lumbosacral Knees and Back C&P

[armyvet89]

Hello brothers and sister!

I went today for an increase on L Knee (currently 0%), R Knee and Back condition secondary to L knee. The left knee received a 0% rating at first because of the doc not doing the range of motion testing. This time the doc used the "at least as likely as not" and agreed that my Back and R Knee is because of my service connected L Knee. I cant get the C&P notes to transfer so ill type up the important parts on here and please ask questions. What im wondering is what my overall percentage would be.

Back Condition:

1. Diagnosed Lumbosacral Strain

2. Range of Motion 0-50 Which should warrant a 20% rating??

3. Functional Loss: yes

4. Pain on motion and repetitive use

5. Guarding or muscle spasms: Yes

6. numbness, pain, paresthesias: Mild on right side all 4 boxes checked

7. Cane and braces used

Right and Left Knee:

1. Left meniscal tear

2. Patellofemoral Pain in left knee

3. ROM R Knee: Flexion 0-130 and 130-0 they say that normal is 0-140 and 140-0

4. ROM L Knee: 15-110 and 110-15 normal is 0-140 and 140-0

5. Strength testing is 5/5 on both knees

6. No subloxation

7. Lateral Instability: Moderate Left knee, Slight Right knee

8. cane and braces used

9. Meniscus surgery 3 times scars noted but not large and not painful

 

any input would be awesome. As soon as I can get the C&Ps uploaded I will do that but if there are questions please ask. Based on this i feel that this is close to what I may get. 20% left knee limitation of extention and 20% left knee instability, 10% Right knee instability, do i get the bilateral factor and how does that apply???? and then 20 percent for lumbosacral strain due to the range of motion. Thanks for all the help!

Edited December 21, 2016 by armyvet89
Left info out.

[Buck52]

Limitation of Motion of the Knee

Code 5261: If the knee is not frozen, but is limited in extension and cannot straighten all the way, then it is rated under this code. If the leg can only straighten to within 45° of being completely straight, then it is rated 50%. If it can straighten to 30°, it is rated 40%. To 20°, it is rated 30%. To 15°, it is rated 20%, To 10°, it is rated 10%, and to 5°, it is rated 0%.

Code 5260: If the knee can straighten, but cannot bend all the way, then it is rated under this code. If the knee can only bend to 15°, then it is rated 30%. If it can bend to 30°, it is rated 20%. To 45°, it is rated 10%, and anything 60° or more is rated 0%.

Now if the knee can move, but cannot either bend all the way or straighten all the way, then it can be rated TWICE—once under code 5261, and once under this code 5260.

Too Much Motion or Dislocation

Code 5263: Genu recurvatum is a condition where the knee bends too far backward. This is sometimes a genetic condition that does not really cause any problems. In these cases, it is not ratable. If it is a result of an accident or injury, however, and causes weakness and insecurity in the knee, then it is rated 10%.

Code 5257: The knee can also have too much motion (instability) from side to side or dislocate regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. If there is only slight instability, then it is rated 10%. If there is more instability that might cause the knee to buckle or dislocate every now and then, then it is rated 20%. If, however, it is so unstable that it gives out or dislocates regularly, it is rated 30%.

Note: Instability can be rated in addition to other ratings for the knee.

So, if the knee has both limited motion and instability, it can be rated for both.

 

[Andyman73]

21 hours ago, armyvet89 said:

Andyman,

So you are saying that you now have a rating for both instability and limited ROM? Thats what I was wondering. Because the things he checked off on and noted show 20% for ROM and due to the box "Moderate" instability being checked I feel like thats another 20% under DC 5257. Or do they normally just rate one DC?

No sir, I have a 10% per side for mild instability, and a single 10% for pain. As for both ROM and instability, you would get which ever rates you higher.  And then a separate rating for pain.  When I had my exam for increase for my knees, the examiner told me he was going to do that.  I know, totally strange, that an examiner would put you in for something so obviously in your favor and tell you that, too. 

  Originally my knee rating was a single 10% for bilateral patella femoral pain syndrome. Come to think of it, I probably should have argued for 10 each side, way back in 2000,  but didn't know any better.

I suppose it's possible to have more than one rating for your knee, but would have to be two separate issues. 

[Andyman73]

16 hours ago, Buck52 said:

Note: Instability can be rated in addition to other ratings for the knee.

So, if the knee has both limited motion and instability, it can be rated for both.

So there you have it, Armyvet89, way to go, Buck on the info!