Tdiu Benefits Based On Lower Back Pain
Veterans who are unable to work due to their service-connected low back pain can apply for total disability based on individual unemployability . TDIU allows for veterans to be paid at the 100 percent disability rate if their service-connected condition prevent them from securing and following substantially gainful employment.
Is Back Pain A Va Disability
Yes, Back Pain is a VA disability.
The VA rates Back Pain under CFR Title 38, Part 4, Schedule for Rating Disabilities, General Rating Formula for Diseases and Injuries of the Spine.
VA Ratings for Back Pain range from 10 percent to 100 percent, with breaks at 20 percent, 30 percent, 40 percent, and 50 percent.
The highest scheduler rating for severe Back Pain is 100%, which means your entire spine is frozen in an unfavorable position.
Your final VA Disability Rating for lower back pain depends upon the Frequency, Severity, and Duration of symptoms to include Limitation of Range of Motion and Painful Motion.
Pro Tip: In accordance with the Painful Motion principle, if you have pain upon flexion or extension of your neck or shoulder, the VA is required to award the minimum compensable rating for the condition, which is 10%.
How To Disagree With Vas C& p Examination
As mentioned above, C& P examinations are incredibly important in relation to how VA rates back pain. If veterans disagree with the VA examiners report, they have the right to disagree by submitting argument and evidence to the contrary. Importantly, VA will not send veterans copies of their C& P examinations automatically. Therefore, veterans should request a copy of their examination from their local Regional Office and then thoroughly review it to ensure the examiner answered all questions adequately. Additionally, veterans should make sure that the examiners report accurately represents what they reported in regards to symptomatology and severity. If the VA examiner failed to address any of the factors mentioned above, including functional loss and flare-ups, veterans can argue that the examination is inadequate. Veterans can also argue against the adequacy of an examination if the examiners fail to provide rationale for their conclusions, or if they do not address all theories of service connection .
Veterans can obtain their own evidence to demonstrate their back pain is more disabling than what is reflected in the examination. For example, veterans can submit lay statements outlining the severity of their symptoms, either generally or specifically in relation to the examiners findings. Veterans can also consider getting a private examiners opinion to contradict the negative C& P examination.
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Va Disability Rating For Depression Secondary To Back Pain
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The VA offers disability benefits to Veterans suffering from certain physical and mental ailments or injuries, including mental illnesses like depression. However, many Veterans dont know that depression, or other mental health condition, caused by another injury or illness can also qualify them for additional disability benefits.
If back pain caused your depressive symptoms, read on. Well explain the VAs disability rating system for depression secondary to back pain and other service-connected injuries and illnesses. Well also explain how you can maximize your chances of a successful VA disability claim.
Direct Service Connection For Back Pain
Service connection or service-connected is the acknowledgement by VA that a veterans current health condition is related to their military service. Veterans need to establish service connection in order to receive disability compensation from VA. In order to establish direct service connection for conditions related to back pain, veterans must show evidence of the following:
- A current diagnosis of a back condition
- An in-service event, injury, or illness and
- A medical nexus between the current, diagnosed back condition and the in-service event, injury, or illness.
However, it is important to note that there is an exception to the first element of service connection involving a current diagnosis. In April 2018, the Court of Appeals for the Federal Circuit held in Saunders v. Wilkie that VA must award disability benefits for pain due to military service. This means that if a veteran has pain related to their time in service, but does not have an underlying medical diagnosis, they can still receive VA disability benefits. In regards to back conditions, this ruling is beneficial as many veterans experience back pain stemming from their time in service, but do not have a diagnosis that serves as a cause for the pain. Nonetheless, veterans will typically need medical documentation from a healthcare professional indicating that their back pain is related to their service.
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Va C& p Exams For Back Pain
After you file your claim, the VA may decide to conduct a compensation and pension compensation exam on your back or spine if they need more information or medical evidence to support your claim.
C& P exams help VA evaluators determine the severity of your condition and assign a rating for it. Your rating will determine your eligibility for monthly payments and other VA health care benefits, according to the VA.
Chronic Pain Diagnosed After Service
If your chronic pain was diagnosed after service, it may still be service-related if it manifested during your service. For example, if your chronic back pain is caused by degenerative disc disorder but was misdiagnosed during your service as muscle strain, you should be able to establish a service connection through a doctors opinion letter identifying the misdiagnosis and stating that the degenerative disc disorder started during your service.
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How To Qualify For Higher Va Ratings For Back Pain
The VA rates back pain based on how much of the spine, or range of motion, is affected.
