armyvet89

Hello folks I hold an 80% rating and I work for the State of Ohio. I have doctor appointment after doctor appointment most for SC conditions some not but I am still fighting those. I am a newer employee to the state and apparently even though you accrue 80 hours of sick time a year the 1st 40 hours are the only hours paid at 100% and then the rest is paid at 70%. This puts me in a real pickle financially. I have to attend these doctor appointments or my health declines dramatically. Working because of my SC issues is getting harder and harder. Do I have to be unemployed to file for IU? I mean I dont necessarily even want to go the IU route because I am the bread winner and insurance provider for my family but if I dont do something then I wont be around for my kids. What other options do I have? Any advice would be appreciated. I know that I have to have at least one of these ratings at 40% and an overall 70 to be eligible so I have an appointment coming up to look at getting my back increased as well as my knees but i have NOT yet filed for IU because I need help and guidance. My VSO is impossible to get ahold of so I lean on you guys for most if not all my help. Thank you for your time. Here are my ratings: Bilaterals: 20% Left knee 20% Lower Radiculopathy Right Leg 20% Lower Radiculopathy left Leg 10% Right knee Others: 30% PTSD 20% Lumbar Strain: 10% Tinnitus

It’s in prep for notification now. My VSO called me and told me I was approved for 30% PTSD. Now I’ll wait on the letter to see their reasoning. I do disagree with the percentage but don’t know if I should NOD or just file for an increase.

Thanks for all of the input and advice. My claim moved to Prep for Decision this morning so it shouldn't be too much longer now. Ill advise what the outcome is when I know.

Gastone- I do not have the SA SC'd but I feel that this was new evidence to support a reconsideration along with some other notes from the doc. I dont know how the doctor missed the paperwork about the CAB. I do have the award letter for it where the ARCOM he refers to is referenced in the award doc. But it did not find its way onto my DD214. I was always told that even tho its not on there as long as i have the supporting documentation i should be fine. Berta- Thank you for the information. It is always a pleasure to get insight from someone as knowledgeable as you, ma'am. I will follow through with you advice. Thank you very much. I just feel like 30% is a low ball and that some of the other things he is referencing in the report would warrant a higher rating despite his selection of the 30% criteria. John- Thanks again friend. Assuming this does get connected I can now go outside the VA to get medical opinions to use for claims for increases correct?

I didn’t intentionally bring this up. When I was in treatment for opioid abuse my parents were phoned and this info was given by them so it’s something I’ve been fighting. So even though this appears to be a favorable exam do you think they still may deny it?

Thanks as always, John. So you think this is likely to be 30% as well?

Thank you Gunny. What’s your thoughts based on? Just the box he checked?

