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Low Back Disability Rating


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22 replies to this topic

#1 Irish-7

 
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Posted 18 March 2012 - 02:35 PM

I had 6 weeks of doctor ordered bedrest within 12 months of military retirement and filing for disability. I felt that this met the criteria for intervertebral disk syndrome in that I have a bulging disk (L4-L5) and a herniated disk (L5-S1). The doctor's clinical notes from the 2 weeks (01-15 APR 10) and the 4 weeks ( 10 MAY - 07 JUN 10) were turned in 4 times. During my Comp & Pen Exam, I asked the doctor if incapacitating episodes had any bearing on my rating. He did not want to talk about it. I had the C&P Exam narrative mailed to me. The question that pertained to incapacitating episodes was answered "about once per month". I copied the notes (3rd submission) and faxed it to the VAMC deciding my claim. I sent the whole exam, with my corrections to all the mistakes, through my VSO with the VFW to the VA as well (4th time). I was rated 20% for my lumbar spine. The Web Automated Reference Material System (WARMS) states that 6 weeks incap/bedrest is 60%. I did get an overall rating of 90% and have been approved for Individual Unemployability. I don't want to sound like a malcontent, but I really want this corrected. Should I appeal or file NOD for DRO? Perhaps I am misunderstanding something here. There is no way the rater missed this evidence, as it was highlighted in my file. Either I did not meet the criteria, or the VA deliberately ignored this. Any input would be appreciated.

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#2 Pete53

 
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Posted 18 March 2012 - 08:49 PM

Welcome to Hadit

#3 Irish-7

 
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Posted 18 March 2012 - 09:34 PM

I am not sure what you mean, Pete53. I have multiple copies of my C-file. I put the record together. I was a Readiness NCO (active duty administrator for an Army National Guard unit). As part of my job, I handled medical records. I was responsible for doing the manual and online Line Of Duty Investigations. I was also the guy that secured the civilian clinical notes, MRI's, surgical reports, etc for my soldiers to support their LODs and to file for disability from the VA. The file that I turned in was over 4 inches thick. I used a multi-section portfolio. I divided the file up as follows: Section 1: Index, VA Eligibility documents, DD 214, Retirement Orders. Sect#2: Civilian Medical File, SECT#3: Line Of Duty Investigations, SECT#4: Retirement Physical Exam, SECT#5 Army Heath Record 1998-2010, SECT#6: Army Health Record 1980-1997. The index referred to color coded tape that I used to mark the injuries that I was claiming as disabling conditions. For example: Low Back was blue, Cervical spine was green, Left Shoulder was purple, etc. These color coded tabs marked the injuries and treatment notes. I thought this system would help the rater establish service connection. Two of the approved LODs specifically stated that my 4 major conditions: lumbar spine/ groin and neck / left shoulder occurred "In The Line Of Duty". Anyway, from the looks of the individual ratings that the VA gave me, I have serious reservations as to whether anyone even read all this material. I opened this topic because I feel that I should have been given a 60% rating for Intervertebral Disk Syndrome for Incapacitating Episodes in that I had 6 weeks of doctor ordered bed rest in less than 12 months before I retired. The VA gave me 20%. I am undecided whether to file a NOD for DRO because I was approved for Individual Unemployability. I was told by 2 VA employees and an attorney that the VA may downgrade my other conditions (out of spite) if I appeal.

#4 Quaymar

 
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Posted 19 March 2012 - 06:45 AM

I would say that, since you are going to get IU. The rating for your back is a moot point as that should get you to 100% anyway. That's how I understand it anyway.

#5 MrPain7

 
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Posted 19 March 2012 - 08:06 AM

C&P examination on 311/2010
Diagnosis: Cervical degenerative disease spondylosis and myelopathy.
Medical Opinion: It is at least as likely as not that the cervical condition is the cause of loss of use of the lower extremities, causing walking limitations.The veteran is not able to perform any gainful employment due to the cervical spine condition.

Diagnosis: lumbar degenerative disk disease, spondylosis and radiculopathy.

Medical Opinion:
It is at least as likely as not that the lumbar condition is the cause
of loss of use of the lower extremity functioning causing walking limitations. The veteran has not been able to work since 1989.The veteran is still not able to perform gainful employment due to his low back condition
I think this opinion would have been in my favor but the regional office ignored or misplaced this report I send a copy of this report
to the regional office in Baltimore and asked fo a reveiw but nothing went down except I found out threw IRIS my claim was received by the BVA in september 2011,along with several other claims dated back to 2005 nothing I can do but wait..........

