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Question On Remarks Section On C&p Exam - Spine



Hello all. This is my first post but I have been lurking for a while and appreciate all the great advice from this network.

I received a copy of my C&P exams and was hoping for opinions on my spine ROM measurements. The examiner indicated my forward flexion ends at 60 degrees with pain at 40 degrees. On the section marked "Is there functional impact of ability to work?" he marked <YES> stating "The impact of the thorocolumbar spine condition on the claimants ability to work is moderate impairment for physical work and mild for sedentary work".

In the remarks section he indicated "There are contributing factors of pain, weakness, fatigability, and/or incoordination and there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. The degree of ROM loss during pain on use or flare-ups is approximately 20 degrees for flexion, 10 degree thorocolumbar extension and all other directions".

I guess my question is, will examiners read all the remarks on these exams and use the ROM in the remarks section? Or will they use the data in the 'initial range of motion' section? I'm not sure why the doc indicated 20 degree forward flexion in the remarks section but marked it differently on the 'initial range of motion'. I realize I won't know how it's read until I get my final rating but just wanted to see if anyone else has had prior experience with this type of issue.

Additional info: I've have three other ROMs (one from the VA and two from the military docs), I submitted with my claim so hopefully those will help my case (they were all under 30 degrees for forward flexion). Thanks :)

- Julie

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Welcome, Julie! I'm sure some of the experts on this will chime in soon. Good luck to you and thanks for your service.


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julie, i am currently 40 percent for my thoracic spine. i don't remember my rom figures but it is very limited. while i am not rated for my lumbar spine, i have several (and some are serious) issues that contribute to my iu and wheel chair bound status. i also have rheumatoid arthritis.

may i ask what your diagnosis is for your back? thanks and good luck.

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Good morning.

I received my final VA rating yesterday and they rated my spine at 20%. Based on my initial post above, can anyone provide guidance on whether I have a case to appeal this rating? I've read about the DeLuca factor and although the C&P examiner marked my ROM at 40 degrees with pain, (honestly not sure why this rating was marked as I physically can't bend forward this far), he put in his notes that my ROM is limited to 20 degrees during pain or flare ups.

I am also planning on filing an appeal for my lower left radiculopathy (sciatic nerve pain). I was rated 10% for this but I am limited on my functional ability due to the nerve pain. My latest MRI (which the VA does not have) reflects moderate to severe spinal stenosis. In my STRs, I have many many appointments and pain mgmt injections for my nerve pain with my pain ratings consistently at 8 or 9 on the pain scale.

I also filed for IU with my initial claim but do not see that in eBenefits.

I'm hoping I have a case to appeal based on the rating not reading the exam notes. I'm new to all of this so appreciate any guidance.


- Julie

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Congrats on the Partial win, and remember that once awarded SC for a condition, you can always submit for an increase if you feel it warrants a higher %.

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