Back is Getting Worse Need to Request New Rating

[AntiqueLT]

I have been researching this for a while and I keep ending up here at HadIt reading old threads.  So, now that I am ready to ask questions I have com to you.  I appreciate the knowledge I have acquired here already.  Thank you all.

My situation is that I was service connected rated 20% for Degenerative Disc Disease (DDD L2-3 and L5-S1) limited mobility as well as 10% each for a shoulder, both knees and PTSD back in 2011.  50% total rating.  This was done through the Army/VA program when they told me I couldn't play with them anymore.

Fast forward to last year and I began to have numbness and tingling in my legs from standing for more that 20 minutes at a time.  Over the course of the year it shortened to 10 minutes and I was experiencing warm and cold flush sensations in my thighs.  In November I had bad sciatic pain and a steroid pack resolved it.  Then in January this year it went precipitously downhill.  I started having numbness start from my groin to just below my knees after 5 or so minutes.  I was down to 5 - 10 minutes of stand or walk time and I started getting wobbly and falling down if I pushed it.  I had to stop working in April because I was stumbling and scared that I was going to fall off the ladder I climbed repeatedly throughout the day.

So I have had MRIs and an EMG and fought with doctors and it appears that all the VA is willing to do is give me a shot in the back and leave me crippled.  The diagnosis is lumbar radiculopathy.  The MRIs show two herniated discs (L4-5 and L5-S1 and a bulging disc above at L3-4) as well as stenosis and multiple moderate and severe nerve impingements at these levels.  The EMG shows "electro-diagnostic evidence of L5-S1 radiculopathy.

Given that I apparently need to grab a Snickers while the VA medical side struggles to do medicine, I figure I need to file a claim on the worsening back and the neurological deficits that it is creating.  My problem is this:  I'm not sure how I should make the new claim and what it should be for, exactly.  I contacted the American Legion rep for my county and he basically said he just files paperwork.

I have looked at 4.71a and I get the rating for the spine itself.  I'll need to get them to do a measurement for flexion to see if I meet the criteria for that to change.  When I go looking for the neurological stuff I get lost.  Same goes for the stenosis and arthritis.  I can't seem to figure out how they get rated and what I would present from my file to establish the criteria.  I have to think the numbness and loss of strength from standing / walking leading to falls have some place in this.  If someone can give me some help and guidance I would be eternally grateful.

Then there is the whole how do you write it up so that the paper shuffler who has a couple minutes to go-nogo the packet sees what they need to see.  But that is a separate matter for when I have the what figured out, I suppose.

Thank you all again for any help you can provide.

[brokensoldier244th]

They rate the back as 1 system, so stenosis, DDD, etc, all encompass the same thing, though you can get rated for nerve impingement separate, and you may be able to get separately rated for cervical spine vs. lumbar, etc- but I dont know for sure on that. I have a 40% back rating and 20% each leg due to the nerve impingement, for example. Stenosis, arthritis, etc, are all encompassed in the DDD back rating.

[AntiqueLT]

On 8/15/2018 at 4:15 PM, brokensoldier244th said:

They rate the back as 1 system, so stenosis, DDD, etc, all encompass the same thing, though you can get rated for nerve impingement separate, and you may be able to get separately rated for cervical spine vs. lumbar, etc- but I dont know for sure on that. I have a 40% back rating and 20% each leg due to the nerve impingement, for example. Stenosis, arthritis, etc, are all encompassed in the DDD back rating.

Thank you for your reply.  I'm sorry it has taken me so long to get back here.  I have some things going on.

That the DDD and it's associated conditions are rated together I can wrap my head around.  What is confusing me is when I looked at the nerve ratings for the weakness it doesn't read like it counts unless you have paralysis.  Is the rating determined from 4.124a-13  Diseases of the Peripheral Nerves?  Or somewhere else?

That is the kind of information I need to get to file a claim, right?  

Thank you again.

[brokensoldier244th]

It falls under partial paralysis.  Radiculopathy is also the term some doctors use. 

[Vync]

@brokensoldier244th is correct. The cervical spine segment (neck) is treated as a completely different disability than the rest of the spine.

Radiculopathy is granted via §4.124a   Schedule of ratings—neurological conditions and convulsive disorders. under the Diseases of the Peripheral Nerves section.

When they rated the sciatica in my legs, they used code 8520. You can follow the above link to locate ratings for other peripheral nerves.

Quote

	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.

 

 

 

[vetquest]

Brokensoldier and Vync are correct on this.  Even though you do not have paralysis per se it is rated under 8520 for neuropathy too.  You will also receive a bilateral factor for each leg if they rate both. 

As I have learned...stay off of ladders.  If your work requires ladders it might be time to start looking for TDIU.  No, you do not qualify for it right now but if they rate you as moderate bilateral you should have the necessary rating.  If you file now you will lock in a date.  The fact that you cannot stand for long periods of time is also a hint.  See if your neurologist will state in a letter you can no longer work due to your service connected condition.  Also see if you cannot get a neurological DBQ and then have your neurologist fill it out.  I believe this is the correct one.  If it is not then someone will be along to correct me.

https://www.vba.va.gov/pubs/forms/VBA-21-0960C-10-ARE.pdf

[Richard1954]

 I am presently rated 60% for herniated disc  at the L3-L4, L4-L5,  L5-S1 level.  I also have degenerative disc disease in my neck, and I have sciatic nerve impingement that  was verified thru a nerve conductive studies . In addition, I have drop foot.  I was given a 60% rating in May 1999, and a K award for the drop foot.  If I thought I could still  get a  60% rating and get a separate rating for the drop foot, and sciatica nerve impingement I would request to reopen the claim... But under the newest rules  a 60% rating requires bed rest on order of the doctors for 6 weeks or more in the last year which  is considered to be a rating under  incapacitating episodes .  First doctors almost never give bed rest for degenerative disc disease, so to get a rating at 60% would almost be impossible, The most I could hope to get based  on the general rating formula under flexion or extension,the ratings are such that I doubt I would even get 40%, and while they go to 50 and then 100%,  the back has to be frozen in a specific limit of flexion. My back is not frozen, and I can still bend as much as the next guy. My problem is that 3 or 4 times a year  the muscles in my back go into spasm and caused me to bend at the waste with terrible pain.  The cervical spine is rated separately, but I can already reach 100% three different ways, so I never requested service connection for my neck. As to the drop foot , the most I would get would be 20%.  I am much better off with the current 60% as it encompassed all the damages to my nerves and muscles, and I get the K award for the drop foot which is about $100  month. The ratings were changed a while back.. and in my opinion they were changed to make it almost impossible to get a high rating. As someone said  you can get bilateral factors for each leg involved.  

 

The point I was trying to make is that under the current rating schedule . it's  impossible to receive a high rating. which is either 50% or 100% for a frozen spine....  In your case you get a lot of smaller ratings, which for combining purposes actual suck especially if your trying to get housebound or Aid and attendance.  

 

My opinion is that you should get an independent medical opinion, do not go to a va c/p exam and let a va paid doctor determine your rating, The problem with c/p exams is that they almost never see you at your worse, and because they don't see how bad the disability affects you, you get a low ball rating.