cervical spine, should I start a claim.

I have assumed the back pain was natural with the arthritis and DDD so my cervical spine has never been a specific complaint to a doctor. It seems apparent that I have progressive issues with my spine over the previous 3 years

Note: All appointments for my lumbar problems and cervical spine have been with VA doctors.

Thanks for any and all responses.

[cooter]

Just thought this might help you as far as the norm's for ROM regarding the Cervical. Didn't know if you had this info or not.

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.

[john999]

that is why I say to wait for your decision since the va may SC you for the neck. If they don't then get the IMO to show secondary condition. Are you working or are you tdiu?

[lt4ds]

Thanks for the advice, I am pretty sure I should hear something in regards to the current claim within the next 4 weeks, so I should be able to make a decision concerning further action.

As far as TDIU I have not filed, but have thought seriously about it in the last few months. I am currently semi-retired. I had to have a break from work because of increasing problems with my lumbar spine. I actually started the form yesterday to begin the process, although I have some concerns about the amount of medical evidence. I have always been reluctant to seek medical advice for aliments, raised with the "rub some dirt" attitude, and it has carried over from childhood. I usually only visit a doctor when it's a cut it off or cut it out situation, which I know in this case doesn't help. I guess it will be a learning opportunity on TDIU as well.

that is why I say to wait for your decision since the va may SC you for the neck. If they don't then get the IMO to show secondary condition. Are you working or are you tdiu?

[lt4ds]

Thanks for the info, it confirms what I thought, my ROM measurement fall outside the normal range. I was just unsure about the secondary rating, but I should hear something within the next 4 weeks or so, I recieved the "Still working on your claim" letter last week, so I am expecting some answer soon.

By the way, I have an uncle named Cooter, funny, that's his real name.

Just thought this might help you as far as the norm's for ROM regarding the Cervical. Didn't know if you had this info or not.

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.

[lt4ds]

What about things (not currently rated) in the C & P exam that are stated as resulting from SC issues?

Hip

Active Range on Motion for each type of motion of this joint :

Flexion: to 80 degrees

extension: to 0 degrees

adductions: to 25 degrees

abduction: to 45 degrees

internal rotation: to 40 degrees

external rotation: to 60 degrees

Note: pain is caused with active excursion and is due to back condition and not due to intrinsic hip joint disease: passive excursion is tolerated with normal flexion to 90 degrees.

Is there objective evidence of pain on active motion: yes

Is there pain on motion after at least 3 repetitions of ROM: unable to test

Additional limitations: no

reason unable to test: baseline pain with active excursion and baseline impairment makes testing an undue burden

Thoraco-lumbar spine ROM

active motion:

Flexion: 0 to 20 degrees

extension: 0 to 0 degrees

left lateral flexion: 0 to 10 degrees

left lateral rotation: 0 to 10 degrees

right lateral flexion: 0 to 10 degrees

right lateral rotation: 0 to 10 degrees

Objective evidence of pain: yes

additional limitations after 3 reps: unable to test

reason unable to test: baseline pain and impairment

Foot exam

right/left

Abnormal findings: weakness, circulatory disturbance

dscription of abnormal findings:

unable to abduct, normally plantat flex toes at MTP joints

very cool to touch

absent ankle jerk

knee jerk hyperactive

Sensory exam:

sciatic nerve right/left lower

vibration: absent

pain/pinprick: decreased

location: entire limb, more severe anterior thigh, medial calf, and foot

light touch: decreased

dysesthesias: yes burning pain anterior thigh

description of other motorimpairment: unable to abduct, plantar flex toes either foot, marked weakness of right EHL; increased tone in both calves; mild atrophy distal quadriceps

effectson usual occupation and resulting work problems:

leg symptoms due to SC degenerative disc disease limit walking, standing, sitting and similar activities of the lower extremities.

hypertonicity of bilateral plantar flexor muscle groups with overuse related to pain; etiology is likely as not disuse due to severity o SC back and sciatic nerve conditions.

that is why I say to wait for your decision since the va may SC you for the neck. If they don't then get the IMO to show secondary condition. Are you working or are you tdiu?

[john999]

What I have seen is that if you don't claim it you don't get it.