#6 Hoppy

 
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Posted 19 March 2012 - 09:30 AM

The doctor's clinical notes from the 2 weeks (01-15 APR 10) and the 4 weeks ( 10 MAY - 07 JUN 10) were turned in 4 times.

When was the C&P and when was the claim filed and when was the decision made? June 7 2010 was the last known episode. If the decison was made recently there is over a years time in which you did not report any flares. Also if the claim was filed after the the episodes there is some obscure law that says the increased symptoms must occur during the pendency of the claim. They can service connect you if you have a disability at the time you file. However, if you are seeking a higher rating based on flares of symptoms they might apply the pendency of the claim rule for an increased rating. If the flares occurred during the pendency of the claim then they could have given you staged ratings. 60% for 2010 and a lower rating for 2011. Just because you have a couple flares in 2010 will not get you 60% for the rest of your life. You need to be seen by VA doctors and the reports entered into the computer inorder for the rater to have any chance of seeing current levels of symptoms. If you were going to to a private doctor and you had flares in 2011 you should have submitted those records prior to the decision.

Disc herniation can be asymptomatic or have symptoms that resolve. Unless the doctor stated that the herniation was so severe to prevent any improvement, they can re-evaluate a back condition such as yours at anytime. If you file a NOD they should give you a better explanation of how they made their determination.

Once you get the higher rating continue treatment and obtain ongoing bedrest prescriptions and keep them in case the VA decides to re-evaluate you. I have seen raters who will not accept a statement from a doctor who states that during the last year the veteran required six weeks of bedrest. The rater would not accept a historical recount. The rater required that the doctor write a prescription for bed rest at the time the bed rest was required.

Edited by Hoppy, 19 March 2012 - 04:55 PM.


#7 Irish-7

 
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Posted 21 March 2012 - 10:33 AM

Hoppy, I am grateful for your timely response. To answer your questions, the following info is provided: Filed for Service Connected Disability on 09 JUL 10 thru VFW VSO. He gave my portfolio to VARO on 13 JUL 10. I retired from the Army on 30 SEP 10. My C&P exam was on 20 & 26 OCT 10. My decision was dated 06 SEP 11. During the C&P exam, I turned in the clinical notes from doctor appointments scheduled between filing in JUL 10 and C&P exam in OCT 10, including an appointment 4 days before the exam. I did NOT submit clinical notes after my exam at the advice of my VSO, as though it would further delay my claim. However, I gave the VA complete civilian and military health records. Both files showed a track record of pain, numbness and subsequent treatment for lumbar spinal conditions since 2000. Also enclosed were multiple MRIs showing degenerative disk disease, bulging and herniated disks. I felt that was evidence of a chronic condition. To me, the approved Line of Duty established service connection. I did turn in clinical notes from office visits between C&P exam and VA award with my request for Individual Unemployability, so there are documents showing these conditions are still present. I would like to clarify my submission of notes 4 times. There was a copy in the file that I submitted. I included duplicates of those documents with the notes that I turned in during the C&P exam (after the examiner avoided my question). I faxed just the pages with physician ordered bed rest directly to the VARO when I read the misrepresentation on the C&P exam narrative. Another copy was sent through my VFW VSO with the corrected copy of my exam report (I made entries in pen, highlighting mistakes). I did NOT just bombard the VA with multiple, duplicate documents. The follow on submissions were motivated by the examiner and errors are the exam report. This perceived error on my decision is merely the largest discrepancy that I have with my award. I felt (after reading WARMS) that I was short-changed / downplayed on several conditions that I claimed. Ulcer (awarded 10%, WARMS states 40%), neck (got 10%, expected 30%), PTSD (given 10%, met WARMS criteria for 30%) and more. Perhaps I should just "let go". Since I was approved for IU, I don't want to complain. I truly believe that the stress involved with the filing, waiting (financial hardship) and deciding to appeal is worse than the combat that made me eligible. Anyway, I have rambled enough. Thanks for your advice.

