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Need help adding a "Secondary" claim to my Lower Back service connected condition

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AirForce99

Question

I’m 40% service connected for chronic lumbosacral strain. I want to add a “Secondary” claim as I have extreme chronic pain on a daily basis that affects my life big time. My chronic lumbosacral strain CAUSED my chronic pain and I have a doctor that will write “Is due to” for my NEXUS letter.

If I understand correctly, they will most likely put this under “9421 Somatic symptom disorder”.

A few questions about this...

1. Is my thinking above correct?

2. If my Doctor, a certified MD, writes that I have chronic pain that is DUE TO my service connected chronic lumbosacral strain, is this good enough or should we expand on that and talk about all the ways the pain affects my life like sleep, social life, can't play with kids, etc?

3. Do they rate this under the “General Rating Formula For Mental Disorders” at the 0, 10, 30, 50, 70, 100 rates?

Thanks so much!

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Hey AirForce99 

Ill try to help some.  Your spine is rated at 40%, this included pain that is caused by the vertebra, muscles and tendons, and disc.  Each one is a minor joint, they are rated all together as you should know by know.  For them to add chronic pain to the back/spine pain would be like pyramiding, or rating the same issue two times under two separate rating codes.  Depression and related issues is not a condition of the spine, but is secondary to the pain.  If you have somatic symptoms, it falls under mental health and thus can and has been attributable to chronic pain vua lumbarosacral strain.

Look here for rating info.

 

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14 minutes ago, pwrslm said:

Hey AirForce99 

Ill try to help some.  Your spine is rated at 40%, this included pain that is caused by the vertebra, muscles and tendons, and disc.  Each one is a minor joint, they are rated all together as you should know by know.  For them to add chronic pain to the back/spine pain would be like pyramiding, or rating the same issue two times under two separate rating codes.  Depression and related issues is not a condition of the spine, but is secondary to the pain.  If you have somatic symptoms, it falls under mental health and thus can and has been attributable to chronic pain vua lumbarosacral strain.

Look here for rating info.

 

Thanks for the reply! So would it be smarter to have my M.D. write a NEXUS letter letting them know that I have depression and it's because of the back pain? Or would I need to schedule an appointment with a mental health professional, get evaluated and go that route?

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If your MD has identified a condition, and is qualified to make the diagnosis, get a nexus.  The VA is going to work on it no matter what after your claim is submitted with the C&P exam.  Just be sure you include it in your claim when you submit it.  Nexus should give the basic scientific/medical reasoning how the one condition is secondary to the primary service connected condition.  Mine also contained a statement that this is in keeping with well known in modern medical journals.  He doesn't have to go to far, but to little and they can disregard his statement.

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Your MD can't diagnose depression, at least not to a standard that would meet ratings. All the MD's I have had have always referred me to a mental health specialist. Your MD may say you have depression symptoms abut they are not quaified to diagnose that as 'depression'. I would suggest seeing private or VA mental health in order to document any depression symptoms that you may have secondary to your back pain. 

 

Edited by brokensoldier244th
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