Favorable findings support claim

[dwbell99]

In the situation below, does the Favorable findings below support what is claimed?

CLAIMED: chronic L5-S1 disc degeneration & bilateral lower extremity sciatica are more likely due to abnormal gait caused by service connected left ankle disability.   

DECISION: Service connection for degenerative disc disease, lumbar spine (claimed as back) is denied. 

Favorable finding identified in this decision:
- Private examination for Dr. XXX opined that chronic L5-S1 disc degeneration & bilateral lower extremity sciatica are more likely than not less secondary connected (due to abnormal gait caused by service connected left ankle disability).  

[Vync]

In my nonprofessional/nonlegal opinion, this definitely looks like it is in your favor even without applying benefit of the doubt. Seems like your private doc did the right thing, but the VA employee weighing the evidence might have screwed up.

Take a look at this:

"more likely due to abnormal gait caused by service connected left ankle disability"

"more likely than not less secondary connected (due to abnormal gait caused by service connected left ankle disability"

 

Notice that the word "less" was somehow added. How did that get in there? Don't know if this was accidental or intended. Whatever the reason, it does appear the VA might have screwed up. The VA employee who evaluates the evidence is not allowed to insert their opinion.

To be certain, go over the rating decision's "reasons and bases" to see if there is anything indicated why SC should not be awarded.

[GBArmy]

I agree with Vync. Unless you can find something else, I would go in person and talk to the RO about submitting a HLR. Explain that it looks "funny" and ask them to take a look. If they balk, at changing it,  just hand them the paperwork for a HLR.The decision has to address why your doc's dbq was not as good as...? If that isn't in the decision, I would expect that they made a mistake. IMO

[Richard1954]

 I have degenerative disc disease at L3-L4,  L4-L5, L5-S1... I  also have sciatica nerve issue both legs, and drop foot left .   I am not a doctor.. but based on all that I have learned about Degenerative disc disease... I doubt an abnormal gait would cause it.   Most degenerative disc disease  of the lower back starts with an injury to the lower back.. I agree that an abnormal gait could aggravate such an injury but cause it  ... that is another question. Is it possible sure anything is possible.  I personally would be interested in the Doctor's medical justification  and the raters reasons for denial , it could be that the rater disqualified the doctors opinion for a couple of different reason... Once I see the justification, and reasons then I would be in a better position to make a recommendation on how to proceed or not. By the way. my DDD is rated at 60%....

Edited October 2, 2019 by Richard1954

[brokensoldier244th]

Good point Richard. I’m 60% also And mine was started by trauma/fall to l5-s1 Caused by, probably not, but exacerbated by abnormal gait? Absolutely. It almost looks like the doc wasn’t sure what he was supposed to write, or worded it funny-dictation is weird like that and a lot of docs use it, or a service where others still type it for them. I’d get clarification from the doc, too, about what it was they were actually trying to say.

[Vync]

@Richard1954 and @brokensoldier244th offer some really good information. If you want to post the DBQ and reasons and bases from the rating decision, be sure to redact any private information before you do so.

Keep in mind that with spine injuries, secondary conditions are often on the horizon. The hip bone is connected to the thigh bone, and so on... Essentially, if a SC disability or the medication used to treat it cause an additional disability, you should consider filing for it. Each secondary condition is rated independently from each other and even the parent disability.

When in the service, I had a motor vehicle accident, fall, and a number of training injuries. I compare the spine to a really tough egg. Sometimes it just takes a one injury to crack the egg, but over time the cracks and effects get worse. It began to progressively affect my lower back, then my neck, then the radiculopathy got worse over time. Gait definitely can be a factor. When you are unable to walk normally due to spasms or injuries, that can cause strain on the discs and nerves. I walk with a cane almost exclusively now.

Below is a list of my spine-related disabilities, their rating percentages, and the diagnostic codes in case anyone wants to look them up. Keep in mind the codes and ratings may change, but these were effective as of 2008.

40% (5010-5242) Lumbar DDD, spondylosis, kyphosis
10% (8513) Lumbar radiculopathy, left lower extremity associated with lumbar DDD, spondylosis, kyphosis
10% (8513) Lumbar radiculopathy, right lower extremity associated with lumbar DDD, spondylosis, kyphosis

10% (5010-5242) Cervical spondylosis
20% (8513) Cervical radiculopathy, left upper extremity associated with cervical spondylosis
20% (8513) Cervical radiculopathy, right upper extremity associated with cervical spondylosis

Because my radiculopathy affects both arms/legs, they are treated as bilateral conditions. That means the VA will use the rating calculation table to first build a combined rating for all bilateral-related ratings. Then they add 10% to the total. After that, they will use the bilateral grand total as a single rating and build your final combined rating to include all other ratings you may have. In my case, the radiculopathy ratings of 20+20+10+10 combine to 48%, then 10% of that (4.8%) is added to produce a bilateral rating of 52.8%, which rounds up to 53%. Everything else is combined with that.