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Most Common Back Pain VA Claims Among Veterans

Most Common Back Pain VA Claims and Ratings Among Veterans

Video Transcription

Emma Peterson: Good afternoon and welcome to another edition of CCK Live.  My name is Emma Peterson and I’m joined today by Bethany Cooke and Frank Padula, and we’re going to be talking about the most common back disabilities that veterans suffer from.

Let’s dive right in.  Veterans experience a range of back disabilities related to their military service.  Back injuries often occur due to the stress of training or combat.  There could be a vehicle accident.  There could be a fall.  Sometimes, even just from carrying the heavy packs and gear, or other common duties that veterans might experience while doing their military service.  And as with most medical conditions, VA disability ratings for back pain depend on a variety of factors.

Today we’re going to be talking about what those factors are and how VA might go about rating your back disability.  As always, if you have questions or comments, please leave them in the comments section and we will do our best to get back to you as soon as we can.

All right, Frank, so, how does VA go about rating back conditions?

Frank Padula: So, VA rates most back conditions under what’s called 38 CFR § 4.71a: the schedule of ratings for the musculoskeletal system, the general rating formula for diseases and injuries of the spine.

The criteria are based largely on the veteran’s range of motion and different diagnostic codes within this formula are used to rate different back disabilities.  Those ratings can range from 0 percent all the way to 100 percent.  And generally, veterans will need to attend a Compensation and Pension examination to measure how far they can bend forwards, backwards, and side to side using a goniometer.

And then, VA will then determine the severity of the back condition based on the range of motion measurements.  VA must also take into account functional loss, pain during motion, and flare-ups as well.

Emma: Thanks, Frank.  So, let’s talk a little bit about the different types of back disabilities that veterans might experience.  Bethany, can you walk us through lumbosacral and cervical strain?

Bethany Cooke: Sure.  So, lumbosacral and cervical strains are very common back and neck disabilities.  They are both an injury of the ligaments, tendons, and or muscles of the low back or neck respectively.  The injury usually results from stretching that causes a small tear in the tissues in the lower back or neck.  They are also typically caused by overuse and trauma.

So, we see these disabilities a lot in veterans who, a lot of the time a veteran with an MLS that required a lot of heavy lifting, they can develop a lumbosacral or cervical strain.  We also see them commonly result just from physical training even.

Pain is a very common symptom of both disabilities and it can also cause trouble bending or having limited range of motion.  So, they’re both rated by the VA under diagnostic code 5237, with ratings ranging from 10 to 100 percent.  And like Frank said, these ratings are based for the most part on forward flexion and range of motion.  Although, 50 to 100 percent ratings are based on the amount of unfavorable ankylosis present.  And typically that 50 to 100 percent ratings, those ratings are very rare with these disabilities.

Emma: That’s right, and it probably would not be typical to see ankylosis with a strain.  Right, Bethany?

Bethany: Right.

Emma: Alright.  So, but something where you could see ankylosis, that might be degenerative disc disease, which is sometimes abbreviated DDD.  And it’s not to be confused with arthritis, it’s a different disability.  It usually occurs in the low back or the neck and it’s a condition where the discs between the vertebrae lose their cushioning, they fragment, or they herniate.  Pain frequently occurs with DDD, although it’s not in every case.  But in some situations, it can also result in numbness and tingling in the upper or the lower extremities depending on which part of the spine the DDD is affecting.  And this is also typically rated based on the range of motion criteria that Frank discussed.

It’s DC (diagnostic code) 5242, but all of these have the same criteria for the 10, the 20, 30, and so on.  It’s really depending on your range of motion.  And for this disability, you sometimes do see ankylosis where the spine is frozen or unable to move in certain segments.

Frank, but what about degenerative arthritis of the spine?  That’s a little different, right?

Frank: Right.  So, there are two main types of arthritis of the back.  There’s degenerative arthritis and rheumatoid arthritis.  Degenerative arthritis occurs when cartilage between joints erodes over time, resulting in joint stiffness, limited mobility, and pain.  This usually takes place in weight-bearing joints.  For example back, even the hips and the knees.

Degenerative arthritis is diagnosed through x-rays, and it is based on the limitation of range of motion of the affected joints.  And that would be under 38 CFR § 4.71a and that could range at 20 percent or 10 percent.  And the diagnostic code 5242 specifically work refers to the spine and this condition.

Emma: That’s right and if you do have degenerative arthritis of the spine, you could also get those higher ratings if you were to show a more severe range of motion picture or even have favorable or unfavorable ankylosis.

Now, something that we see sometimes is something called intervertebral disc syndrome.  Bethany, can you tell us a little bit about that?

Bethany: Sure.  So, intervertebral disc syndrome, or IVDS for short, is also known as a bulging or herniated disc.  It’s a back condition that involves the irritation of the nerve root and causes sharp chronic pain.  IVDS can be very severe.  It can include symptoms such as numbing or tingling in the lower extremities, weakness, and oftentimes you find that it worsens if you spend an extended amount of time sitting or bending.  It can also worsen as a result of extended standing and walking.

And the numbness or tingling in the lower extremities sometimes develops to the point of sciatica.  It can also lead to bladder and bowel issues as well.  VA rates IVDS under diagnostic code 5242.  And this rating criteria is a little bit different.  It’s based on the number of incapacitating episodes that veterans experience due to their low back pain.  So, the ratings under this diagnostic code range from 10 to 60 percent and these ratings considered the length and frequency of bed rest.