In addition to range of motion scores and medical findings like ankylosis, the VA has to consider the severity of a veterans functional loss, said Cecilia Ton, a VA-certified disability benefits lawyer. Functional loss refers to any impairment in a veterans functioning due to a service-connected back or neck disability. Making the VA aware of the severity of your functional loss could trigger the VA to assign a higher rating.
Veterans also might not have to show an actual medical finding of ankylosis. If a veterans condition requires a neck or back brace that could be considered the functional equivalent to ankylosis. For example, braces help a veterans stability, but while wearing the brace, their back may be stuck in an upright position, which could be the functional equivalent of ankylosis.
The VA also factors in conditions related to back or neck disabilities. Neurological disabilities that can be tied to a veterans back or neck pain must receive a separate rating. As we discussed earlier, radiculopathy is a common neurological disability stemming from back or neck injuries. The VA also requires that bowel and bladder incontinence and impairment receive a separate rating.
Contact A Va Disability Lawyer Today
A VA Disability Lawyers role is to assist you throughout the confusing and often frustrating appeals process if you have been denied benefits for your service-connected back pain. Generally, you need to be denied at least once before an attorney can assist, but once a lawyer is involved they will often be able to quickly determine what needs to be done in order to prove entitlement.
If your VA disability claim for back pain has been denied, be sure to contact the VA Accredited Attorneys at VetLaw right away to help make sure you get the entitlement you deserve.
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Va Compensation And Pension Exams For Back Pain
To help the VA determine VA disability ratings for back pain, a compensation and pension exam is usually required. This is where a VA-approved medical professional will perform a comprehensive physical and verbal examination then write their opinion on your condition. The practitioner will assess how far you can bend and flex your joints during the range of motion C& P exam.
While the ROM test is the primary factor in determining VA ratings for back and spine conditions, there are also other portions included in the C& P exams. For example, the VA compensation exam for lower back pain might include a disability benefits questionnaire . Back thoracolumbar spine conditions can have a significant effect on an individuals life, a DBQ allows the veteran to go into detail about how the condition has impacted their life.
Attending a C& P exam with a medical professional can also potentially help you discover the presence of secondary conditions you were unaware of.
Types Of Injuries That Can Cause Back Pain
A medical examination will be required to strengthen the claim and increase your chances of approval. Doctors may or may not be able to pinpoint the source of the pain, but its often linked to one of the following:
- Arthritis. Spinal stenosis, or the narrowing of space around the spinal cord, can occur.
- Bulging discs. When the material in the discs in the back rupture or bulge, it can create pressure on the nerves, causing significant pain.
- Osteoporosis. This condition weakens the bone and can lead to fractures.
- Strains. Both ligament and muscle strains can occur from heavy lifting or awkward movements.
You may be experiencing pain from fractures, sprains, strains, herniations, nerve damage, or other injuries.
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Disability Ratings For Back Injuries
Once the up-hill battle of service-connection for a back injury is over, veterans are often shocked by their rating decision. After years of fighting to show that their back problems are related to service, when they finally win, VA often awards only a 10 percent rating for the veterans pain.
In general, back injuries are rated low for the anguish and disability they cause. Our attorneys understand how the VA rates back conditions and secondary conditions, and we can help increase that rating and make it closer to actual compensation for impact your back disability has on your life.
There are two ways the VA compensates for back disabilities. The first relates to range of motion. The second is specific to intervertebral disc syndrome and rates based on the necessity of incapacitating episodes.
Back Disability Ratings Based on Range of Motion
Most people with back problems dont spend a lot of time thinking about how far they can bend or twist theyre too busy being in excruciating pain. That focus is where many veterans inadvertently get themselves in trouble. Pain of any severity, even life-altering, agonizing pain, is ratable at only 10 percent. There are limited exceptions, but, for the most part, appealing to the VA for a higher disability rating based on pain will not result in an increased evaluation.
Getting Service Connected For Back Impairments
There is a lot of information you need to provide to the VA when trying to obtain service connection for your back or any other orthopedic condition. Some examples of records you will want to submit to the VA include your service medical records, military personnel files reflecting an in-service accident, diagnosis, or change of duty due to back issues, and any private medical records you have that could help establish a connection between your military service and your back condition. You can also submit sworn declarations from fellow servicemembers, family members, friends, or others familiar with your condition who can help verify that your back issues were caused or made worse by your military service.
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Requesting Compensation For A New Disability
You normally do this if you are already getting VA disability, or have filed before and were denied. For example, you hurt your back while in the military so the VA is paying you disability compensation for a bad back. Now, you realize you are having hearing issues that may be related to your military service.
