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Common Secondary Conditions to Back Pain

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Christian McTarnaghan: Hi, everyone. Thank you for joining us for another edition of CCK live. My name is Christian McTarnaghan. Today, I am joined by Kayla D’Onofrio and Brandon Paiva. We are going to be talking about secondary conditions to back disabilities or back conditions including a discussion of back pain. So, Kayla, why do not you give us a little bit of an overview of back conditions?

Kayla D’Onofrio: So, back conditions are one of the most common orthopedic conditions that affect adults across the United States. But we certainly see it as one of the most common conditions, if not, the most common orthopedic condition within our veteran population that we handle and represent in our office. With back conditions, there are a couple of different symptoms that can manifest themselves and that is including pain and stiffness. We will talk a little bit about those symptoms in just a few minutes. But the back conditions themselves do also cause a lot of secondary conditions that can also be separately service-connected and you can receive compensation for. Some of the more common back conditions that we see diagnosed and kind of handle on a regular basis are muscle or ligament strain, which would be caused by maybe an overuse or an injury to that back muscles. Ruptured or herniated discs, as well as arthritis. We do have some links on our website that talk a little bit more about how arthritis is rated. That you can certainly take a look at. We are not going to dive too deep into that today. Osteoporosis is another one, as is spondylosis. So, there are a number of different diagnoses that you can have and all of them can lead to certain secondary conditions that will talk about throughout the presentation today.

Christian: Yes. And so, anyone that has ever had any back problems, whether it is something like arthritis or some sort of degenerative disease or if it is just a strain, you know that they can be really painful. They also can affect how you move, right? You are going to be moving a lot more slowly if you hurt your back. But one of the symptoms we wanted to highlight is pain because it is really the most common symptom that we see when someone has a back condition. So, a quick tangent here. Because VA treats pain just a little bit differently than it treats some of these other conditions that Kayla was just talking about like arthritis. With an arthritis condition, you are really going to need a diagnosis to get anywhere in terms of getting either a direct service connection for your back condition or a secondary service connection for a secondary condition. But with pain, there is this case that came out relatively recently. I guess it has been a few years now actually. Saunders v. Wilkie. It is not important that you know the name, but what we want to let you know is if you have back pain but you do not have a diagnosis, it is still possible for you to get service-connected for that pain as long as it causes functional impairment in earning capacity. “What is functional impairment in earning capacity?” You might be thinking. Frankly, no one knows. But what we think it means is that it has to affect your ability to work. That is what the whole VA rating schedule is going to be about. So, talking about how your pain limits you and what activities you can do. How it limits your you know your potential to work? Things like that. That would be important if you wanted to go just the pain route. We just wanted to take that quick aside everything else. We are really going to be talking today about diagnosed conditions being secondary related to back conditions, but we just wanted to hit that real quick.

Christian: What is also important to really understand is how back conditions are rated. We wanted to talk about that quickly. So, that is really going to be based on limitation of motion or functional loss, or incapacitating episodes. Incapacitating episodes is just like what it sounds. You are going to be completely incapacitated by your back pain and limitation of motion, right? It affects how much you can move. Functional loss is basically where your back condition prohibits you from using your back and using your body normally, right? You should be rated for your functional loss just as if it were actual limitations and how far you could move your back. The ratings go from zero to a hundred and, basically, if you have a diagnosed condition and you have back pain, you are going to get a ten percent rating. There is a special regulation section 4.59. You are going to get a dime for that. If you do not, that is going to be a problem. Okay, so we went over back conditions. We went over what symptoms they have. We talked a little bit about how the primary condition, which would be a back condition, is rated. Brandon, do you want to talk a little bit about this concept of secondary service connection that we alluded to earlier in the talk? Filing for secondary service connection.

Brandon Paiva: Absolutely. We will start by defining very kind of generally what it means. We are talking about the term secondary service connection. So, a secondary service connection disability is essentially a disability that is the result of a condition that is already service-connected. A lot of people think that there is probably a different process to go about filing for this, whether it is a direct service connection or a secondary service connection. Sometimes, people think that you have to sort of exhaust different remedies in order to file a claim for secondary service-connected disabilities, but you actually are supposed to file those secondary service-connected disabilities or what you are seeking secondary service-connected disability compensation for on the same form that you are filing a regular claim. So, it is the VA Form 21-526. This is basically the same thing as an original claim for service connection. You are going to follow the same exact process and provide VA. Very similar information. There is a couple of important piece of information that we do want to highlight for filing a claim for secondary service connection. We cannot stress this enough, but we want to make sure that veterans who are filing claims for secondary service-connected disabilities are demonstrating two things when they are filing these claims with the VA. First and foremost, we want to make sure that they are providing VA with medical information necessary to show that they have a diagnosed condition. You actually have to have that secondary condition formally diagnosed separately. Aside from that, the other important thing we want to highlight is our veterans should be making sure that they are filing this information and getting VA medical evidence or providing VA with a medical nexus. Essentially, providing VA with that medical link, could be a doctor’s opinion, showing that that secondary condition that they are seeking compensation for is linked to their already service-connected condition.

