Shadow2b

Mine jumped back to Prep for Decision today. I am curious to see what claim date they use, since they originally closed my claim when I got called back up for deployment last year and I had to reopen it when I came back, which was over a year later. I don't have any lofty expectations on my claim and am very sure I am gonna get lowballed lol. I didn't use a VSO because I had nothing but issues with them (nothing against VSO's whatsoever, it was mainly just the ones where I live). I submitted everything my self via Ebenefits. I haven't even been getting my 20 percent because restarting that payment was considered a type of claim, and they are going to resolve that and my other one at the same time.

THanks georgiapapa, I appreciate it...I am trying...I am not happy unless I have something to obsess over

My ebenefits jumped back to gathering of evidence last Friday. I called Peggy to see what was going on, but they gave me the usual "we can't speculate what happened", but they said they didn't see that anything else was needed from me. I am hoping maybe someone is just reviewing it before they send it out. I knew that quick jump last week was too good to be true.

It certainly seems that way. I don't know why else I would need another C&P since I got them already. Medic,Did they send you back for a second C&P for the same issues? That seems crazy. I am trying to be optimistic and hope maybe it is getting a last look. It was a massive D%^ktease that it did all this movement in a week just to come to a grinding halt. My RO is Oakland, which has a ginormus backlog, another reason I was surprised at the movement.

LAst Thursday, my eBenefits status changed three times. I had my C&P exam two weeks ago (at which point my claim was at Gathering of Evidence), and my results were received and updated in ebenefits a few days after. Last week on Monday, my status changed to Review Of Evidence, then on Wednesday to Prep for Decision, then Pending Decision approval on Thursday with a completion date of 12/10/14 to 3/25/15., At the end of the day I checked again and it had gone back to Gathering of Evidence with an expected completion date of sometime in 2016. Is it normal for this to happen? Especially since depending on the rating I may be getting a fairly large retro check? I checked all the letters on ebennies and didn't see any updates. A little further info:I am already rated 20 percent, which I haven't received in almost 2 years, since the VA has not restarted my payments since I got back from deployment with the guard a year ago. I originally filed this claim in January of 2012, but it was also closed when I deployed and I had to reopen it when I got back.(Last November) I had four claims, PTSD(open), Hearing Loss, Knee Sprain(increase) and Achillies Tendonitis. I have had all of my C&P's, and submitted every single possible piece of evidence I could think of. SO I am not sure what else they would need to gather. Any thoughts or opinions would be much appreciated

I also recently had a C&P for PTSD, hearing, ankle and knee problems (Last week) and my claim in ebenefits is already at pending decision approval, which suprised the hell out of me, especially since my regional office is Oakland, which has a huge backlog.I dont want ot give them too much credit, especially since it has been over two years since my claim was filed, they closed my original because i got deployed for 6 months, and then havent even given me my original 20 percent checks since i returned last Nov. I can say that at my hearing test they did a revaluation for tinnitus as part of the hearing C&P. From what i have seen it is pretty hard to get a rating for hearing.

Thanks US Vet, I appreciate it. I will say that the examiner did a terrible job on the report. There are a lot of mistakes, and he left a lot of info from my treatment records out. I will definitely post my results when I get them.