This rating criterion is a little bit complicated because oftentimes you might see that you get the 60 percent rating and it’s not necessarily because your doctor wrote a note saying, “I require this number of weeks.”  I think it’s six weeks of bed rest per year.  But that reading will typically come as a result of a Compensation and Pension examination that you attend for the back.  That examiner might make a note that your IVDS is so severe that you probably are in bed around six weeks a year.

Extended bed rest for IVDS, while it’s a part of the rating criteria, can actually cause additional issues.  It can lead to stiffening of the joints and weakened muscles.  So, while your IVDS might be very severe, physicians may prescribe physical therapy and medication for pain as alternative treatments over the extended bed rest.  So, this is a condition where those Compensation and Pension examinations are really important.

Emma: Absolutely.  It’s definitely a tricky diagnostic code because it does have that requirement of prescribed bed rest.  So, it really depends on the examiner and the rater, you know, either sort of overlooking that and looking at your actual individual disability picture to see if what you’re suffering is equivalent to that, or VA looking at the range of motion testing.  But it can be tricky to get the higher ratings here because as Bethany mentioned, you oftentimes aren’t going to find a doctor who’s going to prescribe a bed rest for six to 12 weeks a year.  That’s just not something you see really anymore.

Something to consider when going to those com and pension exams is making sure you’re being really clear with your examiner about how many times you stay in bed or how the disease prevents you from doing things that might be the equivalent of bed rest.  But speak to an accredited rep, an agent, or VSO, attorney, whoever you work with on your claim, if you do have IVDS, about the best way to maximize that rating.

Now, something else that we mentioned that can happen due to back disabilities, includes nerve pain, whether it be in the upper extremities or lower extremities.  And a very common lower extremity condition is sciatic nerve pain that can radiate from the lower back down to the legs.  And it most often occurs when the sciatic nerve has been compressed or pinched, usually by a herniated disc in the spine or an overgrowth of bone in the vertebrae.  Symptoms can include numbness and tingling, a burning sensation, and even muscle weakness.

And while technically it’s a nerve issue, symptoms of a sciatic nerve issue often affect your lower extremities.  These issues can begin in the back, and the rating criteria for the back specifically instruct VA to rate any neurological residuals that result from your back condition, in addition to whatever range of motion rating the testing might reveal.

So, if you do have radiculopathy or sciatica from your lower back condition, VA is supposed to rate that at the same time and you don’t necessarily have to file a separate claim for it.  But diagnostic codes to be on the lookout for are 8520, 8620, 8720, all which deal with sciatic nerve which is a very common nerve issue that we see.  And that deals with paralysis, neuritis, neuralgia of the nerve.  And ratings range anywhere from 10 percent all the way up to 80 percent, being the most severe when there’s complete paralysis, muscle involvement, etc.

Frank, what are some other common secondary conditions that we see due to back disabilities?

Frank: Well, oftentimes back disabilities can cause or aggravate a variety of other conditions.  Some examples include radiculopathy; gastrointestinal or even stomach issues; hip, leg, or foot disabilities; effects of medication used to treat such back disability; effects of obesity caused by a lack of ability to exercise due to such back disability; and even depression can be associated to a back disability on a secondary basis.

And veterans may be able to receive secondary service connection for any of those disabilities caused by or related to their back disability.  And we actually do have another YouTube video about secondary service connection that, for anyone who is watching, can check that out, too.

Emma: Now, Bethany, tell us about how a veteran with a back disability might be eligible for TDIU.

Bethany: Yes.  So, you have noticed that none of the ratings that we said for back disabilities go up to 100 percent typically, so it’s going to be pretty rare for a veteran to get to a combined rating of a 100 percent due to a back disability alone.  So, this is where TDIU, or total disability rating based on individual unemployability, can be really helpful.

If you have a service-connected back disability and are unable to work, which happens a lot as back disabilities cause limitations in sitting, standing, walking, lifting – all of which are required in some capacity by most jobs – then you may be eligible for TDIU.  Which would allow veterans who are unable to work due to their back disabilities to get compensated at the 100 percent rate, even if their combined schedular rating does not add up to 100 percent.

So, we have a lot of videos on TDIU, how to apply, and what VA will look for.  So, if that’s something that you think you might be interested in, definitely check out our videos on TDIU on YouTube.

Emma: Thanks, Bethany.  Well, that pretty much covers just the quick discussion of typical back disabilities that veterans might suffer from.  Frank, any final thoughts or recommendations for those out there watching today?

Frank: I’m just saying, you know, thank you for tuning in.  Any more information can be found in our vlog or any other videos that we have on our Channel.  And as always, you can stay up to date by subscribing to our Channel.

Emma: Thanks, Frank.  Bethany, any final thoughts or recommendations for people watching?

Bethany: Yeah. I would just say that if you have any questions on your back rating, if you think it’s not high enough, definitely reach out to an accredited representative.  Oftentimes, that range of motion testing can be difficult for C&P examiners.  So, that’s something that you’ll definitely want someone who’s accredited to take a look at if you have any concerns about your back rating.

Emma: Thanks, Bethany.  Well, thanks for tuning in everyone.  And as Frank mentioned, to stay up to date on veterans law issues, please subscribe to our YouTube Channel, and we’ll see you next time.