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WVSERVER

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Posts posted by WVSERVER

  1. Went to 90 on a new 50 rating for major depressive disorder with anxious distress. They did back pay the difference to my original date of claim of March 2011 as they stated after they originally denied it they received more of my service records providing service connection. They deferred the fybro and cervical spine injury. The reason they provided is they are seeking further medical opinion and now they have ordered the same C&P that I just had in September .

  2. Straight from 38 CFR

    §4.23 Attitude of rating officers.

    It is to be remembered that the majority of applicants are disabled persons who are seeking benefits of law to which they believe themselves entitled. In the exercise of his or her functions, rating officers must not allow their personal feelings to intrude; an antagonistic, critical, or even abusive attitude on the part of a claimant should not in any instance influence the officers in the handling of the case. Fairness and courtesy must at all times be shown to applicants by all employees whose duties bring them in contact, directly or indirectly, with the Department's claimants.

  3. If you have a strong DBQ from the outside I would say it would cover up any negative remarks of the C&P examiner. The VA had made negative marking on my C&P concerning Tinnitus but I had a letter from an outside ENT and was granted service connection even thought the examiner marked less then likely. Never give up hope especial when you already have medical evidence from a reputable source.

  4. Just want to post my exams to see what you guys and gal think, these exams were from Friday

    Mental Disorders
    (other than PTSD and Eating Disorders)
    Disability Benefits Questionnaire

    Name of patient/Veteran:

    SECTION I:
    ----------
    1. Diagnosis
    ------------
    a. Does the Veteran now have or has he/she ever been diagnosed with a mental
    disorder(s)?
    [X] Yes[ ] No

    If the Veteran currently has one or more mental disorders that conform to
    DSM-5 criteria, provide all diagnoses:

    Mental Disorder Diagnosis #1: Major Depressive Disorder with Anxious
    Distress
    ICD code: 296.32

    b. Medical diagnoses relevant to the understanding or management of the
    Mental Health Disorder (to include TBI): n/a

    2. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder diagnosed?
    [ ] Yes[X] No

    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
    [ ] Yes[X] No[ ] Not shown in records reviewed

    3. Occupational and social impairment
    -------------------------------------
    a. Which of the following best summarizes the Veteran's level of
    occupational
    and social impairment with regards to all mental diagnoses? (Check only
    one)

    [X] Occupational and social impairment with reduced reliability and
    productivity

    b. For the indicated level of occupational and social impairment, is it
    possible to differentiate what portion of the occupational and social
    impairment indicated above is caused by each mental disorder?
    [ ] Yes[ ] No[X] No other mental disorder has been diagnosed

    c. If a diagnosis of TBI exists, is it possible to differentiate what
    portion
    of the occupational and social impairment indicated above is caused by
    the
    TBI?
    [ ] Yes[ ] No[X] No diagnosis of TBI

    SECTION II:
    -----------
    Clinical Findings:
    ------------------
    1. Evidence review
    ------------------
    a. Medical record review:

    Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?
    [X] Yes[ ] No

    Was the Veteran's VA claims file (hard copy paper C-file) reviewed?
    [ ] Yes[X] No

    If no, check all records reviewed:

    [X] Military service treatment records
    [ ] Military service personnel records
    [ ] Military enlistment examination
    [ ] Military separation examination
    [ ] Military post-deployment questionnaire
    [ ] Department of Defense Form 214 Separation Documents
    [X] Veterans Health Administration medical records (VA treatment
    records)
    [ ] Civilian medical records
    [ ] Interviews with collateral witnesses (family and others who have
    known the Veteran before and after military service)
    [ ] No records were reviewed
    [X] Other:
    previous exam, decision narrative

    b. Was pertinent information from collateral sources reviewed?
    [ ] Yes[X] No




    MENTAL STATUS:
    Appearance: casually dressed, adequately groomed
    Activity: normal, no psychomotor agitation or retardation
    Attitude: pleasant, polite, cooperative
    Speech: fluent, coherent
    Mood: depressed
    Affect: worried, mood congruent
    Perception: no hallucinations
    Thought flow: logical, goal directed
    Thought content: no delusions
    Thoughts of harm: no suicidal/homicidal ideation
    Level of consciousness: alert
    Oriented: to all spheres
    Attention: fair