This appears to be a favorable exam but I am confused. I was previously denied for PTSD so I submitted new evidence and also claimed Depressive disorder. I just went to my exam last week and this was the results. The doctor checked the box that would warrant a 30% rating but I definitely feel this is a low ball. My life has not been the same and just keeps declining. He noted in here my suicide attempt and the ideation that still occurs so would that help in the ratings game? I honestly just think that working isnt going to happen much longer. I think IU is in my future but if you could help me understand what the rater may choose I would appreciate it. LOCAL TITLE: C&P MENTAL DISORDER STANDARD TITLE: MENTAL HEALTH C & P EXAMINATION CONSULT DATE OF NOTE: SEP 20, 2017@10:00 ENTRY DATE: SEP 20, 2017@16:45:06 AUTHOR: RAY,CHRISTOPHER L EXP COSIGNER: URGENCY: STATUS: COMPLETED *** C&P MENTAL DISORDER Has ADDENDA *** Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * SECTION I: ---------- 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: F43.10 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Posttraumatic Stress Disorder ICD code: F43.10 Mental Disorder Diagnosis #2: Other Specified Depressive Disorder ICD code: F32.89 Mental Disorder Diagnosis #3: Unspecified Attention-Deficit/Hyperactivity Disorder ICD code: F90.9 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Knee pain, sleep apnea, diabetes. 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [ ] Yes [X] No [ ] Not applicable (N/A) If no, provide reason that it is not possible to differentiate what portion of each symptom is attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Some symptoms, such as his insomnia, irritability, trouble concentrating,and social withdrawal characterize both PTSD and Other Specified Depressive Disorder. His concentration deficits also characterize ADHD. It is difficult to differentiate what portion of each symptom is attributable to each diagnosis without resorting to speculation. 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 [X] No [ ] No other mental disorder has been diagnosed If no, provide reason that it is not possible to differentiate what portion of the indicated level of occupational and social impairment is attributable to each diagnosis: It is difficult to determine to what extent his three conditions are impacting his social and occupational functioning. This is because of shared symptoms. 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 ------------------ Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS Evidence Comments: The veteran was referred for a compensation and pension examination. The veteran was informed of the nature and purpose of the examination and confidentiality limits. He was also informed of the risks and benefits of the current examination. He was provided with a chance to ask questions about the evaluation procedures. He voiced an adequate understanding of the evaluation procedures. He was informed that this examiner is not his treating clinician or the legal determiner of compensation or pension. Instead, he was informed that this examiner is an independent provider of clinical information and expertise to assist those who review and make legal compensation and pension claim decisions and would not be participating in his healthcare. The veteran indicated understanding of these terms and explicitly and freely consented to the evaluation. He was also notified that judgments of symptoms and opinions in this evaluation report are offered to a reasonable degree of professional certainty and are only based upon the information available at the time of the evaluation. He was notified that a copy of the C&P mental disorder evaluation report would be provided to the Veterans Benefits Administration (VBA) and that a copy can be requested through VBA or through the Release of Information Department at the Columbus VA. The psychological evaluation consisted of a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, JLV records, a clinical interview, and the veteran's assessment results. On 6/1/17 the veteran had an initial evaluation of residuals of TBI with Dr. Lin. Although the veteran had difficulty with concentration, memory, and comprehension, these issues were not due to a TBI but attributable to other causes. Multiple records showed no evidence of TBI. The veteran's CPRS records indicate that he has received mental health treatment at the Columbus VA since 12/6/10. The veteran's most recent meeting with Dr. Haraburda, a VA psychologist, was on 10/28/16. The veteran was upset about a C&P exam when he was not diagnosed with PTSD due to overreporting. The veteran said he was interested in couples counseling. The veteran was diagnosed PTSD and Alcohol Abuse. The veteran's most recent psychiatric appointment was with Dr. Churchill, a VA psychiatrist, on 8/17/17. The veteran was diagnosed with ADHD, Combined Type, PTSD, Chronic and Major Depressive Disorder, Recurrent. The veteran indicated that his mood was low and his anxiety was always high. He was psychiatrically hospitalized at the VA in 2012 for 3 days and received substance abuse treatment as well as vocational rehabilitation. Theveteran indicated having problems with depression after returning from Iraq inlate 2010. He said he had been on multiple medications and once made a suicide attempt in January 2012. On 9/1/17 the veteran met with Dr. Nigl, a VA neuropsychologist. Dr. Nigl had previously assessed the veteran in 2011 at which time no significant primary cerebral dysfunction was detected although some ADHD symptoms were endorsed consistent with the veteran's developmental history. Dr. Nigl indicated that even though there was no evidence of primary brain dysfunction, ADHD was not ruled out. Dr. Nigl told the veteran that one or 2 concussions in years past would not be anticipated to lead to permanent brain damage. The veteran was glad to learn that his current concerns were not TBI-related. The veteran stated that his cognitive concerns included forgetting details of conversations, misplacing things, zoning out and needing to write much more down. The veteran was informed that chronic ADHD symptoms are likely being exacerbated by increased depression, PTSD, pain, and sleep that was not optimally controlled by OSA. The veteran's cognitive concerns were more likely than not due to problems with attention and/or encoding. The veteran was diagnosed with PTSD, Depression and ADHD. A statement written by the veteran's wife was reviewed. She indicated that their relationship had been "rocky." Wife noted that the veteran tends to be very jumpy and has trouble going places because he does not want to be around groups of people. She noted that he has not been the same since he went to Iraq. She referenced how he attempted suicide in January 2012 and was psychiatrically hospitalized at the Chillicothe VA. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The veteran stated that he was born and raised in Columbus, Ohio. He indicated he grew up with his parents, who divorced "when I was 10 or 11. I lived with mom and we moved to Newark. My dad stayed on the East side of Columbus." The veteran added, "Both of my parents remarried. My mom and stepdad moved to South Carolina and I stayed 6 months but didn't like it and came back to Ohio to live with my father and stepfmother." The veteran said he has one stepbrother. The veteran did not report being abused or neglected. When asked about his relationship history, the veteran reported,"I married the same woman twice. I got hurt in Iraq and things went downhill. I drank a lot." The veteran stated that he and his wife were married the first time for 2 years, and they have been married the second time for 4 years. According to the veteran, "Ourrelationship is not the greatest. We dated after the divorce and found out we're having our first son. She's left a few times and we argue quite a bit. We have ups and downs." The veteran said he has two children ages 1 and 4. Regarding his social support system, the veteran stated, "My wife is a nurse and says she is supportive of my mental health issues, but she has said I don't have as bad of a case of PTSD as I make it out to be." The veteran added, "I don't really talk to my mom or dad about things." The veteran noted that he keeps up "with some people I went to basic training with on Facebook." When asked about his interests or hobbies, the veteran reported."I used to love to do a lot but don't really do much anymore. I kind of go to school, work, and then go home." b. Relevant Occupational and Educational history (pre-military, military, and post-military): The veteran stated that he graduated from high school. He said that he had a 3.4 GPA. The veteran reported that he did not have any learning disabilities and was never enrolled in special education classes. He said he took Adderall "for about a year. My mom thought I had ADHD (Attention-Deficit/Hyperactivity Disorder) but I stopped taking the medicine on my own and didn't notice a difference." The veteran reported that he attends Park University. He noted, "I seem to have a hard time now understanding and remembering material." He noted, "I failed quite a few classes. I have pretty good grades in some classes. I'm in Voc Rehab right now." Before the military, the veteran stated, "I worked at Golden Corral in Whitehall." The veteran reported that he served in the U.S. Army from January 2008 until January 2014. He stated that his highest rank was E-5. The veteran indicated that his MOS was military police. The veteran reported that he was deployed to Iraq from August 2009-August 2010. He noted that he received the Combat Action Badge among other medals. The veteran's DD-214 contained in his VBMS records indicates that he was awarded the Army Commendation Medal, National Defense Service Medal, Global War on Terrorism Service Medal, Iraq Campaign Medal with Campaign Star, Army Service Ribbon, Overseas Service Ribbon, Armed Forces Reserve Medal with M Device. Notably, there was no mention of the Combat Action Badge. The veteran reported that he had an honorable discharge, which is consistent with his DD-214. Since the veteran left the military, he stated, "I was a police officer from December 2013 until February 2017. Now I work as a criminal investigator. I left the police officer job since I had anxiety and I didn't trust myself carrying a side arm.I have a letter from my old patrol supervisor. She noticed that I had a lot of anxiety and panic attacks." The veteran indicated that his job performance at his current job "is ok but my big problem is my memory. There are things I've left out and forgot in my cases. I have good days and bad days." c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The veteran denied receiving mental health treatment before the military. The veteran reported that while in the military "after my deployment to Iraq I started coming to the VA. I saw Dr. H, and had a break while I was going to the Chillicothe VA. I did the domiciliary and vocational rehab then came back up here. I reconnected with Dr. H up here." The veteran added that he receives psychiatric care with Dr. C. According to the veteran, he is prescribed venlafaxine and nortriptyline hcl. The veteran indicated that his medications are partially helpful in alleviating his mental health symptoms. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): The veteran denied any legal problems before the military. The veteran did not report receiving any Article 15s, non-judicial punishments, infractions or arrests while in the military. The veteran denied receiving any criminal charges since leaving the military. e. Relevant Substance abuse history (pre-military, military, and post-military): Before the military the veteran stated that he tried "pot (marijuana) a few times but that was it." While in the military the veteran did not report consuming illegal drugs. He acknowledged that while in the military he drank alcohol "especially after Iraq. That's when I abused pain meds (Vicodin and Percocet)." After the military the veteran said his use of alcohol has "waxed and waned. I don't know that I've been addicted." The veteran stated, "I have not had a beer in a few weeks." In the past the veteran noted that he has had cravings for alcohol but not recently. The veteran denied any recent negative impact on jobs or relationships. The veteran reported that he has not used opioids since January 2012. f. Other, if any: The veteran reported that he is service connected "for both knees. It shoots into my hips. I also have sleep apnea, diabetes, and high blood pressure." His CPRS records show the following active problems: Code Description 719.46 Knee: arthralgia (ICD-9-CM 719.46) 305.1 Nicotine Dependence (ICD-9-CM 305.1) 836.0 Meniscus Tear, Med (Current) (ICD-9-CM 836.0) V71.09 No Diagnosis or Condition on Axis I (ICD-9-CM V71.09) R52. Pain (SCT 22253000) 110.9 Tinea (ICD-9-CM 110.9) 692.6 Contact dermatitis and other eczema due to plants (except food) (ICD-9-CM 692.6) 309.24 WITH ANXIETY (ICD-9-CM 309.24) Z63.0 Partner relationship problem (SCT 1041000119100) R03.0 Essential hypertension (SCT 59621000) F33.8 Chronic depression (SCT 192080009) F10.10 Alcohol abuse (SCT 15167005) 305.50 Opioid abuse (ICD-9-CM 305.50) F43.12 Chronic post-traumatic stress disorder following military combat (SCT 699241002) His CPRS records show the following active medications: 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: Removed for privacy 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 b. Stressor #2: Removed for privacy 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 c. Stressor #3: Removed for privacy 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 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 Criterion 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 Criterion 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 violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] Intense or prolonged psychological distress at exposure 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 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. 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. 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 [X] Stressor #3 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events 6. Behavioral Observations -------------------------- The veteran was alert and oriented to person, place, the date, time, and situation. The veteran's clothing was appropriate to the situation and weather. He maintained appropriate eye contact. The veteran exhibited acceptable hygiene. His speech was within normal limits with regard to rate, rhythm and volume. He walked with a normal gait. The veteran was cooperative and actively participated in the evaluation procedures. His affect was appropriate to discussion and well-modulated. The veteran described his mood as "down." The veteran endorsed symptoms of depression including sadness, low energy, sleep disturbance, concentration deficits, loss of pleasure, agitation, indecisiveness, and hopelessness. The veteran reported suicidal thinking (without current intent or plan). He noted one past attempt "when I drank a lot and took a lot of Ativan. That was in January 2012." He denied thoughts of harming others. The veteran did not report nor were there clear indications of obsessions, compulsions, or manic symptoms. Regarding the veteran's mental content, his thought processes were linear. The veteran's associations were goal-directed. There were no indications of delusions or hallucinations. Regarding ADLs, he reported that he keeps up with his personal hygiene. The veteran stated that he is able to cook, clean, and complete other basic household chores. The veteran reported that he has a bank account and driver's license. The veteran's judgment in hypothetical situations is intact. The veteran exhibits adequate abstract reasoning and comprehension. The veteran was able to remember events from the past indicating no significant long term memory issues. On a forward digit span task the veteran correctly repeated back 6 digits. The veteran accurately recalled 3 of 3 words after 5 minutes on a brief word learning task. He accurately recalled the months in reverse order. He correctly spelled the word WORLD forwards and backwards. The veteran responded accurately to four basic calculation tasks. Overall there is no obvious evidence of possible short-term memory and/or concentration deficits. The veteran's intellectual functioning appears to be in the average range based upon his educational attainment and vocabulary. DSM-5 ASSESSMENT OF PTSD: I REMOVED THIS PORTION FOR PRIVACY BUT NOTE THAT THE DOCTOR INDICATED THAT I MET ALL CRITERIA NEEDED 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 -------------------------------------------------- Assessment Results: The MMPI-2-RF was administered to measure symptom patterns associated with particular classes of psychopathology. The test includes validity scales to identify unusual test-taking attitudes, including the detection of possible feigning or denial of symptoms. Possible underreporting is indicated in that the veteran presented himself in a positive light by denying some minor faults and shortcomings that most people acknowledge. Inconsistent responding was ruled out. Any absence of elevations on the substantive scales were interpreted with caution as they may underestimate the problems assessed by those scales. The veteran's test scores indicate preoccupation with suicide and death. His test scores suggest that he may have recently attempted suicide. These test results also indicate the presence of helplessness and hopelessness. According to the veteran's test results, he reported feeling anxious. This testing profile suggests the presence of intrusive ideation, anxiety and anxiety-related problems, sleep difficulties, including nightmares and posttraumatic distress. According to the veteran's test results, he reported not enjoying social events and avoiding social situations, including parties and other events where crowds are likely to gather. His test results suggest that the veteran is introverted, has difficulty forming close relationships, and is emotionally restricted. Opinion & Rationale: It is my opinion, with reasonable professional certainty, that it as likely as not (a 50% probability) that his Posttraumatic Stress Disorder resulted from his Iraq trauma stressors. My opinion is based upon my clinical experience and expertise, a review of the veteran's CPRS records, a review of his VBMS/Virtual VA records, the results of a clinical interview, and the veteran's assessment results. The veteran showed no signs of significant exaggeration or feigning of mental disorder symptoms on objective testing. Remote records reviewed by Chillicothe VA staff, however, suggest that the veteran's commanding officer had confronted the veteran because his reported military experiences either did not occur or did not occur to the veteran. Also, during the clinical interview the veteran said he had a Combat Action Badge, which was not located on his DD-214. On the other hand, his VBMS records contain a statement written by battle buddy, who provided information consistent with the veteran's statements about his trauma stressors. Overall, it is beyond the scope of the current evaluation procedures to determine if the veteran's statements concerning his trauma stressors are accurate. Assuming that the veteran's statements about his trauma stressors are true, there appears to be a direct link between his PTSD symptoms and his trauma stressors experienced in Iraq. The veteran's CPRS records suggest that a number of treatment providers have diagnosed him with PTSD. It is my opinion that it is less likely as not (less than a 50% probability) that the veteran's Other Specified Depressive Disorder is proximately due to his physical pain associated with his knees. Although his physical pain likely contributes to some degree to his feelings of depression, there are multiple factors that explain his chronic feelings of sadness. Some of these include his relationship problems with his wife and military trauma stressors. In the past his excessive use of alcohol and drugs have also exacerbated his depressive symptoms. Of note is that the diagnosis of Other Specified Depressive Disorder was chosen because the veteran was vague about the frequency of his depressive symptoms. Concentration deficits were endorsed because even though his mental status did not specifically show concentration issues, information from Dr. N suggests that the veteran's concentration deficits likely are associated with the veteran's mental health concerns, pain, and sleep problems due to obstructive sleep apnea. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:45 09/20/2017 ADDENDUM STATUS: COMPLETED The veteran's C&P exam was completed in CAPRI. /es/ CHRISTOPHER RAY PHD ABPP Psychologist, C&P Signed: 09/20/2017 16:46

