IMPORTANT NEWS FOR ANYONE WITH SPINAL INJURIES

Dear Friends:

1. An issue arose in a case that I had two weeks ago that is critical to all of you who have suffered injuries to the thoracolumbar spine.

2. Contrary to the guidance provided by the VA to its disability examiners regarding the assessment of range of motion of thoracolumbar spine, some PEB members and examiners are under the impression that it is not necessary to isolate out hip flexion when assessing this spinal segment.

3. When I brought this problem to the attention of Dr. Audrey Tomlinson, a senior medical advisor at USAPDA, because of the current Army guidance adopted by many other services does not expressly state that it is necessary to do so, she very courteously and swiftly responded as follows:

a. All Army MEB personnel have been instructed since 14 Oct 08 to follow the VA disability worksheet for assessing range of motion, a publication that expressly requires them to isolate out hip flexion.

b. The current guidance memo on this issue is being pulled from the web site until it is updated.

c. CAPT Noel Howard, the Senior Medical Advisor to the Navy PEB, is taking the same action.

4. Why is this important?

Example: suppose that you had a lumbar fusion. A normal range of motion on forward flexion in the thoracolumbar spine is from 0 to 90 degrees.

a. With a fusion, your range of motion should be much more limited.

b. However, if the examiner includes hip flexion, you could erroneously appear to have had a full range of motion. This could take you out of the disability retirement range into severance or being found fit.

c. In my case, the examiner thought that my client had 105 degrees of forward flexion, 116% of normal after a fusion!

d. Believe it or not, the board members thought that the DeLuca guidelines allowed for inclusion of hip flexion because the Army pub they were using (referenced above) did not expressly require them to isolate it out.

e. This was because it was intuitively obvious to the folks at the USAPDA that the worksheet was attached as an enclosure and someone might actually READ it.

5. My advice to anyone pending a range of motion assessment- go the va.gov web site, pull down the forms menu, go to the disability exam worksheets, pull up the latest range of motion assessment memo from June of this year, read it, learn it and ensure that the person conducting your exam follows its criteria . It will save you a great deal of grief.