Help With Leg/Foot Nerve Claim

[gs106]

I am having bilateral leg and foot pain and numbness, much worse on the left.  I intend to file a claim secondary to SC spine spondylosis.  I had an MRI through my civilian doctor and the report refers to nerve impingement.  CFR 38 has several different nerves listed and I don't know which nerves to claim.  The doctor refers to it as sciatica so I'm thinking sciatic nerve.  Does the sciatic nerve have multiple roots?  I am posting excerpts from the MRI report.  If anyone knows the name of the nerve roots involved please let me know.  Should I just file for lower extremity neauropathy and let VA sort it out?

There is complete loss of disc height at L4-5 with moderately severe loss of L5-S1.

At L2-3, in conjunction with retrolisthesis there is minimal broad-based disc bulge with mild effacement of the thecal sac.  There is moderate narrowing of both lateral recesses with possible impingement of the descending L3 nerve root on the right as best seen on T2 axial image #8.  There is mild foraminal narrowing bilaterally but no direct impingement of exiting L2 nerve roots is seen.

At L4-5, anterolisthesis appears to be related to bilateral pars defects.  There is uncovering of the posterior disc but no appreciable bulge or protrusion is seen.  There is mild effacemdent of the thecal sac across the midline related to anterolisthesis.  There is direct impingement of both exiting nerve roots due to anterolisthesis and resultant foraminal narrowing.

At L5-S1, there is broad-based disc bulge without focal protrusion.  There is mild to moderate effacement of the thecal sac across the midline.  There is probable impingement of the descending S1 nerve root on the left within its lateral recess as best seen on T2 axial image #23 due to disc bulge and posterior element hyoertrophy.  There is moderate foraminal narrowing bilaterally, with probable impingement of both exiting L5 nerve roots.  This is more likely on the left, due to combination of disc bulge and facet joint hypertrophy.

Tarlov cysts are present at the S2-3 level bilaterally, larger on the left.

[iceturkee]

personally, i would file for radiculapothy. thats more than likely what you have from the nerve impingment. i could be wrong but i'm not aware of neuropathy problems coming from the spine per se. thats usually associated with diabetes.

[gs106]

Thanks iceturkee

[iceturkee]

4 hours ago, gs106 said:

Thanks iceturkee

you are welcome. hope it helps.

[gs106]

I am doing the claim through eBenefits and the list didn't include it so I typed in bilateral lumbar radiculopathy.  I hope they can figure it out.  I can't submit it yet because I have a pending claim which went to "preparation for decision" today.  Third time it's gone to that status so maybe they will finally make a decision.

[pwrslm]

Bilateral radiculopathy is not listed.  It would be coded as sciatica, left leg, and sciatica, right leg.  The amount of the rating is dependent on how bad it is.  If its only sensory, meaning, shooting pain and numbness, its 10 or 20% per leg.  If the motor nerves are involved, and you have weakness like foot drop, atrophy or paralysis of the foot/ankle/leg, then it can go from 20-80%.  The ratings can be found under nerves of the low back and legs in the schedule as follows;

 

A condition of the sciatic nerve is rated under one of the following codes with the corresponding ratings.

Code 8520: Paralysis of the sciatic nerve. Complete paralysis: If the foot drops (it cannot be lifted by the muscles in the legs), all the muscles in the leg below the knee do not work at all, and the knee has serious trouble bending (bending the knee doesn’t have to be impossible to rate as complete paralysis of the sciatic nerve, it just has to be limited), it is rated 80%. Incomplete, severe paralysis is rated 60%. Incomplete, moderately severe paralysis is rated 40%. Incomplete, moderate paralysis is rated 20%. Incomplete, mild paralysis is rated 10%.

Code 8620: Neuritis of the sciatic nerve. If the condition causes severe symptoms, it is rated 60%. If it causes moderately severe symptoms, it is rated 40%. If it causes moderate symptoms, it is rated 20%. Mild symptoms is rated 10%.

Code 8720: Neuralgia of the sciatic nerve (“sciatica”). Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 20%. If it is mild, it is rated 10%.

Make sure to check to see if a higher rating can be given under limited motion of the hip, code 5251-5253, limited motion of the knee, code 5260, or limited motion of the ankle, code 5271. If the condition is best rated as limitation of motion, then the final code will look like this: 8620-5251. The first four-digit number is whichever of the three nerve codes the condition best fits under (paralysis, neuritis, or neuralgia), and the second is the limited motion code where it is rated.

 

In the M21 guides, if the nerve issue is only sensory, being shooting pain or numbness, then it can only be rated at 10-20%.  You can only get above that if the are motor nerve problems which impair your ability to move your foot/ankle/knee/leg, but the rating can go as high as 80% each leg (for complete paralysis of the leg).

You are also dealing with instability in your spine, this is what the retro (backward) and anterior (forward) -listhesis are, meaning movement between the lumbar segments in that specific direction. You also have some severe disc problems like I did.  I ended up with spinal fusion from S1 to L3, with laminectomy and foraminotomy to decompress the nerves.  Worked to a degree, now I am waiting to see how much permanent damage there was as the sciatic nerves heal, maybe 1.5 years post surgery before the final disposition on this can be done.

You really should get a non VA orthopedic surgeon who specializes in spine's to  give you an IMO if you can afford it. Mine cost $250, and it wasn't challenged by the VA luckily.   I spent over 5 months with VA's Orthopedic surgeon and their Neurosurgeon, and neither of them wanted to give me a complete, competent diagnosis.

The same guy that did my IMO, did my surgery, he had some 20+ years experience with excellent credentials and did a great job all the way around (thank you Choice Card!!).  The IMO should give you the upper hand in your claim, so make sure to study up and be sure it is written correctly.

Edited March 25, 2016 by pwrslm

[gs106]

Thanks Pwrslm,  Did you have an EMG?  The last EMG I had at VA for carpal tunnel took six months to get the appointment.  According to M21 an EMG has to be done if there hasn't already been one.

III.iv.4.G.4.f.  EMG and Other Tests for Peripheral Nerve Conditions

Electromyelogram (EMG) test results are required for evaluations of peripheral nerve disabilities unless there is a previous EMG test of record or the record contains sufficient clinical evidence to determine the extent of paralysis in the peripheral nerve. As noted in the Peripheral Nerves DBQ, EMG studies are usually rarely required to diagnose specific peripheral nerve conditions in the appropriate clinical setting and, if EMG studies are in the medical record and reflect the Veteran's current condition, repeat studies are not indicated