"I've been service connected since 1975 and haven't recieved a dime"

[WomanMarine]

Sorry for the 'wall of text' ... 

First off I would like to thank everyone for their service. Whether you served in one of the honorable branches or are just a contributor to this wonderful forum I have been lurking on, commitment to Veterans is valued. I am a female, Vietnam era, USMC vet. There are not many of us, as during those days they trained the women as the men, resulting in a high attrition rate. I believe it was due to this intense training that I am, in my old age, starting to feel the burn. 


I was never as proud as the day that my Eagle, Globe and Anchor were pinned on me. It was a lot of work to become a Marine and, sadly, it took its toll. During Boot I started having problems with my R knee giving way. I had this happen to me in high school from running track, but never did my knee cap totally dislocate nor tear my meniscus, as it did that night in the Leather Neck Lanes @ MCRDSD. I was seen the next day in Ortho and subsequently diagnosed with a Sublexing Patella (7244 EPTE) and awarded 10% disability.


This was 1975. Within six months after I was discharged, I got a good job with the railroad. The job only lasted a few months, as my knee went out on me while at work. I was seen at the V.A. in Los Angeles. They put a full leg cast on me, which I was to wear for six months. I applied for my disability then, but was denied. I do not recall the exact reason I was denied, but I do recall that there was an issue with my DD214. I had gone in initially as a Reserve, but later went Active. My last period of service was on my final DD214 but not my first. This required a correction and a  DD215 was issued. Finally the DoD did get my paperwork corrected. 


After a few months in the cast my boyfriend  removed it, as it was causing me back pain. We were both totally amazed to see my leg that had been hidden for over four months, as it was practically non-existent! It had atrophied beyond belief and took quite a bit of work to regain the muscle. However my knee did not act up for some time. The V.A. had stated they rated me at 0% and gave me a card that stated that I was service-connected. In 1980 my knee decided to go out on me again. And again I applied to the V.A. for my service-connected disability. Again I was turned down. And this time they wanted my V.A. service-connected card, stating I was not V.A. rated.


In 1993 I got involved in a new 'fad' called the Internet. I started building small networks. It was a great job, sitting behind a computer, watching my business flourish. In 2000 'dial-up' came to an end, with the prolific growth in wireless comms. My job changed from sitting behind a computer to climbing towers and high rises to install wireless systems.   In 2006 my darn 'Marine Corps' knee returned. It was not the sublexion I had experienced in years past, but more of a 'giving way' that caused me to fall down some stairs and injur my shoulder. By this time I had given up on the V.A. ever recognizing my 'service-connected' injury, so I just started wearing a soft knee brace. In 2012 I was climbing a tower and was 80' in the air when my knee decided to 'give way' ... That was a harrowing experience. If not for my safety harness I would have been 'splat' on the deck. I decided because of this I could not climb anymore. And because of this it cost me more to run my business. In 2014 I sold my business, as I was no longer capable of the physical aspect. I took a loss and now live on a small SS Survivors pension. 


The last two winters have been hell for me, as my knee has now developed arthritis and is causing me sever problems with my back. In 2009 I was diagnosed by the V.A. with DDD of the Lumbar. I am sure that my knee has contributed to this. Also I am now developing arthritis in my left knee. Last summer I tried to be seen for my back in V.A. emergency care, as I had a sever sciatica attack. I waited over four hours and finally checked back in with the ER only to learn that there was only one DR to see the backlog of patients. I left the V.A., once again disgusted.  


I decided last year if Trump was elected that I would re-apply to the V.A., as he made promises to clean-up the V.A. system. I reapplied the day of his Inauguration. I had my C&P last month. The C&P exam I found in MyHealthyVet and stated that my R knee was recognized by the examiner as:
'Recurrent subluxation R, Date of diagnosis: Right 1970.
Knee joint osteoarthritis, both knees, Date of diagnosis: Right 2017.

