To Cue, Or Not To Cue, That Is The Question My Friends.

[Andyman73]

I was looking over some of my recent claim info regarding a granted increase on my back from 10 to 40%. C&P Doc wrote that this is the natural progression of the disease(DDD). And she noted that there was an X-ray from my AD time that showed then the DDD already starting. . And she noted that this should have been the original diagnosis as well. The original rating was/is still for low back pain.

Can some of you well versed VA claim Warriors give me some input on this? Thanks!

Semper Fi.

Andy

[Andyman73]

Broncovet,

I do understand that if there are no symptoms, then 0% is the best you can hope for. However, I do have reduced ROM and pain. I do have radiculapathy, which started showing up while on AD. I even went to the medical clinic because of it, and it's in my SMR for that, at least once. At my recent back C&P, the examiner didn't ask about radiculapathy, I have her exam notes, and it's marked off as a no for the few questions covering that. I did tell her that I have the sciatic pain in both legs, and gluteous maximus(s) and feet. And sometimes burning and pins & needles too.

As far as MH...I'm trying to get myself to the walk-in to get that going.

asknod,

I will check the codes, I recall there are 3 of them. I will post them here, since I did look before, and couldn't make heads or tails of it. As far as a green light, I'm gonna wait till the jump master shouts "Green Light, go go go!" My VSO mentioned something about sciatic as a separate claim, but not much more than that.

[Navy04]

Totally agree with Asknod, I myself recently go SC for lower back under name, yet was denied originally when I left the Military under a different name. Both of my knees were the same issue as well, R Knee and L Knee both SC but again under different Codes, even though they were documented, had evidence and were denied initially as well. What I am trying to say that one disability, can be listed sometimes in 10 ways, does not mean the VA committed a CUE. Good luck and congrats on the SC.

[Andyman73]

asknod,

The rating sheet shows this rating; 5010-5295 for Low Back Condition. And according to the notes from that C&P exam the diagnosis codes are as follows; 724.2 mechanical low back pain, and 846.0 lumbosacral strain. X-ray of the lumbar spine from 09/15/1998 showed impression spins bifida of S-1; sacralization of L5 bilaterally. Also noted was narrowing of intervertebral disc space at the level of L5-S1 due to Degenerative Disc Disease.

I had an MRI done on 03/17/2015 and here are the findings from that; normal alignment and heights of the vertebral bodies; transitional anatomy with partial lumbarization of the S-1; conus is normally positioned at the L1. L1-2 and L2-3 normal disc spaces and posterior elements; spinal canal and neuroforamina widely patent. L3-L4 normal disc space; minimal degenerative changes of the facet joints; neural foramina mildly narrowed bilaterally. L4-L5 normal disc space; mild degenerative changes of the facet joints; right neural foramina mildly to moderately narrowed bilaterally( but the radiologist report shows both L and R neural foramina narrowed). L5-S1 mild disc degeneration with mild mild broad-based central disc buld; minimal degenerative changes of the facets joints; moderate to severe stenosis of the neural foramina. Compromise of either L5 nerve root is possible. The proximal S1 nerve roots appear unimpeded.

Reported "Impression: There is transitional anatomy present with partial lumbarization of S1. At L5-S1 there is mild disc degeneration with mild circumferential disc bulge. There are minor facet changes a well. The combination results in a moderate to severe stenosis of the right and left neural foramina with possible compromise of either L5 nerve root."

The more appropriate diagnosis for DBQ Back(Thoracolumbar Spine) Condition is :Diagnosis #3 Degenerative Disc Disease, ICD code 722.6, diagnosed on 03/17/2015.

And at this point the examiner noted again that x-rays dated 09/15/1998, while I was still on AD, of the lumbar spine report narrowing of the intervertebral disc space L5-S1 due to degenerative disc disease.

Then she wrote that this diagnosis represents a progression of the SCD.

Edited June 1, 2015 by Andyman73

[Berta]

Alex is so right about diagnostic codes errors.

