C&P exam question about thorasic spine & claim timelines

[Kihr]

I am a little confused, I have "psoriatic arthritis, also claimed as back condition" as my current and only rated condition 20%, which was from my initial claim 10 years ago.  They were submitted as 2 different items, "back pain" & "psoriatic arthritis" but combined.  Anyway, I submitted a claim in september for an increase to my P.A. and a few other new claims related to tgr P.A. and had C&Ps in November.  I have been waiting ever since with no updates, denials, deferrals, granted claims etc.  Last week I get a call for a contractor exam about my back.  I was a bit confused, about why I was having the exam but it is what it is so I went today.

The examiner said "you are not rated for a back condition, you have no official diagnosis for your back, it just says back pain."

"I don't know why you had an x-ray without a diagnosis, the x-ray said there was no arthritis in your back. So I don't know why they combine these as a single rating."

I am not entirely sure why I had this exam, it makes me a little nervous about all of this.  

1.) Any reasons my 5(in total including P.A. increase) claims would have no decisions made at all after nearly a year?

2.) Should I be prepared for bad news?  Is it likely they will just deny all of them because they have not done any grants approved?

3.) Has anyone had an issue like this they can shed some light?

4.) Assuming there are no further exams, is 4-6 weeks a good guess for a decision length from this C&P?

[GBArmy]

The quickest thing  you could do is call Peggy (800- 827-1000) and see what they can tell you. The C&P examiner may be telling you that although they haven'y informed you, your claim for your back is (or should be) denied as you don't have a medical diagnosis. Do you actually have a medical diagnosis for it? If not, get one. You would want to be sure that it has rationale for the cause of the pain, and that the Dr. connects it as in "more likely as not" been caused by an in service event. You may be able to submit the new evidence even now since they haven't dispositioned your claim. You need to s-c the back to your service. If you already have, start making some noise.

[Kihr]

I had a spinal tap while AD, it was as a result of a high fever, they wanted to make sure I didn't have meningitis.  I have been having back pain since that time.  The C&P Examiner said he would list it as Thorasic Strain, which I think is equivalent to back pain.  If I knew then (10 years ago) what I know now I would have been much more aggressive when I made my initial claim.  I put almost nothing on there when there are many things that are directly listed in my record that are SC.  Even this claim I submitted in September was filed but done poorly.  I really regret not doing enough research into this process and how everything is determined.  I am very nervous for my claim results (if I ever get them) because of the length of time.  It has been 10 months, 3 C&P back in November and then nothing until 2 weeks ago.  

[GeekySquid]

23 minutes ago, Kihr said:

It has been 10 months, 3 C&P back in November and then nothing until 2 weeks ago.  

I don't know much about spine stuff so others will have to chime in. I do know however that if you have your original handwritten statement of claim, award/denial letters, requests for C&P's and DBQ's from those C&P's if you redact your private info and upload them to this thread people can help you. That background info is really important for any solid opinions to be offered.

let us know.

[jbasser]

Ratings of the spine. The spine is broken up into 2 different segments for VA rating purposes. Cervical and thoarcic and lumbar are considered one. If you are rated for an issue on the spine and have a separate issue on the same segment the VA will only rate one as more than one is called pyramiding. They should rate the most severe condition. You may be better off obtaining an MRI of the spine vs an xray.  There are also 2 different sets of rating criteria for the spine. One is Traumatic Arthritis. The other is Invertrable Disk Syndrome. If you have Arthritis with no disk issues then it should be rated under Traumatic Arthritis. If the Disk is the culprit then it is rated as IVDS. As for the ratings under TA, it is based on Range of Motion. Any separate nerve issues are to be rated separately. Under IVDS it is rated under incapacitating episodes or basically bed rest. You should look uo the ratings in the 38CFR title 38 part 4 under ratings for the spine. It gives you the ratings and percentages for Both issues.

 

Basser

 

 

[Kihr]

I only have the initial claim from 2010 on e benefits.  I submitted a claim for an increase for my psoriatic arthritis (which apparently is combined w/ the back pain).  I will request it when I am able, this was a contractor and will not be available for awhile.  I submitted this claim in September and am waiting for my results.  I don't know how much longer it will be, I feel like it is never ending at this point (10 months).  I think part of the hang up is I am currently 20%, and I submitted simultaneously a claim for 2 dependents in the event I got any increase at all.

Would it be rated under the code 5237 Jbasser?

[jbasser]

Most likely since that is the code for Strain.