Brandon: When you are filing the claim or claims for service connection, these are going to be particularly beneficial for veterans because additional conditions being rated is going to ultimately assist you in getting the combined rating increase, which then, will provide a veteran with increased compensation on a monthly basis. With higher ratings, you may also qualify for additional VA benefits that you may not have had before if you did not have a high enough combined rating. We are talking about things potentially like TDIU. Whether you are under 4.16 a or 4.16 b, we have a number of links provided on our website to talk about the differences between those processes. But the higher the rating, you are actually eligible for more benefits. One thing that we want to stress as well when filing for these conditions is if you believe that your back pain has caused you to develop another condition, do not hesitate to file a claim. As we have learned in various Facebook Lives and in a number of resources that we provide, VA will only grant back to the date of claim. So, the sooner you can get this claim filed, the sooner that you will be eligible for this compensation. Generally speaking, that is what we are talking about and we are defining the term secondary service connection. Again, that is basically a condition that is the result of another service-connected disability. Another key piece that we want to highlight is if you believe that you have a condition that is secondary to maybe an already existing back condition or an already service-connected back condition, make sure you are filing for those secondary conditions on that same 526 form and make sure you are doing it as soon as possible.

Christian: Yes, absolutely. Brandon sort of outlined the best possible way to set yourself up for success. You do not have to have all of these pieces stapled to your 526 in order to get that claim rolling. We had a lot of talks about this before, but VA
does have a duty to assist. You might say, “Hey, I have my back disability.” Kayla is about to get into some of the secondary conditions we see most commonly related to back conditions. “Hey, my back is causing…” You are going to talk about radiculopathy. You do not have to have it all tied up in a neat little package, but that is the best way to do it. It is to give everything they need so they have no reason to be able to deny you. But if you say things like that, VA should be able to look at the record and maybe get you an exam that we were talking about, that medical nexus, to see if there is a connection between your service-connected condition and this other condition you think it is causing. With that being said, back pain and back disabilities can lead to a whole slew of secondary conditions and complications. Do you want to go through some of the most common ones, Kayla?

Kayla: Probably, the most common one that we see in practice would be radiculopathy. Radiculopathy occurs when there is a pinched nerve somewhere along your spine. Depending on where that pinched nerve is, it may affect a different part of your body. Typically, radiculopathy is characterized by symptoms like pain, numbness, and maybe burning and tingling sensations in your extremities. As I was saying, it will kind of depend on where that pinched nerve is. So, if you have, for example, a neck condition and you have a pinched nerve in your neck, you are most likely going to be experiencing radiculopathy in your upper extremity. So, going through your shoulders and your arms into your hands and into your fingers. If you have an upper back condition that is causing that pinched nerve, you may experience radiculopathy throughout your torso or in your chest. Most commonly, what we see is radiculopathy in the lower extremity stemming from a lumbar spine condition or a lower back condition. And again, that will affect kind of your legs. It will go into your hips down through your legs into your feet and into your toes depending on which nerves are affected. Something to keep in mind is if you have more than one radiculopathy, even if it is more than one radiculopathy in your legs, you can be separately service-connected for each of those different radiculopathies.

Kayla: For example, if you have sciatic radiculopathy and femoral radiculopathy, you can still be separately service-connected for both of those and get compensated for both of those different nerves because they are technically affecting two different parts of the body. In particular, the secondary condition does not quite fall within that same kind of guideline for how to file for it that Brandon just talked about. Radiculopathies, if they are diagnosed in the record, they should automatically be granted as part of your claim for your back condition. You should not have to file separately for it. As long as you do have a claim that is open for your back condition, it should automatically be granted. With that said, the effective dates with these radiculopathies do get messed up all of the time. What frequently will happen is you will attend the VA exam, and on that VA exam, the examiner will say that you have radiculopathy. VA will grant the radiculopathy from the date of that exam which they are not technically supposed to be doing. If you have any documentation or any evidence that you have had symptoms of radiculopathy, whether it is just kind of mentioning that those symptoms of pain and numbness in your extremities related to your spinal condition or you do have an actual diagnosis for the radiculopathy from before the date of that exam, make sure that is of record. VA can take a look at that so that they know that they are getting the effective date wrong and they can make sure that they are correcting it moving forward.

