3 Steps | Use Secondaries Based Off Your VA Neck Rating
Understanding your conditions will help you establish secondary conditions with your VA claim!
For those of you whom are curious about VA Claim Strategy and how it works…this article is for you.
I was hit by a truck while in service. I don’t remember this event, but it certainly gave a new meaning to the word “crunchies” (that comment was for the tankers).
Yes, I became a ‘crunchie’ to the literal term. I crunched to the point that I don’t remember the events leading to or 3 months after the event. I have been spending my life trying to understand what happened that day since the VA always wants to know about it whether I am seeking treatment, or during the Veterans Benefits Administration Compensation & Pension (C&P) examinations.
I hate living there, but it is part of who I am. It was one of a few events that changed the rest of my life. Some changes are positive, some are extremely negative…but I digress.
Why does this matter? It is important to understand your event and what happened. Here is what I can tell you….so bear with the story….it WILL clear things up for your claim.
In service, I broke my neck…specifically the transverse process at the C7 & T1 thoracic vertebrae. This inherently saved my life, as if anything else had broken it would have been a straight trip to the ‘forever box’. It was a “fortunate injury”.
So, I am no doctor, medic or any type of medical professional, but I can tell you that this can straight up cause nerve issues. But, at the time, I think they were just trying to keep me alive.
Without getting too involved into the process, I can tell you that later in my service (and close to exit of service) I would notice that my scapula would “wing”. Keep that in mind…as at the time, it wasn’t too bothersome. More of an annoyance. No pain, no anything, just looked funny when I attempted to move anything above my head. After exiting service, I was smart enough to put in a VA claim and received a big ‘goose egg’ – 0% service connection for my neck. That was that. I had no idea what the VA even was at the time. I was informed I could get medical treatment for free for my neck. Well, I was young. Figured…nah…I will never need that!
Fast forward about a decade, my shoulder truly started giving me some real issues. I felt like I had Rice-Krispies in my right arm. I had close to no strength for the exception of being able to move it above my neck. Pain was evident, but weakness was my real complaint. I sought medical treatment, and the surgeons wanted to do a surgery on my arm…a pectoralis major transfer.
Sounded complicated, and at the time…my insurance was awful. It was considered an “elective-surgery” and was not completely covered. So, as a young father and husband, I was informed that the surgery would cost me a whopping $35,000. Yeah, that didn’t happen. The surgeons tried to argue that it wasn’t elective and was needed to avoid permanent injury in the future. Insurance wouldn’t pay, so I was outta luck. I didn’t know what the surgery really was meant to do other than pseudo fix my shoulder winging, and possibly restore my muscles.
To put this all into context on how this relates to my neck…again, bear with the the story.
About a decade after ‘turning down the surgery’, I realized the surgeons were correct. My weakness had turned into almost complete failure, my shoulder itself had slouched 2-3” and I looked a bit like a straight up version of the Hunchback of Notre Dame.
OK, so now…the crux of the story.
I knew I needed the surgery. Insurance had changed over the years, but I knew I had to get this service connected. I had to do my research to find out how to connect all of this. So, from a strategic perspective, I started with a 0% on my neck. Nothing further (in relation to the upper extremities). I had sought enough treatment by that time to understand that Doctors typically know the source of the symptom, but commonly won’t tell people the source unless specifically asked, and even then….it is an ‘opinion’…not always factual as people think. (Thank you, lawyers, for injecting cool words to take away certainty).
All that said, I wondered…could my neck be causing all of these issues? If so…how? This started the journey into secondary VA conditions and claims.
The Secret to winning the VA Claim
Build your story. Period. Read your results from treatment. Take notes, understand the etiology. If any of this is too much to understand, make sure to ask your doctor. I swear, some of my best conversations have been with doctors as I provide a question like “may I ask if scapular winging can cause my humerus to dislocate?” Doctors are not just doctors…most also enjoy educating as well, as that is part of their job. They just don’t always have the time to offer this to patients. But if you show an interest, I have found 9 times out of 10, the providers will have a major discussion with you!
