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Mo

Radiculopathy L4-L5 vs Chronic Sciatica Claim

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Mo    7

Hello all,

First off...BIG THANKS!!!!  I am a newbie (sorta) and have been following this site for close to 2 years. You all helped me go from 40% to 70% total last year! This is my first post so I hope I am asking it in the right place. (Haven't found an answer similar). 

I have initiated a claim for an increase of my PTSD. I am also claiming secondary disabilities to DDD (rated 40%)  such as Depression and Radiculopathy. But I noticed I don't have a diagnosis for it.  All my treatment records state DDD or chronic LBP until they recently starting stating "Radicular symptoms begining 6/18/15".  I have 21 pages of VA medical documentation for burning, altered gait, radical symptoms, inability to ambulate, in addition to over 50 days of work missed this year, 2 local ER visits, and 1 VA ER visit.

Do I file for Radiculopathy or Sciatica and if Awarded ask for retroactive pay from 2004?

I have my medical files and here is the following:

  • 8/13/15 MRI:

Test Name: MRI L Spine without contrast  

Reason for study: 32m with low back pain radianting to right leg

Clinical History: hx of lumbar radiculopathy L$-L% in 2004. Now with worsening pain, muscle spasms, and nubness in RLE

Report:
MRI lumbar spine without contrast.
Clinical Indication: 32M with low back pain radiating to right
leg.
Contrast: None.
Comparison: None.
Findings:
Segmentation: Normal.
Vertebral column: Vertebral marrow signal without evidence of
fracture or metastasis. Alignment normal.
L1-L2: Disc without significant dessication. Negative for disc
herniation or spinal stenosis.
L2-L3: Disc without significant dessication. Negative for disc
herniation or spinal stenosis.
L3-L4: Disc without significant dessication. Negative for disc
 herniation or spinal stenosis.
L4-L5: Moderate disc desiccation and bulge with dorsal annular
fissure and small central disc extrusion with minimal cephalad
migration. Negative for resultant spinal stenosis.
L5-S1: Mild disc desiccation and bulge with dorsal annular
fissure. There is a 10 mm extradural cyst within the right
lateral recess at the upper S1 vertebral level, consistent with a
discal cyst and resulting in moderate right lateral recess
stenosis with displacement and impingement of the right S1 nerve
root. Negative for canal or foraminal stenosis.
Impression:
1. Negative for spinal canal stenosis. 2. Degenerative changes
at L4-5 and L5-S1 with right-sided discal cyst at L5-S1 resulting
in moderate right lateral recess stenosis and impingement of the
right S1 nerve root.
 

  • 6/15/04 MRI 

L3-4: Mild, broad-based disk bulge. The spinal and neuroforamina are unremarkable.

L4-5: Focal, central disk extrusion with partial migration of the disks superiorly along the L4 level posteriorly. There is contact of the exiting L4 nerve root by the disk extrusion. The lateral recess is unremarkable. The spinal canal at the L4-5 level demonstrates flattening from the disks. There is high signal at the central part of the L4-5 disk, which may represent annular.

L5-S1: Mild , broad-basked disk bulge, but the spinal canal and neuroforamina are normal.

Impression: Findings consistent with disk extrusion at the L4-L5 level, with migration of the disk superiorly. Psossible annular tear at L4-L5 level.

  • 8/11/04 In service ER visit

Physical Assessment: Posture and gait both abnormal/ antalgic, abnormal striaight leg raise, ROM (limited to pain), and tender to palpation

Comments: HNP @ L4-L5, annular tear L4-L5

Diagnosis: Chronic sciatica

 

Sorry to be so long on my first post, but I want to give as much info as possible. Thanks so much in advance!!!

Edited by Mo

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15 answers to this question

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iceturkee    100

first, i would ask your doctor to inquire why the neurology consult was cancelled. then i would ask if he or she would list it on your problem list.

 

my radiculopathy has been confirmed several times from emg's and also listed several times on my problem list. good luck.

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pwrslm    304

VA did an evaluation prior to your ETS then?  You might talk to a VSO on that, if that evaluation/decision was defective, you might stand a chance for retro.  Maybe need a lawyer for a reopen on this, but if they failed to award you for a valid condition, and you can prove that based on your MEB and PEB, you could prevail.  They would give at least the min rating.

 

If the gait was altered in 2004,and you had pain, and you were not awarded anything from that, it might be worth checking into.  Remember, regulations state that if a condition causes you pain, then you must be granted at least the minimum rating for it (10%).  If you can establish that you had pain reported in the MEB/PEB in 2004, and then document the back/leg condition as it progressed over the last 11 years, they could grant a staged rating as the condition got worse. 

Edited by pwrslm

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pwrslm    304

Radiculopathy is not a diagnostic code.

It is a medical condition affecting the nerves.  They have to ID which nerve is affected, and rate the condition based on the DC that applies.  Typically, they rate L2 to S1 nerve impingement as sciatic nerve problems. Depending on the level, it can also be rated as the femoral nerve as well.  Your issue looks like sciatic nerve impingement.

Levels of disability depend on the severity of the condition. Paralysis/partial paralysis  is listed as;

 Mild (10%) to moderate (20%) are typically nothing but sensory issues.  Mild are just subjective symptoms alone, where the vet reports numbness, tingling/burning sciatic pain.  Moderate is mostly sensory as well, with objective evidence (medical examination, EMG/NCV tests).  Moderately severe (40%)is a step up that would include motor sensory deficit, abnormal gait, weakness, atrophy would be mild at this level.  Severe (60%) would be the worse than just moderate.  Finally, complete paralysis (80%) would be that the nerve is not functioning at all, you couldn't walk with this condition, atrophy and circulation issues would exist. 

 

Below paralysis, is neuritis and neuralgia.  Both of these are also staged from 10% up. 

Edited by pwrslm

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iceturkee    100

i would file for radiculopathy. as for being awarded retro back to 2004, i dunno. don't see a confirmation of it then. have you had any emg's? did they confer the diagnosis? and, if so, how far back do they go?

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Mo    7

i would file for radiculopathy. as for being awarded retro back to 2004, i dunno. don't see a confirmation of it then. have you had any emg's? did they confer the diagnosis? and, if so, how far back do they go?

I haven't had any EMG's yet. They keep canceling my consult to the Neurologist. The only confirmations I have are:

  • 2004 ER visit while in service stating injury and  a diagnosis of "Chronic Sciatica" > 6weeks
  •  9/11/15 secure messages from my pact MD stating, "... I have yet had the opportunity to meet Mr. XXXXXX but my understanding is that he has been treated for Radiculopathy and nerve pain." "...placed a consult for him to be seen by neurosurgery for further evaluation. I do see they cancelled the consult but I am not sure why..."
  • 9/06/15 MRI stating, "history of radiculopathy L4-L5 in 2004
  • 7/29/15 VA ER Visit stating, "acute lumbar pain with radicular symptoms....altered gait...exquisitely ttp pf lumbar spine, right and left sacroiliac joints, and right hip....sensation to pinprick diminished in right calf..."

I'm wondering if there is enough evidence there without a clear diagnosis or should I ask my PCP to note it on my Computerized Problem List via Secure Messaging until I get to Neuro....

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pwrslm    304

If you have never put in a claim for chronic sciatica (from 2004 medical records) you will not be granted retro for it.  If you were denied from a 2004 claim, never appealed, you can reopen, or CUE, depending on the file contents.

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