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Found 10 results

  1. Has anyone had difficulty in just obtaining simple range of motion (ROM) tests using a goniometer? Practically every physical therapist I have contacted, in my city and neighboring cities, insists on doing a Functional Capacity Exam and Impairment Rating in addition to ROM tests. I already have SSDI and an 80% combined service connect. What's lacking in the evidence VA has considered is measured range of motion tests (with a goniometer), instead of the eye-balling produced by C&P exams, prior physical therapists, neurology and spine specialists. The spine specialist I had seen (in 2018) states measured tests, when in fact he did not ask me to move anything at all. Has anyone encountered difficulties in getting just the range of motion tests? It's like they want to sell me a Cadillac when all I need is scooter. I'm going to pay for this out of pocket, which is another reason I don't want a Functional Capacity Exam and Impairment Rating. Can anyone recommend who or what else does measured ROM tests? I thought physical therapy would be the easiest way to obtain measured ROM tests, short of orthopedics, or spine specialists. I was wrong.
  2. Hello All, I am a 41yr old disabled vet (70%) Degenerative Arthritus of the left Knee 20%Degenerative Arthritus of the Right knee 20%Degenerative Disc Disease of the Lumbar Spine 10%Radiculopathy Right Lower Extremity 10%Radiculopathy Left Lower Extremity 10%Degenerative Tears, Bilateral Knees 20%Tinnitus 10% This exam was scheduled 1 week after my back surgery (Fusion of L4/L5). Hip and Thigh Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) 1. Diagnosis ------------ a. List the claimed condition(s) that pertain to this DBQ: B/L HIP STRAIN DX 9-16 SECONDARY TO LUMBAR SPINE COND. b. Select diagnoses associated with the claimed condition(s) (Check all that apply): c. Comments (if any): No response provided d. Was an opinion requested about this condition (internal VA only)? Yes 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's hip or thigh condition: 16 W/U DX AS ABOVE PAIN STANDING B/L MRI WNL. TX MEDS. b. Does the Veteran report flare-ups of the hip or thigh? [ ] Yes [X] No c. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ (regardless of repetitive use)? [ ] Yes [X] No 3. Range of motion (ROM) and functional limitations --------------------------------------------------- a. Initial range of motion Right hip --------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0-125): 0 to 90 degrees Extension (0-30): 0 to 30 degrees Abduction (0-45): 0 to 45 degrees Adduction (0-25): 0 to 25 degrees Is adduction limited such that the Veteran cannot cross legs? [ ] Yes [X] No External Rotation (0-60): 0 to 60 degrees Internal Rotation (0-40): 0 to 40 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes, (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Flexion Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No Is there objective evidence of crepitus? [ ] Yes [X] No Left hip -------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0-125): 0 to 90 degrees Extension (0-30): 0 to 30 degrees Abduction (0-45): 0 to 45 degrees Adduction (0-25): 0 to 25 degrees Is adduction limited such that the Veteran cannot cross legs? [ ] Yes [X] No External Rotation (0-60): 0 to 60 degrees Internal Rotation (0-40): 0 to 40 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes, (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on examination, which ROM exhibited pain (select all that apply)? Flexion Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [ ] Yes [X] No Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Right hip --------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No Left hip -------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Right hip --------- 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. Left hip -------- 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. d. Flare-ups: Not applicable e. Additional factors contributing to disability Right hip --------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None Left hip -------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None 4. Muscle strength testing -------------------------- a. Muscle strength - rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against so me resistance 5/5 Normal strength Right Hip Rate Strength: Flexion: 5/5 Extension: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Hip Rate Strength: Flexion: 5/5 Extension: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? No response provided c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of the hip. a. Indicate severity of ankylosis and side affected Right side: Left side: [ ] Favorable, in flexion at [ ] Favorable, in flexion at an angle between 20 and an angle between 20 and 40 degrees, and slight 40 degrees, and slight abduction or adduction abduction or adduction [ ] Intermediate, between [ ] Intermediate, between favorable and unfavorable favorable and unfavorable [ ] Unfavorable, extremely [ ] Unfavorable, extremely unfavorable ankylosis, unfavorable ankylosis, foot not reaching ground, foot not reaching ground, crutches needed crutches needed [X] No ankylosis [X] No ankylosis b. Comments, if any: No response provided 6. Additional conditions ------------------------ No response provided 7. Surgical procedures ---------------------- No response provided 8. 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? [ ] Yes [X] No c. Comments, if any: No response provided 9. Assistive devices -------------------- a. Does the Veteran use any assistive devices 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 10. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's hip or thigh conditions, is there functional impairment of an extremity such that no effective functions remain 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 11. Diagnostic testing ---------------------- a. Have imaging studies of the hip or thigh been performed and are the results available? [ ] Yes [X] No b. Are there any other significant diagnostic test findings or results? No response provided c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided 12. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [ ] Yes [X] No 13. Remarks, if any: -------------------- No response provided !