Reevaluation of lower back

[Gatorintel]

So after five years of receiving my disability payments at 100%, the VA scheduled me for a reevaluation on my lower back degenerative disc disease, L4-S1.  My other disabilities had already been given P and T, so I wasn't reevaluated on those.

 The doctor today did the measurement so quick that there is no way he could have line-up the measurement tool for an accurint reading.  

I am concerned that I will be given a lower rating on my back flexation.  I have been regularly seen at the VA for PT on my back and have been scheduled for injections to reduce the pain.  I have had an MRI as recent as two months ago that says my degenerative discs have not improved, but they have not gotten markably worse.  

I would like to know if anyone has had their back rating reduced based on maybe a 10 degree improvement in flexation, but that the flexation brings me to the 20% rating vs the 40% rating.  I am not sure if the VA regional office will say a 10% increase is a marked improvement and lower my rating.  

Any comments will help my monkey mind on this particular subject.

[Vync]

Welcome to Hadit!

The P&T part of your rating really doesn't mean Permanent and Total. The VA has three tiers for rating protection, as of the effective date, which you need to understand first:

5 years = The VA should not attempt to reduce unless there has been sustained improvement
10 years = SC status of the disability is permanent
20 years = Rating % is permanent

Your physician stating you are not likely to improve is beneficial, but you know how the VA works....

 

Now about your exam:

The C&P examiner should have used a goinometer:

For ROM disabilities like this, they should have taken two sets of measurements and had you do repetitions (to see if ROM decreases with each rep).

For example:
Max ROM 30 degrees
Max ROM with pain (or pain begins at) 15 degrees

Pain is a key factor on your rating and it is referred to as "functional loss". As in the above example, even though you could bend to 30 degrees, pain began at 15 degrees and should be used instead.

Quote

§4.40   Functional loss.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.

 

It is possible for your spine rating to go up or down with as little as a 10 degree difference. But ROM is not the only factor in spine rating percentages. Take a look at the criteria below. Notice there are a bunch of semicolons and or's. In the case of someone with a 10% rating, they qualify for a 20% rating if they have spasms/guarding which cause abnormal gait or abnormal spinal contour.

 

Quote

	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.

 

 

 

 

 

[Tward]

I am at 10% lower back after having surgery in 2012 before my ETS, The disks have re-ruptured , I cannot drive, I cannot sit or stand for longer than a few minutes extreme pain in both legs when I do that radiates into the bones from my hips to my feet , with muscle stiffness or cramps in lower back, hips, calves, and feet. The needle sensation is extreme in my feet and joints below the knees. when I try and sleep my hips feel like they are burning, and my legs become like when you sleep on your arm limp no muscle movement I have to have my wife help me out of bed at least twice a week worse part is struggling to take a number 2 by the time I am done I am totally numb from the waist down. Again how is that 10%

They still refuse to go higher than 10%, I can no longer do my normal job, and I am pretty sure if I was to be laid off even with protected status I will never work again luckily my company supports Vets, AND changed my job description, and put me on permanent work from Home.

They refused to do a TBI, and say my Migraines are related to PTSD "HUH whats my PTSD related to an IED explosion in front of my Gun Truck", they refuse to use the new MRI's they themselves performed as evidence of the re-ruptures, they even said my labial tear in my left hip has no relation to the lower back issues, honestly I think they want us all to die first.

Edited August 17, 2019 by Tward