As anyone with a trick knee or a troublesome shoulder knows, musculoskeletal injuries don’t always heal completely. The pain might fade for a while, only to return in spades. In VA disability terms, this is commonly known as a flare-up. The precise cause of flare-ups might not be easy to ascertain. Many injuries flare predictably with repetitive use. Others might be caused by stress or changes in the weather. Often, though, the cause is a mystery. One day, an arthritic knee might be a little creaky and the next it can be agonizing.
The existence of flare-ups often causes musculoskeletal injuries to be underrated by the VA. The Court of Appeals for Veterans Claims has said flare-ups must be accounted for in rating these types of injuries, yet VA examiners rarely follow their guidance. However, it is important to note that you can receive VA disability for flare-ups.
Rating Musculoskeletal Injuries
The VA typically rates musculoskeletal injuries according to their loss of function. Another way to think about this is to consider how much an injury takes away from a Veteran’s daily ability to live his or her life. To determine the level of disability, the VA schedule of ratings gives guidance based on the location and type of injury. For example, a knee injury might be rated based on the limitation of flexion or extension, measured in degrees.
For most injuries, pain warrants a 10 percent disability rating. Many Veterans balk at this, protesting that their level of pain constitutes much higher than 10 percent, particularly during a flare-up. Perhaps on a normal day they would be able to work standing up, a requirement of their job, but on a flare-up day they must sit. On that day, their painful disability becomes much more disabling than 10 percent.
VA Disability Ratings for Flare Ups
Veterans who were given a low disability rating may be able to increase their rating by taking their flare-ups into account. Flare-ups are more prominent in musculoskeletal claims and are an important piece of VA disability ratings.
For example, let’s say a Veteran was given a 20% disability rating for their back injury because they have a limited range of motion in the back (forward flexion of the spine is 30-60 degrees).
Well, in this example, the Veteran also has flare ups for their back injury. The flare ups reduce the forward flexion of the spine to below 30 degrees. In this case, the Veteran would be rated at 40% when the flare-ups occur. Therefore, the VA should increase the Veterans disability rating based on the impact flare ups could have on a Veterans day-to-day life.
If you believe you were given a low VA disability rating for flare-ups because your VA examiner did not take them into account when performing your , you have the right to appeal. If you need assistance appealing your VA claim, contact Berry Law – America’s Veterans Law Firm.
The Court of Appeals for Veteran’s Claimshas made several key rulings about flare-ups. In 1995, in the decision of DeLuca v. Brown, the Court ordered the VA to consider whether a flare-up significantly reduced a Veteran’s ability to function and instructed higher ratings be provided if it did. However, in the 2010 case of Jones v. Shinseki, the Court did allow for an exception if it would be impossible to determine the functional impact of a flare-up without resorting to speculation.
What was intended to be a small carve-out turned into a common excuse for VA examiners not to explore the impact of flare-ups. Almost every examination which purported to explore flare-ups did so inadequately. Examiners checked the box that they could not opine without resorting to speculation more often than not. When they did explain why they felt they couldn’t offer such an opinion, most examiners expressed that they were not seeing the Veteran during a flare-up, therefore it was purportedly impossible to know how a flare-up affected them.
The Court has recently elaborated on their earlier opinions, making it clear that they will not allow a VA examiner to simply say that he or she could not give an opinion without speculation. In the 2017 case of Sharp v. Shulkin, the Court instructed VA examiners to find out about flare-ups the obvious way: by asking the Veteran. VA examiners were already obligated to take the Veteran’s statements about his or her condition into account when making their assessments, but the Court has renewed that obligation regarding to flare-ups.
VA Examiners vs. Private Doctors
Because of these recent cases, a VA examiner must look at all relevant facts, including the veteran’s statements about his or her condition, in providing a medical opinion. The Court still permits examiners to opine that they cannot give an opinion without resorting to speculation, but the examiner must provide details about why he or she could not offer such an opinion. Unless the opinion makes clear that the examiner accounted for all relevant information, the examination will be inadequate and the veteran must be afforded another.