Brandon: Yes. Another secondary condition that we see as well is sort of similar to radiculopathy, but I think in essence is a little bit different. It is myelopathy. Essentially, myelopathy is an injury to the spinal cord that is caused by severe compression that may be a result of spinal stenosis, severe disc degeneration, disc herniation, some autoimmune disorders, or other trauma that you may have experienced to the back or even the affected area. Myelopathy is often accompanied by radiculopathy, but the two are very separate conditions. A common symptom of myelopathy includes radiculopathy. Normally, that sharp shooting pain or radiation. Loss of urinary or bowel control in some circumstances as well. Increased reflexes and the arms are lower extremities depending on which form of myelopathy you have. There are various forms. This condition we often see, unfortunately, gets to the point where it is so severe that it oftentimes does require surgery. Now, if you are service-connected for myelopathy, you also may qualify for a temporary one hundred percent rating if you have to go for surgery for this condition if it is already service-connected. I think some of these sorts of loss of urinary or bowel control is a perfect segue into some other common symptoms that we see that are secondary or some service-connected back conditions as well.

Christian: Yes, absolutely. I do not think we need to say that much more on that but, unfortunately, back conditions can cause urinary frequency or even incontinence. You can get some really high ratings for those symptoms. Obviously, they are serious symptoms. From a zero to a forty for the urinary frequency and incontinence is twenty, forty, or sixty. So, these are conditions we see a lot that is related to what could be some pretty severe back injuries. The way that I sort of think about urinary frequency, myelopathy, and radiculopathy is that these are caused by the injury to the back, right? But they are also still sort of in the spine related to the back. The ability to get secondary service-connected is endless. And so, Kayla, I think you are going to talk sort of about the next realm of secondary service connection for back conditions which is mental health.

Kayla: Yes, absolutely. We talked a lot about kind of the physical disabilities that can result in it. Definitely, as you said Christian, it goes far beyond just what is physically observable. A lot of the chronic pain that can be experienced related to back conditions results in a lot of mental health issues as well. That chronic pain can be completely debilitating and can really take its toll on your life. Having to go through your day with that chronic pain can cause a lot of anxiety about having to really just go about your normal activities of daily living. Things like even just getting dressed or showering where you do have to do a lot of movement and turning. Knowing that that is going to cause pain and having to worry about how long that pain might last or if you are going to have a severe flare-up with just some of those minor activities, that can lead to anxiety and other conditions of that nature. Also, if it is a debilitating back condition that really prevents you from living your life, that can lead to other issues like depression or irritability. Things like that. Just not being able to live a normal life or do things that you used to enjoy doing. It can certainly take its effect on your mental health. So, if you do have symptoms related to mental health that you think might be related to your back condition, as Brandon said, it is definitely something that you might want to file for if you do believe that it is related. And when VA does go to rate these mental health conditions, even though they are secondary, they are rated on the exact same scale as if you had developed PTSD in service, for example. All mental health conditions are rated on the same scale going from zero to one hundred percent in the level of severity as you kind of go up that scale. We do have some links, again, on our website that talk a lot more about kind of the mental health scale that we are not going to get into today. But just know that it is rated in the same way that any other mental health condition would be.

Brandon: Yes. I think that is a perfect segue into sort of another secondary condition that we see that may be classified as one of the invisible disabilities where you cannot necessarily see it with the naked eye like a physical disability. Sleep Disorders. I am sure we have all been there one point or another where we have been up tossing and turning because maybe we have had back pain or maybe we have had ankle pain or a headache or something like that. Now, picture that on a consistent basis. If you are consistently losing sleep, it is really going to make it difficult to concentrate both, not only at work but also in your personal life as well. It could lead to accidents or it could lead to mistakes in your work. Kind of things of that nature. It could lead to separate VA ratings for insomnia if you believe your insomnia is due to your back pain or your service-connected back condition. Even something as simple as you find it difficult to get comfortable in bed to fall asleep at night, or you cannot help but focus on your back pain when you are in bed without having any sort of distractions or anything like that, a lot of those issues can really be linked to insomnia. So, another condition that we often see when we have veterans who suffer from, unfortunately, pretty severe back conditions or back pain, is insomnia. This can lead, as I said, to trouble at work. Basically, overall function is really impacted by the loss of sleep. One thing that is really interesting as well is if you have a diagnosis for insomnia, VA often rates insomnia under the same general formula as they do for mental conditions or mental health disorders, rather. You can get a zero, thirty, fifty, seventy, or a hundred like you had depression or PTSD or something similar. I think some of those invisible disabilities, people do not necessarily believe can be service-connected, but they really can.