Comments:

1. Very mild lateral subluxation of the patella.2. Degenerative change involving the patellofemoral joint.3. Very mild degenerative change involving the knee joint.4. Very small knee joint effusion.5. Small popliteal cyst.6. Degenerative change involving the lateral meniscus.7. Degenerative change involving the medial meniscus and a tear involving theposterior horn of the medial meniscus cannot be excluded.Initial ROM R: Flexion: 5 to 110* Extension: 110 to 5*ROM L: Flexion: 0 to 115* Extension: 115 to 0*

No ankylosis shown in either knee. The examiner noted that my recurrent subluxation and lateral insability of my R knee are both Severe with recurrent effusion. The examiner also noted: Crepitus bilaterally with right more pronounced than left. Atalgic gait with increased weight bearing to the left extremity. Also noted was a recent X-Ray that showed degenerative changes and was noted as Mild degenerative arthritis. The examiner scheduled an MRI and X-Ray of my L knee. The MRI indicated a small effusion.  The X-Ray indicated Mild degenerative skeletal change.  Under 'Functional Impact' it was stated that I "must be afforded opportunity to walk on smooth even surfaces. Must avoid repetitive walking inclines/declines, stairs and the use of ladders. Unable to tolerate prolonged standing or walking. Unable to participate in moderate to high impact aerobics. Unable to tolarate kneeeling or squatting. Also noted in the C&P: Veteran had CT Scan 2012 Lumbar spine indicating L4-L5 vacuum phenoma, DJD with recurrent cronic back pain/right radiculopathy s/s. She is requesting consideration for a MRI of lumbar spine. Veteran has positive history of MST but "does not want to deal with it at this time".


After I read the report and saw that my status had changed from "Gather Evidence" to pending decision with a due date of 9/28/17, I became 'hopeful' that the V.A. was actually finally going to grant my service-connected disability. However yesterday that changed and hence the 'wall of text' I am dumping on your doorstep, in need of help. From my understanding they have sent in a request for 'clarification' from my examiner. As well they have not located my records from 1976 that shows when I initially applied and the course of action. They are now stating that my completion date is 1/18/18. I am well aware that the V.A. is like the military, hurry up just to wait. 

Is this normal that they would bump the date back this far?
AND is there any indication that the V.A. is going to finally do right by this ole vet?  

If you made it this far, thanks! 
Semper Fi!
WM

Edited August 7, 2017 by WomanMarine
typo

[Carl the Engineer]

WomanMarine,

Ok, I can tell you that the rater going back to the examiner to "opine" happens quite often.  In my case(s), it has been favorable.  The rater wants to see the correct VA verbage, I.e., "more likely than" (good) or "less likely than" (bad), etc.  The examiners comments should show up in myHealthyvet about 3-7 days after they opine.

From what I read it sounds like you were service connected right from the start, but then VA confusion set in.  I would wait until you get your letter in the mail and then come back with that as there are some Veterans on here that may opine on the dates.  You may be owed back to 1970, but not my expertice by any means.

After that letter, you need to request your c-file from the VA and your medical records from St Louis.  You may not know what you don't know about your medical issues and future claims.  You need to see what they see.  There not going to help you.

I read that you were awarded 10%.  Was that the med board when you were discharged?  And do you still get that?

Hope you get good news,

Hamslice

 

[Carl the Engineer]

WomanMarine,

I forgot to mention, your title for this post may have cause a delay in responses. "1st C%P, now what", really sounds like a newbee asking a basic question.  Some of the experienced helpers on here may have went right on bye and never gave it a look.  When I'm bored I go back and read most all posts and caught yours.

A better title would have been, "The VA owes me $$$ back to 1970" or "i've been service connected since 1970 and haven't recieved a dime"

Anyway, just a thought,

Hamslice

 

[WomanMarine]

9 hours ago, Hamslice said:

After that letter, you need to request your c-file from the VA and your medical records from St Louis.  You may not know what you don't know about your medical issues and future claims.  You need to see what they see.  There not going to help you.

I read that you were awarded 10%.  Was that the med board when you were discharged?  And do you still get that?

Hope you get good news,

Hamslice

 

Thank you sir!  From my research I am now understanding how important the c-file is and will do my best to acquire.