If VA examiners do an inadequate job exploring the veteran’s flare-ups, the VA is obligated to provide another examination. However, as most veterans know, sometimes there simply isn’t a way to get a good VA examination. For the most part, veterans cannot pick the doctor, the venue, the day, or the level of detail provided by the examiner. That is why many veterans choose to use a private examiner to provide an alternate medical opinion.
Private medical examiners usually have more time to devote to the Veteran in providing their opinion. If they see the Veteran regularly, they will have more insight than a VA examiner who briefly reviews the Veteran’s file. If a Veteran does go to a VA examiner, it is important to provide the examiner with the right tools to give the best medical opinion possible. Regarding flare-ups, it is vital that the examiner provide an opinion about how much function is lost due to them.
Some Veterans may not be able to afford a private examination. For those Veterans who need to rely on VA examinations, the best thing is to be prepared. They should go into the examination prepared to talk about flare-ups and particularly the functional loss caused. Functional loss is any form of weakness, instability, or incoordination caused by the injury or disability. Further, pain can be a form of functional loss if the pain reduces your range of motion.
Records which show functional loss, such as notations of absences from work, can be taken into the examination to show the examiner. While a Veteran may not be able to control what the examiner writes down, providing succinct information and evidence will direct their attention to the right things.
Flare-ups can cause a disability to become worse than the rating schedule provides. While there is no rule that examinations be conducted during a flare-up, examiners must still provide opinions about additional functional loss. This can result in a higher rating.
Veterans Serving Veterans
Berry Law Firm was founded by Vietnam War veteran and legendary trial lawyer John Stevens Berry Sr. We are proud to have many military veterans among our attorneys and staff who understand what it means to serve and know firsthand the struggles many of our clients face every day.
If you suffer from flare-ups and need to appeal a VA decision, Berry Law Firm may be able to help. We have been successfully representing veterans before the VA, the BVA, and the CAVC for decades. Contact us today for a free evaluation.
The flare ups reduce the forward flexion of the spine to below 30 degrees. In this case, the Veteran would be rated at 40% when the flare-ups occur. Therefore, the VA should increase the Veterans disability rating based on the impact flare ups could have on a Veterans day-to-day life.
Flare-ups are typically recurrent, but unpredictable and arise without warning. The abrupt escalation in symptoms, including pain and loss of mobility, can sometimes result in complete incapacitation.
Under the VA rating schedule, there is a standard 20% disability rating if there is x-ray evidence of involvement of two or more major joints, or minor joint groups, with occasional incapacitating exacerbations.
Although it may seem logical to remain inactive with lower back pain flare-ups, most studies indicate that remaining physically active actually leads to a faster recovery. The good news is that most episodes of back pain resolve within 4-6 weeks with conservative management.
VA disability ratings for back pain can range from 10% to 100%, depending on the severity of the pain, the range of motion the veteran is left with, and the frequency of the pain.
Flares can be spontaneous and occur randomly with little or no warning. At the same time, the pain can be triggered by vigorous activity such as exercising and even routine movements like coughing. Flares can also stem from emotional triggers like stress and can show up abruptly when pain medication wears off.
The most common triggers of an OA flare are overdoing an activity or trauma to the joint. Other triggers can include bone spurs, stress, repetitive motions, cold weather, a change in barometric pressure, an infection or weight gain.
"It's true — the symptoms of arthritis can recede and flare up. It's also true that a change in weather can sometimes trigger a flare-up, which is often magnified when a certain type of arthritis is not being well-managed," says Dr. Syed Alam, rheumatologist at Houston Methodist.
Degenerative arthritis, caused by overuse of the joints or an injury, is the most common form of arthritis in veterans and is rated under Diagnostic Code 5003. Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected.
It's important to look into worsening symptoms and secondary conditions that may have surfaced as a result of the degenerative disc disease. DDD can trigger other conditions including radiculopathy, herniated discs, neurological impairments, spinal stenosis, and more.
Degenerative arthritis will be rated at 10 or 20 percent based upon the number of joints/joint groups affected and the level of incapacitation. VA requires that limitation of motion be confirmed by observations such as swelling, muscle spasms, or evidence of painful motion.
If you are approved for Social Security Disability benefits for arthritis, the amount that you will receive is based on your average lifetime earnings. You will receive an annual statement that details your Social Security earnings to date, and it also provides a disability benefits estimate.
