What Does Va Mean By Incapacitating Episodes
As I mentioned above, veterans can also qualify for a 20 percent VA rating by showing at least 2 weeks of incapacitating episodes in the last year. This applies most often to veterans who have periods where their back flares up or goes out, and they simply are unable to do much of anything. This really takes a toll on veterans and should be factored in by VA.
Fortunately, VA does factor that in. Its another way to rate a spinal condition. Having back pain or some limitations alone will not be enough to qualify for the 20 percent VA rating since VA defines incapacitating episodes.
In VAs rules, incapacitating episodes means signs and symptoms that your doctor says require bedrest that your doctor orders. The good news is that the episodes do not have to be two weeks in a row. You just have to have a total of at least two weeks in the last year.
VAs rules also provide that VA should use whichever method of rating your thoracolumbar spine which provides you with the higher rating. So, if you qualify for a ten percent using range of motion and a 20 percent using incapacitating episodes, then VA should assign you a 20 percent rating.
How Do I Get The Highest Rating For My Back Pain
Pain is rated similarly to any diagnosed condition, the VA looks to the extent that your pain impacts your ability to function and work. Thus, in order to get the highest rating you need to provide the VA with as much relevant information as possible. The VA needs to determine the severity of your pain and the extent it impacts your ability to function.
Saunders Disability Benefits For Pain Without A Diagnosis
In April of 2018, the held that VA can award disability compensation for a veterans undiagnosed pain if it is linked to an in-service event, injury, or symptom. The Federal Circuits ruling affects the firstelement of direct service connection, the current medical diagnosis, insofar as it is no longer required.
In the absence of a diagnosis, veterans will need to show VA that there was an in-service event, injury, or symptom that caused their pain, and provide a medical nexus linking their pain to that in-service incident or symptom. To do so, veterans can submit evidence that their neck pain is recurring or long-lasting and interferes with daily life, as neck pain so often does.
One example of such evidence might be a lay statement from the veteran or a family member who has witnesses the way the veterans neck pain interferes with daily life. Military records, such as medical records or personnel files, which display an incident or activity that could have led to the neck condition, can help to establish the relationship between the neck condition and service.
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How To Get A Service Connection For Hip Pain Secondary To Back Injury
Filing for and receiving benefits for a secondary service condition is similar to filing for and receiving benefits for a primary service-connected injury or illness. First, a Veteran must make sure theyve filed their VA Form 21-526EZ their original claim for a current condition or injury.
Then, Veterans must:
- Gather medical evidence that they are suffering from a secondary condition like hip pain. Evidence like personal journals or doctors notes can be very valuable during this process.
- Prove that the hip pain or other secondary condition is related to a service-connected condition already covered by disability benefits. Again, a doctors note can be very helpful. By linking the hip pain to a primary service-related condition, the Veteran proves theres a nexus link to their military service.
- Finally, the Veteran must send in their application and wait for the VA to review it. If the VA finds a problem, the Veteran may need to appeal the decision or re-file an application for a different condition or diagnostic code.
Just like other service-connected conditions, some hip pain conditions might be regularly reviewed by the VA. This may cause your disability benefits to fluctuate or change over time.
For example, if your hip pain is related to a back injury currently receiving treatment, your hip pain may become less intense as your back injury treatment progresses. This might result in a new, lower disability rating for your hip pain and your back injury combined.
How Do I Apply For Va Disability Benefits
The Department of Veterans Affairs recommends eligible Veterans apply for disability compensation benefits through the VA’s eBenefits online portal. However, Veterans may also apply by mail with VA Form 21-526EZ, in person at your regional benefits office, or with help from a trained professional.
In any case, you will need access to your DD214 , the medical evidence of the disability, and dependency records .
If you have yet to separate from service, you may still apply using the Benefits Delivery at Discharge program. To be eligible for the BDD, you must:
- Be on full-time active duty , and
- Have a known separation date, and
- Your separation date is in the next 90 to 180 days
If you have less than 90 days until separation, you may still file a fully developed or standard claim.