Actually the 'first giving way' was in high school in 1970. I was not diagnosed till 1975 when It started again 10 wks into Boot and finally a complete sublexation and tear of my meniscus. Maybe this is the need for clarification? in any event this lead to my discharge. DoD assigned 10% and stated injury was most likely permeate and service-connected.

I am thinking, what may have happened in 1980, is that the V.A. did not have my discharge papers ... Not sure yet.

Does this look like a CUE?

[WomanMarine]

9 hours ago, Hamslice said:

WomanMarine,

I forgot to mention, your title for this post may have cause a delay in responses. "1st C%P, now what", really sounds like a newbee asking a basic question.  Some of the experienced helpers on here may have went right on bye and never gave it a look.  When I'm bored I go back and read most all posts and caught yours.

A better title would have been, "The VA owes me $$$ back to 1970" or "i've been service connected since 1970 and haven't recieved a dime"

Anyway, just a thought,

Hamslice

 

Roger that!

 

[broncovet]

For VA, "its Always all about documentation".  

1.  Do you have a letter which awarded you 10 percent?  If you do, make a copy and send the copy to VA, and request back payment since 1975.  

2.  If you dont have the VA award letter, hopefully you have something to document it.  

     It seems pointless to apply for a disablity to which you are already service connected.  However, DO ask for an "increase".  

       It sounds like VA may have lost or shredded your file which awarded the 10 percent, but, if you have excellent records, you should be able to get that again.  

      I met another Vet, in a wheel chair who was awarded a disabiity in the 80's and VA had no record of it.  THIS VET HAD HIS LETTER.  He sent it to VA and they said the "letter was in error".  

       Remember this, tho.  VA's favorite things, other than delays and denials, and lowballs,  are passing the buck.  You see, its "above a GS7 rating specialistls pay grade" to authorize retro back to 1975, so you can almost expect some bogus excuse as to why they wont give it to you.  Bottom line:  You need an attorney to collect that kind of retro.  Get an experienced NOVA attorney.  

[WomanMarine]

1 hour ago, broncovet said:

For VA, "its Always all about documentation".  

1.  Do you have a letter which awarded you 10 percent?  If you do, make a copy and send the copy to VA, and request back payment since 1975.  

2.  If you dont have the VA award letter, hopefully you have something to document it.  

     It seems pointless to apply for a disablity to which you are already service connected.  However, DO ask for an "increase".  

       It sounds like VA may have lost or shredded your file which awarded the 10 percent, but, if you have excellent records, you should be able to get that again.  

Thank you for your response and service broncovet!

The VA rated me, within my year of discharge, 0% and put the full leg cast on me. However the VA is now saying they never rated me ... and, so far the VA has not been able to come up with the 1975 paperwork. After all these years I do not have this paperwork in my possession. I just recently, for the first time, saw the DoD rating as I ordered my military SRB and it was within that packet. Five years later I reapplied, as my knee never healed. At that time I was denied and they also took away the 0% rating. I was not aware that I could disagree with their decision ... But now my knee is in bad shape and causing back problems.  Maybe my DBQ can shed some light.

Again, sorry for the wall of text ... I tried to format so it is readable. It is interesting to note that the examiner refers to my knee as "SC" ... I would have to think that is Service-Connected, am I wrong?

****************************************************************************

Disability Benefits Questionnaire

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this

document:

[X] In-person examination

Evidence Review

---------------

Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)

[X] CPRS

1. Diagnosis

------------

a. List the claimed condition(s) that pertain to this DBQ:

right knee condition

b. Select diagnoses associated with the claimed condition(s) (Check all that

apply):

 [X] Knee joint osteoarthritis

Side affected: [ ] Right [ ] Left [X] Both

ICD Code: ?

Date of diagnosis: Right 2017

[X] Recurrent subluxation

Side affected: [X] Right [ ] Left [ ] Both

ICD Code: ?