I recently had a C&P exam for achillies tendonitis, and as with my over claims, I tired to research a possible outcome, but to no avail. I was hoping someone could give me their opinion on what a possible rating would be. I figure 10 if I am lucky but 0 percent is just as well. Date/Time: 30 Sep 2014 @ 0900 Note Title: C&P Examination 16255J Date/Time Signed: 30 Sep 2014 @ 0946 Note Ankle 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: CPRS 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 had an ankle condition? [X] Yes [ ] No If yes, provide only diagnoses that pertain to ankle condition(s): Diagnosis #1: Left Achilles sprain ICD code: 848.9 Date of diagnosis: 8-2008 Side affected: [ ] Right [X] Left [ ] Both Diagnosis #2: Chronic Achilles tendinitis ICD code: 726.71 Date of diagnosis: 2014 Side affected: [ ] Right [X] Left [ ] Both 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's ankle condition (brief summary): Veteran is a 35 year old male with multiple periods of active duty in the Army: 8-12-1997 to 4-13-2001 8-16-2008 to 9-02-2009 8-01-2010 to 2-17-2012 5-03-2013 to 12-23-2013 Claimed condition: left Achilles tendonitis The veteran is claiming his current left Achilles tendonitis was incurred in or caused by the rupture, Achilles tendon, left treated on 7/25/2008 (see tabbed STR in VBMS). Opinion Requested #2: Direct service connection Is the veteran's current left Achilles tendonitis at least as likely as not (50 percent or greater probability) incurred in or caused by the rupture, Achilles tendon, left treated on 7/25/2008? Rationale must be provided in the appropriate section below. Your review is not limited to the evidence identified on this request form, or tabbed in the claims folder. If an examination or additional testing is required, obtain them prior to rendering your opinion. Veteran submitted a statement in support of his claim, as follows: "My previous claim for Achilles tendinitis was denied because I did not submit proof that it was service connected. I now have an LOD statement, but didn't receive it until after my claim was denied. I am currently having issues with my Achilles tendon, and am seeking treatment at the Mather VA. It was affecting me running and doing prolonged physical exercise, which as a member of the national guard, I am required to do in order to pass our physical fitness tests. This injury seriously affects my ability to do my job in the Guard as I am an infantryman and we are required to run/road march long distances." Veteran had an original enlistment exam on 7-16-1996. At that time he denied any prior history or arthritis, rheumatism, or bursitis; bone, joint, or deformity; lameness; "trick" or locked knee; or foot trouble. The exam of his lower extremities and feet was reported to be normal and there was no identification of a pre-existing knee or ankle problem. There is a sick leave slip from July 25, 2008 stating the left Achilles tendon is swollen, with a profile and treatment. The note states he has a grade I strain. He was also seen in f/u the next day for the same condition. Enclosed within the STR there is a memorandum dated Feb. 2, 2009, from the Dept. of the Army. Subject: Line of duty investigation for , John: "The enclosed line of duty investigation (LOD) for has been reviewed for completeness and found to have been "In the Line of Duty" for left Achilles tendon. injury occurred on July 22,2008. There is a further "Statement of medical examination and duty status" dated 8-11-2008 stating that the veteran incurred Achilles tendinitis while on active duty. There is a Pre-deployment Health Assessment dated 11-08-2011 in which the Veteran annotated that he had pulled/strained his left Achilles tendon 3 weeks earlier during training. Was on profile for three weeks. Tendon is still slightly sore. The examining clinician noted "Left Achilles strain. treated. No issues". Veteran had an original C&P exam on 10-17-2009 at which time he described his ankle injury as follows: PROBLEM: left achiiles tendon DATE OF ONSET: 8/2008 CIRCUMSTANCES AND INTIIAL MANIFESTATIONS: He was training before going to Iraq and climbing up hills with heavy gear (60-70 pounds of backpack material). He noticed gradually pain on his right achilles tendon and was given rest/light duty due to severity of pain. He still has pain if he goes up inclines and walks alot. Pain is 2-3/10, lasts for 2 days and resolves with rest. Denies any trauma to his achilles tendon. COURSE SINCE ONSET: Stable CURRENT TREATMENTS: None DESCRIPTION OF PAST TREATMENTS: motrin Veteran was seen in orthopedics clinic at Mather on 6-11-2014 as follows: CHIEF COMPLAINT: Pain in left ankle and heel. HISTORY OF PRESENT ILLNESS: This 34-year-old gentleman was referred from Primary Care with complaints of pain in his left ankle. The patient stated that he first noted pain in 2008 just before deployment to Afghanistan. He eventually returned from Afghanistan in November of 2013. The pains kind of waxed and waned over that 5-year period. After he returned from Afghanistan in November of 2013, he had recurrent pain in the left ankle area. He said the pain is a little better now with rest of the ankle. He points to the Achilles tendon as the location for the pain. Primary Care's note here indicates that the patient presented to the Primary Clinic on March 21 stating that he had left posterior ankle pain in the context of running