Most deferrals happen for lack of evidence or information. I had this happen to me twice. Dont panic if it is documented well in your STR's. They deferred my right knee claim because the doc did everything he was supposed to but forgot to provide a diagnosis. So i waited 34 more days from the day i got my BBE for the doc to write "the regional office is requesting an addendum to the DBQ referencing a required diagnosis. The diagnosis is as follows: Right knee strain". Then the rater thought that there was something in my records that indicated i had an in-service knee injury that would permit direct service connection instead of secondary like i had claimed it. I waited another month to go to a C&P just for the doctor to say that the evidence the rater seen was a typo. I cant make this stuff up man. But dont worry. If it is documented well then you should be fine. There are 2 things that you need to ask yourself at this point tho. 1. Of the deferred contentions, did any of them exist prior to entering service? If so, you have to show and have a doc state that your military service aggravated the progression of those disabilities beyond its natural progression otherwise your claim will be denied. 2. Do you have a VSO? Now may be the time to get one. I have become very knowledgeable from our brothers and sisters here at Hadit and I do my own claims but there is still benefits of using one. For example, once your claim hits the "pending decision approval" stage your VSO can look you up and tell you the tentative decision instead of having to wait until you get the mailed decision, at least AMVETS does. Let me know if you have any other questions.

I called and spoke to Peggy and they said that the only C&P ordered as of now is for TBI. So with that said I have 2 questions. 1. Is this because during the TBI exam they will see if I have PTSD? 2. I have been diagnosed by a VA psychologist since 2011 and it is pretty well documented in my VA treatment records that I have the diagnosis and all that stuff. My stressors should be good to go with my combat action badge and 2 buddy statements to boot. But I had a bad C&P in September of 2016 so I am a little nervous they havent ordered a C&P for that. I also claimed depression secondary to pain and all that too. Just too nervous. When I submitted my PTSD stressor letter for this claim I told them about 2 things that I hadnt sent in for my previous claim. So maybe there is sufficient "new and material" evidence to reopen?

