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How To Get Va Disability For Back Pain

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Is Chronic Pelvic Pain A Disability

VA Claims for Back Pain and Back Disabilities | Are You Rated Properly?

Yes. Chronic pelvic pain, like other forms of chronic musculoskeletal pain, qualifies for VA disability benefits. A claim for chronic pelvic pain would be rated based on how the pain affects the hip and thigh.

Additionally, pelvic pain can be rated using residuals for each effect flowing from the chronic pelvic pain. For example, the VAs regulations on fractured pelvis bones advise evaluating residuals, pain in the lumbar spine, muscle spasm, sciatic neuritis, peripheral nerve injury, and range of hip motion to arrive at a disability rating.

What Are Va Benefits For Back Pain

First of all, although it is possible to receive benefits for pain incurred during your time in service without a diagnosis, it is not guaranteed. A current diagnosis is always recommended if possible to obtain. In addition to your current diagnosis, you will need to include a NEXUS letter and DBQ to partner with your medical evidence and in turn, prove your service-connection. Without these outside documents, you are significantly decreasing your chance of winning your VA disability for back problems claim.

In determining benefits, the VA refers to the back as the thoracolumbar spine. This is the term used to reference middle or lower back pain. The VA considers upper back pain in the same category as neck pain. Therefore, anything above middle or lower back pain will be referred to as the cervical spine and falls under a different rating system.

The thoracolumbar spine is composed of two parts of the spine the thoracic and the lumbar . These are the two areas that will be examined in order to determine benefits for any back pain.

What Is The Thoracolumbar Spine

The thoracolumbar spine is what most people refer to as their back. Think of it as your middle and lower back.

It is actually composed of two parts of the spine:

  • The lumbar spine which is made up of five vertebral bodies
  • The other part of your spine is what we would commonly call your neck. VA uses medical terminology and refers to your neck as your cervical spine. Look for me to discuss how VA rates cervical spine disabilities in future articles.

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    How Is Va Disability Rating For Neck Pain Decided

    A cervicalgia VA rating will be decided based on the severity of symptoms and how much they limit an individuals movement or range of motion. VA ratings for neck problems go up fast because so much goes on inside your cervical spine. The more you are immobilized, the more your VA rating will increase. Most neck injuries follow the same diagnostic criteria.

    Va Disability Ratings For Back Pain Explained

    Chronic Pain Syndrome &  Your VA Disability Claim

    Hi Veterans, in this post, I will be covering the VA disability ratings for back pain criteria in detail.

    Many veterans suffer from various back conditions due to their active duty military service and perhaps youre wondering if you can get VA disability for back pain.

    Generally, VA disability ratings for back pain range from 10% to 100% and depend upon the frequency, severity, and duration of symptoms, including Painful Motion, Limitation of Range of Motion , and Functional Loss or Impairment.

    In addition, Back Pain is a common secondary VA disability claim, especially Radiculopathy secondary to back conditions or back pain.

    Okay, lets jump into some important definitions first because these principles are critical to understand and may affect your final VA disability rating for back pain.

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    How Do I Get A Doctor To Support My Claim

    Any physician who is qualified to write an IMO or “nexus” letter on your behalf may do so. Just note that not all doctors are skilled at this task nor do all doctors have the tools at hand to write an IMO report or Nexus Letter.

    If you are interested in getting an IMO, Jim Strickland with the popular website, has a list of recommended IMO doctors here.

    If you absolutely can’t get an IMO, and haven’t submitted a “Nexus Letter” previously, find a doctor who has written these letters before and make a routine appointment to meet face-to-face with that doctor. Ask them directly to draft or sign the letter. Assuming that the physician agrees with your “nexus” claim, it is perfectly acceptable for you to draft the letter on her behalf. Then ask them to review and sign it, or edit and then sign, if the doctor feels more comfortable with that.

    We advise you not to ask a nurse or clerk to perform the task of getting the physician’s signature. These members of the care team often see themselves as “gatekeepers,” to guard and protect the physician from tasks that will only take up more valuable time. They may believe that “rules” or “law” won’t allow the physician to sign such a document and may refuse you access to the doctor. Most physicians will sign such a letter if it is brief, to the point, and factual.

    How Does Va Rate My Back Disability

    VA ratings come from VAs regulations which are published in the Code of Federal Regulations . Different medical conditions have different diagnostic codes.

    For disabilities of the spine, VA uses diagnostic codes between 5235 and 5243. These diagnostic codes fall within the spine section of VAs diagnostic codes.

    Among other things, these codes cover diagnoses for:

    • Vertebral fracture and dislocation
    • Degenerative arthritis of the spine
    • Intervertebral disc syndrome
    • Spinal stenosis

    The formula that VA uses to rate back disabilities with a diagnosis code between 5235 and 5242is the same. That formula actually covers both the cervical and thoracolumbar parts of the spine. This article will only focus on the portion of that formula that relates to the thoracolumbar spine.

