Rheumatoid Arthritis questions

[rdnkjeeper]

I have read a bunch of info on the subject and did a search, but didn't find my question addressed.  I have read 38 CFR and it just makes me more confused.  Here is my question, If a person gets rated say, 60 percent for their rheumatoid, do they also rate the joints effected?  Or is 60 it?  I am just wondering, I do have a claim in for it and was just trying to figure it out since I do have a copy of my C&P, he wrote up every joint effected.

 

Thanks

[Buck52]

Its different percentages  depends, they do rate the joints  and ROM  Range of motion,

this might help ya some?

YOUR VA CLAIM FOR ARTHRITIS

It’s possible to get a service-connected disability rating if you suffer from this common condition.

By Raymond F. Gustavson, Jr.

There are over a hundred types of arthritis, but this article will cover only the two major types: Osteoarthritis (which is the wear and tear of the joint bones – hips, knees, hands, feet, and spine), and rheumatoid arthritis, an inflammatory type that occurs when your body’s immune system mistakenly attacks your joints.

Making your claim

To establish a VA claim for arthritis, you must submit current medical evidence, either in the form of a doctor’s or hospital report, showing that you have this disability. If you do not have a current medical report, the VA will send you a release form (VA Form 21-4142). On the form you should list your doctor’s name and address, and then return the form to the VA. The VA will obtain the necessary medical report(s). Note: Your failure to return the form to the VA relieves the VA of any obligation to secure your private medical records.

If you were treated at a VA Medical Center or other U.S. government facility, the VA will obtain these records for you.

To establish a VA claim for arthritis, you must submit current medical evidence, either in the form of a doctor’s or hospital report, showing that you have this disability

After all the evidence has been received, the VA will review your Service Medical Records to see if you were treated for arthritis while on active duty. A VA examination will be scheduled to determine the severity of the condition.

At the examination the physician will review your claim file, ask you specific questions about your disability, and conduct any necessary tests. When he is finished he will write a summary of his findings. The Rating Specialist (RVSR) in the Regional office will transfer these findings to what is called a Rating Decision, and assign a percentage evaluation for each disability granted. You will then be notified in writing of the decision.

Considerations

Presumption: If your arthritis was diagnosed within one year of release from military service, it is considered to have been incurred on active duty.

Arthritis of the knees: A veteran may be entitled to three separate ratings for the same condition. The rating specialist will look at the following three factors:

Functional Loss: This condition deals with limited range of motion of the knee. It is rated under Diagnostic Codes 5000-5010.

Instability: This is usually caused by a torn ligament from a sports activity, or it may occur from something as simple as twisting the knee when getting in and out of a car. If you have this condition, you may have the feeling the knee is “giving out.” This condition is rated by the VA as either slight (10 percent), moderate (20 percent), or severe (30 percent) under Diagnostic Code 5257.

Pain: This is the most common manifestation of arthritis. The VA can give you a grant for this if your range of motion is affected by pain when using the knee in normal use.

If you feel the VA denied your claim unfairly, you should file what is called a Notice of Disagreement (NOD). This is the first stage of the appeals process.

Examples of arthritis claims

Claim for increase: knee. The veteran was 0 percent service-connected for arthritis of the knee. A VA examination showed limited range of motion at 45 degrees of flexion, with mild instability and pain on repetitive use of the knee. Degenerative arthritis was observed on an x-ray.

A 10 percent rating was assigned for functional loss of use under diagnostic code 5003-5260. Diagnostic Code 5257 was used to assign an additional 10 percent rating for instability of the knee.

Service connection for left knee arthritis as secondary to left knee injury. The veteran was 10 percent service-connected for residuals of a left-knee injury. He reported on his VA examination that periodically his knee gave way, and he had to catch himself to prevent falling. He also reported flare-ups of pain. Range of motion was 10 to 115 degrees, with crepitus and tenderness. X-rays showed degenerative disc disease. The examiner stated the arthritis was as likely as not related to the old left-knee injury. Service connection was granted at 10 percent disabling.

Service connection for degenerative disc disease of the left knee. The veteran’s Service Medical Records indicate he was in a motorcycle accident involving a sustained injury to the left knee. He had an open meniscectomy performed at that time, and did well until post-service when he began having problems.

Outpatient treatment records showed the veteran had progressive pain and swelling of the left knee. He had pain when sitting for prolonged periods of time, along with knee popping. Records indicate he underwent an arthroscopy and partial medial meniscectomy of the left knee. He was granted a 100 percent hospital evaluation under 38 Code of Federal Regulations 4.30, with a period of two months convalescence. Thereafter, the knee was rated 0 percent disabling.

Denial of service connection for left knee sprain. Veteran suffered a left-knee injury while playing soccer during military service. Outpatient treatment records showed complaints of left-knee pain with swelling and tenderness. Assessment was left-knee strain and mild degenerative disc disease. The veteran’s claim was denied because the VA examiner failed to support his diagnosis with x-rays. Note: This is one of those unfortunate incidents that arise from time to time, even though arthritis is a presumptive condition. Undoubtedly, the veteran should appeal this decision.

