Dc 5003

[rpowell01]

Can anybody explain this DC to me because I don't understand what it means:

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):

Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:

With X-ray evidence of involvement of 2 or more major joints

or 2 or more minor joint groups, with occasional incapacitating

exacerbations........................................................................................................................................................ 20

With X-ray evidence of involvement of 2 or more major joints

or 2 or more minor joint groups.......................................................................................................... 10

Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.

Note(2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic code 5013 to 5024, inclusive.

It's been proven by Dr. Bash that I do have DDD and Osteoarthritis in my Cervical, Thoracic and Lumbar spines. The VA has appropriately changed my rate to 5002. I have a funny feeling that since they have changed the rating this is why they are Proposing to Reduce my Ratings, which I read last night that this is illegal.

Anyway I am trying to see since I have osteoarthritis in ALL three parts of my spine should my DC be changed to this and be rated at 20% for the cervical and Thoracolumbar. I need to know so I can add this to my amended NOD I am about to file on Monday.

Today I received a packet in the mail from Morgan and Morgan "For the people" who I am using for the services of my two NODs. So, I am set and ready to fight the VA and feel confident enough that I will prevail, mainly after my EMGs coming up in August on my legs. I am going to see if they will do them also on my arms to see how bad the radiculopathy has gotten. I know in my right arm its pretty bad than my left arm. My legs on the other hands are equal. My toes, the right ones are worse than the left ones and on the bottom of my feet the numbness/pain are equal. I hope none of you ever experience any of this but I know some of you guys that have the herniated discs' are in worse shape than me. My pain is like slow torture where your pain is like quick and fast torture. They both are evil and does things to the mind. Makes you not want to live on days...But, for me, these thoughts are quickly overwhelmed by thinking of my wife and children. They are worth every bit of the pain if I have to endure this the rest of my life.

Rob

Edited July 5, 2013 by rpowell01

[rpowell01]

No answers? I was just wanting to know about this DC and how it would apply to my spine.

[sambo808]

5003 is rated based on limitation of motion of a specific joint involves. VA should be checking the limitation of motion in your cervical spine separate from thoracolumbar spine. The middle and lower back (thoracolumbar spine) are rated together. Again, VA should be checking you for limitation of motion in this part of your spine. If the limitation of motion in your cervical spine is non-compensable and the limitation in your thoracolumbar spine is also non-compensation (meaning 0%) then VA would have to assign one evaluation for your cervical spine and thoracolumbar spine based on X-ray evidence of arthritis. The reason is that cervical spine, thoracic spine, and lumbar spine are considered a group of minor joints. If they resort to 5003 then it is either 10% for group of minor joints (cervical spine, thoracic spine, and lumbar spine) or 20% for group of minor joints with evidence of occassional exacerbations. If your medical evidence can show it you should be rated separately for if you have nerve dysfunction in each extremity (depending on the degree of severity of the affected nerves). If there is no identifiable affected nerves it is considered a wholly sensory dysfunction and moderate degree (usually 20%) is the most you will receive. And so you may be able to receive additional separate compensation for right upper extremity, left upper extremity, right lower extremity, and left lower extremity if it is warranted based on the evidence of record. In short, your spine is either rated based on limitation of motion or group of minor joints with X-ray evidence of arthritis. Pain is a cardinal symptom associated with arthritis and so you are not going to get a separate evaluation for pain alone. Hope this helps.

[71M10]

Did they change your code to 5003 or 5002? you quote 5003 but than state they have changed you to 5002 which is reumatoid arthritis(and rated in an entirely different manner).

As for radiculopathy, Do you have any non-service connected maladies that can cause radiculopathy or thier symptoms? If you do, be prepared for them to argue that the other condition are causing the radiculopathy and it is not related to your SC condition.

I have had arthritis for 26 years and kyphoscoliosis. I can appreciate the pain you suffer from.

Hang in there!

[rpowell01]

They changed the DC from Cervical and Lumbar Sprain to Cervical and Lumbar DDD. I don't know the code for the DDD but I am thinking 5243. I was wondering about the 5003 Code since it deals with Osteoarthritis. I can't understand the meaning of that code, it's confusing.

The radiculopathy is only from the Cervical and lumbar. Two EMGs on my arms proved this and I FINALLY get to have an EMG on my legs in late August. My sister in-law told me that she can't be the inhumane treatment I am receiving with the VA. She said if you tell a Doctor you are having pain in your lower extremities the EMG should have been done back then. I told her the whole story of how the VA has totally messed up my treatment up because its been 3 1/2 and I just now started to see Pain Management. She was upset about this and said that I probably now have permanent damage to my nerves. She is an RN so she knows her stuff. She can't believe the VA is treating veterans like this. She said "This is a vicious unfair cycle." She said that its going to get worse and with me being 44 she told me that if I can get in the Spine Program that Dr. Bash is going to refer me to then they might be able to help. She said once it starts it just progresses, mainly in the spine.

I am all good 71M10. I have taken much advice on here and have used all my energy to get ready for the Proposed Reduction of Ratings hearing. I have a majority of the evidence that actually shows how the C&P examiner basically used inaccurate data. I think what happened was the RO didn't get my treatment, MRIs and XRay records from the Tampa VA and those records are the most important ones. During the hearing I am going to ask the officer to see if those records are in the folder. If not then would that be a CUE?

