VA Disability Ratings for Degenerative Disc Disease (DDD)
What is Degenerative Disc Disease (DDD)?
Degenerative disc disease, otherwise known as osteoarthritis of the spine, typically affects the lower back or neck. The condition occurs when the discs between vertebrae lose cushioning, fragment, and herniate. Many factors can lead to DDD such as heavy lifting, family history of spine problems or spine injury. Military activities, like repeated heavy lifting, can lead to DDD over time.
Degenerative disc disease is often accompanied by varying levels of pain and can also result in numbness and tingling in the upper or lower extremities in some cases. Tingling and numbness may not last for long periods of time, however it can be a sign that the nerves are becoming damaged.
What are the Symptoms of Degenerative Disc Disease (DDD)?
Degenerative disc disease can cause different symptoms for different people. Some people with DDD may experience no pain while others may experience debilitating pain that inhibits their daily life. The following is a list of common symptoms of degenerative disc disease:
- Muscle Tension/Muscle Spasms – Most muscle spasms occur in the lower back or neck.
- Low Back Pain – People with DDD may experience chronic lower back pain. The pain often can spread to the groin, buttocks and thighs.
- Difficulty/Pain When Sitting – Sitting can cause the discs in the lower back to experience three times more load on them than when standing.
- Numbness/Tingling – Numbness and tingling can occur, most commonly in the arms and legs.
- Difficulty/Pain When Bending/Lifting/Twisting – Pain can worsen when performing tasks that require bending, lifting or twisting.
- Pain in Legs or Leg Muscles – DDD can cause pain and weakness in the leg muscles as well as foot drop, meaning difficulty lifting one’s foot. This can be a sign of damage to the nerve root.
How Does VA Rate Degenerative Disc Disease (DDD)?
VA rates degenerative disc disease under 38 CFR § 4.71a, Schedule of Ratings – Musculoskeletal System, Diagnostic Code 5242. The rating criteria for this diagnostic code is virtually the same as Diagnostic Code 5003, which is used to rate degenerative arthritis.
If degenerative arthritis is established by X-ray findings, the veteran’s condition will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. However, if the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent will be applied for each major joint or group of minor joints affected by limitation of motion. Finally, in the absence of limitation of motion, a veteran’s degenerative disc disease will be rated as follows:
- 10% – with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations
- 20% – with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups
When assigning a disability rating based on the severity of symptoms, VA must take into account both anatomical damage and functional loss. Importantly, limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.
Secondary Service Connection for Degenerative Disc Disease
Degenerative disc disease can also arise as the result of an already service-connected condition. For example, if you have a service-connected knee condition that causes you to favor one side when you walk, you might develop an altered gait. This uneven shift in weight may then contribute to complications in your lower back. In this way, your DDD is due to your service-connected knee condition and therefore warrants secondary service connection.
To file for secondary service connection you will still need a diagnosis from your doctor, just as you would if filing for straight-forward service connection. Additionally, you will need a medical nexus linking the primary condition to the secondary condition. This should outline the doctor’s opinion that the already service-connected condition directly caused or led to the secondary condition, which in this case would be degenerative disc disease.
Importantly, you do not have to file for a secondary condition at the same time as the primary condition from service. If your degenerative disc disease develops over time, you can file a claim for secondary service connection later than you filed the initial claim for your primary condition.
Barriers to Service Connection for Degenerative Disc Disease
Degenerative disc disease is known to be a condition that develops over time. When filing a VA claim for DDD, veterans will want to be sure they are submitting a current diagnosis from a doctor, a statement explaining what in service events or conditions contributed to the DDD, as well as a medical nexus from a doctor linking the degenerative disc disease to your time in service.
When denying service connection for degenerative disc disease, VA often relies on an examiner’s finding that the veteran’s condition is due to normal wear and tear and the natural progression of aging rather than their time in service. However, if VA examiners arrive at this conclusion, they must provide adequate rationale to support it, otherwise, VA should not rely on it for adjudication purposes. It is not enough for the examiners to simply say that a veteran’s DDD is due to natural progression and aging. Instead, they must also explain why it is not due to other factors, such as service.
Compensation and Pension Exams for DDD
Sometimes the VA Regional Office (RO) will request you attend a Compensation and Pension (C&P) exam so that a VA doctor can assess your degenerative disc disease. A VA RO will contact you to schedule the exam if one is requested.
The VA examiner will usually ask questions during the exam to establish whether your degenerative disc disease is connected to your time in service or not. Usually, the examiner will ask you about your time in service, the pain levels associated with your condition, and what symptoms you experience. After the exam, the VA examiner will issue an opinion deciding whether they believe your DDD is connected to service.
Extraschedular VA Disability Ratings
There are times when VA can rate veterans outside of what is included in the rating schedule. Extraschedular ratings are assigned when the rating criteria for a veteran’s disability does not accurately reflect their level of disability. Usually this happens when a veteran experiences symptoms or limitations that are not considered by the rating schedule. Therefore, VA must determine if the veteran is eligible for a higher rating than the schedule sets forth. This might be the case for a veteran’s degenerative disc disease, as the highest schedular rating under Diagnostic Code 5003 is only 20 percent.
To receive an extraschedular disability rating under 38 CFR § 3.321(b)(1) for degenerative disc disease, the following requirements must be met:
- A veteran must show, and VA must find, that “the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization” that make it impractical for VA to assign a schedular rating
- The final determination on whether an extraschedular rating is warranted must be made by VA Undersecretary for Benefits or Director of Compensation Service
Extraschedular disability ratings are granted on a case-by-case basis and are very specific to each veteran and his or her disability picture.
Call Chisholm Chisholm & Kilpatrick LTD for Help with Your VA Disability Claim for DDD
If you filed a claim for degenerative disc disease and were denied benefits, Chisholm Chisholm & Kilpatrick LTD may be able to help you appeal your unfavorable decision. For a free case evaluation, call 800-544-9144 today.
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