Date of diagnosis: Right 1970

c. Comments (if any): RIGHT KNEE OTHER DIAGNOSIS CURRENT:

1. Very mild lateral subluxation of the patella.

2. Degenerative change involving the patellofemoral joint.

3. Very mild degenerative change involving the knee joint.

4. Very small knee joint effusion.

5. Small popliteal cyst.

6. Degenerative change involving the lateral meniscus.

7. Degenerative change involving the medial meniscus and a tear involving the

posterior horn of the medial meniscus cannot be excluded.

d. Was an opinion requested about this condition (internal VA only)?

[X] Yes [ ] No [ ] N/A

2. Medical history

------------------

a. Describe the history (including onset and course) of the Veteran's

knee and/or lower leg condition (brief summary):

Military Service Marine Corp:

2/24/1975 - 7/23/1975 and 5/3/1974 - 9/5/1974

Veteran is requesting consideration for direct SC for a right knee

SUBLUXATION, RECURRENT residuals.

STRS, Medical Board evaluation documented 16 June 1975 summarized:

...initial injury 5 years prior to enlistment running on track and experienced giving way of right knee. She was asymptomatic for a long time. By the 10 week of basic training she began to experience several episodes of right knee giving way during physical fitness training events.. Surgical option discussed and declined. Physical therapy for strengthening conducted. She was found unfit for duty with a 10% disability rating for SUBLUXATION PATELLA RIGHT, RECURRENT.

RIGHT KNEE: Per Veteran reporting shortly after leaving medical separation from military service, she went to a VAMC in California. She was placed in a long leg cast x 6 months. The cast was extrememly heavy and finally her boyfriend at the time removed it using a hachet. She had some calf atrophy right side at that time. She was hired by Southern Pacific Railroad and she was on the job training for engineer position. She had recurrent subluxations right knee. Around 1995 she developed an internet system for the MO region. Internet systems changing to satellites from hard wire. She and her associate was required to climb a variety of towers to set up satellites and cables. She once incident in which she was 80 feet above ground moving cable. Her right knee gave way, and luckily she was saved by her safety harness. In 2006 her knee gave way and fell down a few stairs landing on right shoulder.

Review of CPRS indicates she had long hx of using NSAIDS.

LEFT KNEE: no trauma, intermittent discomfort, crepitus and stiffness.

b. Does the Veteran report flare-ups of the knee and/or lower leg?

[X] Yes [ ] No

If yes, document the Veteran's description of the flare-ups in his

Or her own words:

RIGHT KNEE: Recurrent instability at random, pain variable but constant, intermittent edema, chronic crepitus, chronic stiffness. She is not in flare up today. Pain mostly lateral aspect, and slight posterior. She has wore instability brace in past but not comfortable. Treatment is NSAIDS, hot or cold packs. No prior surgery, arthroscopy, steroid or Synvisc injections.

LEFT KNEE: no treatment

c. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ, including but not limited to repeated use over time?

[X] Yes [ ] No

If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: pain, less endurance, instability

3. Range of motion (ROM) and functional limitation

--------------------------------------------------

a. Initial range of motion

Right Knee

----------

[ ] All normal

[X] Abnormal or outside of normal range

[ ] Unable to test (please explain)

[ ] Not indicated (please explain)

Flexion (0 to 140): 5 to 110 degrees

Extension (140 to 0): 110 to 5 degrees

If abnormal, does the range of motion itself contribute to functional

loss? [X] Yes (please explain) [ ] No

If yes, please explain:

less flexion and lacks full extension

Description of pain (select best response):

Pain noted on exam and causes functional loss

If noted on exam, which ROM exhibited pain (select all that apply)?

Flexion, Extension

Is there evidence of pain with weight bearing? [X] Yes [ ] No

Is there objective evidence of localized tenderness or pain on palpation of

the joint or associated soft tissue? [X] Yes [ ] No

If yes, describe including location, severity and relationship to condition(s): entire lateral, anterior and superior, slight posterior Is there objective evidence of crepitus? [X] Yes [ ] No

Left Knee

---------

[ ] All normal

[X] Abnormal or outside of normal range

[ ] Unable to test (please explain)

[ ] Not indicated (please explain)

Flexion (0 to 140): 0 to 115 degrees

Extension (140 to 0): 115 to 0 degrees

If abnormal, does the range of motion itself contribute to functional

loss? [X] Yes (please explain) [ ] No

If yes, please explain:

less flexion

Description of pain (select best response):

Pain noted on exam and causes functional loss

If noted on exam, which ROM exhibited pain (select all that apply)?

