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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys, it's Leah Bee from Prestige Veteran Medical Consulting. I'm a US Army veteran, physician assistant and former compensation and pension examiner. So welcome back to our channel where for those of you that don't know we like to break down VA disability benefits one condition at a time. I am your host Leah and today we're gonna talk about one of the most common orthopedic conditions claimed by veterans and that is degenerative disc disease. So tons of veterans suffer from back pain, right?
Leah Bucholz:Whether that started on active duty, it's secondary to another condition, or perhaps it was related to your jumping on active duty, being a pilot, any of your occupational stresses and develop later, all of these different ways can be related to service. And maybe it's a combination of those ways, right? So if you've been dealing with chronic back pain, stiffness, numbness, or shooting pain down your legs, you are not alone. Degenerative disc disease affects thousands of veterans and it definitely can be service connected. So today we're gonna break down what DDD is, how VA rates it, how you can prove that it's related to your service and what to do if it's part of a secondary condition or worsening over time.
Leah Bucholz:So what is degenerative disc disease or DVD? Let's start with a simple definition. Degenerative disc disease is it's not technically a disease it's more it's a condition that happens when the intervertebral discs in your spine start to wear down over time. These discs act like shock absorbers between your vertebrae and when they lose flexibility or cushioning it can lead to chronic back or neck pain, herniated or bulging discs, nerve impingement, pain radiating down the arms or legs. You can have stiffness and mobility issues.
Leah Bucholz:For veterans, years of rough marching, jumping, carrying gear, physical strain can absolutely cause or accelerate this condition. So can DDD be service connected? So for sure degenerative disc disease can be service connected and the VA recognizes it under several different diagnostic codes depending on the location and severity. So there are two primary paths, direct or secondary service connection. And we talk about this a lot in our videos.
Leah Bucholz:So let's look at each one of those. So direct service connection for degenerative disc disease. So a direct service connection means that the condition started while you were on active duty or you can show a clear medical link between your time in uniform and your current spinal condition. So a real world example of this would be that you served in the infantry, you were an 11 Bravo for ten years, you regularly carried 80 pound ruck sacks for ruck marching and you had multiple trips to sick call for back pain after field exercises. Your medical records demonstrate that you have consistent complaints and after discharge an MRI confirmed that you had disc degeneration.
Leah Bucholz:That is pretty strong supporting evidence to show a direct service connection. So often you'll definitely need a current diagnosis. So that can be based on an x-ray, an MRI, or some type of orthopedic report. Service treatment records may be helpful or personal reports showing your injury or strain. A nexus statement tying your DDD to your service.
Leah Bucholz:So that statement can come at the compensation and pension exam. Your treating doctor can provide a nexus statement saying, Hey, think this is related to their service. Any of those, some medical provider has to agree that your current condition is related to your service. So let's talk about secondary service connection for degenerative disc disease. So let's say that you had back that your back pain didn't start until after service but developed as a result of another service connected condition.
Leah Bucholz:That's where secondary service connection can come into being relevant to your case. So common secondary causes of DDD are things like service connected knee or hip conditions, uneven gait and poor biomechanics can lead to lumbar strain or disc issues. So if you've got service connected flat feet or pes planus, they can alter your posture and your spinal alignment. Obesity, we talk about obesity all the time as an intermediate step. If you are obese because of another service connected disability it can lead to a myriad of things.
Leah Bucholz:And so I urge you if you haven't seen it already to check out our obesity as an intermediate step video because it can apply to a number of things to include orthopedic conditions. Obesity secondary to things like PTSD or medication side effects. Increased body weight definitely puts added strain on the spine and other joints so spinal injuries or surgeries for other service connected issues, TBI related balance disorders can cause it, abnormal movement patterns over time can definitely contribute to degeneration. So another real world example would be if you're rated for service connected knee instability, over time your altered walking pattern has led to chronic back pain, imaging reveals degenerative disc disease. In this case, your DDD could be secondarily related to your knee condition.
Leah Bucholz:So again, things that will be important will be evidence of a primary condition that you may already be service connected for, a diagnosis of DDD, a medical link or opinion or a nexus linking those things. So what does the medical literature say about DDD and veterans? So backing up your case with medical research gives you an edge especially if you're appealing a denial or making a secondary service connection. I often write medical opinions for back pain and if I just said, Hey, I'm Leah B, I'm a PA and I think their back pain is related to service and that's all I said, it probably wouldn't carry a ton of weight because there has to be scientific rationale and reasonable records that support that link. So what does the literature show?
Leah Bucholz:So heavy lifting and impact, multiple studies including those in spine and the Journal of Orthopedic Research show that repetitive axial loading like rucking or airborne operations increase spinal disc degeneration. Psychological stress, chronic stress and PTSD can intensify perception of pain, delay healing, and lead to muscle tension that worsens back problems. Biomechanical compensation orthopedic journals note that knee and hip problems alter gait and increase wear and tear on the lumbar spine leading to DDD as well. So if your doctor includes this kind of evidence in your nexus letter or if you submit these type of studies with your claim, it may help, it may not. It just depends on the specifics of your case.
Leah Bucholz:So how does the VA rate degenerative disc disease? The VA rates DDD under general rating formula for disease and injuries of the spine which is 38 CFR 4.71A. They base your ratings mostly on things like range of motion and symptoms like pain, flare ups, and functional limitations. It So doesn't necessarily matter how many surgeries you've had, it's what are those functional limitations. So typical ratings are things like ten percent where you have some limitation or pain with motion, twenty percent if your forward flexion is limited to 60 degrees or less, forty percent if you have severe limitation or spinal fusion, higher ratings if you're bedridden or if you have spinal cord issues.
Leah Bucholz:You may also get separate ratings for things like radiculopathy in any of your extremities which is nerve pain shooting down the legs or arms And that's often rated under peripheral nerve codes. I've got other videos you guys can check out about radiculopathy that may be beneficial. So the CMP exam and medical evidence. So we have a great back pain CMP exam video. If you have a C and P coming up for back pain that might be one you wanna check out so you can kind of see what you might be able to expect.
Leah Bucholz:So when you file your claim the VA is likely gonna schedule you a C and P exam or a compensation and pension exam with a PA, nurse practitioner or a doctor. They're gonna evaluate your range of motion with and without pain, muscle spasms, tenderness or guarding. They're gonna look for neurologic symptoms like numbness or weakness, any radiculopathy or nerve involvement that you might be having. So if you've got flare ups that limit your motion even if your pain is better that day you wanna talk about your worst day as well and let them know. So before we close out here are some things to think about to make sure your claim is well supported.
Leah Bucholz:So having x rays or an MRI can be helpful in some cases, documented flare ups like a journal for pain, diaries or a symptom tracker. If it's something that's going to be secondarily related, make sure that you're able to articulate that. If your doctor's willing to give you a nexus letter, fantastic. If not, that it's never required. So if you have any work impact, like missed time, physical restrictions, etcetera, that can be important.
Leah Bucholz:So always remember if you need help with filing your claim or appealing, follow-up with an accredited claims agent, BSO or an attorney, accredited VA attorney, they are the best advocates for you to help you kind of navigate the system. And those are never at any cost to the veteran up front. So if you use a BSO, those guys don't charge at all. And the fees associated with accredited attorneys and claims agents are very reasonable and are very regulated and are only upon your award outcome for these types of cases. So I hope this was helpful to you guys.
Leah Bucholz:Please let me know if you have any feedback. I always like to hear your stories. Also, please like and subscribe and I'll see you guys next time. Okay, thanks.