Back Conditions Rates as One

[TexasVeteran]

I left active duty in Jan 2016, my initial rating came back at 90%, but as I added everything together on the VA disability calculator (https://www.va.gov/disability/about-disability-ratings/) I was only getting to 80%. Thus, after asking around it would appear the three back problems which are separately coded are actually three separate 20% ratings, which push me to the 90% mark... now making sense (see ebenefits snap from 2019 below).

Old Rating (before submitting this new claim):  << (Equals 80%? not sure anymore)
10% attention deficit hyperactivity disorder (ADHD)
10% painful scar, surgical, status post left inguinal hernia repair
50% obstructive sleep apnea (also claimed as non-organic sleep disorder/breathing related sleep disorder)
20% thoracolumbar strain, degenerative arthritis, intervertebral disc syndrome
> 10% lumbar radiculopathy involving the sciatic nerve (also claimed as neuritis)
20% cervical strain (claimed as neck pain)
30% pes cavus (claimed as cogenital foot deformity, talipes cavus)

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Last year I found out that I have Ankylosing Spondylitis (AS) so I submitted a fully developed claim with independent medical experts showing the connection to the military. This has gotten much worse over time, so I also submitted for an increase on all back disabilities rated under the range of motion formula. I got back the results in record time (within a month!). They did some kind of funkiness I don't understand though. In the decision letter, they don't actually acknowledge accepting my claim for AS, they say this:

- Evaluation of ankylosing spondylitis (previously rates as thoracoumbar strain, degenerative arthritis, intervertebral disc syndrome), which is currently 20 percent disabling, is increased to 40 percent effective January 9, 2020.
- Evaluation of cervical strain (claimed as neck pain), which is currently 20 percent disabling, is increased to 30 percent effective January 9, 2020

Your combined rating evaluation is:
90% Effective Date: Jan 4, 2016
90% Effective Date: Jan 9, 2019

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Old Rating (after submitting this new claim):    <<(Equals 80% on the calculator, but they are saying 90%?!?)
10% attention deficit hyperactivity disorder (ADHD)
10% painful scar, surgical, status post left inguinal hernia repair
50% obstructive sleep apnea (also claimed as non-organic sleep disorder/breathing related sleep disorder)
20% ankylosing spondylitis (previously rated as thoracolumbar strain, degenerative arthritis, intervertebral disc syndrome)
> 10% lumbar radiculopathy involving the sciatic nerve (also claimed as neuritis)
20% cervical strain (claimed as neck pain)
30% pes cavus (claimed as cogenital foot deformity, talipes cavus)

New Rating (after submitting this new claim):  <<(Equals 90% on the calculator)
10% attention deficit hyperactivity disorder (ADHD)
10% painful scar, surgical, status post left inguinal hernia repair
50% obstructive sleep apnea (also claimed as non-organic sleep disorder/breathing related sleep disorder)
40% ankylosing spondylitis (previously rated as thoracolumbar strain, degenerative arthritis, intervertebral disc syndrome)
> 10% lumbar radiculopathy involving the sciatic nerve (also claimed as neuritis)
30% cervical strain (claimed as neck pain)
30% pes cavus (claimed as cogenital foot deformity, talipes cavus)

   - - - 

So my question for the community is, what am I missing here? I am totally confused and cannot at all figure this out. Did they just screw me over? I should be at 100% now if all four back codes (ankylosing spondylitis, thoracolumbar strain, degenerative arthritis, and intervertebral disc syndrome) are at 40% each. So if that is not actually the case, how did the VA calculate me at 90% for the past four years?

 

[brokensoldier244th]

The back is rated as a system, and divided up into Thoro (lower) and Cervical (upper), except for the residuals of neuropathy/radiculopathy. Back rating codes also changed in 2015. Those are not rated at 40% each. When we take the 526 form, vsr's have to claim it as whatever you call it, so if you used different terms at different times that was what was put on there. That is why there are parentheses- anything its been claimed as, because sometimes doctors use different terms for the same thing, and since the back is treated as a system by the VA, we have to find the ratings code that closest resembles whatever was claimed and what the doctors said. They rated your code back to 2016, so in effect, they backdated your rating to then, so while your rating sheet said 80, after the new claim you were backedated to 90, and should have received back pay for that.

[TexasVeteran]

21 hours ago, brokensoldier244th said:

The back is rated as a system, and divided up into Thoro (lower) and Cervical (upper), except for the residuals of neuropathy/radiculopathy. Back rating codes also changed in 2015. Those are not rated at 40% each. When we take the 526 form, vsr's have to claim it as whatever you call it, so if you used different terms at different times that was what was put on there. That is why there are parentheses- anything its been claimed as, because sometimes doctors use different terms for the same thing, and since the back is treated as a system by the VA, we have to find the ratings code that closest resembles whatever was claimed and what the doctors said. They rated your code back to 2016, so in effect, they backdated your rating to then, so while your rating sheet said 80, after the new claim you were backedated to 90, and should have received back pay for that.

Thank you for the reply. My rating sheet has always said 90%... this is what is confusing. I should not have been at 90% up until this claim was processes, if we add everything together... right? I have to be missing something, and when I call the VA they aren't able to tell me.

[brokensoldier244th]

If they changed your rating code when they changed back condition ratings some years ago, you potentially would have gotten back pay at that time for it, and just been at 90. I got an updated rating letter at the time, but I don't know about you. IF the radiculopathy is bilateral, you have to take that into account, too, it adds like 1.X something percent to the overall rating

[Miken2c74]

10% bilateral factor

 

[TexasVeteran]

3 hours ago, brokensoldier244th said:

If they changed your rating code when they changed back condition ratings some years ago, you potentially would have gotten back pay at that time for it, and just been at 90. I got an updated rating letter at the time, but I don't know about you. IF the radiculopathy is bilateral, you have to take that into account, too, it adds like 1.X something percent to the overall rating

The bilateral thing has to be what is causing it to hit 90% (on my old rating). I left the military on Jan 3, 2016, so I never needed back pay as it has always been 90%. I just could not figure out how they came to that number... nor could the VA help desk. I have seen where some people have said their back conditions were separated out (thoracolumbar strain, degenerative arthritis, intervertebral disc syndrome) ... is this possible to your knowledge?