Flexion

Is there evidence of pain with weight bearing? [ ] Yes [X] No

Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [ ] Yes [X] No

Is there objective evidence of crepitus? [X] Yes [ ] No

b. Observed repetitive use

Right Knee

----------

Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No

Is there additional functional loss or range of motion after three repetitions? [X] Yes [ ] No

Select all factors that cause this functional loss:

Pain

ROM after three repetitions:

Flexion (0 to 140): 5 to 110 degrees

Extension (140 to 0): 110 to 5 degrees

Left Knee

---------

Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No

Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No

c. Repeated use over time

Right Knee

----------

Is the Veteran being examined immediately after repetitive use over time?

[X] Yes [ ] No

Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time?

[X] Yes [ ] No [ ] Unable to say w/o mere speculation

Select all factors that cause this functional loss:

Pain, Weakness, Lack of endurance

Able to describe in terms of range of motion: [ ] Yes [X] No

If no, please describe:

not observed over a period of time

Left Knee

---------

Is the Veteran being examined immediately after repetitive use over time?

[X] Yes [ ] No

Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time?

 [X] Yes [ ] No [ ] Unable to say w/o mere speculation

Select all factors that cause this functional loss:

Pain

Able to describe in terms of range of motion: [ ] Yes [X] No

If no, please describe:

not observed over a period of time

d. Flare-ups

Right Knee

----------

Is the exam being conducted during a flare-up? [ ] Yes [X] No

If the examination is not being conducted during a flare-up:

[X] The examination is medically consistent with the Veteran's

statements describing functional loss during flare-ups.

[ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please mexplain.

[ ] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups.

Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups?

[X] Yes [ ] No [ ] Unable to say w/o mere speculation

Select all factors that cause this functional loss:

Pain, Fatigue, Weakness, Lack of endurance Able to describe in terms of range of motion: [ ] Yes [X] No

If no, please describe:

not observed in acute flare up

Left Knee

---------

Is the exam being conducted during a flare-up? [ ] Yes [X] No

If the examination is not being conducted during a flare-up:

[ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups.

[ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain.

[X] The examination is neither medically consistent or inconsistent

With the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups?

[ ] Yes [X] No [ ] Unable to say w/o mere speculation

e. Additional factors contributing to disability

Right Knee

----------

In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe:

Less movement than normal due to ankylosis, adhesions, etc., Swelling, Instability of station, Disturbance of locomotion, Interference with Standing Please describe additional contributing factors of disability: interference with climbing, kneeling or squatting

Left Knee

---------

In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None

4. Muscle strength testing

--------------------------

a. Muscle strength - Rate strength according to the following scale:

0/5 No muscle movement

1/5 Palpable or visible muscle contraction, but no joint movement

2/5 Active movement with gravity eliminated

3/5 Active movement against gravity

4/5 Active movement against some resistance

5/5 Normal strength

Right Knee: Rate Strength:

Flexion: 5/5

Extension: 4/5

Is there a reduction in muscle strength? [X] Yes [ ] No

Left Knee: Rate Strength:

Flexion: 5/5

Extension: 5/5

Is there a reduction in muscle strength? [ ] Yes [X] No

b. Does the Veteran have muscle atrophy?

[ ] Yes [X] No

c. Comments, if any:

No response provided

5. Ankylosis

------------

Complete this section if the Veteran has ankylosis of the knee and/or lower leg.

a. Indicate severity of ankylosis and side affected (check all that apply):

Right Side:

[ ] Favorable angle in full extension or in slight flexion between 0 and

10 degrees

[ ] In flexion between 10 and 20 degrees

[ ] In flexion between 20 and 45 degrees

[ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more

[X] No ankylosis

Left Side:

[ ] Favorable angle in full extension or in slight flexion between 0 and

10 degrees

[ ] In flexion between 10 and 20 degrees

[ ] In flexion between 20 and 45 degrees

[ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more

[X] No ankylosis

b. Indicate angle of ankylosis in degrees:

No response provided

c. Comments, if any:

No response provided

6. Joint stability tests

------------------------

a. Is there a history of recurrent subluxation?

