Opinions on PDBR Outcome

M

MIKEQ5622

PEB Forum Regular Member
PEB Forum Veteran
Big Will and whoever can answer my question?

Just had a comp and pen exam last month, I have the specifics from the Dr. I am just waiting for va to get back to me. Let me know what you think and if they will bring it back to seperation in 2003 and what you think rating will be. Hence I had a prior service connected left shoulder at 0%. They never check the real cause then.

Diagnosis
1. Degenerative intervertebral disk deisease of the cervical spine with radicular irritation to the left upper extremity.
2.Chronic lumbosacral sprain.
3.Left acromioclavicular degenerative joint disease.


Cervical spine:

Shoulder depression positive bilaterally.

Flex is 40-45
Ext is 15- 45
side bending is 15 left and 10 right of 45 degrees
Rotation left is 10 degress of normal 80 degrees
Rotation right is 20 deg of norm 80 degrees

Neuro
Deep tendon reflexes of the upper extremeties are present and symmetrical bilaterally at +1.

Thoracolumbar spine

Flex 40 of normal 90
ext 10 0f normal 30
side bending right and left side 20 of normal 30
Thoracolumbar rotation is 30 of normal 45 each side

Cervical and lumbar spine range of motion and strength is diminshed and extent and degree of which is not possible to determine due to the extreme subjectivity of the exercise.

Let me know what you think?
 
My Opinion my friend..20% out of the gate, the ROM is what is going to "hurt" you in your case. When they do ROM (Range of Motion) you are supposed to stop whenever you feel ANY type of discomfort.

Did you feel any pain? That will help you get a better percentage to, pain is looked at more than ROM in my experience in the last several years.

Also make sure you have everything documented throughout your life for now on, if you have a pinched nerve, a twitch, if you fart wrong, document it. Its going to be a rough ride brother, especially when it gets worse. Be careful and watch what you do, I actually have days I can't even get out of bed. I used to have just muscle and bone pain, now its moved to nerve and blood issues.

Stay strong and keep your head high, it will all work out. Do you have an organization helping you or congressional support? Get it, actually do it now, I recommend DAV or American Legion, and your Congressman, bring them your records, and sign a representation form from the VA so they can represent you. Thats all I have for now.. Oh and get records of everything from the VA when you go to appointments, etc.

Big Will
 
Big Will,

they rate just on 1 rating or all 3 diagnosis? For pain, The cervical and lumbar spine range of motion and strength is diminished due to complaint of pain on attempt at repetetive motion testing and the extent and degree of which is not possible to determine due to the extreme subjectivity of the exercise. Now what do you think the rating will be? How did you figure at least 20 out the gate.

whats your email?
 
Big Will,

Also was put for cervical spine the veteran complains of pain at these extremes of motion.
 
For Degenerative intervertebral disk, is this rated just for this or seperate ratings involve with this

Example

Shoulder
lower and upper extremities etc
 
Hey Mike,

Them bastards will put everything into one diagnosis..you probably will get 40% with the pain and such, if your lucky 60% for the back since it involves two parts of the spine. The shoulder might get you a different percentage also. But they like to combine everything that had to do with the back into one rating. Good luck brother!

Oh and I came up with 20% according to the VASRD.
 
Dont they have to rate seperatly if the Dr. seperatly rated 3 different diagnosis? How do you figure pain into a rating? I just see basic ratings for spine etc... Nothing extra for pain?
 
MIKEQ5622 said:
Dont they have to rate seperatly if the Dr. seperatly rated 3 different diagnosis? How do you figure pain into a rating? I just see basic ratings for spine etc... Nothing extra for pain?
Click to expand...

Im basing my theories off of experience, thats why they gave me 20% out of the muscle spasms and then when I threw in Degenerative Disk Disease they upgraded it based on pain within certain ROM's. Its also noted in my award letter I can get an increase if pain gets worse in the extremities.

I can't tell you how many diagnosis I have on my back, I think im up to 6 or 7..

- Degenerative Disk Disease
- OsteoArthritis
- Spondylolthesis (Grade II)
- Spinal Stenosis
- Spondylolsis
- Two Buldging Disks
- Herniated Disk
- Fractured Vertebrae

I thought the same thing you thought initially. Until I got my award letter and it came back, "Degenerative Disk Disease w/Osteoarthritis and Spondylolthesis." Thats for the whole spine, but the rating can go higher as the pain gets worse, ROM gets worse, or it affects other regions of the spine. Pain is located underneath the VASRD for the spine ratings in a subsection. Its all up to the rater looking at the report what to add to it percentage wise.
 
[FONT=&quot]The Spine[/FONT]​
[FONT=&quot] Rating[/FONT]
[FONT=&quot]General Rating Formula for Diseases and Injuries of the Spine[/FONT]​
[FONT=&quot](For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating[/FONT]
[FONT=&quot] Intervertebral Disc Syndrome Based on Incapacitating Episodes):[/FONT]

 [FONT=&quot] 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[/FONT]
[FONT=&quot] Unfavorable ankylosis of the entire spine............................................................... 100[/FONT]

[FONT=&quot] Unfavorable ankylosis of the entire thoracolumbar spine......................................... 50[/FONT]

[FONT=&quot] Unfavorable ankylosis of the entire cervical spine; or, forward flexion [/FONT]
[FONT=&quot] of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of [/FONT]
[FONT=&quot] the entire thoracolumbar spine............................................................................. 40[/FONT]

[FONT=&quot] Forward flexion of the cervical spine 15 degrees or less; or, favorable [/FONT]
[FONT=&quot] ankylosis of the entire cervical spine.................................................................... 30[/FONT]

