Secondary Condition; Can I?

[propp3]

I am rated 20% for my back condition...over 20 years now. Originally, my rating was 10% for muscular low back pain but having 2 back injuries in-service, an L3 fx, spondololothesis at L5/S1 documented, I appealed. The VA then increased my rating to 20% after the BVA appeal, and labeled it IVDS/intervertebral disc syndrome, at L5/S1 with degenerative changes. That was 1995. They never found the old L3 fx, but there was also evidence of a T12 compression fx on film, as early as my first C&P exam, Jan 1992...less than 60 days after I'd been discharged after 8 1/2 years active duty.

Later, the old L3 fx showed on film, as well as an L2 crush fx,(1997 & 1999). Then, a T11 compression fx(as well as the older T12) showed up on and MRI(2001). In 2014 I had films and another MRI at my own insistence(the VAMC said there was no need) which pretty much shows all of the above, plus new compression fx's L3, L1, T6, and facet hypertrophy and the start of foraminal stenosis at L4/L5, and L5/S1. I've also had sciatica in my left leg for near 20 years.

I asked that my rating be increased, filing in July, and got a new C&P exam in oct 2014. In Jan, 2015 I rec'd a letter denying an increase. The statement of the case now labels my condition as degenerative disc disease, L5-S1, lumbar spine, with radiculopathy left lower extremity, as 20% disabling...continued(but no increased rating). I've never been rated for the radiculopathy, the sciatica, etc...that was the point of asking for the increase...the sciatica, the new findings over the years showing all the new compression fx's, etc.

I composed a reply/argument and some additional evidence asking for BOTH, a reconsideration of their decision AND a BVA appeal. I asked(using the duty to assist) for the VA to obtain all my previous films(even those taken in-service) and send to the local VAMC, and for a comprehensive comparison study to fully document the changes over the past 20+ years: body loss height, demineralization, etc.

Am I going about this wrong???

Should I be seeking a new claim, set of claims, etc?

I mean, should I be trying to open a new claim for sciatica...DJD of the lumbar spine....DJD of the thoracic spine(because of all those new compression fx's) ? I know the VA treats the thoro-lumbar spine as 1 segment for measuring using the general formula for rating ROM.

BUT, I've always been rated by the VA for the changes/disability at L5-S1...the lumbo-sacral spine(and the lumbo-sacral articulate).

The 38CFR calls the LS spine a 'minor joint' for ratings purposes. But in other parts(The Joints) it also calls both the Lumbar and Thoracic spine/s 'minor joints, treated as major joint'...presumably for rating under arthritis, degenerative or traumatic.

I've got clear cut x-ray/imaging showing: L5/S1 changes(for which I'm rated)...AND...degenerative/arthritic changes and compression fx's in both the lumbar, and thoracic spine.

Advice? Would the VA call any new claim an attempt to pyramid? How would I show DISTINCT manifestations of each, as a separate disability...especially since the general formula treats the entire thoro-lumbar spine as one segment in measuring range of motion?

I asked my rep at the DAV but he doesn't seem to understand what I'm asking...

[Navy04]

Sorry to hear of your troubles bud. I have a topic on hadit currently that says what will I get for my back. Take a look at my C&P exam results on there. I too have had multiple issues with my back and I was just medically retired 2 years ago. I just had a C&P for my back last week and it looks like I will finally be SC. You should pick which condition is more closely related to your back, and would grant a higher %, then apply for that Secondary to your SC back. Good luck and keep us posted bud.

[iceturkee]

I am rated 20% for my back condition...over 20 years now. Originally, my rating was 10% for muscular low back pain but having 2 back injuries in-service, an L3 fx, spondololothesis at L5/S1 documented, I appealed. The VA then increased my rating to 20% after the BVA appeal, and labeled it IVDS/intervertebral disc syndrome, at L5/S1 with degenerative changes. That was 1995. They never found the old L3 fx, but there was also evidence of a T12 compression fx on film, as early as my first C&P exam, Jan 1992...less than 60 days after I'd been discharged after 8 1/2 years active duty.

Later, the old L3 fx showed on film, as well as an L2 crush fx,(1997 & 1999). Then, a T11 compression fx(as well as the older T12) showed up on and MRI(2001). In 2014 I had films and another MRI at my own insistence(the VAMC said there was no need) which pretty much shows all of the above, plus new compression fx's L3, L1, T6, and facet hypertrophy and the start of foraminal stenosis at L4/L5, and L5/S1. I've also had sciatica in my left leg for near 20 years.

I asked that my rating be increased, filing in July, and got a new C&P exam in oct 2014. In Jan, 2015 I rec'd a letter denying an increase. The statement of the case now labels my condition as degenerative disc disease, L5-S1, lumbar spine, with radiculopathy left lower extremity, as 20% disabling...continued(but no increased rating). I've never been rated for the radiculopathy, the sciatica, etc...that was the point of asking for the increase...the sciatica, the new findings over the years showing all the new compression fx's, etc.