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    Evaluating A Knee Disability: Dbqs And C& p Exams

    The VA often uses Disability Benefits Questionnaires to evaluate a veterans disability. These can be completed by your private doctor and submitted to the VA as evidence for your claim. The VA may also schedule you for a Compensation & Pension examination where the C& P examiner will complete a DBQ. Regardless of who is completing the DBQ form, it is important to remember that many knee ratings are based on range of motion measurements, and all range of motion measurements must be performed with a goniometer in order for the VA to accept them.

    How Can I Qualify For Tdiu With Back Pain

    Back Pain, What You NEED TO KNOW to Maximize Your VA Disability Rating!

    Back pain is a common complaint among Veterans due to conditions such as lumbosacral or cervical strain, spinal stenosis, spondylolisthesis or segmental instability, ankylosing spondylitis, spinal fusion, and vertebral fracture or dislocation. Veterans with severe back pain that limits their work opportunities may qualify for additional compensation via Total Disability Individual Unemployability benefits.

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    Understanding Va Back Ratings

    Your VA disability rating for back injury or spine injury will depend on which code the condition falls under. Diagnostic codes 5235 through 5243 of 38 CFR § 4.71a, Schedule of Ratings, Musculoskeletal System are dedicated to back and neck pain. Some of which are listed below:

    Diagnostic codes 5242 and 5243 are reserved for arthritis and spinal disc conditions.

    Tdiu Benefits For Pain In The Lower Back

    TDIU, or total disability based on individual unemployability, occurs when a veteran is unable to work as a direct result of their service-connected disability or condition. If a veterans lower back pain prevents them from securing and keeping substantially gainful employment they may be eligible for TDIU benefits paid at a 100 percent disability rate.

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    How To Get A Range Of Motion Test For Back Pain

    To assess VA disability for back problems, the VA most often uses the General Rating Formula for Diseases and Injuries of the Spine to evaluate them. Their rating is determined most commonly by assessing your range of motion. Their formula looks at the flexion at the waist and determines if it is limited by injury.

    According to the VA, flexibility must be fairly limited to even get a 20 percent disability rating. This will be determined on whether there is forward flexion greater than 30 degrees but less than 60 degrees. Meaning that if you are significantly limited in your ability to bend at the waist, you might qualify for the 20 percent rating. Usually, previous diagnoses from doctors or therapists will be used to determine this.

    The range of motion method of determining your VA benefits rating generally will end up as one of the following:

    Of course, a limited range of motion is not the only way to get VA disability for back problems. It is also possible to obtain at least a 20 percent rating if you are regularly experiencing muscle spasms severe enough to develop an abnormal walking gait. They will also evaluate you for the following abnormal spinal contours:

    • abnormal kyphosis
    • scoliosis
    • or reversed lordosis .

    Finding The Underlying Cause Of Your Pain

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    Chronic pain isnt a specific disability recognized by the VA, so youll increase your odds of being approved for benefits if you can identify the underlying cause of your pain. For example, a herniated disc is a common cause of back pain, and joint pain is often linked to arthritis.

    Seeing a specialist or visiting a pain management clinic can help you get a proper diagnosis. A provider who is trained in identifying and treating chronic pain is also capable of writing a more persuasive nexus letter to support your application.

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    What Is The Va Disability Rating For Chronic Pain Disorder

    Chronic pain disorder is broader than chronic pain. Chronic pain disorder includes the disabling conditions that are caused by chronic pain. For example, chronic pain may lead to insomnia due to the inability to sleep while suffering pain. Similarly, chronic pain may lead to depression about the pain.

    While there is no VA disability rating schedule for chronic pain disorder, you can approximate the effects of all your service-connected disabilities through the secondary service-connected disability doctrine. Under this procedure, you can include claims for secondary disabling conditions that have a nexus to a primary disability. By aggregating the VA disability rating for the source of the pain with the VA disability rating for the effects of the pain, the overall VA disability rating covers the entire chronic pain disorder.

    combined VA rating and monthly payment

    Thus, in the examples above, chronic pain would be your primary service-connected disability, and depression or insomnia would be your secondary service-connected disability. When you use secondary service-connected disabilities, the individual rating percentages for each disability are aggregated using VA math.

    Here is our video explaining how the VA Combined Rating table works and why VA Math can be so confusing.

    How Is Service Connection Established For Back Pain

    The VA will consider your condition to be service-connected if you can show that it was either caused or worsened by your military service.

    It can be tricky to prove that your condition was caused by your time in the military, but not impossible. Your doctor will need to provide objective medical evidence that your condition is connected to your military service.

    Veterans must provide evidence to back up their application for VA disability for back pain. Evidence will include:

    • Diagnosis of the condition where possible or an explanation of how back pain affects daily life
    • The event, injury, or illness that occurred in-service to cause the injury
    • Link, or medical nexus, between service-related events and the pain youre experiencing

    Secondary service connections may also be made. A secondary connection, for example, would link the back pain to another service-related condition. If a knee injury caused by your service altered your normal gait and led to back pain, a claim will be approved if the link is proven.

