Back Injury And Nerve Damage

[ArNG11]

Wanted some opinions on how to pursue a claim for a back injury that I am service connected for and was given a 10% for L1 and 10% for partial paraliys of lower left extremity.still within NOD period. By regs all Ive been able to find is about and entitlement to 40% maybe 60% with the nerve damage to this injury. I am a little stumped on the muscle and nerve ratings. VA only mentioned connection for L1 from an older MRI I submitted but mentioned no others. Wanting opinions on course of actions and possible avenues to have my injury rated fairly.

Specifics.

Lumbar MRI

disk dehydration lower thorasic spine. Notably L1-L2 and L3-4. Prominent Schmorl node herniation along inferion end plate L1

Small disk protrusion T11-T12 effacement of anterior CSF space and central canl space narrowing. Minor disk bulge L1-2 minimal narrowing proximal foramina

L2-3 far right lateral disc protrusion into nerve root foramen contributing to a mild narrowing/stenosis of the right foramen at L2-3

L3-4 broad bulging disc mild face degenerative change. Significant central canal space narrowing suggesting mild aquired central stenosis. Mild stenosis right foramen. Small protrusion out laterally resulting in moderate stenosis of left forament likely some mass effect on the exiting left sided L3 nerve root.

mulilevel degenerative disc disease of mild to moderate degree. Central disc protrusion at t-11-12 significant central canal space narrowing. Boderline mild central stenosis on degenerative basis L3-4. small protrusion out laterally on the left resuliting in moderate stenosis of the left foramen. likely mass effect on left side exiting L3 nerve root. small far right

lateral disk protrusion L2-3 resulting in mild narrowing/stenosis of the right foramen at that level.

mild to moderate mid throasic scoliosis curve to the right

mild multilevel degerative disc disease

tiny right paracentral disc protrusion suggested t5-6 and t6-7

mild disc dehydration upper, mid and very lower throsic spine.

any info and opinions gladly welcomed

[rpowell01]

For your back here is the ratings schedule: http://www.benefits.va.gov/warms/docs/regs/38CFR/BOOKC/PART4/S4_71a.DOC

Rating for your back is based on Range of Motion. The Lumbar and Thoracic are the same segment so they will be rated as one as thoracolumbar.

You can't pyramid, so I think even though you have scoliosis you can only be rated for one thing on your back but the one that rated should be the higher rating. You have to watch this one because the RO will try to low ball you.

For the damaged nerves here is the ratings schedule: http://www.benefits.va.gov/WARMS/docs/regs/38cfr/bookc/part4/s4_124a.doc

This is self explanatory and you can see what your should be rated at based on the degree of paralysis of the nerve.

If you want to know the ins and out of the VA, how to file claims and what is needed and how to challenge the VA with your NODs then purchase the Veterans Benefit Manual from lexisnexis.com or some other website that carries it. This is what attorneys use and they charge us an arm and leg.

[ArNG11]

Thanks for the info. I have been given similar advice. I just feel like they are rating the injury as it was just the L1. I know from members here that the lumbar and thoracic are rated as one unit. Where the higher ratings are gotten is in the ROM. I'm most like going to NOD the decision. 10 disks of the lumbar and thoracic are damaged. I have continuous muscle spams and with the radiculapathy a 10 % rating on each doesnt follow the regs. I know they should have to address all the damage as its all related to my injury they re just not doing so.. The other issues ,muscle and nerve, should be secondary. Unless I'm reading the CFR wrong, it shouldn't be pyramidying.

Edited August 27, 2013 by arng11

[jbasser]

Are you rated for IVDS or DDD/DJD.

IVDS depends on frequency of bed rest. Traumatic Arthritis Or DDD/DJD is based on ROM.

Effected nerves are to be rated separately. This includes the Muscle.

Did you do a ROM test at a C and P exam?

You may need a BASH IMO to get them straightened out.

JBAsser

[ArNG11]

The c& p has ROM measurements, however the examination was at the smallest amount of observation. No measurements or range of motion tests were performed. All my medical evidence is from private physicians. They rated me for both. IVDS and degenerative disk disease. I have 2 MRI s of the lower lumbar and one of the upper thorasic as well as ROM measurements from a physical therapist. . What I am really trying to decide is whether to submit the evidence and cite the regulations that they should be applying to my injuries in a non adversarial manner and if I can't get any movement in my favor then submit my NOD with all the new and relevant evidence and pointing out the evidence that was ignored and or not referenced in their decision. Most likely I would ask for the DRO review if it comes to having to file NOD

This is what the MRI stated. They have a copy of this information.

L1 moderately decreased in T2 signal and height. schmorl's node anteriorly and superiorly at L1 to disc.

L3-L4 mildly decreased in T2 signal and height

Schmorl's node anteriorly and superiorly at L1

Large posterior osteophyte at T-11 and T12, effaces the conus medullar is distally. narrows canal to 7mm AP

L1-L2 mild circumferential osteophytic ridging/disc bulge.

L3-L4 circumferential osteophytic ridging sized disk bulge contacts but does not deform the thecal sac. Mild bilateral facet joint hypertrophy

L4-L5 mild bilateral facet joint hypertrophy

Impression: scattered degenerative and hypertrophic changes in the lumbar spine

Prominent posterior osteophytic ridging at T-11 - T12. produces central stenosis and some mass effect on the conus medullar is.