up to 5 miles, 3-4 times a week. Conservative treatment, NSAID, ice, and rest were all recommended to the patient, and to restrict running and jogging activities. However, he was continuing to have significant ankle and heel pain. X-ray of the ankle was normal. He was referred for orthopedic evaluation of the posterior ankle pain. He had not responded to NSAID medication activity modification. There was concern he might have a partial Achilles tendon tear. The patient does say the pain is better now. He works at a civilian job with the State of California. It is a desk job. However, he works out 4-5 days per week doing squats, lunges, box jumping, jumping rope, and a lot of running. Pains tend to wax and wane. Pain localized to the posterior left ankle and heel area around Achilles tendon. No significant radiation of pain. PHYSICAL EXAMINATION: VITAL SIGNS: Height given 5' 6", weight 165 pounds. LEFT ANKLE AND FEET: I had him stand without shoes on. He has a moderate arch and tends to have bilateral calcaneal varus, left more than right. He walks normally without favoring either foot or leg. He can heel and toe-walk okay with both legs. In the seated position, heels do appear to be in slight varus. Shoe wear on his current shoes is normal on the heel. Deep tendon reflexes, knee jerks are 2+ and brisk bilateral. Ankle jerks 2+ and brisk bilateral with about a 2 or 3 beat clonus of both ankles. Ankle dorsiflexion passively right 35 and left 15 degrees. Ankle plantar flexion passive right 60 degrees, left 50 degrees. Left midfoot and forefoot are nontender. Rotation of the midfoot joints is not painful locking the heel bone. With the knee extended, briskly dorsiflexing the ankles, he has about a 2-4 beat clonus, a little worrisome on the left more than the right. Calves are soft and nontender. Further physical examination of the left Achilles tendon shows tenderness in the mid tendon at the musculotendinous junction of the left Achilles. He is nontender distal Achilles at insertion onto calcaneus. I do not feel any nodules in the Achilles tendon. IMPRESSION: 1. Chronic, intermittent, recurring left Achilles tendinitis related to over activity. 2. Possible neurologic chronic issue related to clonus in the ankles. 3. Chronic low back pain DISCUSSION: Using pictures, diagrams, and drawings, I had a long discussion with the patient about nature of Achilles tendinitis. Basically, he has to back off the activity. When the ankle is hurting, go to activities with lower impact such as walking, bicycle, swimming and/or weightlifting. Stretching of the Achilles is a hallmark. Initially, he declined referral to Physical Therapy, but later he decided he would accept Physical Therapy referral for some instruction and education about home exercises that he can do with a recurrent left Achilles tendinitis. I mentioned that he could have arch supports and heel lifts put in his shoes that would elevate the heels and might give him some relief. However, there is a risk that the Achilles tendon would tighten up in that spot also. For now, conservative care. I mentioned an MRI x-ray of the Achilles tendon, but do not think it is necessary at this time. If he is having more trouble in the future, MRI might be appropriate. Patient initially declined, but later accepted referral to Physical therapy. Return to Orthopedics p.r.n. Conservative care for now with limiting impact activity, stretching and strengthening of both Achilles tendons and calf muscles. D: 06/11/2014 /es/ Dale R. Butler, MD Orthopaedic Surgery Signed: 07/02/2014 17:31 Left ankle x-ray normal from 3-27-2014 No history of ankle surgery. The Vet has had recurring left Achilles' tendon problems since 2008; at times he has had minimal symptoms, but generally that is when he is physically inactive. He remains in the National Guard and in that role he continues to train and that seems to aggravate the condition. He says that he has had intermittent pain for the last year. When it is sore the pain level is a 4-5/10. He then limits his mobility. Pain may last 2-3 days at atime. In a month's time he may have pain 2 days in general. Aggravating factors: walking around a lot; doing exercises; any kind of extended activity where he is on his feet and moving a lot; Mitigating factors: ibuprofen; rest. In the mornings when he first awakens, the left ankle feels stiff and sore. 3. Flare-ups ------------ Does the Veteran report that flare-ups impact the function of the ankle? [X] Yes [ ] No If yes, document the Veteran's description of the impact of flare-ups in his or her own words: He says that he has had intermittent pain for the last year. When it is sore the pain level is a 4-5/10. He then limits his mobility. Pain may last 2-3 days at a time. In a month's time he may have pain 2 days in general. Climbing a hill may aggravate the ankle. 4. Initial range of motion (ROM) measurements: ---------------------------------------------- a. Right ankle plantar flexion Plantar flexion ends (normal endpoint is 45 degrees): 45 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater b. Right ankle dorsiflexion (extension) Dorsiflexion (extension) ends (normal endpoint is 20 degrees): 20 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [X] 20 or greater c. Left ankle plantar flexion Plantar flexion ends (normal endpoint is 45 degrees): 45 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater d. Left ankle plantar dorsiflexion (extension) Dorsiflexion (extension) ends (normal endpoint is 20 degrees): 20 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [X] 20 or greater e. If ROM does not conform to the normal range of motion identified above but is normal for this Veteran (for reasons other than an ankle condition, such as age, body habitus, neurologic disease), explain: No response provided. 