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Need help with Spine C&P exam questions, etc. ankylosing spondylitis

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Dan T.

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I am serviced connected for ankylosing spondylitis back in 1985. I had a C&P exam on 7-7-19 since I am asking for an increase in my cervical, thoracic, and lumbosacral ratings. After speaking with the DAV to find out progress and info on my exam, the Rep. noted sort of what I expected. Radiculopathy was noted and ROM was 0-15 for cervical, and 0-25 for back. I am currently rated as Cervical 30%, Thoracic 10%, and Lumbosacral 40%. The main question that I have is relating to the thoracic 10% and lumbosacral 40%. I am confused on these two. Is Lumbosacral separate from the thoracic/others ? Since my back ROM is at 0-25, does this mean that my thoracic might increase from the 10% to a higher rating ? I am confused how they break down my ratings from cervical at 30%, Thoracic at 10%, and Lumbosacral at 40%. Did the VA make changes to the names of the spine regions after I was rated and how they would rate each one?....because I don't see Thoracic as a region now. I only see cervical and thoracolumbar. I'm not sure how they would rate/increase me...totally confused. Also, with the radiculopathy, is this something that they will rate also ? I am currently at 90% total combined for all my disabilities. I hope this helps for someone to give me advice/answers.

Edited by Dan T.
Wasn't getting answers from previous Title
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The criteria for spine ratings, follows:

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General Rating Formula for Diseases and Injuries of the Spine(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or diseaseUnfavorable ankylosis of the entire spine100

Unfavorable ankylosis of the entire thoracolumbar spine50

Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine40

Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine30

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 kyphosis20

Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height10

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.Note (4): Round each range of motion measurement to the nearest five degrees.Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.5235 Vertebral fracture or dislocation5236 Sacroiliac injury and weakness5237 Lumbosacral or cervical strain5238 Spinal stenosis5239 Spondylolisthesis or segmental instability5240 Ankylosing spondylitis5241 Spinal fusion5242 Degenerative arthritis of the spine (see also diagnostic code 5003)5243 Intervertebral disc syndromeEvaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25.Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating EpisodesWith incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months40With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months20With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months10Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

Based upon this, it appears that VA combines thoracic and lumbar, while the cervical spine verterbrae are rated seperately, at least that is the way I read it.  

Once service connected, as always, you will be rated on symptoms and how they limit your life.  Deluca says pain has to be included in this.  (not to mention ROM).

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Dan T. - I am a newby contributor, however I am a Registered Nurse.  The  spine is divided up into the Cervical, Thoracic, Lumbar, and Sacral regions for anatomical land-marking or guideposts if you will.  For discussions on  Range of motion (ROM), the only moving parts of the spine are the cervical (makes your head nod and swivel), the Lumbar (allows you to bend forward and for some - backwards).  That is all the motion you get from the spine. The thoracic region is connected to the ribs and does not move very much. HOWEVER, in the case of disc bulge, spinal cord compression, or damage to the thoracic region that causes pain (mostly chest and radiating pain to lower regions (thoracolumbar, lumbarsacral)).  If you have noted pain in the Thoracolumbar (between the Thoracic and Lumbar region), or the Lumbarsacral (previous called lumbago- but is between lumbar and sacral region) then these terms are for identification of the area for treatment. 

In your case, and based upon the information from 38 C.F.R (as provided by broncovet) the cervical spine should be rated at 30%, the lumbar sacral should be 40% and the thoracic would remain at 10% UNLESS you have radiculopathy (pinched nerve or nerve pain) in the thoracic area that would decrease you depth of breathing, weight you can carry, or pain that travels from the mid-back to the lower back and buttocks. If the xrays only show degenerative disc disease or arthritis in the thoracic area, without symptoms then you would remain at the 10%.

Hope this helps.  Thanks for allowing my input.

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