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Name of patient/Veteran: PUGH 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) 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: [ ] Ankylosing spondylitis [ ] Lumbosacral strain [ ] Degenerative arthritis of the spine [X] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [ ] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture Diagnosis #1: PO DISC FUSION LUMBAR 2-17 Date of diagnosis: 2-17 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): AS ABOVE, DONE DUE TO R SCIATICA ,DROP R FOOT. b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: PAIN c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words. LESS MOTION 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0 to 90): 0 to 20 degrees Extension (0 to 30): 0 to 10 degrees Right Lateral Flexion (0 to 30): 0 to 10 degrees Left Lateral Flexion (0 to 30): 0 to 10 degrees Right Lateral Rotation (0 to 30): 0 to 20 degrees Left Lateral Rotation (0 to 30): 0 to 20 degrees 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)? Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): LUMBAR PAIN b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [X] No [ ] Unable to say w/o mere speculation d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [X] Yes [ ] No Muscle spasm: [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: 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: 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 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? No response provided. 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: [ ] Normal [X] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [ ] Normal [X] 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 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): Intermittent pain (usually dull) Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Numbness Right lower extremity: [ ] None [X] 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 L4/L5/S1/S2/S3 nerve roots (sciatic nerve) If checked, indicate: [X] Right [ ] Left [ ] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe 9. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- No response provided 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the thoracolumbar spine? [X] Yes [ ] No b. If yes to question 11a above, has the Veteran had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months? [X] Yes [ ] No If yes, select the total duration over the past 12 months: PO SURGERY c. If yes to question 11b above, provide the following documentation that supports the Yes response: [X] Medical history as described by the Veteran only, without documentation: AS ABOVE [ ] Medical history as shown and documented in the Veteran's file: [ ] Other, describe: 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] Brace(s) [ ] Occasional [X] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 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? [ ] 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: NEW DRESSING NOT REMOVED Measurements: length cm X width cm 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? [ ] Yes [X] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? No response provided. c. Are there any other significant diagnostic test findings and/or results? No response provided. 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [ ] Yes [X] No
  3. I recently had a C&P exam (5 Apr 16) for increased compensation. I am currently SC at 50%: 10% patellar Tendonities left knee, 10% limited extension left knee, 10% bursitis - left hip, 10% right knee degenerative joint disease, and 10% bursitis - right hip as of March 2011. I filed for an increase in 2013 and I was denied, but I disagreed with the results via a NOD given the C&P doctor did not do a range of motion test other than 'eyeballing' it when she contorted my knees in such a way, I left there sucking down motrin for six weeks before I kind of recovered, but still live day to day with chronic knee pain and issues. Regardless, from my latest C&P, I read the Dr.'s Notes and I was looking for help interpreting what the numbers mean and speculate approximate C&P increase, if. I've read the ROM information from VA and from http://www.militarydisabilitymadeeasy.com/kneeandleg.html. However, when reading the Dr.'s Notes, the ROM extension values do not line up nicely to the information in these charts. This is where I need help interpreting the results (Boldface - Yellow guess rating). Background: All extension test were conducted from a seated position with my legs at 90 degrees (sitting on exam table). I was only able to extend/lift either leg 10 degrees up or to about 80 -75 degrees given 0 degrees is completely horizontal with the floor. During the exam, I stopped forward motion where the start of pain began (extreme pain) ******Snippet of Dr.'s Notes from C&P 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 140 degrees Extension (140 to 0): 140 to 130 degrees (Diagnostic code 5261? Guessing 50% rating????) If abnormal, does the range of motion itself contribute to functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Extension Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): entire right knee joint, moderate, unclear Is there objective evidence of crepitus? [ ] Yes [X] No Left Knee [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 120 degrees (Diagnostic code 5261? Guessing 50% rating????) If abnormal, does the range of motion itself contribute to functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Extension Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): entire right knee joint, moderate, unclear Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Right Knee Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [X] Yes [ ] No Select all factors that cause this functional loss: Pain, Weakness ROM after three repetitions: Flexion (0 to 140): 0 to 130 degrees Extension (140 to 0): 140 to 120 degrees Left Knee Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [X] Yes [ ] No Select all factors that cause this functional loss: Pain, Weakness ROM after three repetitions: Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 110 degrees c. Repeated use over time Right Knee Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Weakness Able to describe in terms of range of motion: [X] Yes [ ] No Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 120 degrees Left Knee Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Weakness Able to describe in terms of range of motion: [X] Yes [ ] No Flexion (0 to 140): 0 to 140 degrees Extension (140 to 0): 140 to 110 degrees d. Flare-ups No response provided 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: None Left Knee In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None 4. Muscle strength testing a. Muscle strength - Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Right Knee: Rate Strength: Flexion: 5/5 Extension: 4/5 Is there a reduction in muscle strength? [X] Yes [ ] No If yes, is the reduction entirely due to the claimed condition in the Diagnosis Section? [X] Yes [ ] No Left Knee: Rate Strength: Flexion: 5/5 Extension: 3/5 Is there a reduction in muscle strength? [X] Yes [ ] No If yes, is the reduction entirely due to the claimed condition in the Diagnosis Section? [X] Yes [ ] No Thanks! I appreciate translating the ROM values with VA Disability tables.
