Schuermann's Kyphosis; Preexisting Or Not And Does It Matter For Comp?

[AMMOroadkill]

Hi all, First post so hopefully Im doing this right...

A VA ortho surgeon/spine specialist diagnosed me with Schuermann's Kyphosis and says that there is nothing that I could have done in the service that would have aggravated this condition.

At the time of diagnosis he would not listen to my story. He wouldnt even give me a chance to make a rebuttal in the initial meeting (when the diagnosis was made.) In a later phone appt. I interrupted him and told him to listen. Even though he made the diagnosis he says that he can not change it and that it is now a matter for C&P to decide whether or not it was aggravated or caused by my military service.

I had a bad fall on my pelvis and jammed my spine. Problem is that I was AF and went to a Navy ER and the records never got transferred or got lost. I also worked VERY hard lifting alot of VERY heavy items and have many complaints of back pain/problems in my SMRs. There is a notation in the records of my very first visit to the VA (5 yrs prior) of the fall and there is a notation of the fall in my SMRs that say that they are awaiting x-rays from a fall as I described but there is no follow up and there are many missing records of visits to the Dr. for this fall. My SMRs also show that the records that were transferred to my forwarding base were incomplete/lost.

I had a recent C&P exam and the examining doc would not acknowledge and would not even let me talk about the problems in relation to my thoracic spine which include severe muscle spasms, 7 out of 10 pain on most days and literally zero flexion. He also (acted like) was in the dark or had no information concerning the compression fracture at t-12 (minor at 7degrees) and a whole slew of other problems in my thoracic region (enough for a diagnosis of schuermann's).

At the C&P exam the doc raised me from 10% (which I have been since my initial award in 06) to 40% for degenerative arthritis of the lumbar spine... my original claim was purposely vague for "back condition" to include both the identified lumbar pain/problems at my time of separation as well as the unidentified thoracic issues.

To clarify, I have three main questions;

1. Is Schuermanns Kyphosis compensable or not?

2. Seeing as how the thoracolumbar spine is all rated as one disability does the name for the rating actually mean anything

3. Can they actually say that my military service did not aggravate this condition? I could walk upright when I joined and moved like an old man at the time of my discharge... and I still do.

Edited September 5, 2012 by AMMOroadkill

[USMC5811]

Welcome to hadit.com AMMOroadkill! Just my two cents..................

3. Can they actually say that my military service did not aggravate this condition? I could walk upright when I joined and moved like an old man at the time of my discharge... and I still do.

The VA doctors can say whatever and actually did in your case - which is why it is always good to get at least one IMO from a private physician/specialist that states otherwise = that your military service could and did aggravate this condition. I looked up Schuermann's Kyphosis in the Hadit.com search engine - 2 posts came up from vets with the same condition. In one of the posts a member referred the OP to Prec3-2003 - Requirement for Rebutting the Presumption of Sound Condition under 38 USC 1111 and 38 CFR 3304 which is an interesting read. It can be found here: http://www.va.gov/og...entopinions.asp

The 2 posts may be found here: and

2. Seeing as how the thoracolumbar spine is all rated as one disability does the name for the rating actually mean anything.

The diagnostic code that is used for rating can make a difference in the rating where the thoracolumbar spine is concerned. ie.,

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 (whether 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

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.

See here for further of the various DC's pertaining to the spine: http://ecfr.gpoacces...0.1.1.5&idno=38

At the C&P exam the doc raised me from 10% (which I have been since my initial award in 06) to 40% for degenerative arthritis of the lumbar spine..

Just so that others understand....even if you already do - C&P Doctors do not actually raise your rating/percentage - they do submit a medical opinion and are suppose to conduct tests review your previous records etc in order to come to that opinion. Raters at the Regional Office determine the rating. They are suppose to look at ALL the evidence they have and that is submitted to include independent medical opinions, exams and records, SRB, SMR etc and yes, the C&P exam in order to rate your claim.