#8 Hoppy

 
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Posted 22 March 2012 - 11:01 AM

Irish-7

I have done a lot of research and talked with many veterans who have tried to use the bed rest provisions to obtain a higher rating. I will post more over the weekend. They are not allowing civilians on the base for the next two days and I cant get to my main computer where I have my back claim files stored until saturday.

#9 Teac

 
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Posted 22 March 2012 - 03:01 PM

First Irish, Welcom to Hadit,


As to your back disability... I've had back issues since getting thrown from a moving jeep in 1975.In 1986 the va rated me at 10%, but in 1999 things got real bad and I was rated 60% with TDIU. Today it is almost impossible to get a rating at 60% for a degenerative disc issue. Under the old rating schedule the ratings were based partly on subjective findings, and if you had an underlining nerve issues you didn't even get a seperate rating.

Today prescribed bedrest plays a very important part in determining a rating, or the rating is determined based on how well you you can bend, i.e. limited movement. And any nerve issues are rated seperately. Either way it is almost impossible to get a 60% rating under the guidelines they use today. In fact, I very seldem even seek threatment because I am so used to the muscle relaxers, and motrin drills...I figure why bother....

I doubt that under todays rules I would even be rated 60%. My comments are not to discourge you but just to let you know that a 60% rating is very hard to acheive. Regardless, fight for every thing that you think you have coming.. we can only offer opinions, advice and support...unfortunately the va does the ratings......

I wish you the best.

#10 donh777

 
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Posted 22 March 2012 - 08:06 PM

I had a c&p exam in sept 2010.. Examiner said i could bent to 50degrees. Same examiner had in his report I had 47 days of doctor prescribed bedrest. One private physician and one VA pcp. What does VA do,,,,,,reduce me from 40% to 20% effective on date of exam. Got my 40% back on range of motion from another c&P examiner on March 8 this year. I have already filed another NOD. and asked for DRO review.

#11 Irish-7

 
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Posted 22 March 2012 - 08:55 PM

Again, I am most appreciative of everyone's timely replies. I admit, I am naive to the ways and thought process of the Veterans Administration. To me, it seemed cut and dry. WARMS says 6 weeks bedrest was 60%, I had it in writing. But, then again, I was either wrong or mis-rated on the other disabilities, too. After 30 years in the Army, I am accustomed to following written rules and regulations. I get the feeling that the VA does not really go by their established criteria. I truly believe that they just rate you however they please, as long as it does not add up to 100% the first time. You have to fight for every percentage point and every penny. Disgraceful. I am hoping to find a retired DRO, VA rater or attorney that is familiar enough with the system (like you guys) and have them review my whole case before I file the NOD. I would pay them as an attorney or legal representative. I want to have confidence that I read WARMS correctly before I make a move. How deflating this feeling is, that this will never be "over". I will have to punch, kick, scratch and claw just to keep what I have, or to correct what I should have received. I hope I still have that resiliency. But, that battle is down the road. For now, I should be concentrating on tracking down my back pay. I assume that I must start a new topic to address that. Thanks again for your support. Please forgive me if I am not typing these replies in the right place. I spent most of my career in the Combat Arms. I am not a real literate computer-kind-of-guy.

#12 Hoppy

 
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Posted 25 March 2012 - 08:47 PM

IRISH-7
I am having trouble pasting a response into this thread. I will post this and try to finish the post using the edit feature. It would not let me paste into the edit frame. I will finish this post when the board starts working again. I got it to work by using the paste feature on the browser rather than right click.


From a VA training manual 1. How is IVDS rated?

a. IVDS that is primarily disabling because of periods of acute symptoms that require bed rest according to the cumulative amount of time over the course of a year that the patient is incapacitated, i.e., requires bed rest and treatment by a physician, is evaluated at 60 percent if there are incapacitating episodes of at least six weeks total duration during the past 12 months; at 40 percent if there are incapacitating episodes of at least four but less than six weeks total duration during the past 12 months; at 20 percent if there are incapacitating episodes of at least two but less than four weeks total duration during the past 12 months; and at 10 percent if there are incapacitating episodes of at least one but less than two weeks total duration during the past 12 months.



What was the code you were rated under was it for IVDS? Maybe the used the wrong code for 2010.

You stated you were treated in 2011. However, you did not mention bed rest was prescribed in 2011.


