Lumbar Ddd, Need Help.

[Yong]

Hi,

I am new on the board.

I need help on understanding my MRI result and what to expect from VA Claim.

I'd just retired from the Army and I was diagnosed with DDD just before I got out.

MRI dated 26 Oct 2006 states that I have following problems in my lumbar spine;

Diffuse degenerative disc desciccation without significant loss of disc height from L2-L3 through L5-S1.

L2-L3 diffuse annular bulge with a small posterior annular tear mildly indenting the ventral thecal sac and causing mild spinal canal narrowing. The neural foramina are patent.

L3-L4 posterior annular buldge with small central to right paracentral disc protrusion causing mild to moderate spinal narrowing. There is disc contact with the right L4 nerve root in the lateral recess, which is asymmetrically larger relative to the left.

L4-L5 posterior disc protrusion-endplate osteophyte complex, bilateral facet and ligamenta flava degenerative change, which result in mild to moderate spinal canal and moderate right lateral recess/ subarticular zone narrowing. There is disc osteophte contact with the bilateral L5 nerve roots, worse in the right.

L5-S1 bilateral facet hypertrophy and posterior disc and endplate osteophte complex, but no significant spinal or neural foraminal narrowing, nor nerve root displacement.

My Dr. in service told me that one out of 4 people at age 40 develope this problem. He also stated that unless I have hard time walking, I should control the symtems with pain medication (Roxicet, Mobic, Flexeril, and Prednesone).

Need Help!!!!

[david walker]

The VA will base your rating on your ROM. If you have pain that radiates you need to file a separate claim. If the pain is bad I would try the shots. They have helped me. I had surgery and am worse because of it. The hardware used in the surgery broke 6 months after surgery. I have DDD of cervical & lumbar and was only rated 20% and 10% for the other. Plus I have a level to fusion, 3 herniated disks, facets disease and bilateral chronic radiating pain. ROM IS THE KEY TO DDD.

[Vike17]

Young.

As David said you will be ratied on range of motion (how far you can bend over before pain sets in) or the duration of incapacitating episodes (How often within a 12 month period you are assigned bedrest and treatment by your doctor), whichever will resultin the higher rating. The number of disc segements and diagnosis do not have any thing to do with the actual rating assigned.

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):

Unfavorable ankylosis of the entire spine.....100%

Unfavorable ankylosis of the entire thoracolumbar spine....50%

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 spine.......40%

Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine....30%

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%

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 height......10%

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 dislocation

5236

Sacroiliac injury and weakness

5237

Lumbosacral or cervical strain

5238

Spinal stenosis

5239

Spondylolisthesis or segmental instability

5240

Ankylosing spondylitis

5241

Spinal fusion

5242

Degenerative arthritis of the spine (see also diagnostic code 5003)

5243

Intervertebral disc syndrome

Evaluate 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 Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months....60%

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months .....40%

With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months ......20%

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months ........10%

Note (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.

I hope this helps!

Vike 17

[rdawg]

Normal forward flexion of the thoracolumbar spine is zero to 90 degrees,

zero degrees is standing straight up, right? How is that normal??

[Vike17]

Rdawg,

Isn't walking upright normal??? I don't know about you, but most people walk with forward flexion from 0 to 10 degrees. If this isn't the case, the examiner will note that in the exam (see note 3). Also the degrees are rounded to the nearest 5 degrees when it come to determining the limited range of motion for rating purposes.

Vike 17

[rdawg]

when you are walking upright you are not flexing your back. Upright is the normal position. Bending forward, backward or sid to side is flexing. If you can't bend forward past 0 degress then you are normal, by VA and Vike17 standards.

[Vike17]

Rdawg,

It must be that VA wide and Vike 17 conspiracy to screw veterans out of their benefits!

Vike 17

P.S. bending back is called "extension" and side to side movement is called rotation.

Edited January 31, 2007 by Vike17