5. ROM measurements after repetitive use testing ------------------------------------------------ Is the Veteran able to perform repetitive-use testing with 3 repetitions? [X] Yes [ ] No a. Right ankle post-test ROM Post-test plantar flexion ends: 45 Post-test dorsiflexion (extension) ends: 20 b. Left ankle post-test ROM Post-test plantar flexion ends: 45 Post-test dorsiflexion (extension) ends: 20 6. Functional loss and additional limitation in ROM --------------------------------------------------- a. Does the Veteran have additional limitation in ROM of the ankle following repetitive-use testing? [ ] Yes [X] No b. Does the Veteran have any functional loss and/or functional impairment of the ankle? [X] Yes [ ] No c. If the Veteran has functional loss, functional impairment and/or additional limitation of ROM of the ankle after repetitive use, indicate the contributing factors of disability below (check all that apply and indicate side affected): [X] Pain on movement [ ] Right [X] Left [ ] Both 7. Pain (pain on palpation) --------------------------- Does the Veteran have localized tenderness or pain on palpation of joints/soft tissue of either ankle? [ ] Yes [X] No 8. Muscle strength testing -------------------------- 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 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 9. Joint stability ------------------ a. Anterior drawer test Is there laxity compared with opposite side? [ ] Yes [X] No [ ] Unable to test b. Talar tilt test (inversion/eversion stress) Is there laxity compared with opposite side? [ ] Yes [X] No [ ] Unable to test 10. Ankylosis ------------- Does the Veteran have ankylosis of the ankle, subtalar and/or tarsal joint? [ ] Yes [X] No 11. Additional conditions ------------------------- Does the Veteran now have or has he or she ever had "shin splints", stress fractures, Achilles tendonitis, Achilles tendon rupture, malunion of calcaneus (os calcis) or talus (astragalus), or has the Veteran had a talectomy (astragalectomy)? [X] Yes [ ] No If yes, indicate condition and complete the appropriate sections below: [ ] a. "Shin splints" (medial tibial stress syndrome) [ ] b. Stress fracture of the lower extremity [X] c. Achilles tendonitis or Achilles tendon rupture If checked, indicate side affected: [ ] Right [X] Left [ ] Both Describe current symptoms: See medical history. [ ] d. Malunion of calcaneous (os calcis) or talus (astragalus) [ ] e. Talectomy 12. Joint replacement and other surgical procedures ---------------------------------------------------- a. Has the Veteran had a total ankle joint replacement? [ ] Yes [X] No b. Has the Veteran had arthroscopic or other ankle surgery? [ ] Yes [X] No c. Does the Veteran have any residual signs and/or symptoms due to arthroscopic or other ankle surgery? [ ] Yes [X] No 13. Other pertinent physical findings, complications, conditions, signs and/or symptoms ------------------------------------------------------------------------ a. 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 b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the Diagnosis section above? [ ] Yes [X] No 14. 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 15. Remaining effective function of the extremities ---------------------------------------------------- Due to the Veteran's ankle 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 16. Diagnostic Testing ----------------------- a. Have imaging studies of the ankle been performed and are the results available? [X] Yes [ ] No If yes, are there abnormal findings? [ ] Yes [X] No b. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 17. Functional impact ---------------------- Does the Veteran's ankle condition impact his or her ability to work? [ ] Yes [X] No 18. REMARKS ----------- a. Remarks, if any: Right ankle inversion (0-30 degrees): 30 degrees no pain Left ankle inversion (0-30 degrees): 30 degrees no pain Right ankle eversion (0-20 degrees): 20 degrees no pain Left ankle eversion (0-20 degrees): 20 degrees no pain Circumduction right ankle: able to perform Circumduction left ankle: able to perform Additional range of motion after repetitive use: Right ankle inversion (0-30 degrees): 30 degrees Left ankle inversion (0-30 degrees): 30 degrees Right ankle eversion (0-20 degrees): 20 degrees Left ankle eversion (0-20 degrees): 20 degrees Circumduction right ankle: able to perform Circumduction left ankle: able to perform b. Mitchell criteria: Regarding Mitchell v. Shinseki: Pain (but not weakness, fatigability or incoordination) could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. However, it would be mere speculation to express any additional functional limitation in degrees of additional loss of ROM because the veteran was not examined during flare-ups or when the joint was used repeatedly over a period of time. Vet is not having a flare up today. He states that if he were, he would be able to plantar flex and dorsiflex the left ankle at about 50% OF THE RANGE-OF-MOTION THAT HE CAN DO TODAY.