- Seek Treatment
- Assemble the Evidence
- File Appropriately
The best way to find out what is going on is to seek as much treatment as you possibly can. You must advocate for yourself during this process. If you have pain in your neck, and they do an X-Ray, and that X-Ray doesn’t show anything, push/request an MRI. Understand the process of treatment. We do have a huge advantage with the VA system. They don’t have to seek approvals for additional steps through insurance companies. Typically, an MRI would have to have a lot done prior to that, and in a way it has to be ‘justified’ for the insurance company to pay. The VA is very good about giving MRIs where they feel they are justified. I have found that you have to ask for that ‘next-step’ on occasion.
After you have established the problem with your neck, understand what can happen to extremities based on your specific condition. This is important for secondary conditions. If your fingers go numb, and you have neck issues….guess what…that can be caused by the neck. If you have a neck condition that is diagnosed, and then you get a conductive nerve study, it is very plausible that you will eventually receive a radiculopathy diagnosis based on those issues.
So, in order to following the secret to winning my VA neck claim, I knew that I had sought treatment, and started the self exploration. The self exploration component is really about understanding your body, and what happened to it over the years. You must understand your own timeline…when things happened, how they occurred and where in your body it all sourced from. So with this basic premise, I put together the following timeline:
- Broken Transverse Process in C7/T1
- Thoracic nerve palsy is diagnosed
- Delayed onset Scapular Winging (due to thoracic nerve palsy)
- Humerus dislocation due to scapular winging
- Scapular Winging eventually causes Hills-Sachs Lesion
- Surgery for pectoralis major transfer (moves breast to the scapula to retain the scapula against the back to attempt to mitigate further lesions.
It all seems incredibly complicated, but the reality is that if you experience neck issues, you can most likely track that to additional disabilities such as nerves and secondary conditions.
So, with some “googling” several conditions I found out and understood:
- The C7 carries a portion of the nerve root for a nerve called the “Long Thoracic Nerve”. (C5-C7 are the full root for this nerve).
- This nerve is responsible for controlling the “serratus” muscle. The serratus muscle controls the shoulder blade. If the shoulder blade wings, there is a long-term condition that can cause dislocation of the shoulder (in my case a rare posterior permanent dislocation), which inevitably caused something called “Posterior Hills Sachs” syndrome.
- According to physio-pedia.com, “a Hill-Sachs lesion is an injury that occurs secondary to an anterior shoulder dislocation. The humeral head ‘collides’ with the anterior part of the glenoid, causing a lesion, bone loss, defect and deformity of the humeral head. This may cause a change loss of range of motion, feelings of instability and pain.”
- Additionally, nih.gov has a great article that goes over all of the causes of scapular winging, and low-and-behold….THORACIC NERVE PALSY is a primary reason.
- The next logical question is….can a Hill-Sachs lesion be caused by a winged scapula? Time to google again: According to the International Congress for Joint Reconstruction “A winged scapula increases the bony stability posteriorly by anteverting the glenoid .”
What this research has just established (outside a lot of latin words that I can’t pronounce) is that my cervical spine (neck) caused a nerve issue, which made me lose the ability to control a muscle to keep my shoulder blade in my back. Inevitably, this let to shoulder dislocation, causing lesions and issues in my actual shoulder. So, now it is important to understand how the VA will rate these. Using ecfr.gov, I can go into Title 38 Part 4, and find the schedule of ratings.
So, translating this into a VA claim, I see several things:
- An increase in neck due to my current diagnosis (Rated by 38 CFR 4.71a Code: 5235)
- Nerve palsy secondary to my existing neck condition. (Rated by 38 CFR 4.124a Code: 8519)
- Winged Scapula secondary to neck/thoracic nerve palsy (Rated by 38 CFR 4.71a Code: 5301)
- Humerus damage secondary to neck/winged scapula (Rated by 38 CFR 4.71a Code: 5202)
- Bilateral Radiculopathy (lower radicular group) secondary to neck (cervical spine) – (Rated by 38 CFR 4.124a Code: 8512)