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I have been rated 20% for my back. I have a lot of notes and evidence that show (to me) that it should be higher. If that 20% got raised to 40% I would get an overall rating of 100%. My question is the guidlines for back disability. One of the criteria is for time of incapacitating episodes. I have notes from my V.A. Dr., my FMLA forms and attendance records which include reason for missed work. Will the V.A. ever use the critera of incapacitating episodes since it is listed as a critera? Thanks. 

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  • HadIt.com Elder
Posted (edited)

Incapacitating episodes are worded stupid, and old school, with the word "prostrating", which hardly any doctor uses anymore. That said, I used work records with mine, some years ago (2002-2003 ish), and with that and range of motion I got 40%. Prostrating wasnt mentioned. 

Edited by brokensoldier244th
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1 hour ago, VeteranNadine said:

I have been rated 20% for my back. I have a lot of notes and evidence that show (to me) that it should be higher. If that 20% got raised to 40% I would get an overall rating of 100%. My question is the guidlines for back disability. One of the criteria is for time of incapacitating episodes. I have notes from my V.A. Dr., my FMLA forms and attendance records which include reason for missed work. Will the V.A. ever use the critera of incapacitating episodes since it is listed as a critera? Thanks. 

I don't think they focus on incapacitating episodes at that percentage, it's more so about the ROM. A buddy of mine who has been retired for about a decade, with no treatment or visits for back pain since he left active service went from 10 to 40% on ROM alone. This happened about 3 months ago I was shocked and I know he's not the type to exaggerate or make false claims. 

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VN,

Well I was in the same boat.  I was 90, actually 91 for a while.  My lumbar was 20 and I felt it had gotten worse.  I asked my VA PCP if I could go to PT, and she prescribed it.  I had 6-10 visits and they put me through the ringer and actually help the pain some.  Mean while, I had a new malaldy pop up that was from my service which I had medical records from and I made that claim for it, and threw in my lumbar for an increase to 40.

If I got the 40 for my lumbar, but got denied for the new issue, I still would not make it to 100.

I got denied for my new issue and my Lumbar was referred, so I thought that was the end of it.  2 months later, my CVSO called me and told me that I was now 100 P&T.

In the end, they not only gave me the 40 for my lumbar, but they gave me 10 each for radiculopathy of my legs, bingo, 100.

After I got the letter from the VA, I accertained that the VA had used the medical records from the VA PT physician(?), where he opined regards my radiculopathy.  Before this, I didn't know what radiculopathy was or that I had it.  You don't know what you don't know.

Tell them it hurts, go to PT, get all your medical records regarding what hurts. Point to what you can (highlight) and let them do the rest.

Claim it,

Carl

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I was granted 100% P&T with an effective date in February 2015, but my back, knee and left ankle claims were denied on that same rating, and I originally applied for them in 2010. I kept the appeals going until they were all finally granted in 2021. I had also had back surgery in 2014. I ended with a 40% rating for my back and I also got 10% in each leg for radiculopathy that was inferred. I believe ROM is the most important thing for a back rating. 

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Don't forget to consider functional loss with ROM...

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Great advice vyn. Make sure when they are doing rom to consider flare ups on your worst days. Some drs will only measure once 

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Issues with the spine - cervical or lumbar (back) is one of the disabilities where the VA makes the most mistakes in rating decisions.  See attached report from the VA OIG for some excellent detail on how secondary conditions (e.g. radiculopathy) or often missed during VA C&P exams .... and because these conditions are missed, vets are being underpaid.  

I'd do some homework ... you may have a winnable CUE claim if the VA failed to rate your condition properly.

VAOIG-18-05663-189 spine eval.pdf

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