Right: [ ] None [ ] Slight [ ] Moderate [X] Severe

Left: [X] None [ ] Slight [ ] Moderate [ ] Severe

b. Is there a history of lateral instability?

Right: [ ] None [ ] Slight [ ] Moderate [X] Severe

Left: [X] None [ ] Slight [ ] Moderate [ ] Severe

c. Is there a history of recurrent effusion?

[X] Yes [ ] No

If yes, describe: right only

d. Performance of joint stability testing

Right Knee:

Was joint stability testing performed?

[X] Yes

[ ] No

[ ] Not indicated

[ ] Indicated, but not able to perform

If joint stability testing was performed is there joint instability?

[X] Yes [ ] No

If yes (joint stability testing was performed), complete the section below:

- Anterior instability (Lachman test)

[ ] Normal

[X] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Posterior instability (Posterior drawer test)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Medial instability (Apply valgus pressure to knee in extension

and with 30 degrees of flexion)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Lateral instability (Apply varus pressure to knee in extension and with 30 degrees of flexion)

[ ] Normal

[X] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

Left Knee:

Was joint stability testing performed?

[ ] Yes

[X] No

[ ] Not indicated

[ ] Indicated, but not able to perform

e. Comments, if any:

No response provided

7. Additional conditions

------------------------

a. Does the Veteran now have or has he or she ever had recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment?

[ ] Yes [X] No

b. Comments, if any:

No response provided

8. Meniscal conditions

----------------------

a. Does the Veteran now have or has he or she ever had a meniscus (semilunar cartilage) condition?

[X] Yes [ ] No

If yes, indicate severity and frequency of symptoms, and side affected:

Right Side:

[X] Frequent episodes of joint "locking"

[X] Frequent episodes of joint pain

[X] Frequent episodes of joint effusion

b. For all checked boxes above, describe:

CURRENT MRI: indicates right knee small effusion 7/2017

9. Surgical procedures

----------------------

No response provided

10. Other pertinent physical findings, complications, conditions, signs, symptoms and scars

------------------------------------------------------------------------

a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above?

[X] Yes [ ] No

If yes, describe (brief summary): Crepitus bilaterally with right More pronounced than left. Atalgic gait with increased weight bearing to the left extremity. No edema or erythema to knees.

b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis

Section above?

[ ] Yes [X] No

c. Comments, if any:

No response provided

11. Assistive devices

---------------------

a. Does the Veteran use any assistive device(s) as a normal mode of locomotion,although occasional locomotion by other methods may be possible?

[ ] Yes [X] No

b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition:

No response provided

12. Remaining effective function of the extremities

---------------------------------------------------

Due to the Veteran's knee and/or lower leg condition(s), is there Functional impairment of an extremity such that no effective function remains other than,that which would be equally well served by an amputation with prosthesis?

(Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.)

[ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran.

[X] No

13. Diagnostic testing

----------------------

a. Have imaging studies of the knee been performed and are the results available?

[X] Yes [ ] No

If yes, is degenerative or traumatic arthritis documented?

[X] Yes [ ] No

If yes, indicate knee: [X] Right [ ] Left [ ] Both

b. Are there any other significant diagnostic test findings and/or results?

[X] Yes [ ] No

If yes, provide type of test or procedure, date and results (brief summary):

KNEE,RIGHT,1 OR 2 VIEWS (RAD Detailed)

Report Status: Verified Date Reported: MAY 18, 2017

Right knee 2 views. There are degenerative changes present. No fracture or dislocation. No bony destruction.

