IDES Referral - Lumbar DDD (3-20h); Claiming secondary conditions

[Strongcore]

Hey everyone,

I was recently given a P3 profile for Lumbar Degenerative Disc Disease (3-20h) and referred to the IDES (Active Duty Army).

I wanted to know if anyone could help me when it comes to claiming secondary conditions.

BACKGROUND: I started to experience general lower back pain which progressively worsened to the point that I can not bear to sit. The pain began to spread down my right leg, followed by my left leg. My legs feel like they're tingling over 50% of the day and will go numb if I sit for more than a few minutes. I will experience intense jolts of pain when moving certain ways. The leg pain, and inability to participate in physical activities that I enjoy because of it, have resulted in what I think is restless leg syndrome.

IMAGING & DIAGNOSIS: MRI revealed L4-L5 & L5-S1 disc extrusions with severe subarticular narrowing on both sides with mass effect on both descending L5 and S1 nerve roots. Hip MRI also revealed SI joint osteoarthropathy and type 1 modic changes.

My question is how exactly should I claim the leg pain and restless leg syndrome on the VA 21-526EZ?

With the referring condition being lumbar DDD, would I put 'bilateral radiculopathy' as another disability secondary to DDD? Same with Sciatica/Neuralgia and restless leg syndrome?

Worth noting: bilateral radiculopathy is on my MHS 'problem list' and is well documented, but RLS has not been yet.

Any help is appreciated!

 

[thanks4urhelp]

You can claim everything, the VA isn't expecting you to be a doctor and know exactly what you've got.

As far as RLS goes you will likely be made to do a sleep study. They measure how often your limbs move during sleep, and over a certain threshold they diagnose you. AFAIK it's a higher threshold than you might think. I didn't claim it, but they denoted 80+ limb movements in my sleep I think it was 12 per hour, and this didn't meet whatever threshold they had set. Keep in mind this was an in-person sleep lab since I'm under 23, which is apparently how the VA runs things. If you're 23 and over you can do an at home sleep test.

Given you have DDD and hip issues I would suggest discussing with your MSC to claim bilateral ankle, bilateral foot, bilateral knee, and bilateral leg pain and numbness.

I suggest these things because assuming your back is shot you likely bend over only when you absolutely must, I crouch down for most things and my knees and feet paid the price for it. Had my feet examined and the examiner told me I had severely flat feet along with a very marked limitation of my knee ROM.

I would also see pain management and discuss potential fibromyalgia. I know some people roll their eyes when they see people claim this but given the VA examines and diagnoses this by issuing an 18 point poke test I'd say it's always a good idea to at least claim it. CFS is also one people roll their eyes at but if you are diagnosed by CFR standards it can also be a heavy hitter.

Don't neglect your hearing, your skin, mental health, or any kind of scarring either. This isn't the time to be modest, you only get one shot at this claim ordeal.

 

[Strongcore]

You can claim everything, the VA isn't expecting you to be a doctor and know exactly what you've got.

As far as RLS goes you will likely be made to do a sleep study. They measure how often your limbs move during sleep, and over a certain threshold they diagnose you. AFAIK it's a higher threshold than you might think. I didn't claim it, but they denoted 80+ limb movements in my sleep I think it was 12 per hour, and this didn't meet whatever threshold they had set. Keep in mind this was an in-person sleep lab since I'm under 23, which is apparently how the VA runs things. If you're 23 and over you can do an at home sleep test.

Given you have DDD and hip issues I would suggest discussing with your MSC to claim bilateral ankle, bilateral foot, bilateral knee, and bilateral leg pain and numbness.

I suggest these things because assuming your back is shot you likely bend over only when you absolutely must, I crouch down for most things and my knees and feet paid the price for it. Had my feet examined and the examiner told me I had severely flat feet along with a very marked limitation of my knee ROM.

I would also see pain management and discuss potential fibromyalgia. I know some people roll their eyes when they see people claim this but given the VA examines and diagnoses this by issuing an 18 point poke test I'd say it's always a good idea to at least claim it. CFS is also one people roll their eyes at but if you are diagnosed by CFR standards it can also be a heavy hitter.

Don't neglect your hearing, your skin, mental health, or any kind of scarring either. This isn't the time to be modest, you only get one shot at this claim ordeal.

Thanks for the input!

I have a prior at home sleep study that was conducted, but this was before my injury (sleep apnea).

I'm planning on claiming bilateral leg/knee/foot pain and numbness. I've been seeing Podiatry and have been told I have flat feet & bunions along with some other issues. I'm definitely in the same boat as you; I don't bend over unless absolutely necessary, I'll crouch for everything.

I guess my thing is that I know a lot of things have been causes/exacerbated by my lower back pain and immobility, but some of the issues (foot pain) are prior to my back issues.

 

[thanks4urhelp]

Thanks for the input!

I have a prior at home sleep study that was conducted, but this was before my injury (sleep apnea).

I'm planning on claiming bilateral leg/knee/foot pain and numbness. I've been seeing Podiatry and have been told I have flat feet & bunions along with some other issues. I'm definitely in the same boat as you; I don't bend over unless absolutely necessary, I'll crouch for everything.

I guess my thing is that I know a lot of things have been causes/exacerbated by my lower back pain and immobility, but some of the issues (foot pain) are prior to my back issues.

If you're getting boarded it doesn't matter if they are directly related to your back or not. The DoD will consider the back, but everything else will be accepted by the VA so long as the provider is willing to diagnose you. Typically they are since you're still active: any and all findings will be service connected. I hope you're not under the impression you can only claim things secondary to your back, your complaint list is a composite list of any and all issues you have. Whether they can be added to your DoD consideration is a different story.

