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kegs

Lumbosacral Strain and Vertebrae fractures caused by osteopenia

Question

Hi.  I have a couple questions and welcome all recommendations for my disability claim.  I am currently 10% disabled for lumbosacral strain and deferred decision for this and vertebrae fractures caused by osteopenia.  I had a MRI February 2018 and results include moderate compression fracture of L1, mild to moderate compression fracture of L2, moderate to severe compression fracture of L3, mild compression fracture of T11.  Additionally, L3 moderate spinal canal stenosis, L2 mild to moderate retropulsion with mild spinal canal stenosis, multilevel degenerative changes, multilevel disc bulges, disc herniations, L1-L2 mild broad-based disc bulge with mild spinal canal stenosis, L2-L3 mild broad based disc bulge with mild to moderate spinal canal stenosis,  L3-L4 mild to moderate broad based disc bulge and severe bilateral neuroforaminal narrowing.   I have read that these malfunctions should have been claimed individually.  Will the VA evaluate/rate each condition separately?  If not, I may have to appeal or submit a new claim.  What are some thoughts and suggestions.  Do these disabilities belong in the lumbosacral strain or the vertebrae fractures caused by osteopenia.  I am totally in the dark on this stuff.  I am pretty sure no diagnosis codes have been assigned.  What can I do to support my claim?  HELP!!!!!

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Here's a link to some search results for osteopenia which should give you a good place to start researching while you wait for others to jump in. http://tinyurl.com/ybfd333b

 

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On 12/4/2018 at 11:44 PM, kegs said:

Hi.  I have a couple questions and welcome all recommendations for my disability claim.  I am currently 10% disabled for lumbosacral strain and deferred decision for this and vertebrae fractures caused by osteopenia.  I had a MRI February 2018 and results include moderate compression fracture of L1, mild to moderate compression fracture of L2, moderate to severe compression fracture of L3, mild compression fracture of T11.  Additionally, L3 moderate spinal canal stenosis, L2 mild to moderate retropulsion with mild spinal canal stenosis, multilevel degenerative changes, multilevel disc bulges, disc herniations, L1-L2 mild broad-based disc bulge with mild spinal canal stenosis, L2-L3 mild broad based disc bulge with mild to moderate spinal canal stenosis,  L3-L4 mild to moderate broad based disc bulge and severe bilateral neuroforaminal narrowing.   I have read that these malfunctions should have been claimed individually.  Will the VA evaluate/rate each condition separately?  If not, I may have to appeal or submit a new claim.  What are some thoughts and suggestions.  Do these disabilities belong in the lumbosacral strain or the vertebrae fractures caused by osteopenia.  I am totally in the dark on this stuff.  I am pretty sure no diagnosis codes have been assigned.  What can I do to support my claim?  HELP!!!!!

I will give it a go. Clearly and unmistakably there are a number of conditions present with your spine.

The good thing is  that you have  a SERVICE-CONNECTED DISABILITY  and some of your conditions may be rated as Secondary conditions to your lumbosacral strain. (Secondary conditions are rated separately  , in most cases).The VBA or Veteran's Benefits Administration rates spinal conditions by the general rating formula and incapacitating episodes. This website can better explain in depth http://www.militarydisabilitymadeeasy.com/thespine.html#form

Look for the codes that best describe your conditions and see if they'll fall under either the general rating formula or incapacitating episodes. 

For example: Let's say you have two or more of the conditions that would be rated under the general rating formula. The Ratings Scheduler might put those conditions together to avoid pyramiding, like this- "Lumbosacral Strain with osteopenia and vertebrae fractures" (This is just an example, don't quote me on it.)

They did that with me. I was rated PTSD with Major Depression. This avoids pyramiding, and pyramiding is big no-no in VA claims. Secondary conditions rated are not pyramiding.

Here is similar information that reiterates Secondary-Connection towards the end. I hope this gives you an idea of how to go about building your claim. Best wishes.

Getting the Most Out of VA Disability Claims Involving the Spine – Part 1

August 15, 2016/in Veterans /by Anne Linscott, Attorney

Claims involving the spine, both the cervical spine and the thoracolumbar spine, are rated under the same general rating formula. The following spinal conditions are all rated under the same general rating formula:

  • Lumbosacral or cervical strain (diagnostic code 5237): this would be the diagnostic code assigned to a veteran experiencing pain in their neck or back.
  • Spinal stenosis (diagnostic code 5238): spinal stenosis is when the spaces in the spine are narrowed and cause pressure on the spinal cord and nerves. Frequently, spinal stenosis is present in the low back, but can be present in the cervical spine area as well.
  • Spondylolisthesis or segmental instability (diagnostic code 5239): this is a condition that causes one bone in your back (a vertebra) to slide forward over the bone below it. This can result in the spinal cord or nerve roots being squeezed can cause back pain and numbness, or even weakness in one or both legs.
  • Ankylosing spondylitis (diagnostic code 5240): this is a form of spinal arthritis that causes inflammation of the spinal joints and can result in severe, chronic pain. Ankylosing spondylitis can also cause inflammation, pain, and stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet.
  • Spinal fusion (diagnostic code 5241): Spinal fusion is a type of surgery that is performed to join two or more vertebrae together so that there is no movement between the two vertebrae. This surgery is often performed in individuals with spondylolisthesis and spinal stenosis.
  • Vertebral fracture or dislocation (diagnostic code 5235): A vertebral fracture occurs when a vertebra becomes compressed due to trauma. Typically, a vertebral fracture results in symptoms such as limited spinal mobility, and standing/walking will make the pain worse while lying down on the back makes the pain better. A vertebral dislocation is when one of the small vertebrae in the neck is displaced following a traumatic injury to the head or neck. Symptoms of a vertebral dislocation include pain that spread into the shoulder and arms, tingling or numbness in the arm, muscle spasms in the neck, and weakness in the arms.

