Below you will find what the VA put out in a conference call (newsletter style) on October 18th to their raters. There was some goodness to what they put out but, as you can see in my response, they missed the key point. I will continue to work the situation with them. If you have recent AS ratings decisions that don't consider the issues covered under DC 5002 (constitutional manifestations, incapacitaing excerbations, impairment to health), please let me know so I can forward to them as examples.
You conference call section on Ankylosing Spondylitis missed a major mark. I have assisted numerous veterans with this condition and the number one issue resulting in improper ratings stems from m rater not evaluating the condition under the DC 5002 criteria. Below is a passage from a letter (attached) signed by Mr. Pamperin over a year ago. It clearly states Ankylosing Spondylitis is to be evaluated under DC 5002 for constitutional manifestations, impairment to health and incapacitating exacerbations. The vast majority of the Ankylosing Spondylitis veterans I have assisted would get the highest ratings via the 5002 criteria. However, most raters are unaware of the DC 5002 provisions for Ankylosing Spondylitis. This is the problem that needs to get fixed. Could you please include Mr. Pamperin’s passage below in your next conference call so this issue can be properly understood by the field raters?
LTC, USA (Retired)
Passage from letter signed by Mr. Pamperin:
Ankylosing Spondylitis is currently evaluated in accordance with 38 USC Para. 1155 using the Schedule for Rating Disabilities. This schedule evaluates AS by constitutional manifestations of impairment of health, incapacitating exacerbations, and disability of the joints, muscles and nerves. However, some of these residual disability residuals may indeed overlap. As a result, the law precludes the AS active disease process residuals to be combined with residual ratings for the limitation of motion or ankylosis.
Thus, the disability evaluation most advantageous to the veteran (be it the constitutional manifestations, limitation of motion, or ankylosis) will be assigned the appropriate percentage evaluation. This percentage evaluation represents the overall disability evaluation of the AS by the Schedule for Rating Disabilities, using Diagnostic Codes (DC) 5002 and 5240.
If AS becomes so severe as to affect entirely different body systems, such as neurological deficits of bowel and bladder, these deficits may be evaluated under appropriate DC’s, rated as separate disabilities, and incorporated in the combined overall disability evaluation of the AS.
From the VA Conference Call newsletter:
Rating Ankylosing Spondylitis
It has been brought to the attention of the C&P Service that the proper evaluation of ankylosing spondylitis can present problems and that clarification is needed. Ankylosing Spondylitis (AS) is a rheumatic disease that causes arthritis of the spine and sacroiliac joints and can cause inflammation of the eyes, lungs, and heart valves. It varies from intermittent episodes of back pain that occur throughout life to a severe chronic disease that attacks the spine, peripheral joints and other body organs, resulting in severe joint and back stiffness, loss of motion and deformity as life progresses.
The disease is rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5240, of the Schedule for Rating Disabilities, as a disorder of the spine. Disorders of the spine are primarily rated based on loss of motion or frequency of incapacitating episodes. With any disc involvement, neurological manifestations are rated separately. Because the disease can affect joints other than the spine as well as other body systems, RVSRs must be mindful of this and manifestations clinically associated with ankylosing spondylitis must be rated apart and separately from the spinal symptoms rated under DC 5240.