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masters101

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My wife was medically discharged from the USAF 15 years ago and rated at zero percent from the VA. We were young and did not know what to do so we simply took the rating and moved on with our lives. My wifes condition has become severe and she can hardly get out of bed. We found this great site and started our quest for justice and we really owe so much to everyone; Thank you , thank you , thank you. My wife finally received a 20 percent rating from her knees but she is still rated zero percent for her back because the last C&P did not have a Range of Motion completed. We notified the VA through our DAV office, the VA has done a great job getting my wife another appointment to have her ROM completed. We have found many helpful people along the way to include the VA, the DAV, the Doctors and nurses at the VA, and of course the great group of people on hadit.

My wifes last C&P clearly stated she should be at 40 percent for her back, however there was not a ROM test completed. The Doctor even put the words that she should be at 40 percent. My wife recent C&P was only 5 minutes long and it was simply for Range of Motion. Can someone please look at the report below and give us a opinion?

Again Thank you all so much.

Objective abnormalities of Thoracic Sacrospinalysis

Spasm

Left: Yes

Right: Yes

Atrophy:

Left: No

Right: No

Guarding

Left: No

Right: No

Pain with Motion

Left: Yes

Right: Yes

Tenderness

Left: Yes

Right: Yes

Weakness

Left: No

Right: No

Is the muscle spasm, Localized Tenderness or guarding severe enough to be responsible for abnormal Gait or abnormal spinal contour: NO

CERVICAL SPINE RANGE OF MOTION- (Thoraco-lumbar spine range of motion)

Active Motion

Flexion: 0-30 Degrees

Extension: 0-8 Degrees

Left Lateral Flexion: 0-15

Left Lateral Rotation: 0-15

Right Lateral Flexion: 0-15

Right Lateral Rotation:0-15

Is there objective evidence of pain on active ROM: YES

Additional Limitation with Repetitive motion

Is there objectvice evidence of pain following repetitive motion? Yes

Are there additional limitations after three repetitions of Range of Motion? Yes

What is the most important factor? Pain

Range of motion after Repetitive motion:

Flexion: 0-20 Degrees

Extension: 0-8 Degrees

Left Lateral Flexion: 0-15

Left Lateral Rotation: 0-15

Right Lateral Flexion: 0-15

Right Lateral Rotation:0-15

Other significant Phsical Exam Findings:

(+) Deluca, lumbar spine, all range of motions

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The last C&P report stated:

VA Examination was conducted and results show an increased severeity of your lumbar spine condition that would warrant an evaluation of 40 percent disabling. However, VA revealed regional weakness or sensory changes which deviate from accepted meuranatomy. We requested VA examiner to clarify the findings and examiner respnded that the range of motion findings are not reliable and that further examinations are not expected to bring forth a different outcome.

That is why we asked for another C&P to be accomplished with a range of motion examination completed. The last Doctor never did a range of motion.

My wife is currently rated for her back, however it is at zero percent. Based on all of the finding she should be at 40 percent. The VA Doctor even stated that in his report. Hopefully with the Range of motion completed she will be rated correctly at 40 percent.

Masters,

What you need to do is find the rating schedule for back conditions, specific to your wife's condition (e.g. Scoliosis, MS, Degenerative Disc Disease, etc.), and see what the exact verbage is that allows a rater to rate a veteran's back at 0, 20, or 40%.

Then you (and friends or family who have witnessed first hand how her back affects her) need to write her a letter of support as a lay person testifying/affirming that she suffers from the symptoms of A,B, and C; and when communicating to the C&P (or other) doctor exactly what she is going through and ask (not demand) that he/she be sure that he addresses that symptomatology and the ROM and the medically certain future repercussions that she will face as a result of her condition and overall symptoms.

As carlie said, a C&P examiner cannot state what % he/she thinks a veteran should be rated (they can say so, but as carlie said that opinion alone carries no weight); it's their medical examination, diagnosis, and overall professional medical opinion of the condition being examined for that will matter when the rater juxtaposes the rating regulations with that of the medical findings that will utlimately determine the rating she will get.

Also, all you can really do now is reiterate your interests for her 0% rating to be evaluated for an increase and not a retroactive issue since too much time has passed and no NOD or appeals were filed within the alotted time frame once that original decision was made. Sorry, but that is the way the VA adjudication process works.

T.S.

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