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Question in reference to "New" Back Injury

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smoothc100

Question

I currently receive 30% for herniated L5-S1 disk (20%) and right lower extremity radiculopathy (10%).  Last year I had surgery where they removed ½ of my L5-S1 disc (the herniation). Early June while cleaning I attempted to move my coffee table (light), which I have done many of times before, but unfortunately my back did the snap, crackle, and pop. Last Saturday I had a MRI done, which shows the following:

L4-5: Left central/subarticular disc extrusion extending superiorly 1.3 cm above the disc space posterior to L4. Severe left subarticular recess stenosis. Severe left neural foraminal stenosis.

 

L5-S1: Redemonstrated right central/subarticular disc protrusion. Moderate right subarticular recess stenosis. Moderate bilateral neural foraminal stenosis.

 

The new injury is currently the L4-5 and I have been scheduled for epidural steroid injections to help with the pain and strengthen the leg.  Should I file for an increase for my back or just leave things as they are? I’m thinking I will need a nexus letter to show how the new injury was caused by the original disc herniation.

 

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  • Content Curator/HadIt.com Elder
On 6/26/2016 at 8:48 AM, smoothc100 said:

I currently receive 30% for herniated L5-S1 disk (20%) and right lower extremity radiculopathy (10%).  Last year I had surgery where they removed ½ of my L5-S1 disc (the herniation). Early June while cleaning I attempted to move my coffee table (light), which I have done many of times before, but unfortunately my back did the snap, crackle, and pop. Last Saturday I had a MRI done, which shows the following:

L4-5: Left central/subarticular disc extrusion extending superiorly 1.3 cm above the disc space posterior to L4. Severe left subarticular recess stenosis. Severe left neural foraminal stenosis.

L5-S1: Redemonstrated right central/subarticular disc protrusion. Moderate right subarticular recess stenosis. Moderate bilateral neural foraminal stenosis.

The new injury is currently the L4-5 and I have been scheduled for epidural steroid injections to help with the pain and strengthen the leg.  Should I file for an increase for my back or just leave things as they are? I’m thinking I will need a nexus letter to show how the new injury was caused by the original disc herniation.

Oh man, I know how you feel. I hope you get some relief soon. Epidural injections sometimes help, but you might have to have more than one.

It's hard to say if you should file for anything without knowing how bad things are, ROM's, radiculopathy changes, etc.., but I will try and help.

Well, from the rating perspective, the VA will usually treat the thoracic/lumbar region as a single spine segment. You can have problems at one various vertebrae levels, but it would still fall under the same spine segment. However, take a look at the spine rating criteria (below) because you could qualify for an increase in other ways. In addition, you mentioned being rated for radiculopathy of the RIGHT leg, so we can explore that first.

Radiculopathy
Because you are SC on the RIGHT leg, not the LEFT, if your LEFT leg has sciatica-type problems, you might file for radiculopathy of your LEFT leg secondary to your lumbar spine disability, but would need a doc to opine the usual nexus statement. Radiculopathy of the legs based on the sciatic nerve is typically rated under code 8520. I guess the mild/moderate/etc.. levels of severity would be determined by your doc or during a C&P exam. If your RIGHT leg got worse, it might make sense to file for a increase.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_1124a

  Rating
Sciatic nerve  
8520   Paralysis of:  
Complete; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost 80
Incomplete:  
Severe, with marked muscular atrophy 60
Moderately severe 40
Moderate 20
Mild 10
8620   Neuritis.  
8720   Neuralgia.  

 

Spine
You are currently 20% for your spine. Explore the rating levels above 20% to see if you meet the requirements.

The 30% rating applies to cervical only.

The 40% level has two lumbar criteria:
1. "or, forward flexion of the thoracolumbar spine 30 degrees or less;" (this is simple to figure out, get your ROM measurements, add them up)
2. "or, favorable ankylosis of the entire thoracolumbar spine"

If you wonder what "ankylosis" means, here is a generic description:

  • Unfavorable ankylosis: Stuck in an "unnatural" position, like if you can not straighten your back out at all and are permanently hunched over even when standing up right; or stuck in a bent position leaning to the right or left.
  • Favorable ankylosis: Opposite of unfavorable, but are stuck in a more "natural" position.

You might be able to meet the 50% criteria if your thoracolumbar spine is really jacked up, but 40% would be your next threshold.

For IVDS, you would need 4 weeks minimum of incapacitating episodes to qualify for 40%.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_171a

  Rating
General Rating Formula for Diseases and Injuries of the Spine  
(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):  
With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease  
Unfavorable ankylosis of the entire spine 100
Unfavorable ankylosis of the entire thoracolumbar spine 50
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine 30
Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis 20
Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height 10
Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.  
Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.  
Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.  
Note (4): Round each range of motion measurement to the nearest five degrees.  
Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  
Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.  
   5235   Vertebral fracture or dislocation  
   5236   Sacroiliac injury and weakness  
   5237   Lumbosacral or cervical strain  
   5238   Spinal stenosis  
   5239   Spondylolisthesis or segmental instability  
   5240   Ankylosing spondylitis  
   5241   Spinal fusion  
   5242   Degenerative arthritis of the spine (see also diagnostic code 5003)  
   5243   Intervertebral disc syndrome  
Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.  
Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes  
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months 60
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months 40
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months 20
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months 10
Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.  
Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.  

 

Lastly, if you end up having surgery, it might be worth exploring filing for convalescence if you meet criteria. This link explains it pretty clearly.

http://www.benefits.va.gov/COMPENSATION/claims-special-convalescence.asp

 

 

Good luck!

"If it's stupid but works, then it isn't stupid."
- From Murphy's Laws of Combat

Disclaimer: I am not a legal expert, so use at own risk and/or consult a qualified professional representative. Please refer to existing VA laws, regulations, and policies for the most up to date information.

 

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Vync,

Thanks for the advise and insight.  I'm going to give it a few months before I file anything, because that should determine how bad it is with the treatments and all. I know the injections didn't work for the right side, so they went in and burned the nerves around the disc, which might end up happening on the left, but we shall see.

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3 hours ago, smoothc100 said:

Vync,

Thanks for the advise and insight.  I'm going to give it a few months before I file anything, because that should determine how bad it is with the treatments and all. I know the injections didn't work for the right side, so they went in and burned the nerves around the disc, which might end up happening on the left, but we shall see.

Sounds like a plan.

Injections don't always for for everyone. Sometimes it takes a couple of rounds of them before they start working. The doc who does mine is excellent, but I still worry about risks.

"If it's stupid but works, then it isn't stupid."
- From Murphy's Laws of Combat

Disclaimer: I am not a legal expert, so use at own risk and/or consult a qualified professional representative. Please refer to existing VA laws, regulations, and policies for the most up to date information.

 

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