VA disability rating for hip pain caused by hip replacement schedule is 100% for one year following the hip replacement surgery. A hip replacement surgery qualifies you for a minimum 30 percent VA disability rating for hip pain. As noted, the VA considers you totally disabled for one year after your hip replacement.
Because of the severity of osteoarthritis the Social Security Administration (SSA) has determined that it is a disability, meaning you may be eligible to receive disability benefits.
You may have stiffness in the lower back, hips, and buttocks area. Your back may feel stiff, and it might be slightly difficult to stand up after sitting or lying down. Stiffness is typically worse in the morning and at night and improves during the day. It may get worse during rest or inactivity.
Lifting and bending were the most common reported triggers of flare-ups, with each reported by approximately one quarter of subjects with flare-ups. Non-specific actions such as 'over-activity', 'moving wrong', 'movement', or 'physical activity' were also frequently reported as triggers.
People said their joints felt hot and burning. Muscle spasms and more sensitivity also happened. More morning stiffness may be a sign that a flare-up is coming. Sometimes, you could have stiffness and fatigue throughout the day.
What Is the Maximum Disability Rating for Degenerative Disc Disease? Despite how much pain the condition causes, the maximum VA disability rating for degenerative disc disease, as mentioned above, is typically 20 percent. However, there are a few ways veterans can increase their DDD VA rating.
VA can now award service connection for chronic pain that lacks a specific diagnosis, as long as that pain is connected to an event that occurred or symptom that appeared while the veteran was on active duty. Furthermore, the veteran's chronic pain must cause functional impairment or loss.
A few examples of these secondary conditions or complications are radiculopathy, myelopathy, urinary incontinence and/or frequency along with mental health conditions as well.
It's usually caused by chronic, progressive nerve disease, and it can also occur as the result of injury or infection. If you have chronic neuropathic pain, it can flare up at any time without an obvious pain-inducing event or factor.
From a statistical viewpoint, if pain is being measured on a 0 to 10 pain intensity scale, with the zero level implying no pain, a flare-up will mean episodes in which the pain is at level 7 or higher. Chronic pain flare-ups usually last for varying periods of time, ranging from a few seconds to several hours.
How long does an OA flare-up last? An OA flare-up can last from one or two days to a week or more. If you suspect you are going through a flare-up episode, it is crucial to seek medical attention before the symptoms worsen.
The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms. Osteoarthritis is caused by mechanical wear and tear on joints.Rheumatoid arthritis is an autoimmune disease in which the body's own immune system attacks the body's joints. It may begin any time in life.
“Most patients describe 'flare ups' as a sudden increase in pain, stiffness, and swelling of the joints of the body,” she notes. Other common RA flare up symptoms include limited joint mobility along with severe fatigue and symptoms that mimic the flu. Note that your symptoms' frequency and severity may vary.
The longer you're exposed to stress, the more destructive the inflammation can become. In a PLoS One study, people with RA identified stress as a trigger for disease flare-ups. Arthritis symptoms contribute to stress, especially when they're unrelenting. Constant pain, fatigue, and poor sleep create a vicious cycle.
1 : a sudden outburst or intensification a flare-up of hostilities. 2 : a sudden bursting (as of a smoldering fire) into flame or light a danger of flare-ups. 3 : a sudden appearance or worsening of the symptoms of a disease or condition an asthmatic flare-up.
February 12, 2018. A fibromyalgia flare is a temporary increase in the number and/or intensity of symptoms. Some flares only last for a day or two but others may continue for several weeks or even months.
How is a Service Connection Established for Arthritis? To establish a service connection for arthritis, a veteran must prove that the condition was a result of an event that occurred during service, such as an in-service injury or overuse of a joint during a service-related task that caused the condition to develop.
Knee pain can also cause hip pain, or other hip conditions. If your military service caused you to experience knee pain, and eventually hip pain, you may be eligible for additional VA disability benefits. Continue reading for a comprehensive look at how VA rates hip pain secondary to knee pain.
The most common rating VA assigns for limitation of flexion of the knee is 10 percent, although the highest rating a veteran can receive is 30 percent.