Several years ago I did a lot of research on the bed rest issue and found very little. I do all my research by reading BVA cases. WARMS will not tell you how the laws are interpreted. The BVA decisions include a summary of the medical evidence and the application of the laws. If you talk to an attorney, you need to find out if the “pendency of the claim” issue could have affected your claim for 60% for 2010. When doing my BVA research, I only found one claim that was awarded 60% using the bed rest criteria.. I found tons that were denied because there was no prescribed bed rest. The claim that was awarded was for a VA clinician (MD) who kept a log of days missed from work and he wrote a prescription for himself for bed rest to cover the days he missed work.

A veteran who posted on hadit asked his VA primary care doctor for a prescription for bed rest and the doctor told him that the bed rest was not part of the treatment for a back condition. It would not surprise me if there are VA clinicians who make up excuses not to write bed rest prescriptions because they are anti compensation doctors.

http://en.wikipedia.org/wiki/Bed_rest

Bed rest is commonly prescribed in the following cases.

For sufferers of acute pain in the spine or joints; for example, in the case of backache the unloading of the corresponding spinal segment decreases the intradiscal pressure, and it would bring relief in cases such as compression of spinal nerve. The prescribed duration of bed rest vary and opinions differ.

There was another veteran on hadit who wrestled with the bed rest issue.

He got letters from his doctor saying that he had been placed on bed rest in excess of six weeks during the last year. A DRO challenged the doctor’s assessment. The DRO wanted a more detailed explanation of the bed rest. The DRO told the veteran that he did not believe that he went an entire six-week period without getting out of bed. The DRO’s definition of bed rest was a requirement that you could not get out of bed at all. This DRO could be an idiot. The problem is that his decision to delay the claim or worse yet someone at the BVA might agree with them. I guess this DRO did not know the difference between bed rest and strict bed rest. Maybe the DRO just makes up requirements that are not beneficial to claims.

http://medical-dicti...ry.com/bed+rest

bed rest

restriction of a patient's activities, either partially or completely. A person on strict bed rest must remain in bed at all times. Many patients are placed on bed rest with bathroom privileges and are permitted to ambulate to a toilet in the bathroom.

Edited by Hoppy, 25 March 2012 - 08:54 PM.


#13 Irish-7

 
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Posted 26 March 2012 - 03:46 PM

Thanks again for your input, Hoppy. To answer your questions, I believe I was rated under Diagnostic Code 5240 Ankylosing Spondylitis as my award letter refers my range of motion as 0-60 degrees. It also listed lumbar strain (5237) and disk dessication (5242?). There are no numbers (Diagnostic Codes) typed anywhere on my decision. I don't think that they would use 5243 (IVDS) in that would be admitting that they read the clinical notes ordering bed rest for the 6 weeks in 2010. I read somewhere in WARMS that the VA is REQUIRED to give the veteran the HIGHER percentage where a condition meets the criteria of multiple codes. No, I did not have bed rest in 2011. That should not have any bearing on my award. I filed for Service Connected Disability a few months before I retired in SEP 2010. I assume that the 12 month period goes back from the date that I filed. The VA decision should have been made on the complete records that I turned in, not the presumption of repeating the treatment in 2011. I felt that I met the criteria as stated in WARMS at the time I filed. Now, if they wait a full year to make a decision, I no longer meet the criteria. Perhaps that is what I am misreading. If(?) the clock goes back 12 months from when they finally get around to deciding your case, not from when you turned in your evidence. Anyway, please don't tie yourself up with it. You have done far more to explain this stuff than anyone that I have asked (VFW VSO, VA County REP, VA Benefit Blog, Wounded Warrior Project). If your example of how the DRO treated previous veterans with the same issue is the norm, then I don't have a leg to stand on. It sounds to me like the DRO in your story was determined to shoot the guy down. I don't know exactly what their powers are, but it appears that this DRO is reading far too much into it. I will end up hiring a lawyer that just does VA cases. Thanks again for your efforts.

#14 Teac

 
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Posted 26 March 2012 - 04:44 PM

Irish,

Another thing the VA does very well is stagger ratings. For example in your case , they could have given you a 60% rating based on the bed rest for a period of time and then reduce it to say 30% or 20% depending on the severity of the disability.

If you could win an appeal arguing that you deserve a higher rating based on the bed rest, it is highly likely that since you had no bed rest in 2011, they would reduce the rating anyway. Now I'm not saying you should not appeal.. what I am saying is that unless you had 12 weeks of bed rest every year since 2010, you will likely end up with a reduced rating. In fact they could if he evidence warrants it reduce the rating to 0%....