    Current Suicide Risk Factors:
    _X____ Does not have thoughts of suicide or self harm at this time
    _X____ Does not express feelings of hopelessness or helplessness at
    this
    time

    Current Suicide Assessment:
    _X____ Low: Patient judged NOT to be at significant risk for self-harm




    d. Relevant Legal and Behavioral history (pre-military, military, and
    post-military):
    Denied


    e. Relevant Substance abuse history (pre-military, military, and
    post-military):
    Denied


    f. Other, if any:
    n/a

    3. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
    Veteran's diagnoses:

    [X] Depressed mood
    [X] Anxiety
    [X] Panic attacks that occur weekly or less often
    [X] Chronic sleep impairment
    [X] Disturbances of motivation and mood

    Behavioral observations:
    worried

    4. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to mental disorders
    that are not listed above?
    [X] Yes[ ] No

    If yes, describe:
    reduced concentration, restlessness, irritability, fatigue

    5. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes[ ] No

    6. Remarks (including any testing results), if any:
    ---------------------------------------------------
    On August 4, 2014, VA published an interim final rule, RIN 2900-A096 -
    Mental
    Disorders and Definition of Psychosis for Certain VA Purposes to update
    regulations in accordance with the Diagnostic and Statistical Manual of
    Mental Disorders, Fifth Edition (DSM-5). The publication of this interim
    final rule indicates that a diagnosis of a mental disorder must conform to
    the standards set in the DSM-5.

    As of August 28, 2014 all examinations must be conducted utilizing DSM-5.
    Examiners no longer need to comment on DSM-IV diagnostic criteria if DSM-5
    diagnostic criteria is not met.

    The GAF score is not used in DSM-5.

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

    Medical Opinion
    Disability Benefits Questionnaire

    Name of patient/Veteran:

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

    [ ] Review of available records (without in-person or video telehealth
    examination) using the Acceptable Clinical Evidence (ACE) process
    because
    the existing medical evidence provided sufficient information on which
    to
    prepare the DBQ and such an examination will likely provide no
    additional
    relevant evidence.
    [ ] Review of available records in conjunction with a telephone interview
    with the Veteran (without in-person or telehealth examination) using the
    ACE process because the existing medical evidence supplemented with a
    telephone interview provided sufficient information on which to prepare
    the DBQ and such an examination would likely provide no additional
    relevant evidence.
    [ ] Examination via approved video telehealth
    [X] In-person examination

    Evidence review
    ---------------
    Was the Veteran's VA claims file reviewed? Yes

    If yes, list any records that were reviewed but were not included in the
    Veteran's VA claims file:
    VHA medical records

    MEDICAL OPINION SUMMARY
    -----------------------
    RESTATEMENT OF REQUESTED OPINION:

    a. Opinion from general remarks: Is the Veteran's recurrent major depression
    a continuation of the complaint/note in service?

    b. Indicate type of exam for which opinion has been requested: DBQ Mental
    Disorder

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

    a. The condition claimed was at least as likely as not (50% or greater
    probability) incurred in or caused by the claimed in-service injury, event
    or
    illness.

    c. Rationale: Veteran's current symptoms are the same symptoms noted while
    in
    the service. His symptoms are ongoing and are considered a continuation of
    the same disorder.

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



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

    =========================================================================
    Date/Time: 19 Sep 2014 @ 1300
    Note Title: COMPENSATION AND PENSION EXAMINATION
    Location: MARTINSBURG VAMC
    Signed By: CANETE,LUCILA Z
    Co-signed By: CANETE,LUCILA Z
    Date/Time Signed: 19 Sep 2014 @ 1600
    -------------------------------------------------------------------------

    LOCAL TITLE: COMPENSATION AND PENSION EXAMINATION
    STANDARD TITLE: C & P EXAMINATION NOTE
    DATE OF NOTE: SEP 19, 2014@13:00 ENTRY DATE: SEP 19, 2014@16:00:13
    AUTHOR: CANETE,LUCILA Z EXP COSIGNER:
    URGENCY: STATUS: COMPLETED