Hello folks! I have recently submitted a claim with the VA to reopen my previously denied PTSD, depression diabetes and sleep apnea secondary to pain, medications, weight gain and depression and TBI and TBI residuals with headaches. I got a call yesterday from VES and I have never heard of them. Anyone have input on them? It looks like the only C&P they ordered was for TBI. Any reason why they wouldn't ask for a C&P for the other claimed conditions? Thanks for any and all help!

Sleep apnea is one tough cookie to get connected if you were not diagnosed in service. I have tried to connect it secondary to PTSD and was denied even after I went for an IMO with a favorable C&P filled out. The darn C&P they sent me to resulted in the doc saying its due to weight gain. Now I am in the process of proving them wrong. The biggest thing I can say in your case is you have to get a doctor that specializes in that field to agree with you and provide written solid medical rationale as to why your OSA is linked to your already service connected TBI. Give the doc something to work with. Tell him that you dont get out of the house because of your TBI. Do the medicines the VA has prescribed cause weight gain, you could link it to that. There are several things that OSA can be linked to but its not likely that a VA c&p doc will link it at a C&P. I recommend going outside and getting a doc to write up the C&P for you. How did your exam go? Favorable I hope...

Jfrei, Glad things are working out for you now and best of luck in the future. What can I expect with the TBI C&P? what all happens and is covered?

Buck52, Now let me ask this, I submitted a claim after I was denied PTSD. Because I was second guessing my treatment team and current diagnosis I claimed depression NOS, anxiety NOS and adjustment disorder because I was diagnosed with all of these in addition to the PTSD. When the VA received my claim they changed it from the disabilities I claimed and reopened my PTSD claim because they said that those are symptoms of PTSD. At the time I did not have any new evidence to submit so they ultimately denied the claim again even though I did NOT intend for PTSD to be reopened. Knowing this, does that change my EED to the current denial of PTSD? The VA has received my claim and yet again reopened it with new evidence so I am assuming I just ride this claim out and if denied I can appeal this decision. Thoughts are appreciated!

Buck52, So if I send in a NOD on the decision what is the process like from there? This is what initiates the appeal correct? So this could take years to complete? What happens next? I am not familiar with the appeal process.

Broncovet- This is where I get very aggravated and confused. I feel that I do have the 3 pillars of service connection. In the records that I have I was 1. Diagnosed with PTSD, anxiety and depressive disorder NOS by a VA psychologist 2. Submitted my award of a Combat Action Badge to verify one of a few inservice event along with 3 buddy statements from guys that were there as well as news articles that it actually happened and 3. In my treatment notes it shows that my doc at the VA diagnosed my PTSD due to events that happened during a combat tour of duty to Iraq. Mind you I had 5 years of treatment and care under this doctore before I even filed for PTSD. So this doc knows me and my situation inside and out and then I met with the VA C&P Doc for 45 minutes and he decides I dont have PTSD and the claim is denied. Heres the tricky part. My VSO said that since I had all 3 pillars all the C&P doc should have done was asses my current occupational and social deficiencies levels for a proper percentage. Now I have not filed an appeal or NOD on it yet because the VSO I was working with has "no call no showed" and they fired him. So I am wanting advice from you folks here because I feel there is more to learn here than sitting down with that VSO. What do I do here? I feel that this was done wrong. I honestly think that trying to connect my head injury to the LOD and opening PTSD up again is a quicker route than an appeal. Maybe I am missing something but I never understood why vets would appeal a decision and wait years on end when you can get N&M evidence to submit to reopen the claim. jfrei- your head injury, is that event what causes or linked your PTSD? I was hit in the head by another soldier during training and I also was involved in several blasts but there is no record of the blasts causing me any sort of headaches or anything other than them just happening. I have been fighting the VA since 2011 and I just got to 60% but that was mostly secondary service connections on back and knees stuff. Thanks for all the help ladies and gents. I feel like I am some what knowledgeable about this sort of stuff but I definitely rely on any and all info and support I can get from you all!

I've always gone to Myhealthyvet via ebenefits and just copied the whole exam and paste it into here. Try that if ya want.

If I had to throw out a WAG Id say 70% likely based on the "occupational & soc impairment with deficiencies in most areas". If you could redact and post your C&P that would help alot of folks out on here. I can tell you that the C&P is just a piece of evidence that the VA will use to decide your claim. You doctors notes and treatment records and everything will come in to play when they go to decide your claim. In my opinion, the C&P is one of the biggest pieces because I was diagnosed with PTSD in 2011 by a VA doc and have been on meds and going thru treatment ever since and when I applied they denied me because the doc that did the exam was a joke. On the other hand I had a buddy diagnosed with anxiety in service retired and applied for comp and the exam was not favorable at all and he still ended up with 30%. So it will depend on more than just the C&P.... Hope this helps!

How did your exam go? I am SC'd for my back as well. I just put in an increase and unless you have favorable or unfavorable ankylosis of the spine its rough to get above 40% assuming you were rated for a lumbosacral strain. I have 20% now and I am trying to increase to 40%. It shouldnt be to hard since its all based on ROM. As far as the IU, I assume its not based solely off of your back. It looks like you have 70% right now...?

