VA Rating for current disc herniation

Jason R. Baltutis

Jason R. Baltutis

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Was put on PDRL (Navy) for back injury. Submitted findings to VA for re-evaluation (431 days ago). First time, I had a herniated disc at L4-L5 w/S1 pain. VA originally rated me at 20% but now should be 40% based on my forward flexion being a 20. I found out that I also have another herniated disc at L3 from the last MRI. Was told it is common once you have had other discs herniate. Will the VA rate for me having a current herniation due to my previous injury? I can't seem to find it anywhere under spine conditions.
 
Jason R. Baltutis said:
Was put on PDRL (Navy) for back injury. Submitted findings to VA for re-evaluation (431 days ago). First time, I had a herniated disc at L4-L5 w/S1 pain. VA originally rated me at 20% but now should be 40% based on my forward flexion being a 20. I found out that I also have another herniated disc at L3 from the last MRI. Was told it is common once you have had other discs herniate. Will the VA rate for me having a current herniation due to my previous injury? I can't seem to find it anywhere under spine conditions.
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The VA should schedule you for a C&P exam in which your current ROM will be measured. If it is 20 degrees, then you will get the 40% rating. It doesn't matter how many discs are herniated, it is based on ROM, and or incapasitating episodes.
 
Thanks ranger. I already had the C&P and my forward flexion of the thoracolumbar spine is only 20. I didn't know I had another herniation when I went through the C&P so I wasn't sure if they rate differently now that I submitted additional information to the VA. What do you know about them rating radiculopathy separate? I've seen where it's been combined and I've seen where they've rated it separately. Thanks again for your reply.
 
Jason R. Baltutis said:
Thanks ranger. I already had the C&P and my forward flexion of the thoracolumbar spine is only 20. I didn't know I had another herniation when I went through the C&P so I wasn't sure if they rate differently now that I submitted additional information to the VA. What do you know about them rating radiculopathy separate? I've seen where it's been combined and I've seen where they've rated it separately. Thanks again for your reply.
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When it comes to your NARSUM review, you absolutely need to appeal if they don't list the radiculapthy as a separate DX (condition). It is very common for the MEB to initially lump it into DDD, but it is a completely different condition. I wrote an appeal in my case, and it was successful. Even if it is not successful, you get the information into your records that go before the PEB. It is a very strong brick in the foundation for later appeals should you need them.

If you need a copy of my appeal, let me know. I wrote my own, but any good MEB legal counsel can write one for you.

Joe
 
Thanks for the info. I will wait for the VA to get my rating back and see how they rate me. They've had it for approximately 433 days already so there's nothing I can do until they decide to do something with it. If they jam me, I'll get back with you and get a copy of your appeal.

Jason
 
Jason R. Baltutis said:
Thanks for the info. I will wait for the VA to get my rating back and see how they rate me. They've had it for approximately 433 days already so there's nothing I can do until they decide to do something with it. If they jam me, I'll get back with you and get a copy of your appeal.

Jason
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Was radiculapathy listed as a DX on your NARSUM?
 
The Navy listed it on my "Findings of the Physical Evaluation Board Proceedings" when they put me on the PDRL list.

1. Recurrent Low Back Pain
1.1. Left Leg Radicular Pain
1.2. Degenerative Disc Disease with Grade 1 Spondylolisthesis of the L5/S1 Level
1.3. Status Post L5/S1 Discectomy

When I first left the Navy (TDRL), the VA didn't rate me on Left Leg Radicular Pain. They gave me 20% for Degenerative Arthritis of the Spine (5242).
 
Jason R. Baltutis said:
The Navy listed it on my "Findings of the Physical Evaluation Board Proceedings" when they put me on the PDRL list.

1. Recurrent Low Back Pain
1.1. Left Leg Radicular Pain
1.2. Degenerative Disc Disease with Grade 1 Spondylolisthesis of the L5/S1 Level
1.3. Status Post L5/S1 Discectomy

When I first left the Navy (TDRL), the VA didn't rate me on Left Leg Radicular Pain. They gave me 20% for Degenerative Arthritis of the Spine (5242).
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It appears to me that all your back conditions were listed as one DX. That would be the 1, 1.1, 1.2, and 1.3. The way it should read in my opinion is DX 1 would include item 1.2, and 1.3. DX 2 would read radicular pain, and be evaluated for neuro effects on the nerve impacted.

The way it is written, would only warrant a single rating under 5242
 
The Navy stated that all of that falls under 5237 (40%) whereas the VA initially rated me under 5242.
 
Jason R. Baltutis said:
The Navy stated that all of that falls under 5237 (40%) whereas the VA initially rated me under 5242.
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Both of those codes are rated exactly the same, using ROM. Radiculapathy is rated under 8512 for the sciatic nerve. It should be listed separately from 5237,or 5242. This is why I am saying it should have been listed as a separate DX on your NARSUM
 
Ranger--others can provide input too,
I'm in similar situation. After about three years on chronic LBP with radiating pain with numbness down left leg, seeking treatment from VA, the only ICD codes they provided in notes are 719s(pain) I sought 2nd opinion, outside VA, with physiatry, who suspected SI dysfunction. After three months of PT with very little improvement, I got an SI injection. It's been four months now but I no longer have SI issues. Just waiting for the pain and radiating to return--just like cervical radiculopathy after 2 epidurals there as well. It's been five years since onset and/or aggravation of most of my conditions.
Conditions include DDD for back, L hip condition(no diagnosis at this point), cervical C5-C6 DDD, right shoulder tendinitis, right arm numbness and tingling(no diagnosis at this point), right middle finger left knee pes anserine, right middle proximal interphalangeal joint tenosynovitis.
In spite of my submitting this past year's medical documentation( about a reams worth) to VA in Seattle and to my PEBLO, it doesn't appear that anyone is seems to be relating anything to anything.
At this point, the VA is saying 10% and DOD is 20%--seems pretty odd doesn't it?? Anyway, needless to say I requested FPEB and submitted VARR.
Noting that radiculopathy should be separate from LBP and DDD is interesting to me; as when I have brought that up to JAG, both at MEB and IPEB phases, it was dismissed as if it didn't matter. Is there a clearer reference than 8512--not putting two and two together-- and/or cases that references this at all. Anything would be helpful. Thanx
 
Just talked to DAV rep as she wanted to know what to do with the supporting documentation I sent her regarding my radiculopathy. She said they have already rated me at 0% bilateral and that they can't count it separately. This ought to be great! My claim has only been out for 451 days now!
 
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