    Fibromyalgia
    Disability Benefits Questionnaire

    Name of patient/Veteran:

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

    [X] In-person examination

    Evidence review
    ---------------
    Was the Veteran's VA claims file (hard copy paper C-file) reviewed?
    [X] Yes[ ] No

    If yes, list any records that were reviewed but were not included in the
    Veteran's VA claims file:

    vbms efile; VAMC


    1. Diagnosis
    ------------
    Does the Veteran now have or has he/she ever been diagnosed with
    fibromyalgia? (This is the condition the Veteran is claiming or for which an
    exam has been requested)
    [X] Yes [ ] No

    [X] Fibromyalgia
    Date of diagnosis: 2005

    2. Medical history
    ------------------
    a. Describe the history (including onset and course) of the Veteran's
    fibromyalgia condition:
    33 years old USAirforce veteran from 2000 to 2006, is here for a
    C&P
    evaluation on his current condition of fibromylagia.
    In 2003, he started coming unexplained fatigue which described
    coming with similar symptoms when one suffers from flu-like symptoms
    when one developes generalized muscle soreness, insides of both legs,
    thighs, shoulder and neck areas and medial side of both arms and
    achiness of both hands (described it as fatigue feeling). When he
    would wear the body armour, he feels that his entire body feels sore
    and touch of the armor which is heavy makes him feel the soreness.
    More noticeable over the medical surfaces of the thighs. During his
    active service he worked with Nuclear Program at Minot, Airforce
    Base,
    North Dakota he is on strict monitoring due to the sensitivity
    concern
    of the program. (Perosonal Reliability Program).
    Around the same year 2003 the Base physician and several times
    2003-2004. He was tried on Amytriptylline 25 mg po hs which helped X
    2
    months only to return back to his initial symptoms. 6 months before
    he
    left the USAirforce, he had sleep study done which confirmed sleep
    apnea which he wears CPAP to date. It seemed to help his drowsiness
    during the daytime but it has not affected his sensation of muscle
    soreness. He had a medical board but was honorably discharged. He was
    recommended not eligible to re-enlist and or serve the remaining 2
    years of inactive reserve.
    He has been coming here at Martinsburg VA since 2012 for scheduled
    Compensation & Pension Evaluation. He has been placed on
    Sertraline
    for depression which did not help his body pain. It has been
    discontinued and not on any medications. He sees the Pain Mgmt for
    his
    neck complaints and have an appointment for PT regarding the rest of
    his body pains.
    Reviewed vbms STRS efile:
    11/10/2005: Routine Physical Examination
    Note on his active problem list: Mylagias/Myositis
    (Non-specified)
    Multiple progress notes/Behavioral Clinic: Mild
    Depression 2003/ Major Depression 2005/ Involutional Melancholia
    2005.
    Medications: Amitriptylline 25 mg po qd (prescribed to
    problems with Depression) No specific mention that this was given for
    fibromyalgia.
    1/25/2005 Progress notes: Mentioned that member was seen prior for
    fibromyalgia which responded well to Elavil a hs. Mention about
    implication for his work statys (PRP) using Elavil. There as a
    discussion with Dr. Higgins who mentioned that the medication causes
    no limiting side effects, and is not being used for anti-depressant
    purposes, that this case does not automatically require PRP
    suspension.
    Memorandum from XXXXwritten by TODD P Huhn,
    CAPT, USAF, MC
    XXXXXhas been seen for symptoms consistent with
    fibromylgia, a condition of chronic muscle pain. He responded very
    well to medication for this which he takes at night. This is not
    being
    used as an anti-depressant medication. After conferring with the
    AFSPC PRP medical consultant, Lt. Col Higgins, we concurred that Sra
    XXX was medically cleared to take this medication and maintain his
    PRP clearance.
    Routine H&P by an outpatient primary care provider at Martinsburg
    VA 7/18/2014:
    LOCAL TITLE: PHYSICIAN, PRIMARY CARE/OUTPATIENT CLINIC
    STANDARD TITLE: PRIMARY CARE PHYSICIAN NOTE
    DATE OF NOTE: JUL 18, 2014@08:59 ENTRY DATE: JUL 18,
    2014@09:01:34