Thanks for the quick reply Broncovet. So how exactly is the link between PTSD and TBI established? When I was denied PTSD before (never appealed) the doc acknowledge that I did have a current diagnosis from a VA provider for PTSD and I did have symptoms related to the diagnosis but said that he felt that my drinking was a big part of my MH issues and that I should have 6 months of sobriety before a good decision could be made. Funny thing is that I told the guy that i drank occasionally and that i used to have a drinking problem. There were so many things added to that exam that I never said or did. So I am hoping that this claim comes out more favorable.

Hello all you wonderful folks! I just found some of my service medical records the other day and in it was a LOD from where I suffered a head injury while training. I had (no pun intended) completely forgot about it. I dont feel that there was ever a diagnosis provided but it did knock me out and I was out for quite some time, so I'm told. I dont really remember much after that. I was told that the doc that was seeing me said that I was out for a while ordered bed rest WITHOUT sleep and to follow up the next morning. I did not go to the hospital but I guess she was asking me several questions to which I had inconsistent responses for like what is todays date? President Obama was my response. I still get jabbed about this from my buddies that were there. It took a good day or 2 before I came around to being close to normal. I was also involved in several explosions in iraq (rockets and mortars and a parachute grenade). The parachute grenade hit next to my truck and it knocked my gunner out. We were all pretty stunned. Since all of this I have had some serious issues with MH also headaches/migraines, balance and dizziness problems, tinnitus (SC'ed), blurred vision and a twitch in my left eye that is also documented on the LOD. One of the mortar blasts forced me off the top of the MRAP and I hurt my left knee. When I came back to the states I was put on pain meds most with tylenol in them and when I would complain about headaches it never made its way into my VA records because I was told that its likely do to the high blood pressure and the knee pain. So what I am getting at is that I think I may have covered up some of the headaches with the pain meds I was on and I think this is going to make it look like they arent bad at all when in fact they are. I am not taking the pain meds anymore and this migraine stuff is for the birds. In 2011 I was also diagnosed with PTSD and depression NOS by a VA doc and have continued treatment and medication ever since but last year I was denied PTSD from the RO because my c&p doc was a xxxxxx xxx. The exam doc works for another company on the side where they fight against people going for social security based on MH contentions. I feel like he is completely inadequate at his job and isnt deserving of the position he holds so I wrote the VA and told them about it. So now I have recently submitted a claim for headaches, migraines, TBI, residuals of TBI and PTSD. I feel like if i can get them to SC me for the TBI that it would help with my PTSD claim. What are your thoughts? How should I approach this? What should I prepare for? Since there was never a diagnosis given for the head injury will the VA not provide a TBI diagnosis? Not sure if it matters but I am currently connects for left knee 20%, Right knee 10%, Radiculopalthy right side 10%, lumbosacral strain 20% and tinnitus 10% totaling 60%.

Buck, Sorry for the tardiness of my reply. I have yet to receive a decision yet. During the C&P the doc didnt provide a diagnosis for the right knee. So they just recently (31 January) went back and got one from him of "right knee strain". Over 30 days for that response! This was only part of the claim. They went ahead and finished the rest of it and deferred my right knee. I went from 10% to 50% but if I get at least 10% for my right knee ill bump to 60% overall. I felt that 10% was warranted for the right knee but now we are playing the waiting game with the VA... Thanks for the reply. I hope to hear back soon.