Edited September 5, 2012 by USMC5811

[71M10]

AMMOroadkill,

To shoot this down and tear this up you will need an IMO.

They have tried this schuermanns crap with me, but the fact I had a clean enlistment physical put them in check in a hurry. It came up again 2 years ago with a manual medicine doctor who wanted to call it schuermans, in our discussion he pointed out that skeletal development in many, continues into thier 20th year.

Three questions for you:

How old were you when you joined?

What did you do (any work in hunched spaces like a munitions loader on a plane)?

Is there any identification of the condition pre-existing service on your enlistment physical?

Even if it is Schuermans, if you were young enough, and the type of work you did had you working with heavy loads in a stooped over positon, it should be covered. People may have a genetic predispotion for Schuerman's but many will not acquire it because they lacked the environmental conditions to cause it to happen. A good manual medicine doctor could address this in an IMO.

This may be a moot point though because it sounds like you have a spine rating already?

As far as ratings, ratings based on range of motion combine the lumbar and thoracic spine. So them labling the thoracic spine as schuermans doesn't necessarily create a problem until you start discussing secondary conditions such as nueropathy or chest wall compliance problems. SC for your lumbar cannot be reversed if it has been in effect for at least 10 years unless they can prove fruad.

Best regards,

Edited September 19, 2012 by 71M10

[ketchup56]

Hi all, First post so hopefully Im doing this right...

A VA ortho surgeon/spine specialist diagnosed me with Schuermann's Kyphosis and says that there is nothing that I could have done in the service that would have aggravated this condition.

At the time of diagnosis he would not listen to my story. He wouldnt even give me a chance to make a rebuttal in the initial meeting (when the diagnosis was made.) In a later phone appt. I interrupted him and told him to listen. Even though he made the diagnosis he says that he can not change it and that it is now a matter for C&P to decide whether or not it was aggravated or caused by my military service.

I had a bad fall on my pelvis and jammed my spine. Problem is that I was AF and went to a Navy ER and the records never got transferred or got lost. I also worked VERY hard lifting alot of VERY heavy items and have many complaints of back pain/problems in my SMRs. There is a notation in the records of my very first visit to the VA (5 yrs prior) of the fall and there is a notation of the fall in my SMRs that say that they are awaiting x-rays from a fall as I described but there is no follow up and there are many missing records of visits to the Dr. for this fall. My SMRs also show that the records that were transferred to my forwarding base were incomplete/lost.

I had a recent C&P exam and the examining doc would not acknowledge and would not even let me talk about the problems in relation to my thoracic spine which include severe muscle spasms, 7 out of 10 pain on most days and literally zero flexion. He also (acted like) was in the dark or had no information concerning the compression fracture at t-12 (minor at 7degrees) and a whole slew of other problems in my thoracic region (enough for a diagnosis of schuermann's).

At the C&P exam the doc raised me from 10% (which I have been since my initial award in 06) to 40% for degenerative arthritis of the lumbar spine... my original claim was purposely vague for "back condition" to include both the identified lumbar pain/problems at my time of separation as well as the unidentified thoracic issues.

To clarify, I have three main questions;

1. Is Schuermanns Kyphosis compensable or not?

2. Seeing as how the thoracolumbar spine is all rated as one disability does the name for the rating actually mean anything

3. Can they actually say that my military service did not aggravate this condition? I could walk upright when I joined and moved like an old man at the time of my discharge... and I still do.