    AUTHOR: VU,PETER D EXP COSIGNER:

    URGENCY: STATUS: COMPLETED

    CHIEF COMPLAINT: chronic neck strain w/ headache


    PRESENT ILLNESS: said
    he has chronic neck strain and occasional tension headache w/o any
    trauma or
    injury. pt said he needs clearance to participate in walk for
    wellness at home.
    pt gained some wt w/ BMI >35. Today,PT denies any SI or
    HI,fever,chills,sob,cp,
    productive cough, n/v,abdominal pain,vision problems, weakness,
    dizziness,headache, change of bm,orthopnea, palpitation,syncope, LOC,
    urinary or
    stool incontinence, hematuria or hematochezia.


    PAST HISTORY:
    Active problems - Computerized Problem List is the source for the
    following:

    1. Recurrent major depression (SNOMED CT 66344007) 09/30/13
    ASGHAR,ALI
    2. Nonallopathic lesions of rib cage
    3. Pain in Thoracic Spine 05/09/13
    NEFF,SHAWN M
    4. Somat Dysfunc Thorac Reg 05/09/13
    NEFF,SHAWN M
    5. Somat Dysfunc Cervic Reg 04/09/13
    NEFF,SHAWN M
    6. Cervicalgia 04/09/13
    NEFF,SHAWN M
    7. Headache
    8. Hyperlipidemia 01/24/13
    VU,PETER D
    9. SUBJECTIVE TINNITUS 01/23/13
    SHALLIS,JULIE
    B
    10. Depression 01/18/13
    VU,PETER D
    11. GERD 01/18/13
    VU,PETER D
    12. Anxiety 01/18/13
    VU,PETER D
    13. Cholelithiasis 01/18/13
    VU,PETER D
    14. Hx of tobacco user in remission 01/18/13
    VU,PETER D
    15. OSA on c-pap 01/18/13
    VU,PETER D
    16. Hx of tinnitus
    01/18/13
    VU,PETER D
    17. Irritable Bowel Syndrome

    PHYSICAL EXAM:
    GENERAL: ambulatory, awake, alert, oriented x3,nad, pleasant,obese
    young man.
    HEENT: PERRLA. Clear oropharynx and tympanic membrane. no sinus
    tenderness.
    no cervical adenopathy.
    NECK: No bruits or stiffness. Good ROM w/o difficulty but mild
    discomfort on
    rotation and moderate trapezius muscle stiffness on palpation.
    CHEST: Chest normal shape and symmetrical.No masses,tenderness or
    other
    abnormalities
    LUNGS: Clear, no crackles, wheezing, or rhonchi.
    HEART: RSR, no murmurs, no gallop
    ABDOMEN: obese. Soft, non tender, positive bowel sounds, liver and
    spleen are
    not palpable. No rebound tenderness to palpation.
    BACK: No cva tenderness or point tenderness.slr negative.
    EXTREMITIES: No edema. Good ROM w/o pain or difficulty. Good muscle
    strength
    and tone plus well developed muscle. nl sensation and good radial
    pulse and capillary refill.
    NEUROLOGICAL: Cranial nerve intact, no focal deficit, ambulatory w/o
    difficulty.

    ASSESSMENT:
    - Hx of chronic neck strain: discussed and full explaination about
    his
    condition
    and booklet about neck given w/ instruction for home exercise.
    increase flexeril
    to 10mg qhs prn w/advise of side effects and continue heating pad
    alternate
    w/icepack. pt already was tx by PT, chiropractor and pain school in
    past. pt
    said he does not want to be on pain medication. pt had xray of neck
    in
    past was
    negative.
    -hx of IBS: Discussed and tx w/ bentyl 10mg bid and metamucil and
    f/u GI as
    directed.
    -hx GERD: on prilosec
    -hx Depression/anxiety: stable and denies any SI or HI. f/u w/ MHC as
    directed.
    -hx of OSA:stable on C-pap



    b. Is continuous medication required for control of fibromyalgia symptoms?
    [ ] Yes [X] No

    c. Is the Veteran currently undergoing treatment for this condition?
    [ ] Yes [X] No

    d. Are the Veteran's fibromyalgia symptoms refractory to therapy?
    [X] Yes [ ] No