Can someone please help me out here. I asked for an increase on my left knee and claimed right knee secondary to already service connected left knee. This appears to a pretty favorable C&P. I received an award letter saying my left knee was increased to 20% from 0% and my right knee was deferred because the doc didnt provide a diagnosis for it during the C&P. So just this Monday he added an addendum that provided a diagnosis of "Right knee strain". Im just curious as to what percentage I can get from this because if I can at least get 10% it would be enough to round my overall percentage to 60%. From what I've read on here and other cites it looks like I should get 10% for the "slight instability" that he checked under DC 5257. I may be wrong all together. Please, any advice or help will be appreciated! 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 SECONDARY TO LEFT KNEE STATUS POST LEFT MEDIAL MENISCECTOMY AND CHONDROPLASTY, LEFT PATELLOFEMORAL JOINT b. Select diagnoses associated with the claimed condition(s) (Check all that apply): [X] Knee meniscal tear Side affected: [ ] Right [X] Left [ ] Both ICD Code: M23 Date of diagnosis: Left SC [X] Patellofemoral pain syndrome Side affected: [ ] Right [X] Left [ ] Both ICD Code: M22 Date of diagnosis: Left SC c. Comments (if any): No response provided 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): The veteran's claim file was reviewed in VBMS, CPRS, Vista Web, and Vista Imaging. Previous C&P history and physical exam records from 9-21-2016 were reviewed and it was noted that the range of motion testing for the veteran's LEFT knee could not be completed during that C&P exam. The veteran served active duty United States Army from 2008 - 2014. The veteran earned a combat badge while serving on active duty. In January 2010 the veteran sustained an injury to his LEFT KNEE while taking mortar fire during combat while serving in Iraq and this injury is documented in the veteran's STRS as well as prior C&P exams. Ultimately, the veteran was placed on light duty while still serving on active duty several times due to LEFT knee pain and instability. The veteran eventually underwent a second LEFT knee surgery to correct a meniscus tear and also repair arthritic changes (the first LEFT knee surgery occurred prior to the veteran's active duty service). 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: The veteran states he has continued to have pain since the LEFT KNEE injury on active duty occurred. The veteran states he has at least DAILY flare-ups of pain in his LEFT knee which he describes as a "sharp pain" that severely limits his range of motion. The veteran ALSO states he has at least WEEKLY flare-ups of pain in his RIGHT knee which he describes as a "sharp and throbbing pain in two different spots" that limits his range of motion. 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: The veteran states the flare-ups in both his RIGHT and LEFT knee make it difficult to stand for long periods and walking for long distances becomes difficult. 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): 0 to 130 degrees Extension (140 to 0): 130 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: Limited ROM as described above 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): Mild soft tissue tenderness to palpation diffusely over knee joint but no redness or warmth 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): 15 to 110 degrees Extension (140 to 0): 110 to 15 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: Limited ROM as described above 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): Mild soft tissue tenderness to palpation diffusely over knee joint but no redness or warmth 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? [ ] Yes [X] No 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? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran's statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss during repeated use over time as this cannot be objectively quantified. Left Knee --------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran's statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss during repeated use over time as this cannot be objectively quantified. 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: [ ] 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 [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss as this cannot be objectively quantified. 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 [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss as this cannot be objectively quantified. 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: Disturbance of locomotion, Interference with sitting, Interference with standing Left Knee --------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Disturbance of locomotion, Interference with sitting, Interference with standing 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: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] 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: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe b. Is there a history of lateral instability? Right: [ ] None [X] Slight [ ] Moderate [ ] Severe Left: [ ] None [ ] Slight [X] Moderate [ ] Severe c. Is there a history of recurrent effusion? [ ] Yes [X] No 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? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 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) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Left Knee: Was joint stability testing performed? [X] Yes [ ] No [ ] Not indicated Page 45 of 76 [ ] Indicated, but not able to perform If joint stability testing was performed is there joint instability? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 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) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) 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: Left Side: [X] Meniscal tear b. For all checked boxes above, describe: Surgery x 3 for left knee meniscus tears 9. Surgical procedures ---------------------- Indicate any surgical procedures that the Veteran has had performed and provide the additional information as requested (check all that apply): Left Side: [X] Meniscectomy, arthroscopic or other knee surgery not described above Type of surgery: MENISCUS REPAIR Date of surgery: 2011 [X] Residual signs or symptoms due to meniscectomy, arthroscopic or other knee surgery not described above: Describe residuals: Chronic pain with daily flare ups and limitied range of motion 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? [ ] Yes [X] No 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? [X] Yes [ ] No If yes, is there objective evidence that any of these scars are painful, unstable, have a total area equal to or greater than 39 square cm (6 square inches) or are located on the head, face or neck? (An "unstable scar" is one where, for any reason, there is frequent loss of covering of the skin over the scar.) [ ] Yes [X] No If no, provide location and measurements of scar in centimeters. Location: LEFT KNEE POST OP X 3 Measurements: length 1cm X width 0.5cm 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? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Brace(s) [ ] Occasional [X] Regular [ ] Constant [X] Cane(s) [X] Occasional [ ] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: Brace and cane are both used for chronic and pain and flare ups in the veteran's RIGHT and LEFT knee. 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