[ketchup56]

When smr's records are lost are go missing while in the hands of the government, the government assumes a "heightened duty" to assist the veteran in the development of a claim. Make sure you mention this in all communications with the vba , as they will NOT let you know this. Schuermanns disease by vba law exisisted before military service, BUT it is commonly aggravated by physical activity, and long periods of standing OR sitting. There is also no knowned cause of this condition. IMHO i would let vba state that it pre existed military service then get them on the "aggravation prong" of the PRESUMPTION OF SOUNDNESS RULE 38 USC 1111& 1132 AND 38 usc 1153 IF APPLICABLE. There is an high "Onerous "burden on vba to rebut this presumption. The veteran is relieved of the burden of proving increase in severity during service forcing vba to prove by "clear and unmistakable evidence standards" which does not include the vba's less likely, at least likely bs. Any two different IMO'S saying opposite opinions should get you service connected by aggravation under the benefit of doubt theory. Are there any other secondary conditions such as sciatica, deg. disc disease, stenosis, pain etc.. i would claim as secondary and aggravated by the schuermann's kyphosis. This condition could also be "SUPERIMPOSED" on by disease or injury. (see VAOPGCPREC 82-90 JULY 18, 1990). All the previous post on this thread are DEAD ON POINT on the way to pursue your case. Good luck.

[AMMOroadkill]

First off, thanks for the replys.

71M10 in answer to your questions;

-I was 22 when I joined, I had a job of one form or another from the time I was 14 and I worked construction and manual labor from HS graduation to a couple weeks prior to my joining the AF.

-As for being stooped/hunched over all the time, I am (was) over 6'3" tall and the safe drop distance on most of our munitions was less than 30". If I wasnt hunched over while working I was ducking to keep from hitting my head... and Ive got a few scars to prove it... and all of it included heavy lifting. I am barely 6'2" now.

-My enlistment physical is clean other than a slight scoliosis that the doc said was most likely due to heavy manual labor and being predominantly right handed.

I dont agree with the Schuermanns at all because the timeline of my condition doesnt correlate to what Ive read about the onset of Schuermanns. The VA doc said that he gave me this diagnosis based on the extreme stiffness of my spine, the evidence of multiple schmorls nodes and the wedged vertebra, and the extremely tight hamstrings. I had never heard of this disease before at the time of diagnosis. I listened to him while he explained the typical onset of the disease and when I told him that didnt match at all he just kept talking over me and not listening.

As for the accident, I didnt mention that after I hit the ground on my tailbone, I had another guy fall on my back hard enough to bounce my head off the floor between my knees hard enough to knock me out. On a positive note, I had the whole squadron there to witness it as it happened while playing basketball on a squadron PT day.

I agree that an IMO is necessary but there is no way in hell I can afford one at this time.

Ketchup56;

I have a lot of secondary symptoms, all that you listed as well as worsening problems with my shoulders and SI joints, not to mention the effects of being on opiates for the past 6 years.

USMC5811;

Thanks, I was aware that the C&P docs dont grant the percentages... but their observations and opinion do have a fairly significant role. In this case I have seen this Dr three separate times for C&P exams on my back and not once has he ever used a goniometer. ...Ive also read through more than a couple complaints on QTC medical examinations...

One of my questions was what constitutes an incapacitating episode? I have numerous episodes a month that take me out for days(3-4) and a couple (2-3)times a year I have them that will take me out for a month or more. The last long one lasted from October - July...

If it werent for the medication (opiates, muscle relaxers and NSAIDS) I would barely be able to move on the best of days.

I have been going to the VA now for 6 years and have only been prescribed bed rest one time, and that was by an ER doc. At my next primary care appointment my doctor said that my back condition was being complicated by underlying somatic issues and cancelled my pain medication. I was in tears and asked him if he thought "it was all in my head then" and "What in the hell does it take to see a specialist around here?" When I asked him this I could barely stand and my left hip was visibly out of line by 3" at least (identified as mild retrolisthesis in my records...)

The "diagnosis" of somatic complaints was used by the VA to knock down/deny the results of every C&P exam up until I finally saw a specialist nearly two years later... and is currently being used to deny back pay as my "VAMC medical records do not show my condition as worsening" until then even though the numbers from prior exams support it except for them being denied due to "somatic complaints", and prior to that they just said that my VA medical records did not support the results from the exams.

Fun stuff... and Im sure alot of this would fall under different headings on here.

I also have an open claim for individual unemployability and I couldnt say at this time whether its looking good or not. They keep asking for more info and sending me to more C&P exams...