Diagnostic Codes for spine ratings changed in 2003.

https://www.federalregister.gov/articles/2002/09/04/02-22440/schedule-for-rating-disabilities-the-spine

In 2006 a VA General Counsel Opinion on "Multiple Ratings under Former 38 C.F.R. § 4.71a, Diagnostic Code 5285 (2003)"
was generated :

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFjAA&url=http%3A%2F%2Fwww.va.gov%2Fogc%2Fdocs%2F2006%2FPREC3-2006.doc&ei=3chtVdaUD4XFogS_nIC4DA&usg=AFQjCNGwXne9iJO9qgUMulrIoRf7fjyZYg&bvm=bv.94911696,d.cGU

and multiple discussions here at hadit:


Schedule Of Rating -- Back Injury - (VA Claims Research) Veterans ...
www.hadit.com/forums/topic/33727-schedule-of-rating-back-injury/
Jan 2, 2010 - Schedule Of Rating -- Back Injury - posted in (VA Claims Research) Veterans ... Does anyone know what the diagnostic code is for a back injury/pain? .... code 5237 Lumbosacral or cervical strain) had been changed to 5295.
Was I Rated By Analogy , What Does This Mean
Dec 2, 2013
I Need Help With M21- Interpretation - Entitlement - VA ...
May 16, 2011
Multiple Ratings Under Former 38 C.f.r. § 4.71a, Diagnostic Code ...
Apr 15, 2007
Questions On Back Strain (5295) & Tinnitus
Feb 25, 2007
More results from www.hadit.com ( from Google)

I dont know if any info above will help you but one thing is for sure, VA makes MANY errors in Diagnostic codes, that are often the bases for Valid CUE claims.

My 1151 100% P & T SMC S CUE of 2003 ,awarded 2012, was based on the wrong diagnostic codes in a past 1998 decision from the VA.
Also my Nehmer AO IHD death award and accrued resulted from the "lack of" any diagnostic code at all nor any rating, for my husband's established 1151 IHD.in the same 1998 decision, that CUE claim was awarded as well.

This was my initial DIC decision when they finally read my FTCA settlement,that they had ignored for many months.

I didnt CUE them , I raised Hell with the General Counsel and that is the only way I finally got the proper DIC award....but the DCs were wrong.

The decision clearly stated , from the OGC FTCA documents the malpracticed conditions, yet it took them 18 years after my husband died to correct those errors...in a 1998 decision...

that my former vet rep discouraged me to file NOD on.........

He said 1151 issues are different from regular SC.

I found out years later that he was absolutely wrong.Good thing I filed those CUE claims.

Edited June 2, 2015 by Berta

[FormerMember]

A combo diagnostic code like DC 5010-5295 is a "built up" analogous rating. VA doesn't do a lot of ICD code other than to winnow it down to a VASRD code. So look at 4.27 first to understand it.

https://www.law.cornell.edu/cfr/text/38/4.27 Right about the time where it says "Great care must be exercised..." is where the VA examiners go off the tracks. This is your problem.

https://www.law.cornell.edu/cfr/text/38/4.71a-----DC 5010---Arthritis, due to trauma, substantiated by X-ray findings: Rate as arthritis, degenerative.

I think the sub rating of 5295 is a typo. VASRD currently has no 5295 but that is not to say they didn't have it in an earlier revision and changed/deleted it. Here's 5296 (the closest). Search through the ratings on the back in the 5200 range and see if you find the exact same language VA rater used to rate with. Often, I find they copy it verbatim but fail to actually list the Diagnostic code in these "rate by analogy" things.

Edited June 2, 2015 by asknod

[Andyman73]

asknod,

I read the federal rating change proposal that Berta linked above, it shows that they wanted to change the 5295 to something else. But that occured after my SC was originally awarded. That's probably why mine is still shown as the 5010-5295. I read both of yours and it just made my mad cow diseased brain even more mad. I'm even more confused than I was before. I'll check the back ratings list later, at this time it's not letting me in.