Opinion on Rating

[RBrogen]

Hello Everyone,

I wanted to gut check my rating for my neck which I just had double laminectomy (c4/c5)

Rating was

   10% cervical spine degenerative disc disease with spinal stenosis and intervertebral disc syndrome

   20% radiculopathy left upper extremity

   20% raiculopathy right upper extremity

 

Here was my MRI: 

There is mild retrolisthesis of C3 on C4 and C4 and C5. Trace anterolisthesis of C5 on C6. Straightening of the cervical lordosis. Vertebral body height is preserved. There is no suspicious focal marrow replacing lesion. BROGEN, RANDY CONFIDENTIAL Page 4 of 6 There is intramedullary spinal cord signal abnormality seen at the C4 and C5 levels, consistent with myelomalacia, and progressed from the previous MRI. There is no evidence of syringohydromyelia. The visualized portions of the brain are unremarkable. The paraspinal soft tissues are unremarkable. Mild enlarged lateral level IIa lymph nodes are noted, nonspecific, and measuring up to 1.7 cm on the left.

SIGNIFICANT FINDINGS BY LEVEL:

C2-C3: No significant posterior disc abnormality. Mild, left greater than facet hypertrophy. Mild uncovertebral hypertrophy. Ligamentum flavum thickening. Minimal spinal canal stenosis. Mild left neural foraminal stenosis.

C3-C4: Posterior disc osteophyte complex. Mild bilateral facet and uncovertebral hypertrophy. Mild to moderate spinal canal stenosis with mild flattening of spinal cord. Mild bilateral neural foraminal stenosis, slightly worse on the left.

C4-C5: Posterior disc osteophyte complex. Mild to moderate bilateral facet and uncovertebral protrusion. Moderate to severe spinal canal stenosis with flattening of spinal cord. Moderate right and severe left neural foraminal stenosis.

C5-C6: Posterior disc osteophyte complex. Mild facet and uncovertebral hypertrophy. Mild to moderate spinal canal stenosis with slight flattening of the spinal cord. Mild right neural foraminal stenosis.

C6-C7: Posterior disc osteophyte complex. Moderate uncovertebral and mild facet hypertrophy. Mild spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.

C7-T1: No significant posterior disc abnormality. No significant spinal canal or neural foraminal stenosis.

Conclusion: 1. Multilevel degenerative changes of the cervical spine as above, most pronounced at C4-5. 2. Intramedullary spinal cord signal abnormality seen at the C4 and C5 levels, consistent with myelomalacia and mildly progressed from the prior MRI. There is no evidence of syringohydromyelia. 3. Mildly enlarged bilateral level II cervical lymph nodes, nonspecific. Clinical correlation suggested

Edited July 13, 2019 by RBrogen

[RBrogen]

1 hour ago, NoZZZ's said:

Would the loss of lordosis result in a 20% rating because of abnormal spinal contour?

From militarydisabilitymadeeasy.com:

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

 

That's what I was wondering as well.  reverse lordosis is a requirement for 20% rating.  I filed a NOD and supplemental claim for it.

[NoZZZ's]

Did the C&P examiner note the abnormal curvature in the exam? I believe it must be noted, and not just observed in the radiologic evidence.

[Buck52]

5 hours ago, NoZZZ's said:

Did the C&P examiner note the abnormal curvature in the exam? I believe it must be noted, and not just observed in the radiologic evidence.

YES  indeed it needs to be noted, raters are not medical Dr's or Technicians  so they read our evidence  or suppose to anyway and they do rely on these examiners notes.

[RBrogen]

29 minutes ago, Buck52 said:

YES  indeed it needs to be noted, raters are not medical Dr's or Technicians  so they read our evidence  or suppose to anyway and they do rely on these examiners notes.

Examiner noted it only by pasting in the results of the MRI in my C&P under abnormal results.  In my supplemental, I highlighted and noted a copy of the page of the C&P it was on.

[Buck52]

Thats good you highlighted it   hopefully the rater will see it.

[RBrogen]

2 hours ago, Buck52 said:

Thats good you highlighted it   hopefully the rater will see it.

I hope so ... hey would you know if the bilateral factor applies to the mandible jaw bone?  I've seen some claims indicate that it is bilateral and was wondering if the VA applies the bilateral factor to that since there is a left/right joint.