Service connection for degenerative arthritis of the shoulders. Service connection for degenerative arthritis of the shoulders was previously denied by the VA Regional Office (VARO). The veteran appealed the denial to the Board of Veterans Appeals (BVA) which noted that a private physician reviewed an October 1999 VA examination report, to include x-ray reports and films. The physician’s impression was that an in-service shoulder injury and bilateral shoulder degenerative arthritis were causing the veteran’s current shoulder disability. The x-rays showed degenerative changes involving both acromioclavicular joints. He stated that a December 1992 x-ray report was very likely wrong because degenerative changes noted in April 1992 could not have gone away by December 1992, and then reappeared in February 1997 and October 1999. The Board of Veterans Appeals granted service connection for degenerative arthritis of the shoulders.

Evaluation of degenerative disc disease of the neck, rated 20 percent disabling. At his VA examination the veteran complained of increased neck pain that made it difficult for him to sleep, work, and do daily activities. Range of motion of the cervical spine was 50 degrees of flexion and 10 to 15 degrees of extension. X-rays showed a severe amount of degenerative disc disease at C5-C6, and C6-C7. An increase was granted to 40 percent under diagnostic codes 5003-5293.

Service connection for arthritis of the lumbar spine. Service Medical Records showed veteran with numerous sick-call entries related to low back pain. On the VA examination the veteran complained of lower back pain when he lifted more than 40 pounds. Examination of the back showed normal curvature but with paraspinal spasm on the right side. He had full range of motion, with x-rays showing degenerative disc disease of the lumbar spine. Service connection was granted at the 10 percent level.

Evaluation multiple joint rheumatoid arthritis, 20 percent. At his VA examination the veteran complained of pain in his toes, knees, and ankles as well as his hips and shoulders. Deformities were noted along with inflammation. Range of motion was limited. The examiner diagnosed rheumatoid arthritis with evidence of ongoing inflammation in multiple joints. The RVSR assigned a 40 percent evaluation under diagnostic code 5002.

Service connection for post dysentery Reiter Syndrome. Reiter syndrome, also known as reactive arthritis, is a joint pain and swelling caused by a bacterial infection in another part of the body. The infection usually occurs in the intestines, genitals, or urinary tract, along with the joints (with swelling and pain), and the eyes (inflammation). Sexually active males between the ages of 20 and 40, and those with HIV (human immunodeficiency virus), are at high risk.

At the VA examination the examiner noted the veteran had bacterial gastroenteritis with intractable diarrhea along with a subsequent development of migratory polyarthralgias. The veteran also had joint pain complaints of from one to two times per year. Diagnosis was post dysentery Reiter Syndrome.

Service connection for arthritis of lumbar spine, right and left knees, and right and left hands. At the VA examination the veteran complained of generalized pain and stiffness in his joints. Increased levels of activity lead to increased pain. The examiner noted range of motion of the spine as follows: 55 degrees of flexion and 20 degrees of extension, with 15 degrees of right and left lateral bending. There was pain on motion. X-rays of the lumbar spine showed mild right scoliosis and some marginal osteophytes at L1-2. Service connection was granted at the 20 percent rate under diagnostic code 5003-5292.

Examination of both knees noted they lacked 5 degrees in terminal extension, and had 125 degrees of flexion, with pain on motion, tenderness, and enlargement. X-rays of the knees showed degenerative changes, moderately severe. Arthritis of the knees was granted at 10 percent disabling each under diagnostic code 5003.

Examination of the hands revealed the veteran made a good fist with both hands and could oppose the thumb and remaining fingertips satisfactorily. X-rays of the hands showed degenerative changes in the distal interphalangeal joints of the little fingers bilaterally. Arthritis of the hands was granted at 0 percent disabling each under diagnostic code 5003

Edited January 10, 2017 by Buck52

[broncovet]

Buck gave a good explanation.  Make no mistake tho.  Pyramiding prevents you from receiving duplicate benefits.  In other words, you wont be given a general rating for arthritis AND arthristis in specific joints, also.  One or the other.  Never both.  

As Buck explained, you may get arthritis for a specific joint.   

All this said, make sure you focus on service connection first, before you think about a rating.  Neglecting this step wont get you a good result.  Get it service connected first, then the percentage rating, then the effective date.  Neither the effective date, nor the percentage matters if your SC is denied.  

[rdnkjeeper]

I have read that before Buck, but not really sure what to think.  I have been told by someone that I will get a rating for Rheumatoid and one for each joint affected.  I don't know, guess I wait until they make a decision.

[rdnkjeeper]

Update: It was denied, because the examiner thought that I should have more erisions (SP?).  Anyway, I talked to my  rheumatologist and she said she doesn't refute exams or give opinions.  She doesn't have time.  She is the only fairly local rheumatologist in the area.  I have contacted my ex wife who I married while in the Marine Corps and she is writing me a letter saying that I had joint issues since we got together about a year into my contract.  My wife, who I dated before the Marines and married after I moved back home after my divorce is also going to write one and say that I had no joint issues before going in and since we have been together after I have had nothing but joint issues.