But I am ready for the hearing and just waiting on Dr. Bash and his report and DBQs. Hopefully he will send them soon. He told me he would be a witness at the hearing but I don't have the funds for him to do this, I wish I did.

I appreciate all the help you guys and gals have provided for me.

[rpowell01]

5003 is rated based on limitation of motion of a specific joint involves. VA should be checking the limitation of motion in your cervical spine separate from thoracolumbar spine. The middle and lower back (thoracolumbar spine) are rated together. Again, VA should be checking you for limitation of motion in this part of your spine. If the limitation of motion in your cervical spine is non-compensable and the limitation in your thoracolumbar spine is also non-compensation (meaning 0%) then VA would have to assign one evaluation for your cervical spine and thoracolumbar spine based on X-ray evidence of arthritis. The reason is that cervical spine, thoracic spine, and lumbar spine are considered a group of minor joints. If they resort to 5003 then it is either 10% for group of minor joints (cervical spine, thoracic spine, and lumbar spine) or 20% for group of minor joints with evidence of occassional exacerbations. If your medical evidence can show it you should be rated separately for if you have nerve dysfunction in each extremity (depending on the degree of severity of the affected nerves). If there is no identifiable affected nerves it is considered a wholly sensory dysfunction and moderate degree (usually 20%) is the most you will receive. And so you may be able to receive additional separate compensation for right upper extremity, left upper extremity, right lower extremity, and left lower extremity if it is warranted based on the evidence of record. In short, your spine is either rated based on limitation of motion or group of minor joints with X-ray evidence of arthritis. Pain is a cardinal symptom associated with arthritis and so you are not going to get a separate evaluation for pain alone. Hope this helps.

Okay wow you answered the question sambo. I have a NOD they are currently working on for the upper radiculopathy and right leg radiculopathy (at the time my left leg didn't both me) and I just recently filed a NOD for the left leg radiculopathy, Bladder and Bowel Incontinence (last week a VA GI doctor diagnosed me with these even though the Dr. Bash had already done this last year but the RO still denied it because they said I didn't have a diagnosis). Yep crazy I know. Noway should a Veteran have to be diagnosed by a VA doctor. If I am not mistaken isn't rules on this that shows that ANY doctor can diagnosed and it's a legit diagnosis? Its all good trust me...

But on the ROM if the spine has reversed lordosis then the ROM is waived and the reversed lordosis has greater weight. I have an MRI report showing I have mild reversed lordosis of the cervical spine. I am trying to find one report that shows that my C5-6 is actually reverse.

[sambo808]

Okay wow you answered the question sambo. I have a NOD they are currently working on for the upper radiculopathy and right leg radiculopathy (at the time my left leg didn't both me) and I just recently filed a NOD for the left leg radiculopathy, Bladder and Bowel Incontinence (last week a VA GI doctor diagnosed me with these even though the Dr. Bash had already done this last year but the RO still denied it because they said I didn't have a diagnosis). Yep crazy I know. Noway should a Veteran have to be diagnosed by a VA doctor. If I am not mistaken isn't rules on this that shows that ANY doctor can diagnosed and it's a legit diagnosis? Its all good trust me...

But on the ROM if the spine has reversed lordosis then the ROM is waived and the reversed lordosis has greater weight. I have an MRI report showing I have mild reversed lordosis of the cervical spine. I am trying to find one report that shows that my C5-6 is actually reverse.-VA

Yes, numerous precedents cases have repeatedly stated that a diagnosis is a diagnosis regardless whether by VA or a non-VA doctor based on the idea that doctors, whether it is VA or non-VA has presumption of competence. In fact the whole point of VA's Disability Benefit Questionnaire Program is to allow your private doctor to examine you and diagnose you so that you do not have to be examine and get diagnosed by VA Compensation and Pension examiner. Once complete, you should be able to take the completed DBQ and submit to VA and VA then must rate your claim based on that evidence. The caveat is that VA can still ask for medical opinion if VA is basically rebutting the findings by your private doctor or if they see some inconsistencies in the records and need clarification. But generally VA can decide on claims without VA examination, and based the evidence of record if the records are sufficient to decide on your claim.

When you filed your NOD you should have asked for DRO review of your case. Meaning, local review of your entire claim by a decision review officer. If you are not satisfied with the DRO review you can always take it up a notch and go all the way to the Board of Veterans Appeals. The reason I am recommending a DRO review is because it is much faster to go this route than the traditional appeal route. In many cases, appeals can be resolve by the DRO review.

As far as the lordosis in your spine. Limitation of motion of joints is never waived, at least that is not how VA views it. The most recent VA rating schedule for spine does contemplate lordosis of the spine but the most you are going to get for that is 20 percent. And you cannot get a separate evaluation for limited range of motion of the spine and lordosis of the spine. What VA does is they determine which route is going to get you the highest evaluation (whether it may be based on limited range of motion, or lordosis, or guarding of movement, or incapacitation). So the idea that ROM gets waived in the presence of lordosis is not entirely accurate, because every single one of them are considered at their own merit during the evaluation determination. VA will take the highest evaluation (limited ROM or lordosis, kyphosis, or guarding of movement...) and that is what they will assigned to you but not both.

Thanks for your service.. hope this information helps... take care bud