A reported increase in pain, or a refusal to do the test, is a positive sign. Headache is common. VA Disability Claims (General) > Spinal Fusion w/ Degerative Disc Disease Rating. He had cervical spine surgery. §§ 3.102, 3.159, 3.321, 4.1, 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5243 (2014). Why Hire CCK for Your VA Disability Appeal? VA Disability Rating. With aging, the disc tends to dry out and shrink, causing the annulus fibrosis to deteriorate and bulge outward. 259 (1994). Do you have a low back (lumbar) injury related to your military service? 100%. Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. Nerve root damage from any cause is called radiculopathy. •Anterior cervical decompression, with or without fusion: surgery for cervical IVDS, in which the disc material is removed and the spine may be fused at the level of the abnormal disc. In its section on Disorders of the Spine, the blue book lists several impairments which, if met, will automatically qualify a person for disability benefits. Two anatomic areas are of importance in IVDS: the spine itself and the area(s) innervated by any nerves that are affected due to compression of the nerve roots, spinal nerves, or spinal cord by a displaced disc or disc fragments. How do the new evaluation criteria for IVDS compare to the old ones? The hallmark is pain. This is a bulging disc. Are Veterans (VA) Disability Benefits Taxable? The C6-C7 level is the most common, and the C5-C6 level the next most common level for cervical IVDS. IVDS – •Compare the two overall evaluations, and assign an evaluation for IVDS based on the method that results in the higher evaluation. Are there permanent restrictions after a spinal fusion? 5242 Degenerative arthritis of the spine. It is thus surprising that Veterans receive disability ratings of 10 to 20% for back injury, but receive much higher ratings and unemployability for conditions like depression or cardiac disease. 2. The American College of Physicians and the American Pain Society provided the following guidelines for the treatment of back pain (excerpts are from Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Ann Intern Med. The General Counsel stated: [T]he key consideration in determining whether rating under more than one diagnostic code is in order is whether the ratings under different diagnostic codes would be based on the same manifestation of disability or whether none of the symptomatology upon which the {24 Vet. Severe 20 Overall, VA’s consideration of functional loss and flare-ups accounts for how a veteran’s spinal fusion actually impacts their daily life, making up for the otherwise very mechanical application of the rating schedule. •Laminotomy: newer, less invasive type of surgery for lumbar IVDS, in which only the small area of the lamina directly surrounding the affected disk, instead of the whole back of the lamina, is removed. Veteran does not need a continuous 6 weeks of bedrest. Pronounced; with persistent symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to site of diseased disc, little intermittent relief…60 Referred pain is pain perceived in an area of the body that is far away from the site of pathology. The advocate should argue, therefore, when a Veteran’s back pain was so severe that it required physical therapy, enhanced drugs including narcotics, and multiple visits to physicians and healthcare providers, that the time expended in using these modalities should be equivalent to the bedrest used in the regulation to prove incapacitation. App. The PD/WPI rating is based on the AMA 5th edition to rating disability/impairments... once that number is calculated, it's covereted to a final PD rating per the PDRS/Permenant Disability Rating Schedule. Depending on the location and extent of your surgery, you may experience some pain and discomfort but the pain can usually be controlled with medications. It is ... (civilian & VA), gotten injection in my spine, used the TENS unit, and have taken (and currently still am With continued degeneration due to mechanical stress, wear and tear, or trauma, the annulus may tear and allow the nucleus pulposus to extrude or rupture through the tear into the spinal canal. Mild flare-ups of sciatic type pain occasionally develop. Some raters have overevaluated IVDS by assigning 60% under diagnostic code 5293, and a separate 40% or 60% for sciatic or common peroneal nerve dysfunction, based in part on the same signs and symptoms. With true muscle weakness, there should be a smooth, non-jerky motion when range of motion is resisted. VA Math .. •Supplies the muscles of the back of the knee and lower leg and sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Appellant’s symptomatology is distinct and separate…Thus, as a matter of law, appellant is entitled to combine his 10% rating for disfigurement under [Diagnostic Code] 7800 with an additional 10% rating for tender and painful scars under [Diagnostic Code 7804] and a third 10% rating for facial muscle injury interfering with mastication under [Diagnostic Code] 5325. b.  IVDS that is disabling primarily because of chronic orthopedic manifestations (e.g., painful muscle spasm or limitation of motion), chronic neurologic manifestations (e.g., footdrop, muscle weakness or atrophy, or sensory loss), or a combination of both, is evaluated by assigning separate evaluations for the orthopedic and neurologic manifestations, using diagnostic code 5293 hyphenated with the appropriate orthopedic (musculoskeletal) or neurologic code. 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 Severe, with marked muscular atrophy 60 The VA was very resistant to updates and upgrades of its rating index. CONCLUSIONS OF LAW 1. As such, VA should assign a disability rating in accordance with this additional loss. I argue that pursuant to 5285-5295 a Veteran is entitled to a combined rating for 3 distinct symptoms : 1. d.  