Can someone please help me understand this C&P exam? I tried to research on how the flexion and extension limits affect the rating, but I had a hard time understanding it. I know my ROM is limited after the repetition tests, but I wasn't sure if it was that or something else that were the major contributing factors to the rating. Any help would be much appreciated. Thanks. Knee and Lower Leg Conditions Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [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:CPRS 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 had a knee and/or lower leg condition? [X] Yes [ ] No Diagnosis #1: Left knee sprain (chronic) ICD code: 848.9 Date of diagnosis: 2001 Side affected: [ ] Right [X] Left [ ] Both 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's knee and/or lower leg condition (brief summary): Veteran is a 35 year old male with multiple periods of active duty in the Army: 8-12-1997 to 4-13-2001 8-16-2008 to 9-02-2009 8-01-2010 to 2-17-2012 5-03-2013 to 12-23-2013 The veteran is claiming an increase in his service connected: - Left knee sprain: Currently evaluated as 0% disabling. Veteran had an original enlistment exam on 7-16-1996. At that time he denied any prior history or arthritis, rheumatism, or bursitis; bone, joint, or deformity; lameness; "trick" or locked knee; or foot trouble.The exam of his lower extremities and feet was reported to be normal and there was no identification of a pre-existing knee or ankle problem.The medical history is excerpted from the veteran's C&Pexam on 10-17-2009 as follows: PROBLEM: left knee pain DATE OF ONSET: 2001 CIRCUMSTANCES AND INTIIAL MANIFESTATIONS: Reports pain was noticible particularly when he was in the service getting in/out of vehicles and jumping and placing stress on the knee (ex, running more than 1 mile, standing for porlonged periods of time). Pain has especially gotten worse recently since getting back from Iraq. Pain is 4/10, constant, worsens with activity and improves with rest. Reports he had an episode when he banged his knee on the front of his car. His knee was visibly swollen and the doctor gave him rest, and motrin. This injury worsened his knee pain in the sense that pain went from occuring 1-2 per month to weekly and it took less activity to aggravate the pain. COURSE SINCE ONSET: Progressively worse CURRENT TREATMENTS: None DESCRIPTION OF PAST TREATMENTS: motrin . 　 I did find an entry in the STR consisting of a referral (May 2010) to orthopedics in which the referral note states: "30 year old male 2 months s/p left posterior cruciate ligament reconstruction on limited duty during rehab period. Vet denies that he ever had arthroscopy or knee surgery, on either knee. Left knee x-ray normal on 9-04-2009.　 Vet states that his left knee is sore when he awakens; he hears it "pop" a lot. He tries to exercise regularly (couple times a week) low impact; can't run like he used to as it bothers his knee. He is still in the National Guard. He states that he can run about 2.5 miles before his knee starts to bother him; plus he'll feel it afterwards. Doing squats will aggravate his knee. Aggravating factors: running; squats; stairs; sitting in one position at work, when he gets up it will pop and kind of hurt until he moves around a bit. Mitigating factors: Ibuprofen; elevation. He has intermittent pain in the left knee...2-3 times a month. Especially when he does his drills. Pain level is 4-5/10. The highest has been 8/10 after having been on his feet all day with all his gear on. Pain lasts 1-2 hours. 3. Flare-ups ------------ Does the Veteran report that flare-ups impact the function of the knee and/or lower leg? [X] Yes [ ] No If yes, document the Veteran's description of the impact of flare-up in his or her own words He has intermittent pain in the left knee...2-3 times a month. Especially when he does his drills. Pain level is 4-5/10. The highest has been 8/10 after having been on his feet all day with all his gear on. Pain lasts 1-2 hours. 4. Initial range of motion (ROM) measurements 　 a. Right knee flexion Select where flexion ends (normal endpoint is 140 degrees): [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [X] 135 [ ] 140 or greater Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [X] 135 [ ] 140 or greater b. Right knee extension Select where extension ends: 　 [X] 0 or any degree of hyperextension (check this box if there is no limitation of extension) Select where objective evidence of painful motion begins: [X] No objective evidence of painful motion 　 c. Left knee flexion Select where flexion ends (normal endpoint is 140 degrees): [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 [X] 125 [ ] 130 [ ] 135 [ ] 140 or greater Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 [X] 125 [ ] 130 [ ] 135 [ ] 140 or greater d. Left knee extension Select where extension ends: 　 [X] 0 or any degree of hyperextension (check this box if there is no Select where objective evidence of painful motion begins: [X] No objective evidence of painful