While the neck or back pain that DDD causes can make life miserable and can make it very difficult to continue working, it's not easy to get disability benefits for the condition, especially for individuals younger than fifty (and particularly for individuals under the age of forty).
Degenerative disc disease by itself is not recognized as a listed disability by the Social Security Administration (SSA). Why? For one reason, the pain caused by disc degeneration is usually intermittent, and often goes away after a few months of conservative treatment.
Patients who find themselves unable to work because of their degenerative disc disease may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
Limitation of Flexion of the Knee (Diagnostic Code 5260)
This refers to the range of motion a person has when their knee is moving towards the body. This is the most common knee problem eligible for VA disability benefits, with ratings that typically range from 10% to 30%.
A few examples of these secondary conditions or complications are radiculopathy, myelopathy, urinary incontinence and/or frequency along with mental health conditions as well.
Ratings for neck pain can be anywhere from 10-percent to 100-percent, if the condition is severe enough and involves the entire spine, rather than only the cervical spine. Most neck ratings fall between 10-percent and 30-percent, depending on your range of motion limitations, including painful motion.
Functional Loss - Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal exertion, strength, speed, coordination, and endurance.
VA rates TBIs based on the residual symptoms a veteran is currently experiencing due to the trauma under 38 CFR § 4.124a. Rating criteria for TBI residuals are divided into 10 subcategories to evaluate the condition based on the level of severity and impairment in each area. Ratings range from 0 to 100 percent.
According to 38 C.F.R. § 4.115a, urinary frequency is to be rated as follows: Daytime voiding interval between 2 and 3 hours, or, awakening to void 2 times per night, warrants a 10 percent disability rating.
VA can now award service connection for chronic pain that lacks a specific diagnosis, as long as that pain is connected to an event that occurred or symptom that appeared while the veteran was on active duty. Furthermore, the veteran's chronic pain must cause functional impairment or loss.
VA generally rates low back pain as follows: ”100% – unfavorable ankylosis of the entire spine. 50% – unfavorable ankylosis of the entire thoracolumbar spine.
Yes, Erectile Dysfunction (ED) is a VA disability and is assigned a 0% rating under Special Monthly Compensation (SMC) Category K. Normally, the VA will grant a 0% service connected VA rating for Erectile Dysfunction unless you are eligible under the other Diagnostic Codes (DCs) listed above.
The service-connected disability manifested by arthritis of the neck has been rated by the RO in this case as 40 percent disabling under the provisions of 38 C.F.R. § 4.71a including Diagnostic Code 5293.
Veterans that obtain an 80 percent VA Disability rating receive $1,778.43 a month from the Veterans Administration. Eligible disabled veterans may also be able to receive extra monthly compensation for dependent children and parents.
Functional impairments (FI) manifest themselves as difficulties in taking care of yourself or performing everyday actions. For example, these could be vision, hearing or movement limitations or growth, behavioural, language development or physical or spiritual development disorders.
Pain was strongly associated with all measures of functional limitation regardless of whether subjects had arthritis, although the relationship between pain and functional limitation was stronger for subjects without arthritis, particularly for ADL difficulty (Table 3).
Functional limitations include difficulty with grasping and fine manipulation of objects due to pain, locking, or both. Fine motor problems may include difficulty with inserting a key into a lock, typing, or buttoning a shirt.
According to a recent Veterans Administration report to Congress, the ten most commonly awarded medical conditions that are getting approved for benefits are as follows:
Tinnitus.
Limitation of flexion (knee)
Hearing loss.
Lumbosacral or cervical strain (back and neck strains)
What is the VA 55-year-old rule? Veterans who receive VA disability benefits for service-connected conditions are exempt from periodic future examinations once they turn 55 years old. This includes veterans who will be 55 by the date of a future examination, according to the VA Adjudication Procedures Manual.
Despite how much pain the condition causes, the maximum VA disability rating for degenerative disc disease, as mentioned above, is typically 20 percent.
Introduction: My name is Twana Towne Ret, I am a famous, talented, joyous, perfect, powerful, inquisitive, lovely person who loves writing and wants to share my knowledge and understanding with you.
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