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    Please Answer A Few Questions To Help Us Determine Your Eligibility

    Back pain can be caused by many different spinal conditions, many of which happen normally with age. Chronic conditions causing back pain include scoliosis and degenerative discs inflammatory conditions like rheumatoid arthritis, arachnoiditis, and spondylitis and problems impacting nerves in the back: spinal stenosis, nerve root compression, herniated discs, and spondylolisthesis .

    This article focuses on how Social Security views symptoms of pain and how the consistency between your medical records and your statements about your symptoms and pain can affect the success of your back disability claim.

    How Va Disability Ratings Determine Your Benefits

    VA Disability for Back Pain

    The VA gives every veteran who applies for benefits a disability rating for each service-connected condition. This rating ranges from 0%-100%, which also determines your benefit payments. These ratings indicate the occupational limitations a soldier may have due to active military duty. The higher your VA disability rating, the more you may potentially receive in monthly compensation. The VA lists all spinal conditions under section 4.71 Schedule of ratingsmusculoskeletal system. Here you can find information on which criteria the VA looks for when determining a disability rating for various back issues.

    For spinal conditions that cause back pain, the VA uses certain guidelines to determine a disability rating. First, the VA conducts a variety of back tests to determine your overall range of motion. Those results help determine your overall VA disability rating and final benefit amount.

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    When Youre Diagnosed With Radiculopathy

    If you see a doctor for your back pain, they typically look at your back in three sections. Each of these sections connects nerves from your brain to parts of your body: the cervical section near and around your neck and shoulders the thoracic section down your lower back and the lumbar section that extends to your tailbone. A veteran can suffer radiculopathy in all three areas:

    What Is The Painful Motion Principle

    The painful motion principle means that regardless of range of motion, if pain is present, the claimant should at least be awarded the minimum level of disability for that condition.

    For example, lets say you have full range of motion for your back, but you have pain during movement, you should be awarded the minimum level of disability for the condition, which for most muscuoloskeltal conditions is 10%.

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    Scars That Are Painful Or Unstable

    If you have a scar that is painful or unstable, the scar must have a frequent loss of covering of skin. A painful scar VA rating of 10% may be added if you have more than one unstable scar. The other painful scar VA rating system for diagnostic code 7804 is as follows:

    • 10%: one to two painful or unstable scars
    • 20%: three to four painful or unstable scars
    • 30%: five or more painful or unstable scars

    VA disability for surgery scars is under diagnostic code 7804 since most surgical scars are superficial

    How Social Security Evaluates The Severity Of Your Back Pain

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    Social Security sees many disability claims for back pain, but approves a only few of the most severe cases Social Security expects most others to be able to work through their back pain. So, Social Security’s job is to determine which claims for back pain are the most serious and truly prevent the claimant from being able to do any kind of work. After determining that you have an MDI, the agency assesses the severity of your impairment by looking at:

    • your objective symptoms, to see whether they match the requirements in Social Security’s impairment listings for certain spinal problems , and
    • your functional limitations to see what type of work you could do.

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    How To Get Disability For Back Pain

    Back pain is an incredibly common condition, with as many as 80% of all people expected to experience back pain at some point in their lifetimes, according to the American Chiropractic Association . Additionally, the ACA notes that back pain accounts for over 265 million lost hours of work every year. It is one of the top reasons people miss work, and it is the single leading cause of disability. All this to say, if you’re currently experiencing debilitating back pain or have been unable to work in the past due to back pain, you’re not alone!

    But, do you qualify for disability for your back pain? And, if you do, how do you actually get your Social Security disability benefits?

    Can I Be Rated For More Than One Va Disability For Back

    The legal concept Avoidance of Pyramiding applies to the back just like any other VA disability.

    However, you can be rated for more than one disability condition for your back that cause different levels of impairment and are clearly separately rated conditions.

    For example, you may have a 50% VA rating for your back due to unfavorable ankylosis of the entire thoracolumbar spine.

    Perhaps this condition has also led to Radiculopathy, which occurs when nerve roots become pinched or damaged, the resulting symptoms lead to this painful condition.

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    Provincial Income Support Benefits

    Each province in Canada pays income support benefits to people who cant work because of disability. If you qualify, you can receive fixed payments for life.

    You can qualify for provincial benefits even if youve never worked however, they only apply if your total family income falls below a certain amount. This amount differs from province to province. Family income doesnt affect the approval process for other types of disability benefits.

    You apply for provincial disability benefits by applying with your local agency or program. As usual, your doctor will need to provide a report or certificate confirming you are unable to work because of your medical condition.

    For denials, you can appeal internally within the agency or program. In some provinces, you can also appeal to an outside tribunal for a final decision. Check with your province for the proper procedures.

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