Appealing spondylosis claim denied by VA

C

Crash

PEB Forum Regular Member
Greetings, I have a 30% rating for S/P L1 burst and L4 compression with degenerative disc discease and residuals.

I recently applied for an increased rating for spondylosis which was diagnosed last March. The VA denied my claim for spondylosis. I am assuming they rated this as a residual effect caused by the disease (5200 series of codes).

Is there any way I can appeal the claim? I honestly don't understand how they can deny my claim for spondylosis. Wouldn't this be considered a "secondary condition?"

Any and all help is greatly appreciated.
 
Josh,

It is not clear if you are saying that you applied for service connection and was denied, or you made a claim for an increased rating of an already SC condition. Would need more details to give any meaningful thoughts on this.
 
Hi Jason,

I made a claim for an increased rating of an already SC condition of 30% for S/P L1 burst and L4 compression with degenerative disc discease and residuals.
 
Josh,

Then, from what you have said, the reason must be that they thought you did not meet the criteria for a higher rating. The decision letter should state why. But, understand, the issue is not denial of SC, it is for the increased rating. Are you appealing?
 
Jason,

I most likely will be appealing. In the exam I had, the doctor "did not take into account evidence demostrating excess fatigability, or pain nor did the exam provide the VA with an opinion as to whether pain could significantly limit functional ability during flare-ups or when used repeatedly over time." Basically, in order to have my rating go from 30 - 40% I "have to have incapacitation episodes of a total duration of at least 4 weeks but less than 6 weeks during the past 12 months."

Shouldn't the spondylosis be rated seperately from the original 30%? I wasn't asking the VA to increase my original 30% but to rate the spondylosis as a secondary condition, Is that possible or do they lump spondylosis in with the original rating for S/P L1 burst and L4 compression with degenerative disc discease and residuals?
 
Josh,

It sounds like you are talking about rating criteria for both incapacitating episodes and Range of Motion limitations. What you are discussing as part of the inadequate exam was failure to comment on Deluca criteria (which has to do with additional limitations due to pain, incoordination, fatigue, etc). They need to assess that. However, if you have had more incapacitating episodes, they need to document that, too.

Almost certainly, you won't get additional rating for disability of same anatomical region due to rule against pyramiding.

This is a simplified explanation and it is based on just what you wrote. Your file may have more in it that could change things. I hope all goes well for you.
 
Jason,

Yeah that seems the just of it. Thank you for your help as well.

Quick side note. I applied for the PDBR back in July. I received 10% from the Army and 30% from the VA upon discharge for the back fractures. The PDRB received my file in July and I have a docket number. From your experience how long does it take to adjudicate? I haven't heard anything from them since.
THank you again.
 
Josh,

I have seen too small of a sample to make any valid estimates. I have seen a few cases take 6-7 months, while I have seen several other cases still pending more than a year later. It seems like there is a wide variability and it is hard to see what is causing that. However, it seems likely to me that as time goes by, the speed with which they decide cases should go down (I think that they likely had a large waive of claims initially, and I imagine that thereafter, the applications would likely have dropped off)...I hope you get a good result and soon. Best of luck!
 
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