#15 Irish-7

 
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Posted 26 March 2012 - 08:48 PM

You folks know the system far better than me. I had some exposure to the VA criteria in helping countless soldiers file for disability. I did their Line Of Duty, pulled the supporting documents from their Army Health Record, secured the required treatment notes/tests/labs or surgical reports from their civilian physicians, then put it together and told them "Send this to the VA. Bring me a copy of the decision when it comes". I was not familiar with the bed rest / incapacitating episodes clause until right before my retirement exam. That question came up on several of the forms for the Army physician that verified my conditions. Honestly, until my case came up, it was my observation that the VA was very generous, highly sympathetic and overtly supportive of my part-time soldier's injuries. When I highlighted the evidence of service connection for my disabilities, I expected the same treatment that all my soldiers received. Looking back at it, I feel as though my rater did not take me to be assisting or expediting the decision of my case, but rather developed the attitude "I'll show this know-it-all". Reality is, the rating that I received for lumbar spine was only one of the disagreements between the VA's criteria and the percentage actually assigned. After 30 years in the Army, I have grown accustomed to following written rules and regulations. I admit that I am having difficulty dealing with these discrepancies and the potential results in challenging them. As Hoppy pointed out earlier, the DRO can further add or read into rules that the VA did not follow to begin with. I feel guilty pursuing the truth in that I was approved for IU and am eligible for the maximum pay and benefits. What a system! I have not even been paid yet, and I am already worried about them taking it back. Anyway, I appreciate everyone's input. At the very least, I have learned not to "expect" or "anticipate" anything. I now know that this will never really be over. I pray for those veterans that are far worse off than me. Thanks again timely replies.

#16 john999

 
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Posted 27 March 2012 - 10:57 AM

I think this is why when you have chronic back pain or any chronic pain condition get to a psychiatrist and discuss depression. If the VA only wants to give you 20% for a bad back you may be able to get an extra 50% for the depression the chronic pain has caused in your life. I have chronic back pain, foot pain and shoulder and neck pain. Game over for most things including work.

#17 Irish-7

 
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Posted 28 March 2012 - 12:19 PM

I have chronic neck and shoulder pain, too. Those were 2 of the other conditions that I feel the VA shorted me on. They gave me 20% for my left shoulder and 10% for my cervical spine. Again, I believed that they would follow the criteria spelled out in the Web Automated Reference Material Systems (WARMS). If they went by their own rules, I would have received 30 or 40 percent for both neck and shoulder. You are correct, I should be seeing a psychiatrist. But, the POS at the VA Medical Center that did my Comp & Pen Exam, said that I did not meet the criteria for PTSD. I admitted that I had nightmares for more than 25 years. He gave me 10% for "Mood Disorder". I am afraid if I pursue some sort of treatment at the VAMC, I will end up on a couch in his office. We did not really talk about combat during the C&P screening. This "Company Man" just beat around the bush until he found some positive things in my life (active with RC church, close to family, etc), then more-or-less said "He's alright". He must have been worried that the VA would make him pay me out of his check if I had PTSD. I am planning on calling my PCM to see if there are other physicians available. I have been putting it off out of fear that the shrink will want me to take some sort of anti-anxiety drugs. I am not doing that. I already take multiple medications for chronic pain, ulcer, high cholesterol, arthritis, etc. I am pretty sure that you cannot mix those medications. Anyway, thanks for your input. I am calling for an appointment this week to ask about several things. I will check out the availability of other "mental health" provider.

#18 donna68

 
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Posted 29 March 2012 - 07:53 PM

Irish-7

Pay-If you got severance pay when you retired the VA will hold your benefits until its recouped.

Shoulder- A 20% for a shoulder is high as shoulders are rarely rated at 20%, because to rate at a 20% it means that you can only raise your shoulder or arm to parallel to the ground or 90 degrees.

Lumbar or Back- As mentioned earlier, a veteran can have IVDS, DDD or DJD and rate at 0%, if there is no pain on motion or no decreased range of motion. If you were entitled to 60% for IVDS when you submitted your claim and they didn’t rate you with the IVDS Diagnostic Code, you have grounds to appeal. It will become a stepped rating, and decrease based on prescribed bed rest. So consider this, if they change the DC to IVDS and you currently rate at a 0% based on the IVDS DC, because you havent been prescribed bedrest, you will eventually be dropped from 60% to 0%. They may have rated you under a different code so that you are at risk of dropping to a 0% based on the IVDS DC.

