Copy of NARSUM
- Thread starter BigNes
- Start date
Well, went to the appointment this morning. Definitely was disappointing. Only had his shoulder as a boardable condition. His doctor told him, if his shoulder is not considered a boardable condition, his neck certainly would be. We want to have the neck added but not sure if there is any point to it. Do they go off ROM for the neck? His C&P exam says ROM for neck is normal and noticed they didn't mention the spondyolitc changes nor the fact that he has loss of lordosis in his cervical spine(basically completely straightened). We also want to see about having his back added. He has lumbar degenerative disc disease, bulging disc, bone spurs and will be going to a specialst to see if there is more wrong than they originally thought. The C&P exam says his ROM on his back is in the normal range. That is a bunch of crock! His back is horrible! He walks with a cain, is having bad back spasms, back injections are not helping, nor is medication. He is a lot of pain all the time. He went and seen legal right after and was told get get letters written by people closest to him, myself, commander, ect. I'm just wondering if it's even worth it? With his back ROM being considered normal, even it is added as boardable, they would probably give a 0%. Just don't know what to do.
I would, most definitely, recommend that both of you get an appt. ASAP with a MEB JAG attorney.
He went straight to legal right afterwards. Made an appoinment for Friday but the lawyer talked to him right then. So, not sure if we are still going Friday. I just hope there is something that will be in our favor. At this point, we aren't even sure what to ask.
Well, if the atty. is a good one, he will spell everything out on Fri. after reviewing your NARSUM thoroughly. Ask him if he thinks the neck should be added as an unfitting condition.
ROM is one of the tools that they use. They also use curvature and shape of the spine. Take a look at the VA's rating schedule:
http://ecfr.gpoaccess.gov/cgi/t/tex...ode=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.98.26
General Rating Formula for Diseases and Injuries of the Spine (For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes): With or without symptoms such as pain (whther or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine 100 Unfavorable ankylosis of the entire thoracolumbar spine 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine 30 Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis 20 Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height 10 Note (1):Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2):(See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3):In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4):Round each range of motion measurement to the nearest five degrees. Note (5):For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6):Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.
ROM, pain with ROM, or curvy-ness of the spine. Whatever is best for the Service Member.