In this case, you just have to file a new disability claim with the VA. Some disabilities may have time limits, and you do have to document everything just like any other application for VA disability.
General Rating Formula For Lower Back Pain
In most cases, VA uses the General Rating Formula for Diseases and Injuries of the Spine under 38 CFR § 4.71a to evaluate back conditions, including low back pain. This general rating formula is based primarily on range of motion, or the measurement of the amount of movement around a specific joint or body part. The range of motion measurement typically encompasses the range of flexion and extension as well. VA generally rates low back pain as follows:
Importantly, if veterans do not meet the range of motion criteria outlined above, it is still possible to obtain a high rating for their low back pain if they have intervertebral disc syndrome as well. VA rates IVDS under Diagnostic Code 5243, which focuses on the number of incapacitating episodes veterans experience as a result of their low back pain. Here, VA defines an incapacitating episode as a period of acute signs and symptoms that requires bedrest as prescribed by a physician. IVDS is rated as follows:
- 60% with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months
- 40% with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months
- 20% with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months
- 10% with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months
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What If I Have Other Symptoms As A Result Of My Back Disability
VA will rate some conditions caused by your back disability separately. For example, the diagnostic codes instruct VA to rate neurological symptoms separately. Some examples of neurological conditions that could be rated separately include:
- Radiculopathy including pain, numbness or tingling in your arms and legs
- Bowel or bladder symptoms
Frequently Asked Questions About Va Ratings For Back Pain
What are VA ratings for back pain?
The VA ratings for back pain reflect the seriousness of a veterans mobility loss and how much their spine is affected. The ratings also factor in whether a veteran feels pain, stiffness, or aching in their spine. To receive a 30% rating or above, a veteran must prove ankylosis, which is joint stiffness caused by an injury or a disease. Fixed movement of the entire spine qualifies for a 100% rating.
How can a veteran get a 100% VA rating for back pain?
A veteran receives a 100% rating if their entire spine is immovable because of a back injury. However, more commonly, veterans are able to achieve a 100% rating through a combination of back and neck injury ratings and other conditions.
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Traumatic And Degenerative Arthritis
Traumatic arthritis is joint damage, pain, or inflammation due to an injury. If an individuals joints begin causing problems after excessive movement or physical trauma, their arthritis will not be considered chronic.
Degenerative arthritis refers to a chronic breakdown of cartilage around joints. The joints between vertebrae are called facets. When facet joints are damaged, veterans experience facet arthropathy. The VA rating for facet arthropathy can contribute to the VA rating for degenerative arthritis of the spine.
Both of these forms of arthritis are rated under code 5003. Each specific joint will also have its own identifying arthritis code. For example, degenerative arthritis of the spine is listed under diagnostic code 5242, meaning decisions regarding degenerative arthritis of the spine will reference the condition as 5242-5003.
Saunders V Wilkie Disability Benefits For Pain
It is important to note that veterans typically need a current, diagnosed back condition in order to qualify for VA disability benefits. However, in April 2018, the Federal Circuit decided VA must award disability benefits for pain due to military service. Prior to this decision, the Court of Appeals for Veterans Claims held that pain alone without an underlying diagnosis was not compensable. Now, if a veteran experiences back pain as a result of their military service, but does not have an actual diagnosis causing that back pain, they can still receive VA disability compensation. The Federal Circuits decision in Saunders may affect both veterans seeking service connection and those seeking increased ratings for their back pain.
How To Get A 100% Rating For Back Pain
A 100% rating is given when the entire spine is immovable because of a back injury. However, more commonly, veterans are able to achieve a 100% rating through a combination of back and neck injury ratings and other conditions. Often, nerve issues can arise from back or neck conditions and cause a veteran to lose mobility of their feet and hands.
The VA considers back issues in the lumbar spine separate from the cervical spine. A veteran with issues with both portions of the spine could get a rating for a back condition and a neck condition.
Veterans with a severe neck or back condition may be entitled to total disability based on individual unemployability .
TDIU, which pays at the same rate as a 100% rating, is given to veterans with service-connected conditions that prevent them from keeping substantially gainful employment. A veteran must have at least one service-connected disability rated at least at 60%, or two or more service-connected disabilities with a combined rating of 70% or more, including one single disability rated at 40% or more.
One way to find out if you could be entitled to this benefit is to look at your functional limitations, Ton said. The VA has to consider impairments in standing, sitting, bending, climbing stairs, grasping, and carrying objects, for example, because those are common work tasks.