The general rating formula that is used to rate the conditions listed above is mainly based on range of motion (ROM) measurements.  The cervical spine (neck) and the thoracolumbar spine (low back) are rated according to the following criteria:

  Cervical Spine Thoracolumbar Spine
0% Flexion ≥45 degrees, OR combined ROM ≥ 340 degrees Flexion ≥ 90 degrees, OR combined ROM ≥ 240 degrees
10% Flexion between 30 and 45 degrees, OR combined ROM between 175 and 340 degrees Flexion between 60 and 90 degrees, OR combined ROM between 125 and 240 degrees
20% Flexion between 15 and 35 degrees, OR combined ROM ≤ 170 degrees Flexion between 30 and 65 degrees, OR combined ROM ≤ 120 degrees
30% Flexion ≤ 15 degrees, OR entire cervical spine is frozen in a favorable position Not applicable to thoracolumbar spine
40% Entire cervical spine is frozen in an unfavorable position Flexion ≤ 30 degrees, OR entire thoracolumbar spine is frozen in a favorable position
50% Not applicable to cervical spine Entire thoracolumbar spine is frozen in an unfavorable position
100% Entire spine is frozen in an unfavorable position Entire spine is frozen in an unfavorable position

As you can see, ROM measurements play a huge role in rating spinal conditions. Because the rating formula is almost entirely based on ROM measurements it is important to make sure that a doctor performs ROM testing as accurately as possible. Also, the VA requires that all ROM measurements be taken with a goniometer. If a doctor doesn’t use a goniometer to measure your ROM, the VA will not consider the results.

In addition to the ROM measurements, the general rating criteria for spinal conditions looks at whether the cervical and/or thoracolumbar spine is frozen in a favorable vs. unfavorable position. A favorable position means the ROM measurement for flexion or extension is 0 degrees. Unfavorable means any position that is not 0 degrees in flexion or extension.

Conditions Secondary to Spinal Conditions

Oftentimes, spinal conditions will cause other conditions that can be rated in their own right. For example, fractured and/or dislocated vertebrae can lead to pain and weakness in the arms, hips, shoulders, etc. People with spinal conditions also often change how they walk to compensate for the pain which can lead to knee and hip problems.

Spinal conditions can also cause nerve problems. One of the most common conditions secondary to spinal conditions is radiculopathy. Radiculopathy is caused by compressed nerves in the spine and results in pain, numbness, tingling, or weakness along the nerve. If radiculopathy is caused by a low back condition, the symptoms will be felt in the lower extremities (thigh, calf, foot). If radiculopathy is caused by a neck condition, the symptoms will be felt in the shoulder and can travel down the arm and into the hand.

If your spinal condition results in the development of a new disability or makes an existing disability worse, remember that you may be entitled to secondary service-connection for the new or aggravated disability. These secondary conditions would be rated separately from the underlying spinal condition.

 

 

 

Edited by doc25

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Good info above.

in brief, the VA rates the spine as two segments: cervical (neck) and thoracolumbrosacral (everything else). Based on your thoracic and lumbar level issues, you likely could get a single rating. If problems spread into your neck, you should consider filing for cervical spine issues as a secondary claim.

Most of the spine rating criteria is based on limited range of motion, abnormal curvature, and gait problems. They also consider IVDS (bedrest) as an alternative rating option.

Consider secondary claim possibilities. Do you have radiculopathy in your limbs? Does the medication given to treat your spine-related issues cause additional disabilities (GERD, ED, depression, etc...)?

 

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Hi everyone.  Thanks for all the information.  I received a determination, finally.  The VA did lump my spine issues into one.  20% for lumbosacral strain, degenerative arthritis, spinal stenosis, and vertebrae fracture.  10% for radiculopathy, left lower extremity and 10% for radiculopathy, right lower extremity.  I have some other rated disabilities for a combined 60%.  I am working on an appeal.  I will claim my spine issues be rated individually. Is that reasonable?  I think I will also claim my cervical spine be rated as secondary to my lumber spine.  My cervical ROM is less.  Also, the cervical has degenerative disease, narrowing of disc space, degenerative changes.  In addition to my spine malfunctions, I plan to appeal my shortness of breath.  As secondary, I will request sleep apnea.  I use a CPAP nightly as prescribed by the VA.  I also use oxygen nightly.  What insights do you folks have, along with your suggestions and recommendations?  Also, is sciatica the same as radiculopathy?  The VA has used the term sciatica all along and that is what I claimed.  Thanks.

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