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Proving Va Service Connection For Your Back Or Spine Condition
Similar to the majority of VA disability claims, to earn VA disability ratings for back pain you must provide three main pieces of evidence:
- A current diagnosis from a medical professional of the condition you are currently filing a claim for.
- Proof of an inciting event that you believe to have caused the condition you are currently filing a claim for.
- A medical nexus or statement that connects the military event or experience to your current diagnosis. This should be presented as a statement of opinion from a medical professional.
After gathering this information and attending a C& P exam, you will receive a disability rating from the VA in the form of a percentage.
Combined Rating System For Veterans With Multiple Disabilities
Veterans with multiple disabilities use the combined rating system.
To use the combined rating system, arrange the disabilities in order by severity and locate the intersect of the two numbers on the table below.
The VA rounds the final figure to the nearest to 10 percent.
If the Veteran has more than two disabilities, find the combined value for the first two, without rounding, and repeat with the third disability. Once you have a final number, round to the nearest 10%.
For example, if disability 1’s rating is 40% and disability 2’s is 20%, the combined rating is 52%. That figure gets rounded to the nearest 10%, making the disability rating 50%.
For a three-disability example, if disability 1’s rating is 60%, disability 2’s rating is 30%, and disability 3’s rating is 20%, we first find the rating of 1 and 2. The rating of 1 and 2 comes out to be 72. We then take the first combined rating and find the intersect with disability 3. The final number comes out at an even 80% rating.
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Va Ratings For Sciatica
The VA rates sciatica and other nerve problems that affect the back using three categories based on how severe your symptoms are:
- Paralysis. This is the highest level of severity. Youll likely receive an 80% rating for complete paralysis if the muscles in your leg below the knee barely work and you have severe problems bending your knee. You may receive 60% for incomplete paralysis, with severe muscle atrophy, limited functionality, and poor circulation. A rating of 20 – 40% is given for moderate to moderately severe paralysis. And 10% is given for mild paralysis.
- Neuritis. In this category, you can receive a 60% rating for loss of reflexes and sensation, muscle atrophy, and severe limitation of body part functionality. A 10% rating is given for mild neuritis.
- Neuralgia. In this category, you may receive a 10 – 20% rating depending on the severity of the numbness, pain, tingling, and limitation of body part functionality.
List Of Va Secondary Conditions To Back Pain
Many veterans suffer from various service connected back conditions, which can affect your back.
For example, the following codes from 38 CFR, Part 4, Schedule for Rating Disabilities apply:
- Code 5237: Lumbosacral or cervical straina generic label for back pain
- Code 5238: Spinal stenosisthe spinal column narrows and presses on the spinal cord or nerves
- Code 5239: Spondylolisthesis or segmental instabilitywhen a vertebra slips out of position
- Code 5240: Ankylosing spondylitisan arthritic disease that causes the spinal joints to freeze in place
- Code 5241: Spinal fusionthe vertebrae are surgically fused together
- Code 5235: Vertebral fracture or dislocationthe bones of the spine break or slip out of alignment due to a traumatic event like a car accident. Any generic spinal bone injury would be coded here.
These six back conditions can often lead to pinched or damaged nerve roots, which can cause significant pain known as Radiculopathy.
Radiculopathy is commonly rated as a secondary VA disability claim for secondary service connection due to one or more service connected back conditions.
Note that a veteran is eligible to be rated for both a back condition, and Radiculopathy secondary to lower back pain.
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Whats A Disability Rating
We assign you a disability rating based on the severity of your disability. We express this rating as a percentage, representing how much your disability decreases your overall health and ability to function.
We then use your disability rating to determine your disability compensation rate, so we can calculate how much money youll receive from us each month. We also use your disability rating to help determine your eligibility for other benefits, like VA health care.