    3. Findings, signs and symptoms
    -------------------------------
    Does the Veteran currently have any findings, signs or symptoms attributable
    to fibromyalgia?
    [X] Yes [ ] No

    a. Findings, signs and symptoms (check all that apply):

    [X] Widespread musculoskeletal pain
    [X] Fatigue
    [X] Sleep disturbances
    [X] Headache
    [X] Depression
    [X] Irritable bowel symptoms

    For all checked conditions, describe:
    Musculoskeletal symtpoms: 1) constant sensation of 'muscle
    fatigue/sore'on both anterior thighs, skin feels sore over the medial
    portion of both thighs, localized sensitivity(soreness) over the
    specific medial portion of both arms, bilateral scapular muscles and
    back of his neck.
    2) Feels tired even if he has not done anything but can still do his
    routines both at home and at work.
    3) He feels no motivation, problems with concentration, crying for no
    reasons, feels anxiety and hx/o bouts of panic attack and chest pain
    while in the active service. Diagnosed with Depression while in the
    active service and was not placed on medication because he wants to
    continue working with Nuclear Program. Taking a anti-depressants will
    disqualify him from that program. He was evaluated by a psychologist.
    He was receiving regular psychological therapy while in the active
    service.
    He is currently seen by psychologist here at Martinsburg VA and
    received Cognitive Therapy and currently on the HOPE Program (Group
    Therapy). No medications for depression given to date.
    4) Hx/o IBS and is service connected for IBS. Takes Dicyclomine BID.
    He
    said his current meds seem to help him.


    b. Frequency of fibromyalgia symptoms (check all that apply):

    [X] Constant or nearly constant

    c. Does the Veteran have tender points (trigger points) for pain present?
    [ ] Yes [X] No

    4. Other pertinent physical findings, complications, conditions, signs
    and/or
    symptoms

    -----------------------------------------------------------------------------
    Does the Veteran have any other pertinent physical findings, complications,
    conditions, signs or symptoms related to any conditions listed in the
    Diagnosis section above?
    [ ] Yes [X] No

    5. Diagnostic testing
    ---------------------
    Are there any significant diagnostic test findings and/or results?
    [ ] Yes [X] No

    6. Functional impact
    ---------------------
    Does the Veteran's fibromyalgia impact his or her ability to work?
    [ ] Yes [X] No

    7. Remarks, if any:
    -------------------
    He now works both patroling
    and now in the office. He has so far able to carry on his duties as a
    security officer.
    Physical examination today revealed: (-) direct tenderness on palpation
    over the occipital, supraspinatus, sternal, knees.
    He points to overall sensation of soreness on his neck area, and
    localized sensitivity on the bilateral thigh muscles and linear medial
    thigh bilaterally and medial areas on both arms. Strength 5/5 all
    throughout. Sensory are all WNL both upper and lower extremeties.

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

    Neck (Cervical Spine) Conditions
    Disability Benefits Questionnaire

    Name of patient/Veteran:

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

    [ ] Review of available records (without in-person or video telehealth
    examination) using the Acceptable Clinical Evidence (ACE) process
    because
    the existing medical evidence provided sufficient information on which
    to
    prepare the DBQ and such an examination will likely provide no
    additional
    relevant evidence.
    [ ] Review of available records in conjunction with a telephone interview
    with the Veteran (without in-person or telehealth examination) using the
    ACE process because the existing medical evidence supplemented with a
    telephone interview provided sufficient information on which to prepare
    the DBQ and such an examination would likely provide no additional
    relevant evidence.
    [ ] Examination via approved video telehealth
    [X] In-person examination

    Evidence review
    ---------------
    Was the Veteran's VA claims file reviewed?
    [X] Yes [ ] No

    If yes, list any records that were reviewed but were not included in the
    Veteran's VA claims file:

    vbms efile; VAMC

    If no, check all records reviewed:

    [ ] Military service treatment records
    [ ] Military service personnel records
    [ ] Military enlistment examination
    [ ] Military separation examination
    [ ] Military post-deployment questionnaire

    [ ] Department of Defense Form 214 Separation Documents
    [ ] Veterans Health Administration medical records (VA treatment
    records)
    [ ] Civilian medical records
    [ ] Interviews with collateral witnesses (family and others who have
    known the Veteran before and after military service)
    [ ] No records were reviewed
    [ ] Other:

    1. Diagnosis
    ------------
    Does the Veteran now have or has he/she ever been diagnosed with a cervical
    spine (neck) condition?
    [X] Yes [ ] No

    Cervical Spine Common Diagnoses:
    [ ] Ankylosing spondylitis
    [X] Cervical strain
    [ ] Degenerative arthritis of the spine
    [ ] Intervertebral disc syndrome
    [ ] Segmental instability
    [ ] Spinal fusion
    [ ] Spinal stenosis
    [ ] Spondylolisthesis
    [ ] Vertebral dislocation
    [ ] Vertebral fracture

    Diagnosis #1: Cervical Strain (Cervicalgia)
    ICD code: 847.0
    Date of diagnosis: 2002-2003

    2. Medical history
    ------------------
    Describe the history (including onset and course) of the Veteran's cervical
    spine (neck) condition (brief summary):
    33 years old USAirforce veteran from 2000 to 2006, is here for a C&P
    evaluation on his neck condition.
    In 2002-2003, he start noticing when he works out his posterior neck
    feels sore. He said he has problems wearing the ballistic helmet. He feels
    localized soreness on the back of his head and also localized sensation of
    soreness over the parietal portion of his head.
    He was referred while in the active service to PT. In 10/25/2004. MRI
    of his neck was carried out which showed very minor disc bulge C5-C6 and
    C6-C7 levels, not felt to be of significance. Stretching exercises while
    in
    PT helped. But sit-ups and turning it wrong and bending it a lot seems to
    accentuate the neck soreness. He described his constant low level soreness
    2-3/10. It feels tight most of the time.
    He has upcoming schedule for PT related to the neck but also to his
    complaints of his wholebody pain.


    3. Flare-ups
    ------------
    Does the Veteran report that flare-ups impact the function of the cervical
    spine (neck)?
    [ ] Yes [X] No

    4. Initial range of motion (ROM) measurements
    ---------------------------------------------
    a. Select where forward flexion ends (normal endpoint is 45 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 or greater

    b. Select where extension ends (normal endpoint is 45 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 or greater

    c. Select where right lateral flexion ends (normal endpoint is 45 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 or greater

    d. Select where left lateral flexion ends (normal endpoint is 45 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 or greater

    e. Select where right lateral rotation ends (normal endpoint is 80 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [X] 70 [ ] 75 [ ] 80 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 or greater

    f. Select where left lateral rotation ends (normal endpoint is 80 degrees):
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [ ] 70 [ ] 75 [X] 80 or greater

    Select where objective evidence of painful motion begins:
    [X] No objective evidence of painful motion
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 or greater

    g. If ROM does not conform to the normal range of motion identified above
    but
    is normal for this Veteran (for reasons other than a cervical spine
    (neck)
    condition, such as age, body habitus, neurologic disease), explain:
    No response provided.

    5. ROM measurements after repetitive use testing
    -------------------------------------------------
    a. Is the Veteran able to perform repetitive-use testing with 3 repetitions?
    [X] Yes [ ] No

    b. Select where post-test forward flexion ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

    c. Select where post-test extension ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 or greater

    d. Select where post-test right lateral flexion ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 or greater

    e. Select where post-test left lateral flexion ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
    [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

    f. Select where post-test right lateral rotation ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [X] 70 [ ] 75 [ ] 80 or greater

    g. Select where post-test left lateral rotation ends:
    [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
    [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
    [ ] 60 [ ] 65 [ ] 70 [X] 75 [ ] 80 or greater

    6. Functional loss and additional limitation in ROM
    ---------------------------------------------------
    a. Does the Veteran have additional limitation in ROM of the cervical spine
    &

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