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Petty Officer 3rd class

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Garrett

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I recently had a C&P back exam and while going over my medical records the physician saw there were to incidents involving my back. One was during service in 1994 and the other was related to a car accident in 2011. When they took x-rays, degenerative arthritis was diagnosed. I was granted four claims that involved degenerative arthritis for my shoulders and both ankles back in 2010. My question is will VA likely deny my back due to the last incident was the car accident or will they rate it as degenerative joint disease with limited range of motion? 

 
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3 hours ago, Garrett said:

I recently had a C&P back exam and while going over my medical records the physician saw there were to incidents involving my back. One was during service in 1994 and the other was related to a car accident in 2011. When they took x-rays, degenerative arthritis was diagnosed. I was granted four claims that involved degenerative arthritis for my shoulders and both ankles back in 2010. My question is will VA likely deny my back due to the last incident was the car accident or will they rate it as degenerative joint disease with limited range of motion? 

 
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Was your C&P exam done by QTC or VA?? I ask because your exam will show up in your VA records via myhealthevet or e-benefits and will show what the examiner put. As long as  the examiner put "at least as likely as not" in the nexus of opinion, you will get something, but that all depends on the Ratings Scheduler and how the scheduler interprets all the medical evidence.

Here is some literature to look over to give you an idea how your degenerative arthritis for your back will be rated.

 

Code 5003: Degenerative arthritis is the second most common rating for any joint condition, and it can get VERY confusing. The most common rating for joint conditions is limitation of motion, partly because conditions are required to be rated under limitation of motion first before they can be rated as degenerative arthritis. If any condition causes a decreased range of motion in a joint, then it MUST be rated on that limited motion.

A joint condition can only be rated as degenerative arthritis if it does not have a limited enough range of motion to rate under those codes. Conditions CANNOT be rated under both limitation of motion and degenerative arthritis. Limited motion first, and if not, then only arthritis. Got it?

So on to the rating: Once a condition cannot possibly be rated as limited motion of the affected joint, we can proceed with rating it as degenerative arthritis.

Please note that there must be x-ray evidence of arthritis in the joints to rate under this code.

For rating arthritis, the shoulder, wrist, elbow, hip, knee, and ankle are considered major joints. The finger and toe joints, spine, and sacroiliac joint are considered minor joints. If two or more major or minor joint groups have arthritis and it is occasionally incapacitating, then it is rated 20%. If two or more major or minor joint groups have arthritis but it is never incapacitating, then it is rated 10%.

If only a single major or minor joint group has arthritis, it can only be rated more than 0% under code 5003 if there is painful motion. If it hurts to move it, then it rates 10% because of the Painful Motion principle.

 

 

Hopefully, the Ratings Scheduler gives a favorable percentage. I imagine your car accident aggravated your condition and that will give added weight to a favorable decision.

Best wishes on your claim.

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Let me check my crystal ball, and I will predict what VA will do:

Errriie music...........whewwwwewer.....

Ok, I predict VA will deny 85 percent of first time claimants, usually for bogus reasons, just like they have done in the past.   Then you will wait years for appeals.  Finally, they lowball you, which also has to be appealed.  Then, they hornswaggle you on the effective date, and, after you die they try to con your spouse out of DIC.  This is what VA calls a "pro claimant, Veteran friendly, claims system".  For me, its taken 16 years and I probably have at least 2 more years to go, that is, if everything goes like clockwork from here on. (unlikely).  

Once you have a condition service connected, its always service connected.  This said, if you injured your back in a car accident while you are not in service, dont expect VA to compensate you for injuries sustained in this accident.  

Further, I will predict VA will fight you at every turn for every dime, delaying and denying every chance they can.  Or, worse, loose all your paperwork.  

Your best bet is to keep a copy of everything you send VA (better is to send them the copy and you keep the original.  Persistence will win out, as long as you have a legitimately winnable claim. (one that has all three caluza elements.)

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