How Much Can I Receive In Va Disability Compensation For My Back Pain Injury
The amount of monthly compensation you can receive depends on the disability for your service-connected back pain. Generally speaking, the more disabling your back condition is, the more compensation you will receive. VA uses a disability rating schedule from 0 to 100 percent to assign a percentage consistent with the level of severity. Your disability rating then determines the monetary amount you will receive.
Range of motion is the primary criterion the VA uses to assign disability ratings to back pain injuries. The more restriction in your ROM, the more money you will receive in compensation.
For example, the VA assigns a 100 percent disability rating for a veteran with unfavorable ankylosis of the entire spine, while it only assigns a 10 percent disability rating for a vet with forward flexion between 60 and 85 degrees.
A rating of 0 percent does not qualify for monthly disability benefits. A rating of 100 percent allows you to receive the highest amount of benefits. The following is the general rating schedule for diseases and injuries of the spine. Muscle and disc injuries might differ.
As of December 1st, 2021 the VA disability rate benefit amounts are as follows:
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How Back Pain Affects Mental Health
Due to the nature of back injuries, it is common for other parts of the body or bodily functions to be affected by secondary conditions to back pain. However, it is important to note that your mental health can also be adversely affected. We discuss how chronic pain affects mental health in a different blog. If you have a direct service connection for your back condition and have developed any of these conditions or symptoms of these conditions, you may be entitled to VA benefits due to secondary disability and are entitled to a VA disability rating for the same.
Alexander CE, Varacallo M. Lumbosacral Radiculopathy. . In: StatPearls . Treasure Island : StatPearls Publishing 2020 Jan-. Available from:
Myelopathy. Myelopathy | Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/myelopathy.
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How Do I Get A Doctor To Support My Claim
Any physician who is qualified to write an IMO or ânexusâ 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 vawatchdog.org, has a list of recommended IMO doctors here.
If you absolutely canât get an IMO, and havenât submitted a âNexus Letterâ 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 ânexusâ 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 physicianâs signature. These members of the care team often see themselves as âgatekeepers,â to guard and protect the physician from tasks that will only take up more valuable time. They may believe that ârulesâ or âlawâ wonât 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.
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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.
Proving Va Service Connection For Your Back Condition
According to the VA, to prove a service-related back injury you must:
- Provide VA, military or private medical records related to your back pain injury claim that support when your condition began and how it has worsened over time.
- Provide military separation documents, including your DD-214
- Provide supporting statements from family members, friends, clergy members, law enforcement personnel or those you served with that can tell the VA more about your claimed condition and how and when it happened or how it got worse.
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Filing A Claim For Va Benefits
If you have back pain as a result of your military service, you can file a claim for VA disability benefits. You will need to provide evidence linking the cause to your time in service.
If you would like help with your claim, contact the team at Woods and Woods for guidance. We never charge veterans for help filing the initial application. Our team works diligently to submit your application correctly, allowing you to avoid the lengthy VA disability appeals process.
Tdiu With Common Back Disabilities
Total disability based on individual unemployability is a monthly benefit that compensates veterans who are unable to gain or maintain substantial employment because of their service-connected disabilities. TDIU pays veterans at the 100 percent rating level, even if their combined rating does not equal 100 percent.
VA outlines TDIU regulations under 38 CFR § 4.16, which includes subsections and . In order to qualify for TDIU under 38 CFR § 4.16, or schedular TDIU, a veteran must have:
- One service-connected condition rated at 60% or higher or
- Two or more service-connected conditions, one of which is rated at 40% or higher, with a combined rating of 70% or higher.
Notably, both ratings for a back condition and a secondary condition can contribute to the veterans overall combined rating. For example, a veteran may be eligible for schedular TDIU if they receive a 60 percent rating for Intervertebral Disc Disease and a 10 percent rating for depression. Veterans who do not meet the schedular requirements under 38 CFR § 4.16 may still be considered for extraschedular TDIU under § 4.16.
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