Mental disorders including PTSD and a mood disorder are rated together, so if you are already service connected for a mood disorder and you put in for PTSD, and they grant it, your rating % will not change just because there is a new diagnosis of PTSD. The rating is based on the mental health symptoms, whether PTSD, anxiety disorder, depressive disorder or a mood disorder. The % will change if your overall condition or symptoms have changed. Advice, since the new text generated system is rating veterans much higher than in the past, submitting a claim for an increase may be beneficial.

Weigh the pros and cons. You are 100% IU now, if you appeal, you can risk getting decreased and no longer qualifying for IU. If you win the appeal, you will still end up receiving the same %. If an actual error (CUE-clear and unmistakable error) was made on your rating decision, you can point it out at any time and they will have to correct your rating back to when the error occurred.

Hope this helps.
Donna

#19 donna68

 
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Posted 29 March 2012 - 10:04 PM

http://www.benefits....rms/bookc.asp#q


The Spine

Rating

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):

With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease

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.

General Rating Formula for Mental Disorders:


Total occupational and social impairment, due to such symptoms as:
gross impairment in thought processes or communication;
persistent delusions or hallucinations; grossly inappropriate
behavior; persistent danger of hurting self or others; intermittent
inability to perform activities of daily living (including maintenance
of minimal personal hygiene); disorientation to time or place; memory
loss for names of close relatives, own occupation, or own name .......................... 100

Occupational and social impairment, with deficiencies in most areas,
such as work, school, family relations, judgment, thinking, or mood,
due to such symptoms as: suicidal ideation; obsessional rituals
which interfere with routine activities; speech intermittently illogical,
obscure, or irrelevant; near-continuous panic or depression affecting
the ability to function independently, appropriately and effectively;
impaired impulse control (such as unprovoked irritability with periods
of violence); spatial disorientation; neglect of personal appearance and
hygiene; difficulty in adapting to stressful circumstances (including
work or a worklike setting); inability to establish and maintain
effective relationships ........................................................................................... 70

Occupational and social impairment with reduced reliability and
productivity due to such symptoms as: flattened affect; circumstantial,
circumlocutory, or stereotyped speech; panic attacks more than once
a week; difficulty in understanding complex commands; impairment
of short- and long-term memory (e.g., retention of only highly learned
material, forgetting to complete tasks); impaired judgment; impaired
abstract thinking; disturbances of motivation and mood; difficulty in
establishing and maintaining effective work and social relationships ........................ 50

Occupational and social impairment with occasional decrease in work
efficiency and intermittent periods of inability to perform occupational
tasks (although generally functioning satisfactorily, with routine
behavior, self-care, and conversation normal), due to such symptoms
as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or
less often), chronic sleep impairment, mild memory loss (such as
forgetting names, directions, recent events) ........................................................... 30

Occupational and social impairment due to mild or transient symptoms
which decrease work efficiency and ability to perform occupational
tasks only during periods of significant stress, or; symptoms controlled
by continuous medication ..................................................................................... 10

A mental condition has been formally diagnosed, but symptoms are not
severe enough either to interfere with occupational and social
functioning or to require continuous medication........................................................ 0



#20 Irish-7

 
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Posted 03 April 2012 - 10:13 AM