Also anything needing a sleep study will have a fresh one done, even if you have done one before.

 

[Strongcore]

If you're getting boarded it doesn't matter if they are directly related to your back or not. The DoD will consider the back, but everything else will be accepted by the VA so long as the provider is willing to diagnose you. Typically they are since you're still active: any and all findings will be service connected. I hope you're not under the impression you can only claim things secondary to your back, your complaint list is a composite list of any and all issues you have. Whether they can be added to your DoD consideration is a different story.

Also anything needing a sleep study will have a fresh one done, even if you have done one before.

Clarification: I was under the impression that conditions caused by the referred condition will contribute to the DoDs percentage for separation/retirement determination.

Good information about the sleep study, did not know that!

 

[JoelPettit]

@Strongcore

Contributing conditions must have a functional impact on the performance of your duties; meaning, conditions merely caused by a referred condition won't necessarily supplement your DoD disability percentage unless they functionally contribute to you being unfit. For a very well-written discussion on this topic, read the Sissel v. Wormuth case, decided July 8, 2023. The decision addresses exactly your questions, and it's only 16 pages long!

I hope this helps.

S/f,

Joel

Disclosure: I was a Marine JAG, Active Duty and Reserve IPEB & FPEB attorney, federal government civilian FPEB & TDRL-focused attorney at the Navy PEB, and now a private attorney focused solely on IDES cases. This post is meant as procedural insight only and should not be construed as legal advice related to a specific case or a legal analysis of facts thereof.

 

[Strongcore]

Contributing conditions must have a functional impact on the performance of your duties; meaning, conditions merely caused by a referred condition won't necessarily supplement your DoD disability percentage unless they functionally contribute to you being unfit. For a very well-written discussion on this topic, read the Sissel v. Wormuth case, decided July 8, 2023. The decision addresses exactly your questions, and it's only 16 pages long!

Thanks, Joel. That was a pretty informative read; Much of the commanders statement should address how my radiculopathy & leg/feet pain have affected my work performance. We'll see what the MEB has to say about it.

 

[NHow20]

@Strongcore

Contributing conditions must have a functional impact on the performance of your duties; meaning, conditions merely caused by a referred condition won't necessarily supplement your DoD disability percentage unless they functionally contribute to you being unfit. For a very well-written discussion on this topic, read the Sissel v. Wormuth case, decided July 8, 2023. The decision addresses exactly your questions, and it's only 16 pages long!

I hope this helps.

S/f,

Joel

Disclosure: I was a Marine JAG, Active Duty and Reserve IPEB & FPEB attorney, federal government civilian FPEB & TDRL-focused attorney at the Navy PEB, and now a private attorney focused solely on IDES cases. This post is meant as procedural insight only and should not be construed as legal advice related to a specific case or a legal analysis of facts thereof.

So if I have multiple appointment reports of my back pain significantly impacting my mental health will that count as a contributing condition and be rated along with the DOD rating?

 

[JoelPettit]

@NHow20

That's a tricky question because the Combined Effect theory of contributing conditions being found unfitting is not crystal clear when it comes to a physical disability (which causes intense pain) contributing to a mental health issue (let's say Major Depressive Disorder (MDD)). To extend the logic, imagine a scenario where a Service member lost both lower extremities and is extremely depressed. The question is whether that Service member would remain depressed and to what extent would that depression render him or her unfit? Of course, that is a clear example. Now walk it back to a Service member who has DDD but has not reached the highest echelon of care. Is it the pain that is causing the MDD or is it the immediate loss of a military career? If so, are either or both of those issues permanent or merely transient and will fade with time and treatment? If so, how much time and how much treatment? This is why the Combined Effect theory is very hard to apply when you apply it to separate body systems that aren't somehow linked physically: for example, radiculopathy and lumbar spine issues, or cervical spine issues and migraines.

Put simply, the effectiveness of a Combine Effect argument is 100% based on the nuances of each case. One tiny fact being different could torpedo a case. Needless to say, 9 times out of 10, Combined Effect would not be my first argument of choice. But it all comes down to your specific facts.

 

[NHow20]

@NHow20

That's a tricky question because the Combined Effect theory of contributing conditions being found unfitting is not crystal clear when it comes to a physical disability (which causes intense pain) contributing to a mental health issue (let's say Major Depressive Disorder (MDD)). To extend the logic, imagine a scenario where a Service member lost both lower extremities and is extremely depressed. The question is whether that Service member would remain depressed and to what extent would that depression render him or her unfit? Of course, that is a clear example. Now walk it back to a Service member who has DDD but has not reached the highest echelon of care. Is it the pain that is causing the MDD or is it the immediate loss of a military career? If so, are either or both of those issues permanent or merely transient and will fade with time and treatment? If so, how much time and how much treatment? This is why the Combined Effect theory is very hard to apply when you apply it to separate body systems that aren't somehow linked physically: for example, radiculopathy and lumbar spine issues, or cervical spine issues and migraines.

Put simply, the effectiveness of a Combine Effect argument is 100% based on the nuances of each case. One tiny fact being different could torpedo a case. Needless to say, 9 times out of 10, Combined Effect would not be my first argument of choice. But it all comes down to your specific facts.

I see, for me its the fact that I was extremely active and physical before being injured, with the injury I was unable to do those activities anymore and led to me getting diagnosed with GAD and Panic Disorder.