Thin band of edema in the proximal left femur represent contusion or reaction to degenerative changes in hip. Mild thinning of hyaline cartilage in the hip joints superiorly.

Mild joint space narrowing in the hip joints superiorly, likely early or mild osteoarthritis.

They rated my injury as follows:

Degenerative spondylosis levoconvex sumbar spine with IVDS and vertebral compression

deformity L1 10%

Tinnitus 10%

SVC for Radiculopathy left lower extremely associated with degenerative spondylosis, levoconvex sumbar spine with IVDS and vertebral spine compression. 10%

SVC for or tinnitus is granted with an evaluation of 10%

SVC for degenerative spondylosis levoconvex lumbar spine with IVDS and vertebral body compression deformity L1 is granted with eval of 10%

This is new evidence

Thoracic MRI

Mild to moderate mid throrasic scoliosis curve convex to the right.

Mild disc dehydration to upper and mid , and very lower thoracic spine.

Minor bulging discs. minimal or tiny right paracentral disc protrusion at T5-6 and T6-7

Lumbar MRI

disk dehydration lower thorasic spine. Notably L1-L2 and L3-4. Prominent Schmorl node herniation along inferior end plate L1

Small disk protrusion T11-T12 effacement of anterior CSF space and central canl space narrowing. Minor disk bulge L1-2 minimal narrowing proximal foramina

L2-3 far right lateral disc protrusion into nerve root foramen contributing to a mild narrowing/stenosis of the right foramen at L2-3

L3-4 broad bulging disc mild face degenerative change. Significant central canal space narrowing suggesting mild aquired central stenosis. Mild stenosis right foramen. Small protrusion out laterally resulting in moderate stenosis of left forament likely some mass effect on the exiting left sided L3 nerve root.

mulilevel degenerative disc disease of mild to moderate degree. Central disc protrusion at t-11-12 significant central canal space narrowing. Borderline mild central stenosis on degenerative basis L3-4. small protrusion out laterally on the left resuliting in moderate stenosis of the left foramen. likely mass effect on left side exiting L3 nerve root. small far right

lateral disk protrusion L2-3 resulting in mild narrowing/stenosis of the right foramen at that level.

OhFrom what I have read and from peers on this site. round about figure 40% 50 % rating for the spine segments. The angle of defense that I was going to use to defend my case is the structural damage to the spine. I see that my injury is ratable for muscle spams and moderate nerve damage as well, and range of motion is an avenue that I have supporting evidence for, rom loss for flexion minimal loss with hip pain lateral and anterior,slide gliding right extention moderate to major loss with low back pain.slide gliding left Inability to maintain posterior pelvic tilt with double lower extremity lowering past 55 degrees. Spring test positive for localized pain with notable spasms. painful abdominal bracing in left thoracic. Mild to moderate TTP thoracic TL spine and paravertebrals, left greater than right.

My apologies for skipping around. Pain meds are affecting my writing a bit. I hope this clears it up a bit. Thanks for your insight.

Edited August 28, 2013 by arng11

[rpowell01]

This doesn't sound correct because Spondylosis is actually Osteoarthritis. Osteoarthritis and DDD are two different medical terms but isn't rated under IVDS. I don't see how you are rated under IVDS, this is probably why you have such a low percentage. I would fight and get that changed from IVDS because IVDS is NOT based on ROM and is based on bed rest like JBasser stated.

Sounds like a low ball because degenerative spondylosis levoconvex means you have arthritis with curvature (scoliosis). I would put in a claim to have all this changed or appeal your last award if its under the 1 year mark.

[ArNG11]

I was under the same impression. The advice from members here have been explaining the differences and how IVDS is rated and how ROM would be applied but it wasn't making sense to me from reading the regs and applying it to my decision letter. I know from the physical damage my rating on that should warrant a higher rating. Since I have muscular issues and nerves issues that is a another separate matter entirely. I do have a combination of the two. My spine is curved because of the way I had adjust myself when wearing the IBAS (body armor) when I was overseas to minimize the pain and function with mission activities. I have x rays of my back before I left and x rays when I came back. I was pretty shocked. MRI show how ugly the picture is. I've been gathering all my evidence and trying to formulate a rebuttal and statement to contest the decision. I feel I should call attention for the VA to acknowledge all the evidence I submitted. I also will ask for them to reopen the claim and correct the error and apply the correct ratings and percentages but don't feel all that confident in the wording. I could try to prove a CUE but statistically that is a gamble. Since I have new evidence I am not sure if I should just be blunt and cite the regs and ask they reopen the claim as NEW EVIDENCE and that they rate it correctly according to regs and/or file an NOD. These are two avenues that I can take. File for an increase with new evidence and if they still low ball it, then hit it with an NOD, and hopefully a fair and competent rater/senior or DRO reviewer will rate it fairly. I believe if it goes to BVA I will be stuck in limbo, just for the BVA to remand it back to the regional office. I know wishful thinking, or not wishful, however, I feel confident that the evidence is too overwhelming for them to ignore. Luckily my evidence is from private providers and I have copies of everything. I am just at a loss on my plan of attack.