Christian: Absolutely. And then, even taking this one step further, if you take pain meds, they can be some pretty serious medications like opiates, fentanyl, or anything in that sort of realm. Any sort of medication whatsoever for your back. That medication causes issues like liver issues and stomach issues. You can be rated for those too. So, the sort of scope, if the service-connected disability causes another disability or problem, you really can be entitled to service connection and compensation for those problems. Also, substance abuse. Your back is really bad so some people turn to drugs and alcohol to try to help that pain. If it leads to another disability, there is a possibility that can be service-connected too. Also, a medication that treats pain can cause weight gain that can result in some weight-bearing issues in your knees, ankles, and things like that. This just really shows that it goes from things that are literally related to the spine all the way to a stomach issue that can be caused by the medication that you are taking for your pain.

Kayla: Kind of just to add to that. You kind of touched upon having weight gain be a part of it. Keeping in mind that a back condition in and of itself can lead to weight gain, which can also lead to other secondary conditions. You cannot get weight gain in and of itself service-connected, but if you do become obese because you are not able to exercise or maintain a healthy weight because your back is in so much pain, you may develop something like diabetes or sleep apnea or something related to that obesity. Again, just something else to keep in mind. It may be what you might think of as unrelated to a back condition, but you may still be able to get service-connected through another intermediate step. Thinking about back conditions, we have talked a lot about how you can get other conditions secondary to a back condition. But keep in mind that a back condition itself may also be secondary to another condition. Commonly, we see a back condition secondary to something like a knee condition. If a veteran has maybe a right knee condition that causes them a lot of pain, now, they favor one side of their body and it causes them to walk with an altered gait, that may cause some increased strain on the back that eventually will lead to a secondary back condition that may be able to get service-connected as a result. So, as long as you have records that do show that altered gait has kind of persisted over a period of time, it cannot just be one day or once a year. It does have to be sort of consistently an active part of your life where you are kind of altering your gait in that way. It could also be even more straightforward if you have instability in your knee, for example, and you fall and hurt your back, you may be able to get service-connected for a back condition in that way as well. It may not be as internal as kind of the kinetic energy going up the body. It can literally be injuring yourself as a result of something that you are service-connected for. So, just something to keep in mind as well.

Christian: That is all we really have for you today. But as always, I want to give Brandon and Kayla an opportunity to provide any closing thoughts before we say our goodbyes.

Kayla: I know we kind of sound like a broken record. We say this in almost all of our videos, but attending VA exams is incredibly important. When VA is rating those conditions and kind of determining what secondary conditions could be granted from that back condition, even though they should not, but they do rely almost exclusively on these VA examinations. Make sure that you do attend them if they are scheduled and be honest with the examiner about the symptoms that you are experiencing. If you do not feel like they are asking you questions about your secondary symptoms or just about the severity of your condition in general, try to offer that information to them. If you can bring records that might support what you are saying or if it would not, otherwise, kind of already be of record, so that they can consider that on exam too.

Brandon: I think just to kind of harp on what I mentioned before is that if you are a veteran who has a service-connected back condition or you are seeking service connection for back pain and you believe that you have a condition that is secondary to something going on with your back, go ahead and file that claim sooner rather than later. Again, we have various training and blog posts where we have mentioned different issues with effective dates. More often than not, VA goes back to the day that they receive your claim. So, if you believe you have a condition that is secondary to your back, go ahead and file. Kind of harping on this as well, just because you are filing a claim under secondary service connection, does not mean that you are going to be entitled to any less compensation. VA is only concerned with how severe your condition is, and that directly correlates to the amount of compensation that you are going to be paid. So, whether you are seeking service connection for a condition on a direct basis, secondary basis, even presumptive or aggravation theory, or anything like that, VA strictly uses the severity of your condition and that directly correlates to the amount of compensation that you would be entitled to. Make sure that you are getting those claims in as soon as you believe you are entitled to those benefits.

Christian: Okay. Well, that is all we have for you guys today. For more information on this topic, please check out our blog at cck-law.com/blog. Blogs on the conditions that we discussed today are going to be linked to this video. So, thank you very much for tuning in.