Impression: Mild degenerative arthritis

**************

KNEE,LEFT 1 OR 2 VIEWS (RAD Detailed)

Report Status: Verified Date Reported: JUL 14, 2017

Report:

Two views of the left knee reveal mild degenerative skeletal

change with no acute osseous or adjacent soft tissue abnormality.

Impression: No acute process

c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions:

No response provided

14. Functional impact

---------------------

Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)?

[X] Yes [ ] No

If yes, describe the functional impact of each condition, providing one or more examples:

RIGHT KNEE: Must be afforded opportunity to walk on smooth even surfaces. Must avoid repetitive walking inclines/declines, stairs, and use of ladders. Unable to tolerate prolonged standing or walking. Unable to participate in moderate to high impact aerobics. Unable to tolerate kneeling or squatting.

15. Remarks, if any:

--------------------

SUBLUXATION RIGHT KNEE, RECURRENT etiology onset five years prior to enlistment. Recurrent within the tenth week of active duty physical fitness training. Refer to MO. Offset weight bearing shifting toward the left lower extremity. Refer to MO.

****************************************************************************

Medical Opinion

Disability Benefits Questionnaire

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this document:

[X] In-person examination

Evidence Review

---------------

Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)

[X] CPRS

MEDICAL OPINION SUMMARY

-----------------------

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: Does the Veteran have a knee injury for direct SC for a right knee injury residuals.

b. Indicate type of exam for which opinion has been requested: knee

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR AGGRAVATION OF A CONDITION THAT EXISTED PRIOR TO SERVICE ]

a. The claimed condition, which clearly and unmistakably existed prior to service, was aggravated beyond its natural progression by an in-service event, injury or illness.

c. Rationale: STRS, Medical Board evaluation documented 16 June 1975 summarized: ...initial injury 5 years prior to enlistment running on track and experienced giving way of right knee. She was asymptomatic for a long time. By the 10th week of basic training she began to experience several episodes of right knee giving way during physical fitness training events... Surgical option discussed and declined. Physical therapy for strengthening conducted. She was found unfit for duty with a 10% disability rating for SUBLUXATION PATELLA RIGHT, RECURRENT.

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RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: Veteran is claiming left knee arthritis as secondary to offset weight bearing of SC right knee condition.

b. Indicate type of exam for which opinion has been requested: knee

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ]

a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition.

c. Rationale: Chronic pain, less endurance, instability of SC right knee patella subluxation issues has lead to the osteoarthritis left knee.

RATIONALE: It is well documented in the medical literature that alteration in gait imposed by the RIGHT knee condition precipitates the development of osteoarthritis in the contralateral LEFT knee.

Minor compensations can increase stress on a contralateral limp and predispose the patient to premature degenerative arthritis. Journal of Rehabilitation Research and Development January 2008.

Harrison's Principles of Internal Medicine, 18th Edition, Copyright 2012, page 2830-2831. (ISBN 978-0-07174889-6, MHID 0-07-174889-X)

Joint vulnerability and joint loading are the two major factors contributing to the development of Osteoarthritis. On the one hand, a vulnerable joint whose protectors are dysfunctional can develop OA with minimal levels of loading, perhaps even levels encountered during every day activities. On the other hand, in a young joint with competent protectors, a major acute injury or long-term overloading is necessary to precipitate disease. Risk factors for OA can be understood in terms of their effect either on joint vulnerability or on loading. Risk factors for osteoarthritis either contribute to the susceptibility of the joint (systemic factors or factors inthe local joint environment) or increase risk by the load they put on the joint. Usually a combination of loading and susceptibility factors is required to cause disease or its progression.

Systemic factors affecting joint vulnerability: increased age, female gender, racial/ethnic factors, genetic susceptibility, nutritional factors. Intrinsic joint vulnerability (local environment): previous damage (e.g. meniscetomy) bridging muscle weakness increasing bone density, mal-alignment, proprioceptive deficiencies. Use (loading) factors acting on joints: obesity injurious physical activities.

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While the V.A. has never given me a dime ... they recently gave me a cane ... :/

 

Edited August 7, 2017 by WomanMarine
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