I composed a reply/argument and some additional evidence asking for BOTH, a reconsideration of their decision AND a BVA appeal. I asked(using the duty to assist) for the VA to obtain all my previous films(even those taken in-service) and send to the local VAMC, and for a comprehensive comparison study to fully document the changes over the past 20+ years: body loss height, demineralization, etc.

Am I going about this wrong???

Should I be seeking a new claim, set of claims, etc?

I mean, should I be trying to open a new claim for sciatica...DJD of the lumbar spine....DJD of the thoracic spine(because of all those new compression fx's) ? I know the VA treats the thoro-lumbar spine as 1 segment for measuring using the general formula for rating ROM.

BUT, I've always been rated by the VA for the changes/disability at L5-S1...the lumbo-sacral spine(and the lumbo-sacral articulate).

The 38CFR calls the LS spine a 'minor joint' for ratings purposes. But in other parts(The Joints) it also calls both the Lumbar and Thoracic spine/s 'minor joints, treated as major joint'...presumably for rating under arthritis, degenerative or traumatic.

I've got clear cut x-ray/imaging showing: L5/S1 changes(for which I'm rated)...AND...degenerative/arthritic changes and compression fx's in both the lumbar, and thoracic spine.

Advice? Would the VA call any new claim an attempt to pyramid? How would I show DISTINCT manifestations of each, as a separate disability...especially since the general formula treats the entire thoro-lumbar spine as one segment in measuring range of motion?

I asked my rep at the DAV but he doesn't seem to understand what I'm asking...

i will say it again. i have 5 herniated discs, foraminal and apinal stenosis at all 5 of my lumbar discs, a grade one slipped vertebrae, 2 torn discs and arthritis on my last lumbar mri from 2014. i am currently 40 percent for my back.

[Buck52]

propp3

copy & paste your last C&P& the denial letter on here so hadit-members can help you!

Be sure to cover your name and SS Number.

you may have a CUE?

Buck!

[Punisher]

This string is close to what was documented in my C&P for similar IVDS and osteoarthritis in my lower back. The arthritis is documented throughout my C&P exam notes for basically every major joint.

What I've been wondering, as I've been stuck in the "Preparation For Decision" since I retired at the beginning of June, 2015, is whether the VA will rate each of my injuries in those major joint areas or will they simply just combine everything into one overall degenerative arthritis rating.

Does anyone know?

Thanks in advance!

[Andyman73]

Here's my 2 cents worth,

I am currently rated at 40% for low back strain/pain. I have neural foramina narrowing from mild to severe at several different spots. I have central disc bulge L5-S1 where the narrowing is listed as moderate to severe, bilaterally, and could possibly impinge upon the nerve root there. I have had vary types of radiculapathy for 20 years, pain, burning, electric shock, hot wet sensation, pins and needles, numbness, and most recently a buzzing type sensation. Nowhere in my back rating letter is there any mention of any of this towards the back rating.

I do intend to claim radiculapathy for both lower extremities ASAP.

Andy

[pwrslm]

There is a whole group of conditions for the spine that only get 1 rating.  Both the neck, and the rest of the spine (thoracic, lumbar and sacrum), are rated as 2 separate joints.

 

Here are the spine condition names and codes:

• Code 5237: Lumbosacral or cervical strain—a generic label for back pain
• Code 5238: Spinal stenosis—the spinal column narrows and presses on the spinal cord or nerves
• Code 5239: Spondylolisthesis or segmental instability—when a vertebra slips out of position
• Code 5240: Ankylosing spondylitis—an arthritic disease that causes the spinal joints to freeze in place
• Code 5241: Spinal fusion—the vertebrae are surgically fused together
• Code 5235: Vertebral fracture or dislocation—the bones of the spine break or slip out of alignment due to a traumatic event like a car accident. Any generic spinal bone injury would be coded here.

This isn't all, DDD/IVDS and other things like foraminal stenosis, etc, all combine in the spine rating.  They use 2 means to rate it, ROM is the most popular, and incapacitating events directed by the Dr. (which they never do anymore, its outdated treatment).

Outside of the spine, you can also be rated for the nerve conditions of the lower back that radiculopathy causes, based on the conditions that the nerve impingement/damage causes, like drop foot, burning pain, leg and foot and toe weakness, circulation and muscle atrophy.  If the nerve is damaged at the L5, the foot can be substantially affected.  You can be totally disabled with a 100% rating through the combined ratings that come from spine conditions (and the secondary effects).

 

This is not to mention effects over the long run in the cervicel spine (neck), hips, and knee's, all of which can be rated separately if they are affect by the spine condition and secondary nerve conditions.