Sorry all. I previously started a thread but couldnt edit it to include my C&Ps. This claim was for an increase on my Left Knee and Back and Right Knee secondary to my left knee. Anyone care to give a guess at percentages? Im already at 10% for tinnitus and 0% for left knee. Provide description and/or etiology: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss as this cannot be objectively quantified. Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss as this cannot be objectively quantified. Loss of normal lordotic curve Guarding: [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Provide description and/or etiology: Loss of normal lordotic curve f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Disturbance of locomotion, Interference with sitting, Interference with standing 4. Muscle strength testing -------------------------- a. 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 Hip 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 Page 30 of 109 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 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 Great toe 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 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Page 31 of 109 Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [X] Negative [ ] Positive [ ] Unable to perform Left: [X] Negative [ ] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No a. Indicate symptoms' location and severity (check all that apply): Constant pain (may be excruciating at times) Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Numbness Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of L2/L3L/L4 nerve roots (femoral nerve) d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe Left: [X] Not affected [ ] Mild [ ] Moderate [ ] Severe 9. Ankylosis Page 32 of 109 ------------ Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- Does the Veteran have any other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes)? [ ] Yes [X] No 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the thoracolumbar spine? [ ] Yes [X] No 12. 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? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Cane(s) [X] Occasional [ ] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: Cane is used for both knee pain and low back pain 13. Remaining effective function of the extremities --------------------------------------------------- Due to a thoracolumbar spine (back) condition, 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.; functions of the lower extremity include balance and propulsion, etc.) [X] No 14. 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? Page 33 of 109 [ ] Yes [X] No 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 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis documented? [X] Yes [ ] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [X] Yes [ ] No If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples: The veteran states the pain in both his RIGHT and LEFT knees creates a functional limitation of inability to complete his recurrent PT testing that may cause the veteran to lose his employed postion as a police officer at DSCC. 17. Remarks, if any: -------------------- The veteran's claim file was reviewed in VBMS, CPRS, Vista Web, and Vista Imaging. Previous C&P history and physical exam records from 9-21-2016 were reviewed. The veteran served active duty United States Army from 2008 - 2014. The veteran earned a combat badge while serving on active duty. In January 2010 Knee and Lower Leg Conditions Disability Benefits Questionnaire Name of patient/Veteran: 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 SECONDARY TO LEFT KNEE STATUS POST LEFT MEDIAL MENISCECTOMY AND CHONDROPLASTY, LEFT PATELLOFEMORAL JOINT b. Select diagnoses associated with the claimed condition(s) (Check all that apply): [X] Knee meniscal tear Side affected: [ ] Right [X] Left [ ] Both ICD Code: M23 Date of diagnosis: Left SC [X] Patellofemoral pain syndrome Side affected: [ ] Right [X] Left [ ] Both ICD Code: M22 Date of diagnosis: Left SC c. Comments (if any): Page 36 of 109 No response provided 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): The veteran's claim file was reviewed in VBMS, CPRS, Vista Web, and Vista Imaging. Previous C&P history and physical exam records from 9-21-2016 were reviewed and it was noted that the range of motion testing for the veteran's LEFT knee could not be completed during that C&P exam. The veteran served active duty United States Army from 2008 - 2014. The veteran earned a combat badge while serving on active duty. In January 2010 the veteran sustained an injury to his LEFT KNEE while taking mortar fire during combat while serving in Iraq and this injury is documented in the veteran's STRS as well as prior C&P exams. Ultimately, the veteran was placed on light duty while still serving on active duty several times due to LEFT knee pain and instability. The veteran eventually underwent a second LEFT knee surgery to correct a meniscus tear and also repair arthritic changes (the first LEFT knee surgery occurred prior to the veteran's active duty service). 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: The veteran states he has continued to have pain since the LEFT KNEE injury on active duty occurred. The veteran states he has at least DAILY flare-ups of pain in his LEFT knee which he describes as a "sharp pain" that severely limits his range of motion. The veteran ALSO states he has at least WEEKLY flare-ups of pain in his RIGHT knee which he describes as a "sharp and throbbing pain in two different spots" that limits his range of motion. 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 Page 37 of 109 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: The veteran states the flare-ups in both his RIGHT and LEFT knee make it difficult to stand for long periods and walking for long distances becomes difficult. 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): 0 to 130 degrees Extension (140 to 0): 130 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: Limited ROM as described above 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): Mild soft tissue tenderness to palpation diffusely over knee joint but no redness or warmth Is there objective evidence of crepitus? [X] Yes [ ] No Left Knee --------- [ ] All normal Page 38 of 109 [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 15 to 110 degrees Extension (140 to 0): 110 to 15 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: Limited ROM as described above 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): Mild soft tissue tenderness to palpation diffusely over knee joint but no redness or warmth 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? [ ] Yes [X] No 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? Page 39 of 109 [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran's statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss during repeated use over time as this cannot be objectively quantified. Left Knee --------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran's statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent or inconsistent Page 40 of 109 with the Veteran's statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss during repeated use over time as this cannot be objectively quantified. 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: [ ] 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 [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional Page 41 of 109 limitation in terms of additional ROM loss as this cannot be objectively quantified. 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 [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Pain is the functional limitation impacting the veteran's abilities during flare-ups. The exam today WAS NOT DURING A FLARE-UP and the veteran was able to perform repetitive range of motion maneuvers. In summary, it is not practical or feasible to express additional limitation in terms of additional ROM loss as this cannot be objectively quantified. 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: Disturbance of locomotion, Interference with sitting, Interference with standing Left Knee --------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Page 42 of 109 Disturbance of locomotion, Interference with sitting, Interference with standing 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: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] 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: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe b. Is there a history of lateral instability? Right: [ ] None [X] Slight [ ] Moderate [ ] Severe Left: [ ] None [ ] Slight [X] Moderate [ ] Severe c. Is there a history of recurrent effusion? [ ] Yes [X] No 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? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Posterior instability (Posterior drawer test) [X] Normal [ ] 1+ (0-5 millimeters) Page 44 of 109 [ ] 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) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Left 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? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 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) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Page 45 of 109 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: Left Side: [X] Meniscal tear b. For all checked boxes above, describe: Surgery x 3 for left knee meniscus tears 9. Surgical procedures ---------------------- Indicate any surgical procedures that the Veteran has had performed and provide the additional information as requested (check all that apply): Left Side: [X] Meniscectomy, arthroscopic or other knee surgery not described above Type of surgery: MENISCUS REPAIR Date of surgery: 2011 [X] Residual signs or symptoms due to meniscectomy, arthroscopic or other knee surgery not described above: Describe residuals: Chronic pain with daily flare ups and limitied range of motion 10. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ------------------------------------------------------------------------ a. Does the Veteran have any other pertinent physical findings, complications, Page 46 of 109 conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No 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? [X] Yes [ ] No If yes, is there objective evidence that any of these scars are painful, unstable, have a total area equal to or greater than 39 square cm (6 square inches) or are located on the head, face or neck? (An "unstable scar" is one where, for any reason, there is frequent loss of covering of the skin over the scar.) [ ] Yes [X] No If no, provide location and measurements of scar in centimeters. Location: LEFT KNEE POST OP X 3 Measurements: length 1cm X width 0.5cm 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? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Brace(s) [ ] Occasional [X] Regular [ ] Constant [X] Cane(s) [X] Occasional [ ] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: Brace and cane are both used for chronic and pain and flare ups in the veteran's RIGHT and LEFT knee. 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? Page 47 of 109 (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 sorry for the length i couldnt figure out how to shorten it without removing information. Any and all help or guidance is appreciated. Thanks!

Any help would be appreciated