C&p Tomorrow!

[silverdollar22]

Well I've waited 13 months for this and tomorrow is the day. Can't say I'm looking forward to this but with all the reading and research I've done here I guess I'm as ready as can be!! This is for my 6 Herniated discs, arthritis and DDD and left knee to try to get service connection because of my bad right knee and back.

[NavyWife]

Good luck!

I recommend you write or type up a single page for each issue that lists your current symptoms and anything else that you want to tell the doctor. Make two copies -keep one for yourself to refer to and give the other one to the doctor. The doc may or may not look at it. C&P's can be very stressful and you may forget important things unless they are written down.

[silverdollar22]

Thanks for the tip Navy,

Just wrote down all the symptoms I could think of and made two copies. Anything I should stress to the doctor about trying to get my other knee service connected other than the obvious (putting all the weight from my other leg on left one now and aquired limp from my other leg and back pain)? The VA has already said that there is dammage to the knee but is not service related or no record of that knee in my SMR. But this knee is hurting worse than my other bad knee now. Any last minute help would be really appreciated

[Navy04]

Just be honest with the Doc, and don't let the Doc force you to do something that will cause serious pain. Good luck, God Bless and keep us posted.

[NavyWife]

If you haven't already then you should review the DBQ or disability benefits questionnaire for your issues.

Here is the link.

http://www.benefits.va.gov/compensation/dbq_ListByDBQFormName.asp

Then you should review the rating schedule for your issues.

Here is the link for that.

http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title38/38cfr4_main_02.tpl

By doing this it should help you to understand how VA should be rating your issues, As well as what questions the examiner should be asking you at your C&P.

At one of my hubby's CNP's the examiner read the questions verbatim off her computer that were from the DBQ. That was a good and proper exam and she followed what she was supposed to do.

Another C&P He had, the doctor did not ask any questions from the DBQ and didn't know what the hell he was doing. Most likely we will have to appeal that exam as "insufficient for rating purposes".

And lastly after your exam I would try to write down everything you can remember from the exam in case there are problems later. For example if the examiner doesn't write down what you say correctly.

In 3 to 5 days after the examiner completes and signs off on the CNP you can view it on Ebenefits using MyhealthyE vet in the notes section.

[silverdollar22]

Question, and mabe am misunderstanding what i am reading, but i thought that the center segment of the spine the thoracic vertebrae were combined with the lumbar vertebrae but what i read here from( §4.45 The joints the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints). What does this mean? Are these rated seperate or together? I'm asking because now my T-12-L-1 is herniated can this be rated seperate? By the way thanks for the last minuite stuff!!!

Eric

[Vync]

Also, depending on your physical examination, the C&P doc might also order additional tests like X-rays or MRI's. Sometimes they request them on the same day, but it could require a future visit.

I will try to clarify, but someone with more experience might be able to clarify better than I can.

Let's say, for example, that you have herniated 4 of your 5 lumbar discs. The VA will not rate you based on the number of herniated discs, but instead rates you on the named collection of vertebrae.

I checked §4.45 and found it to be about joints in general, but was not able to find the text you quoted. When I was rated for my spine, they focused on §4.45: http://www.benefits.va.gov/warms/docs/regs/38CFR/BOOKC/PART4/S4_71a.doc (see below)

The Spine

Rating

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

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

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

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest five degrees.

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

5235 Vertebral fracture or dislocation

5236 Sacroiliac injury and weakness

5237 Lumbosacral or cervical strain

5238 Spinal stenosis

5239 Spondylolisthesis or segmental instability

5240 Ankylosing spondylitis

5241 Spinal fusion

5242 Degenerative arthritis of the spine (see also diagnostic code 5003)

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.

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.