Computed Tomography/Myelogram (CT Myelogram): A myelogram is an x-ray taken after contrast material is injected into the spinal canal to outline the spinal cord and nerves. But, that beats the hell out of living in a power wheelchair, with a respirator to keep you breathing! After successful surgery, 80-85% of patients do extremely well and are able to return to work in about six weeks. Claims involving the spine, both the cervical spine and the thoracolumbar spine, are rated under the same general rating formula. To be granted service connection for spinal fusion, veterans must demonstrate that the spinal fusion was necessary as a result of their time in service. Furthermore, as to case summaries, reports of past results, individual lawyer biographies, news posts and other information pertaining to past and present cases, these descriptions are meant only to provide information to the public about the activities and experience of our law firm. § 1155 (West 2014); 38 C.F.R. Moderate; recurring attacks………………………………………………………….20 As your arthritis develops, the spinal canal may narrow, pinching the spinal cord or the nerves around it. 2. C6-C7 IVDS may include pain in the lateral forearm, thumb, and index finger; weakness of elbow and wrist extension; sensory loss of the long finger; and a decreased triceps reflex. •Incomplete damage may appear identical to damage to one of its branches (tibial or common peroneal nerve). Discs, or intervertebral discs, are named according to the number of the vertebrae above and below. This relatively new classification allows a rating of 60%, which enables the Veteran to file for unemployability. Instead of bedrest, the panel recommended: “Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).”. Straight leg raising (SLR) is a test is done by gently lifting the relaxed, extended lower extremity to approximately 90 degrees, with the patient lying supine. Burn Pits: The Agent Orange for Post-9/11 Veterans, “Other related factors” must be considered in extraschedular analysis. Positive when there is pain or tenderness extending over a wider area than that expected from the nerve pinched. Spinal fusion relieves pain that occurs because the affected vertebrae move and shift abnormally. This information is not a substitute for legal advice. Although you will not meet a listing simply by undergoing a spinal fusion procedure, it is possible that you could meet a listing for your underlying back problem or that you will meet a listing after receiving an unsuccessful spinal fusion. For example, a veteran is receiving a 10 percent disability rating. For example, a veteran is receiving a 10 percent disability rating. 38 U.S.C.A. A hospital stay of two to three days is usually required following spinal fusion. •Sensory abnormalities may include sensory changes of the back of the calf or the sole of the foot, such as numbness, tingling, burning, pins and needles sensation, other abnormal sensations, and any level of pain up to excruciating pain. The posterior arch of the spine (lamina) is removed to create more space for the nerve root, in order to relieve compression. The reason for this low rating is based on the history of disability rating. Therefore, during the flare-up the veteran’s spinal fusion becomes much more disabling than 10 percent. They are not intended as a guarantee that we will obtain the same or similar results in every case we undertake. Lumbar IVDS accounts for 62% of all disc disease. Incomplete: Severe……………………………………………………………………30 If an examiner fails to do so, then the examination is inadequate for VA rating purposes and a new examination may be warranted. “In Esteban v. Brown, 6 Vet.App. picture. There are usually pain and other signs and symptoms at or near the site of the disc, and there may be pain referred to more remote areas, plus neurologic abnormalities due to irritation or pressure on adjacent nerves or nerve roots. Such inconsistency is a positive sign. On most days, the veteran is unable to bend forward more than 60 degrees. Patient may complain of pain or limitation of motion in a normal SLR test, but not when examiner extends the knee with the patient seated, while examining the foot, etc. The Esteban Court, however, found: The condition embodied in a rating under [Diagnostic Code] 7800 is entirely cosmetic in nature. 2. Veterans frequently experience back conditions after their time in service. This severe condition causes many Veterans to be unable to work. Clinical findings are always a significant factor in diagnosis because neurodiagnostic imaging studies show positive findings in at least one-third of patients who are free of symptoms. Contacting us does not create an attorney-client relationship. For example, Brad, a 57 year old man previously worked as a janitor. However, when experiencing a flare-up, the veteran is unable to bend forward more than 30 degrees. § 4.71a, DC 5293 (1993). Technically, the highest VA rating for a thoracolumbar spinal disability is 50 percent. Recently, the VA added new and modern rating classifications for mental disease and cardiac diseases which conform with the newest accepted classifications by the American Medical Association, but progress in updating the ratings of common musculoskeletal ailments is slow. IVDS may also be referred to as slipped, herniated, ruptured, disc, degenerative disc disease (DDD) or sciatica. IVDS commonly includes back pain and sciatica (pain along the course of the sciatic nerve into the buttock and the leg) in the case of lumbar disc disease, and neck plus arm or hand pain in the case of cervical disc disease. Positive when the skin is tender to light touch. In this case, the veteran should receive a disability rating that is consistent with both the range of motion measurements and the functional limitations caused by their back pain. Positive if there is inconsistent hypersensitivity to light touch or an exaggerated, nonreproducible response, such as excessive grimacing, tremors, etc.
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