motion e. If ROM does not conform to the normal range of motion identified above but is normal for this Veteran (for reasons other than a knee and/or leg 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. Right knee post-test ROM Select where post-test flexion ends: [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [ ] 120 [X] 125 [ ] 130 [ ] 135 [ ] 140 or greater Select where post-test extension ends: 　 [X] 0 or any degree of hyperextension (check this box if there is no limitation of extension) 　 c. Left knee post-test ROM Select where post-test flexion ends: [ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25 [ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55 [ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85 [ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115 [X] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater Select where post-test extension ends: 　 [X] 0 or any degree of hyperextension (check this box if there is no limitation of extension) 　 6. Functional loss and additional limitation in ROM --------------------------------------------------- a. Does the Veteran have additional limitation in ROM of the knee and lower leg following repetitive-use testing? [X] Yes [ ] No b. Does the Veteran have any functional loss and/or functional impairment of the knee and lower leg? 　 [X] Yes [ ] No c. If the Veteran has functional loss, functional impairment or additional limitation of ROM of the knee and lower leg after repetitive use, indicate the contributing factors of disability below (check all that apply and indicate side affected): [X] Less movement than normal [ ] Right [ ] Left [X] Both [X] Pain on movement [ ] Right [X] Left [ ] Both 7. Pain (pain on palpation) --------------------------- Does the Veteran have tenderness or pain to palpation for joint line or soft tissues of either knee? [X] Yes [ ] No If yes, side affected: [ ] Right [ ] Left [X] Both 8. Muscle strength testing -------------------------- 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 Knee flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 9. Joint stability tests ------------------------ a. Anterior instability (Lachman test): Right: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Left: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) b. Posterior instability (Posterior drawer test): Right: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) 　 　 Left: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) c. Medial-lateral instability (Apply valgus/varus pressure to knee in extension and 30 degrees of flexion): Right: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Left: [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) 10. Patellar subluxation/dislocation ------------------------------------ Is there evidence or history of recurrent patellar subluxation/dislocation? [ ] Yes [X] No 11. Additional conditions ------------------------- Does the Veteran now have or has he or she ever had "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment? [ ] Yes [X] No 12. Meniscal conditions and meniscal surgery -------------------------------------------- Has the Veteran had any meniscal conditions or surgical procedures for a meniscal condition? [ ] Yes [X] No 13. Joint replacement and other surgical procedures --------------------------------------------------- a. Has the Veteran had a total knee joint replacement? [ ] Yes [X] No b. Has the Veteran had arthroscopic or other knee surgery not described above? [ ] Yes [X] No c. Does the Veteran have any residual signs and/or symptoms due to arthroscopic or other knee surgery not described above? [ ] Yes [X] No 14. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------- a. 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 b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the Diagnosis section above? [X] Yes [ ] No If yes, describe (brief summary):Minimal patellar crepitance on the left side. Gait is normal 15. 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. 16. 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.) [X] No 17. 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? [ ] Yes [X] No b. Does the Veteran have x-ray evidence of patellar subluxation? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 18. Functional impact --------------------- Does the Veteran's knee and/or lower leg condition(s) impact his or her ability to work? [ ] Yes [X] No 19. Remarks ----------- a. Remarks, if any: No response provided b. Mitchell criteria: Regarding Mitchell v. Shinseki: Pain (but not weakness, fatigability or incoordination) could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. However, it would be mere speculation to express any additional functional limitation in degrees of additional loss of ROM because the veteran was not examined during flare-ups or when the joint was used repeatedly over a period of time.

Thanks Pete...I appreciate all of the information I have gotten from this site and look forward to contributing my own experiences with the VA here.

