Does Anyone Know The Answer?

[gamorris]

When are the bed rest days calculated? Is it when the claim was first processed, or the date of the C & P exam???? I do have prescribed bed rest for back pain, but do not know when the VA actually calculates the days within a year period. Thanks for all responses.

[jbasser]

here is the criteria:

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months 60

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months 40

With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months 20

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months 10

Note(1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note(2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

J

[gamorris]

here is the criteria:

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months 60

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months 40

With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months 20

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months 10

Note(1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note(2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

Thanks for the reply! I wanted to know when the 12 month clock starts. From the date of the claim, after the C & P exam, or the current calendar year.. As an example; A claim is dated June 2010, there were a total of six weeks of bed rest prescribed from July 2010 to November 2010. No decision has been made on the claim yet, C & P done September 2011, decision to follow sometime within the next 6 weeks. When do they (the VA) count the bed rest period since a decision wont be made until November 2011....

J

Edited October 7, 2011 by gamorris

[jbasser]

There is really no set time limit. just as long as you can show the bed rest verses the rating schedule.

J

[gamorris]

There is really no set time limit. just as long as you can show the bed rest verses the rating schedule.

J

Thanks, I really appreciate your time!