C&p For Lower Back - Insight From My Examination

[E-4 Marine]

Hi everyone,

I had a C&P for my lower back yesterday and wanted to provide some insight for those who might have an upcoming C&P for a lower back issue.

• The examiner came out to meet in the waiting area, where it appeared he was monitored how I got up from my chair and how I walked to the exam room.
  
• Once we entered the exam room he looked at my file and asked the following questions: when did the injury first occur, last time I was seen for my back by the VA or outside clinician, and medications and procedures that I have had. He continued to read my chart and entered some things into the computer.
  
• While reading my chart he asked that I remove my shoes and shirt in preparation for the exam.
  
• He asked to me to face the wall away from him and he checked the alignment of my spine for abnormal curvatures. He then had me lay down on the examination table and asked that I perform alternate foot raises. I then sat up and he checked reflexes in my knees, ankles, and performed the Babinski test.
  
• I was asked to stand and he explained that he will check my ROM (goniometer was available). I faced the wall; he checked my ROM lateral, front, and back, then he asked that I kept my hip straight and twist my back like I was reaching for something behind me and he measured that ROM. With every ROM he asked that “Is that the farthest you can go?” I replied yes sir.
  
• He asked me to sit down on the examination table again he performed a pin prick test to see if I can feel the sensation of a pin pricking the sides of my legs. At this point he informed me that all ROM checks are done twice. So he had me stand up face the wall and perform the ROM movements again.
  
• At that point I was told that the examination portion of the C&P was done and that I could get dressed and put my shirt and shoes back on.
  
• I sat down on the chair and he asked me questions that appeared to be on the DBQ form (i.e. how do injury affect veterans daily living, job, how much weeks have I missed from work due to the injury, etc…)
  
• He then ordered an x-ray of my back and said that I was done and accompanied me to the waiting area.
  

In general the appointment was about 50 minutes long must of which was spent answering questions. I would urge veterans to review the questions on Spine examination sheet and DBQ form; wear loose fitting clothes (especially shoes) that can be removed easily. The examiner monitors your every move even when it seems like they are distracted entering something in the computer. Know your ROMs (before the exam test your ROM so you know your limitations and be sure that you can repeat the ROM consistently, when asked). Lastly be polite to everyone and thank them for their time and care for veterans. I have to add that the C&P examiner was very nice and seemed like he cared.

Semper Fi,

Oli

[Carl the Engineer]

E-4 Marine,

Sounds like how mine went. I got rated 20% for ROM.

For all those talking about a MRI, please explain how that helps out. From what I read, ROM is the only thing that will get you any higher than 10%. Unless your back us completly fused (?). Let me know what I am missing.

I ended up with Foresters Syndrome with DDD and DJD of the spine, however, again, was rated 20% for ROM. How would a private MRI help E-4 or me?

Good luck with your rating E-4,

Hamslice

[jbasser]

The raings are based off of Range of motion, A Mri may Nerve involvement and that may up the rating as the nerves are to be rated separately.

[Rover]

Thanks for sharing your C&P exam experience. My examiner also went by the worksheet to check ROM.

Hi everyone,

I had a C&P for my lower back yesterday and wanted to provide some insight for those who might have an upcoming C&P for a lower back issue.

• The examiner came out to meet in the waiting area, where it appeared he was monitored how I got up from my chair and how I walked to the exam room.
• Once we entered the exam room he looked at my file and asked the following questions: when did the injury first occur, last time I was seen for my back by the VA or outside clinician, and medications and procedures that I have had. He continued to read my chart and entered some things into the computer.
• While reading my chart he asked that I remove my shoes and shirt in preparation for the exam.
• He asked to me to face the wall away from him and he checked the alignment of my spine for abnormal curvatures. He then had me lay down on the examination table and asked that I perform alternate foot raises. I then sat up and he checked reflexes in my knees, ankles, and performed the Babinski test.
• I was asked to stand and he explained that he will check my ROM (goniometer was available). I faced the wall; he checked my ROM lateral, front, and back, then he asked that I kept my hip straight and twist my back like I was reaching for something behind me and he measured that ROM. With every ROM he asked that “Is that the farthest you can go?” I replied yes sir.
• He asked me to sit down on the examination table again he performed a pin prick test to see if I can feel the sensation of a pin pricking the sides of my legs. At this point he informed me that all ROM checks are done twice. So he had me stand up face the wall and perform the ROM movements again.
• At that point I was told that the examination portion of the C&P was done and that I could get dressed and put my shirt and shoes back on.
• I sat down on the chair and he asked me questions that appeared to be on the DBQ form (i.e. how do injury affect veterans daily living, job, how much weeks have I missed from work due to the injury, etc…)
• He then ordered an x-ray of my back and said that I was done and accompanied me to the waiting area.

In general the appointment was about 50 minutes long must of which was spent answering questions. I would urge veterans to review the questions on Spine examination sheet and DBQ form; wear loose fitting clothes (especially shoes) that can be removed easily. The examiner monitors your every move even when it seems like they are distracted entering something in the computer. Know your ROMs (before the exam test your ROM so you know your limitations and be sure that you can repeat the ROM consistently, when asked). Lastly be polite to everyone and thank them for their time and care for veterans. I have to add that the C&P examiner was very nice and seemed like he cared.

Semper Fi,
Oli

Great Write up.........

[cham1968]

E-4 Marine

Thanks that was great information and I will defnitely need it as I move slowly up the BIG hill.

God Bless Good luck with your ratings

[SueEdel]

How you you decipher what limited ROM is? I have a copy of my C&P. Not sure how to add up numbers to see how limited they believe my ROM is. It does state that "Physical work requiring repetitive lifting and bending would be impaired". Is it all about Flexion or is the painful motion an issue too?

[71M10]

Your ROM for rating purposes should be the pain-free ROM. If forward flexion was 75 Degrees total, but painful motion started at 40. Your rating should be based on 40 not 75. They should have done each measurement 3 times and average the results.

The rating schedule as it relates to ROM looks at Forward flexion, total of all (forward, extension, side bending, rotation...) and compares it to the total of the normal values for the joint. I have inserted the back ROM portion from the Schedule.

General Rating Formula for Diseases and Injuries of the Spine (For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes): With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine 100 Unfavorable ankylosis of the entire thoracolumbar spine 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine 30 Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis 20 Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height 10

Best regards,