Spinal Arthritis

[mooose]

Greetings to All,

In 2010 I injured my lower back from lifting. I am currently SC 30%, 10% of that is for lumbar degenerative disc disease with intermittent radicular symptoms, I was awarded the service connection about 2 yrs ago. In the past 4 months my leg/nerve pain has gotten significantly worse. It has started bothering in more and more places, not just my legs. The location of the bulging disc has become more painful, with sensitivity in other areas of the spine. With all that said, I got a civilian referral for a Spine Dr. During the visit he looked at my new MRI and said that I had arthritis in my spine, "beefy joints"-his words. He said the combination of the bulging disc and the arthritis was causing all my issues. It explains a lot about how I feel, in the morning, etc.. I am only 33 years old and still work full time, but I can easily imagine how my medical issues could put me out.

I am trying to figure out if I should file and what to file for, it looks like there are a ton of codes out there associated with the back?

Arthritis? DDD? Hip issues? Depression? They could all be applicable in my mind.

The only nexus would be from the original claim or IMO if needed.

I know I need to have me ducks in a row before starting this process again.

Not sure if it should be filed separately from the initial injury or as a condition that has gotten worse?

Any input would be greatly appreciated.

-moose-

Edited April 22, 2013 by mooose

[jlrith]

I am rated for an almost idential problem; here is my 2 cents:

All spine problems are primarily rated under limitation of motion (look up "General Rating Formula for Diseases and Injuries of the Spine" in 38 CFR Vol 1, part 4)

or incapacitating episodes.

Since the incapacitating episodes are 'Dr prescribed bed rest' its unlikely that will apply.

That covers your bulging disk and arthritis, regardless of how many bits of your back are involved.

In my experience that rating is much lower than the impact the disability has.

Here is the good news:

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

I have a 40% rating for my sciatic nerve affecting my leg and a 20% rating for a voiding dysfunction - Urinary frequency (see 38 CFR Vol 1, 4.115a.)

Both of these started after I left the military and both are secondary to my DDD.

Take note of the areas that feel weird from your lower back on down; write it down if need be.

Some of the symptoms I get:

Numbness

Pins and needles

Areas that feel like hot water has been spilled on them

Muscle weakness

Pain, both dull and sharp(feels like a have a red hot steel rod in my leg)

Nerves show up in an MRI, so your Dr should be able to determine if you have a pinched or displaced nerve or if the bulge is abutting the nerve. Get him to write that down and you have your physical evidence for the neurological claim.

One thing I found out and would really help you if your doctor is willing to make note of it: The sciatic nerve exits the spine in something like 4 locations; the specifics of which signals go through which exit varies from person to person. This means there is no map showing that if a certain spinal disc is bulging it will cause these neurological symptoms.

Download 38 CFR vol 1, part 4 (the listing of ratings) and check your symptoms against it. Pay attention to 4.115a, 4.123, 4.124 and 4.124a "diseases of the peripheral nerves" specifically "Sciatic Nerve" and down.

Do your homework and match your symptoms and the symptoms listed in your medical records against the rating list (beware: the nerve names the VA uses aren't always the same as what the medical world uses so you need will have to cross reference.)

When making the claim I use form 4138 and say:

I hereby claim the following disabilities as secondary to my service connected degenerative disc disease:

1- Sciatic: Code 8520: 80%

Justification: Medical exam dated 4/3/21 shows that I have complete paralysis of my sciatic nerve.

2- And so on...

Use the verbage in 38 CFR section 4 whenever possible.

One test the VA may subject you to is an EMG. The put electrodes in your body to stimulate the nerves and read their responses. Its not bad.

If it shows a nerve issue, thats basically iron clad proof you have something wrong. If it shows nothing, don't allow the VA to use that against you: EMGs routinely miss nerve problems; it has been proven that the nerves can be severed and an EMG won't pick up the problems until months later.

It does not matter if you claim it as a new injury or a condition that has gotten worse. It is treated the same way.

These claims suck; it took me about 4 claims and 3 remanded appeals over 7 years plus a different regional office for them to finally get it right.

When you get your decision make sure you keep an eye on what they actually considered, both the disabilities and the evidence they list.

It took me a number of claims for the VA to even acknowledge what I was claiming and they also forgot to look at pertinent evidence.

If the disability is not listed in your decision letter, it has not been adjudicated ( I received 7 years of retro because of that.)

If the evidence is not listed in your decision letter, it was not considered; you can appeal on that basis alone.

I have claimed depression as secondary to my back problem. Its in the "Rating Phase" right now. Who knows, they might decide before Christmas.

I also made the mistake of taking my pain medication when going for a neurological C&P exam.

Low and behold, it ended up being a full neurological and lower back workup. Wouldn't you know it, my range of motion was pretty good, so they bumped my DDD from 40% to 20%...Thats on appeal.

Feel free to ask if you have additional questions.

Good luck.

[meghp0405]

You can request a re-evaluation on your service connected disabilities. If you have additional conditions that are secondary to the SC disabilities, then you can submit a claim for those also. Obtain a appointment with your doctor and have him/her place in writing about how your back has worsened and that the conditions you want to add, are secondary to your SC disabilities. Submit this with a VA FM 21-526ez and your claim will go faster.

[mooose]

Jlrith,

Thank you so much for your input. Everything you said makes sense. I do have a EMG scheduled for this Friday and am worried that it won't show much cause my nerves do not hurt real bad all the time.

On a side note I have a doc of emergency medicine doing a IMO for the following conditions that affect me. These are what I am filing for, VSO helping me now too

Increase in lumbar DDD.

Middle back DDD.

Cervical DDD.

ED

Constipation

Neuropathy in all extremities.

I am currently be treated by the VA for PTSD stuff, so I am filing for it to. There should be enough evidence in my current VA notes to lock this in. Also submitting stressor letter, wife letter, and sister letter. Taking meds for it.

Hopefully I can add my EMG results to claim..

[jlrith]

No problem Mooose.

I wish I could be more help.

My situation was complicated; the VARO in Reno simply decided to ignore my claims and evidence for 5 years, even through a BVA remand.

I had tons of evidence from private doctors, VA medical and C&P exams.

It finally took a DRO denovo review at the Denver RO to decide my claim. Ended up being exactly what I asked for, all the way back to my initial claim 7 years earlier.

[meghp0405]

jlrith,

you just confirmed what has been stated over and over. The initial people working these claims at the VARO are not doing their jobs! Fire them and place someone in there that has a little common sense.

I know a few people that work in the VBA, and they are stressed every night they get home. The policies that they get placed on them at the last minute, do as I say, not as I do, save the VA money, deny, deny and deny. That's why in large measures why the rating decisions were changed. Use to be when you were denied a disability, the RD told you exactly why it was denied and what you were lacking for that Service Connected disability and what the veteran needed to do for the disability to become service connected. Now, they just say, not chronic, not diagnosed, just simple bullet statements.

[mooose]

One more question, how does one go about trying to get the VA to cover massage or chiropractor in local area?