Good Evening Everyone I have gotten a lot of good info from this forum and was just looking for an opinion of what my rating might be based on my C&P exam from last week. My guess is 30% for sure, but is there any chance of 50?, There are glaring errors in this exam (i didn't fire on the vehicle with women and children in it, the Iraqis did, i just witnessed the event and aftermath, I didn't recieve a CAB, i had a CIB), and a bunch of other details that he didn't transfer correctly from my files. Since i had submitted a stressor statement ato the VA allready, it seems he just reviewed those and only asked me the questions on the DBQ.He clearly didn't review any of my treatment records from the VA. I don't want to bitch to the VA anymore about this being incorrect, since this has take a few years just to get this far, but these errors are mildly irritating. I also have been diagnosed by the VA with depression and anxiety, but from what I understand these are included in this correct? Any help or opinions would be much appreciated. I know it hinges off of the occupational and social impairment, but I wasn't sure if they take all the other factors (treatment, medication, the fact I was turned down from a law enforcement job because I had PTSD in my medical record) Any help or opinion would be greatly appreciated. I am also applying for Achilles tendonitis and knee sprain, but I don't think I will be getting anything for those. 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD ICD code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): none 3. 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 [ ] No [X] Not shown in records reviewed 4. 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 occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation 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 ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. 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 yes, list any records that were reviewed but were not included in the Veteran's VA claims file: 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: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Veteran grew up in the . His father was a welder and his mother was a grocery clerk. Veteran has two sisters, one younger and one older. His parents divorced when veteran was 14. Veteran's father physically and mentally abused veteran, and an uncle sexually abused him. It appears the abuse was reserved for the veteran.Veteran was removed from the home and put him in group and foster homes from ages 12-18. He did not get any treatment for this. In high school veteran's GPA was 3.5. He played soccer for a year. He had buddies and a part-time job. He had 2-3 girlfriends in his junior and senior years. He went to community college from 2005-2008. After his 1997 graduation, veteran went right into the military. His current marriage has lasted 12 years, with a 5-year relationship before. They have 2 children. The family lives in a house veteran and wife are buying. Their income is from veteran's job and his drill check (reserves) every month. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Veteran has been in the National Guard and the Army, 1997-2001 and 2007-present. He was deployed in Iraqnd Afghanistan, with 15 months total in the mid-East. His highest grade was SGT, and this was his rank when honorably discharged. Infantryman was his job. He was awarded the Combat Action Badge (for Afghanistan). He had one Article 15 rank for failing a drug test. "This is what I regret the most." He was busted from E-4 to E-1, but he was repromoted. Veteran has been working since his discharge. His wife doesnt work "Our income barely covers our expenses." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Veteran was treated for insomnia in Iraq, with medication. In 2009 his sleep was getting worse, and he went to the VA for help. He was given buproprion. He had a few appointments but stopped going. He tried to keep things together but in October 2010 "my wife and I almost split up over my anger issues." Veteran was working in the SanDiego area, so he went for help to the Naval Medical Center. He went to marriage couseling without his wife because she could not drive. He thinks this helped "a little bit." He then stopped this because he was deployed to Afghanistan, but he went to the Combat Stress Clinic there. When he came back home, his wife "spotted right away that I was not right, and I decided to go back to the VA. Veteran in now in individual therapy and is getting medication management. He takes sertraline and propanolol, which he finds helpful. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): none e. Relevant Substance abuse history (pre-military, military, and post-military): none f. Other, if any: No response provided. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Veteran has the Combat Action Badge, and combat exposure is conceded. On one occasion veteran was a machine gunner when a small car approached them. Veteran fired some warning shots to get the car to stop, which it eventually did. Veteran could see that there were women and children in the car. The Iraqi Police approached the car. Veteran heard screaming and crying. Veteran was able to see one woman dead and one of the children shot. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No b. Stressor #2: During one of 80 IDF attacks when he was in Afghanistan veteran and a SGT heard and felt a large explosion right in front of them. They ran to get equipment and when they got to the pint of explosion they saw 3 injured service members and 3 severely injured soldiers. One soldier was missing some butt cheek and lower leg. Another female was struck in the face and stomach, screaming for help, and another had many shrapnel wounds. Veteran did what he could to help. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [ ] Yes [X] No 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). [X] Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Suicidal ideation 6. Behavioral Observations -------------------------- Veteran's suicidal ideation is passive. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any