In response to Donna: I read the attached section of WARMS about a month before I filed for Service Connected Disability. Actually, it was a few days shy of my Army Retirement Exam in June 2010 (as I was coming off my 2nd period of bed rest). This information is what made me think that I would get 60% for my lumbar spine. Anyway, let me try to answer your statements from your first post in order. I separated from the Army by a normal retirement. There was no severance pay. Shoulder: I cannot lift my left arm above shoulder level. WARMS listed percentages of 30 & 40%, depending on how severe or if your dominant arms was affected (Diagnostic Codes 5301 thru 5306). Lumbar / back: So, what you are saying is that if I was awarded 60% (for IVDS) in 2010, it would have dropped to 0% if I did not have bed rest the next year? I figured that the MRI's, X-rays and 10+ years of treatment notes would be worth something beyond the incapacitation time. But, if I am understanding you correctly, that my award would have dropped to zero, then I am better off with 20 percent. I realize that there are no precedents set, but I know a few guys that were rated higher for their back than me, even though they lacked the same volume of supporting clinical notes and MRI's verifying degenerative disk disease, bulging and herniated disks. They each only had one or two disabilities, so perhaps the VA gave them a better consideration. Since I had a whole stack of conditions, to rate me high would risk breaking the unwritten rule that you don't get 100% schedular on an initial claim. (Not as a regular retirement, anyhow. I would like to think that this does not apply to severely wounded/broken veterans that were discharged by a medical review board). As far as the mental disorders go, I met the criteria for 30%, almost word for word. The C&P doctor hardly asked me about combat. I feel that the Psychiatrist and Comp & Pen General Practitioner were of the mindset to downplay or reduce my rating. They are the reason that I am worried about VA medical care. My PCM at the local VAMC seems alright. I am about to make another appointment. I thank you for your time and effort. Are you the same Donna from the VA Benefits Blog on Facebook? If you are, I am pleased that we meet again. Please say "Hello" to Richard, Ben and Wendell for me. I am lost with the new program, so I dropped out when the site went to Timeline.

#21 john999

 
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Posted 03 April 2012 - 11:13 AM

Just remember you don't have to have PTSD to get 100% for a mental condition from the VA. You can have depression, panic disorder, anxiety disorder, depression etc. You don't even have to have been in combat or in a combat zone.

#22 Irish-7

 
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Posted 03 April 2012 - 09:11 PM

Thanks, John. I did not initially believe that I had PTSD. My diagnosis was made by a counselor at a VETs Center. I did have nightmares for over 25 years. I just figured that was a "right of passage" for the Combat Infantryman. I started to experience mood swings, depression and stress related disorders in early 2006. I believe the triggers were multiple duties as Casualty Notification Officer, Casualty Assistance Officer, NCOIC of Military Funeral Honors for one of my soldiers that was KIA in Afghanistan and the intricate involvement in the services for another one of my men that committed suicide in 2009. Working the other end brought things full circle for me. I was coaxed to claim these conditions when I filed for disability. I ignored the advice of fellow veterans who told me to talk about people getting shot, dead bodies and all the gory details of battle. I felt that I had enough serious physical disabilities to be rated 100 percent. Hell, I read the criteria in WARMS and highlighted evidence of service connection in my file. During my mental evaluation of the Comp & Pen exam, the doctor controlled the conversation. I just answered his questions. He really did not talk about combat. He asked me the same questions over and over. "What made you start going to the VETs Center for counseling"? I thought, "Either this guy can't hear, or he is just plain stupid". He was dumb like a fox. He asked enough things about the positive aspects of my life to make me look fine. I think that the raters just give you 10% if you have war related decorations, like the Combat Infantryman's Badge or Combat Action Badge. Obviously, I did not receive the individual disability ratings that I expected. Now, I am second guessing not taking my friends advice. I am the only veteran that I know, that admitted anxiety issues, but was denied PTSD. I also have serious reservations about the staff in the mental health department of the VAMC. My counselor at the VETs Center was very angry that I was denied. He knew the Psychiatrist that evaluated me. They worked together for over 20 years. I get the feeling that there is some "bad blood" there. Anyway, I have the name of a different doctor in the same hospital. I set up an appointment with my Primary Care Manager today. I believe that I must go through the PCM to see specialists. I will talk to the new shrink and see what he has to offer. I won't hold back this time!

#23 bhoward422

 
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Posted 11 June 2013 - 10:08 PM

Irish-7

I have done a lot of research and talked with many veterans who have tried to use the bed rest provisions to obtain a higher rating. I will post more over the weekend. They are not allowing civilians on the base for the next two days and I cant get to my main computer where I have my back claim files stored until saturday.

 

Irish-7

I have done a lot of research and talked with many veterans who have tried to use the bed rest provisions to obtain a higher rating. I will post more over the weekend. They are not allowing civilians on the base for the next two days and I cant get to my main computer where I have my back claim files stored until saturday.

Do you still have your back claim on file if you do please can I get a sample if I can could you forward to [PM Member for email] because I have  other issues that I have to file secondary to my back Thanks!


Edited by Tbird, 12 June 2013 - 05:36 AM.
Removed email address: Please do not post personal identifying information.





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