2018 NEW RULE PAIN RATABLE

[randylan2]

Any news how you can get increase for chronic low back pain if your already rated at 20% since 2002 for

Recurrent Low Back  Sprain and Lumbar Spondylitis 

[brokensoldier244th]

You can receive a rating for pain alone in the absence of a diagnosis for the back, but if you are already rated then pain was taken into account along with range of motion (flexion-forward, extension-backward, and where the pain starts within that arc). You'd have to think about your pain, your back issues, frequency, etc, and look at the chart(s) below and decide if you are worse than what you are rated, then file a claim.

 

The general ratings schedule for the back is: 

 

• ”100% – unfavorable ankylosis of the entire spine
• 50% – unfavorable ankylosis of the entire thoracolumbar spine
• 40% – 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
• 30% – forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine
• 20% – 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
• 10% – 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 of more of the height.

You can also be rated specifically for Intervertebral disc syndrome (code 5243, I think) but that focuses on incapacitating episodes (bedrest) that doctors rarely use anymore.  Flareups in either the above situation or below are supposed to be taken into account, so if you don't tell the examiner how often and when they happen they won't be considered. You also don't need to be a hero during an exam- when it starts to hurt STOP MOVING and describe the pain, location, whether it radiates, etc to the examiner. They may do a straight leg raise test- if they lift your leg and its straight if you have lower disc impingement it will hurt somewhere in your back. If they bend your leg and lift it generally it won't because a bent leg is not pulling on the sciatic nerve fiber. 

 

• “60% – with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months
• 40% – with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months
• 20% – with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months
• 10% – with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months”

 

[broncovet]

Good advice by Broken Soldier.  I would add to "consider" if any other conditions may be secondary to back issues: 

Knees, limp, neck issues,  etc. etc, can be related to your back conditions.  If this is the case especially if a doc said your condition was related to back issues, then filing another claim (secondary to back issue) may be a great idea.  

[brokensoldier244th]

True. I was trying to jet it simple.

[El Train]

VA denied my spine claims even though I had more that enough evidence, diagnosis, and decades of treatment.  However, they did give me 40% fibromyalgia gulf war presumptive.  Probably more than I would've got had my spine claims been approved.  I get Chiropractic and massage for it through the VA.

[Vync]

The Saunders v. Wilkie (2018) pain ruling doesn't have much to do with currently service connected disabilities. @brokensoldier244thdescribed the criteria for obtaining an increase. Additionally, for increases if you have documented medical evidence from the prior 12 months which shows you qualify, the VA can backdate the increase to the date you qualified within that time period. Additionally, don't forget to factor in secondary disabilities which may stem from your low back disability such as depression and side effects of any meds used to treat SC disabilities.

So, what is the 2018 pain ruling about? It is for cases where the veteran is not yet service connected and states they experience pain, but do not have a current diagnosis. Much of the background stems from Sanchez-Benitez v. West (1999), which set the precedent that “pain alone is not a disability for the purposes of VA disability compensation.” 

In Saunders v. Wilkie (2018), the United States Court of Appeals for the Federal Circuit held VA must award disability benefits for pain due to military service. Prior to this Court decision, the U.S. Court of Appeals for Veterans Claims had held that pain alone without an underlying diagnosis was not compensable. They said, “disability refers to a condition that impairs normal functioning and reduces earning capacity.”