[FONT=&quot] Forward flexion of the thoracolumbar spine greater than 30 degrees but not [/FONT]
[FONT=&quot] greater than 60 degrees; or, forward flexion of the cervical spine greater [/FONT]
[FONT=&quot] than 15 degrees but not greater than 30 degrees; or, the combined range of [/FONT]
[FONT=&quot] motion of the thoracolumbar spine not greater than 120 degrees; or, the [/FONT]
[FONT=&quot] combined range of motion of the cervical spine not greater than 170 degrees; [/FONT]
[FONT=&quot] or, muscle spasm or guarding severe enough to result in an abnormal gait [/FONT]
[FONT=&quot] or abnormal spinal contour such as scoliosis, reversed lordosis, or [/FONT]
[FONT=&quot] abnormal kyphosis................................................................................................ 20[/FONT]

[FONT=&quot] Forward flexion of the thoracolumbar spine greater than 60 degrees but not [/FONT]
[FONT=&quot] greater than 85 degrees; or, forward flexion of the cervical spine greater than [/FONT]
[FONT=&quot] 30 degrees but not greater than 40 degrees; or, combined range of motion of [/FONT]
[FONT=&quot] the thoracolumbar spine greater than 120 degrees but not greater than 235 [/FONT]
[FONT=&quot] degrees; or, combined range of motion of the cervical spine greater than [/FONT]
[FONT=&quot] 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, [/FONT]
[FONT=&quot] or localized tenderness not resulting in abnormal gait or abnormal spinal [/FONT]
[FONT=&quot] contour; or, vertebral body fracture with loss of 50 percent or more of the [/FONT]
[FONT=&quot] height.................................................................................................................... 10[/FONT]

[FONT=&quot]Note (1):[/FONT][FONT=&quot] Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.[/FONT]

[FONT=&quot]Note (2):[/FONT][FONT=&quot] (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.[/FONT]

[FONT=&quot]Note (3):[/FONT][FONT=&quot] 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.[/FONT]

[FONT=&quot]Note (4):[/FONT][FONT=&quot] Round each range of motion measurement to the nearest five degrees.[/FONT]

[FONT=&quot]Note (5):[/FONT][FONT=&quot] 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.[/FONT]

[FONT=&quot]Note (6):[/FONT][FONT=&quot] 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.[/FONT]

[FONT=&quot] 5235 Vertebral fracture or dislocation[/FONT]

[FONT=&quot] 5236 Sacroiliac injury and weakness[/FONT]

[FONT=&quot] 5237 Lumbosacral or cervical strain[/FONT]

[FONT=&quot] 5238 Spinal stenosis[/FONT]

[FONT=&quot] 5239 Spondylolisthesis or segmental instability[/FONT]

[FONT=&quot] 5240 Ankylosing spondylitis[/FONT]

[FONT=&quot] 5241 Spinal fusion[/FONT]

[FONT=&quot] 5242 Degenerative arthritis of the spine (see also diagnostic code 5003)[/FONT]

[FONT=&quot] 5243 Intervertebral disc syndrome[/FONT]

[FONT=&quot]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.[/FONT]






[FONT=&quot]Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes[/FONT]​

[FONT=&quot]With incapacitating episodes having a total duration of at least 6 weeks during the [/FONT]
[FONT=&quot] past 12 months................................................................................................................ 60[/FONT]

[FONT=&quot]With incapacitating episodes having a total duration of at least 4 weeks but less than [/FONT]
[FONT=&quot] 6 weeks during the past 12 months................................................................................ 40[/FONT]

[FONT=&quot]With incapacitating episodes having a total duration of at least 2 weeks but less than [/FONT]
[FONT=&quot] 4 weeks during the past 12 months................................................................................ 20[/FONT]

[FONT=&quot]With incapacitating episodes having a total duration of at least one week but less than [/FONT]
[FONT=&quot] 2 weeks during the past 12 months................................................................................ 10[/FONT]

[FONT=&quot]Note (1):[/FONT][FONT=&quot] 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.[/FONT]

[FONT=&quot]Note (2):[/FONT][FONT=&quot] 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.[/FONT]
 
"Ankylosis" is a stiffness of a joint, the result of injury or disease. The rigidity may be complete or partial and may be due to inflammation of the tendinous or muscular structures outside the joint or of the tissues of the joint itself.
 
Big Will,

My shoulder was rated 10%, my degen disk and lumbosacral were deferred back to the comp and pen dr for medical opinionWTF, what is going to happen now? I do have some back issues in my record, the only xray is from a year and half after discharge... Whats your opinion?
 
Hey Mike,

I figured they would do that! Get ahold of a vet organization to help you out and your congressman to put heat on the VA.
 
I spoke to a VA Dr, his opinion(as a friend) said that it would be service connected. He said its like your back was a tire, it started to wear down and now it popped. What is your opinion with what will happen, the 10 percent did increase me to 70 according to the regional office rep. It is still in authorization, how long does authorization take? Its been over a week. Do you think it will be service connected, its in my records back and neck pain etc?
 
Big Will,

So how long do you think that the VA Comp Dr will take to give back a medical opinion? What is the usual out come? My back and neck were deferred for medical opinion. I have documentation in my records. Also, if I have degenerative joint disease in my shoulder, cant they use that relating to my degenerative disc disease?
 
It is all up to how much you push, write letters, get involved with a vet organization, bug the hell out of the VA. Shove it up their ass..lol.. If not it could be months!
 
I saw a doc from QC for my VA Rating in March of 2003, and had my rating back in July 2003. I am 80%.
 
I do an IRIS request all the time for this, they say that it is with the rating specialist which is working on the deferrment
 
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