  4. Good morning! I am working on a lengthy NOD for my initial rating. There are things that appear to me were overlooked or not considered. I hope it's okay if I piece-mail it in this thread for feedback. I'm still working on my opening statement but I broke down each contention below using a format found on this site. :) Here is the first one for my spine, my husband helped me with it. Please let me know what you all think; I've never appealed before so welcome constructive feedback. All medical evidence that I state below will be attached to my NOD. Specifically, I disagree with the ratings for the following: -------------------------------------------------------------------------------------- 1. Thoracolumbar Spine Rating a) WHAT: I disagree with the decision for 20% assigned for my thoracolumbar strain and lumbar degenerative disc disease status post spinal fusion, L5, S1/Spinal cord stimulator implants and laminectomy/Pain syndrome with degenerative changes per X-ray. b) WHY: My medical records and C & P exams reflects forward flexion of the thoracolumbar spine not greater than 30 degrees when factoring in the provisions of 38 CFR 4.40 & 4.45, and as cited in DeLuca v. Brown, 8 Vet. App. 202 (1995). In regards to my medical contention for the spine, forward flexion not greater than 30 degrees is a more accurate picture of my chronic spine condition, also known as DDD, Spinal Fusion, and Pain Syndrome. As stated in my and my husbands support letter to the VA in my original claim, I am not able to bend over and pick up items due to limited motion of my spine. If I drop an item on the floor I am unable to pick it up and will leave the item on the floor until my husband or kids pick it up. My husband has relocated many items in our home so they are within my reach without having to bend forward (i.e. shampoo, soap, utensils, towels, etc). My ability to bend forward has remained extremely limited. When considered as a whole, my disability picture clearly reflects limited flexion as noted in the medical evidence below IAW C.F.R. §4.7. c) Evaluation Seeking/Percentage: 40% in accordance with 38 C.F.R § 4.71a; based upon my range of motion of my thoracolumbar spine not greater than 30 degrees and including/considering my newest MRI which reflects my spine is continuing to deteriorate. d) Medical Evidence: - 12/17/2014: A range of motion was performed at QTC, San Antonio on as requested by the VA. While the examiner initially marked my forward flexion of the thoracolumbar spine at 60 & 40 degrees respectively, he noted additional limited function of my thoracolumbar spine. The examiner stated the following on my Thoracolumbar Spine Conditions Worksheet, section 20 in the remarks section: "There are contributing factors of pain, weakness, fatigability, and/or incoordination and there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. The degree of ROM loss during pain on use or flare-ups is approximately 20 degrees for flexion, 10 degree thorocalumbar extension and all other directions". Forward flexion on this exam was 20 degrees for flexion and the combined ROM for my thoracolumbar spine was 70 degrees combined. Additionally, I’ve had three other range of motion exams and I have included a new MRI completed after my initial claim file date: - 08/19/2011: Range of motion test conducted by Audie L. Murphy VA Clinic in San Antonio Texas was as follows: forward flexion of the thoracolumbar spine is 25 degrees with evidence of painful motion at 20 degrees. Combined range of motion of the thoracolumbar spine not greater than 130 degrees. With painful motion, combined range of motion of the thoracolumbar spine not greater than 80 degrees. This exam noted that I had functional loss and/or impairment of the thoracolumbar spine with the following contributing factors: Less movement than normal, pain on movement, interference with sitting, standing and/or weight bearing. A goniometer was used and repetitive testing was completed during this exam. - 04/01/2011: Range of motion test conducted by Physical Therapy at the 359th Medical Group, Randolph AFB, Texas was as follows: forward flexion of the thoracolumbar spine is 20 degrees and a combined range of motion of the thoracolumbar spine not greater than 270 degrees. A goniometer was used but repetitive testing was not completed during this exam. - 12/03/2009: Range of motion test conducted by Physical Therapy at Wilford Hall Medical Center, Lackland AFB, Texas was as follows: forward flexion of the thoracolumbar spine is 27 degrees and a combined range of motion of the thoracolumbar spine not greater than 130 degrees with evidence of painful motion in each direction. A goniometer was used and repetitive testing was completed during this exam. - 03/25/2014: I had an MRI on 03/25/2014 which was not available when I filed my original claim. The MRI revealed: “L4-5 disk level: Disc is normal in height and signal. Small broad-based posterior disc protrusion with mild bilateral facet arthrosis and ligament flavum hypertrophy which results in mild bilateral subarticular zone narrowing and mild bilateral neuroforaminal narrowing. No significant central canal stenosis. L5-S1 disk level: Disc space height loss status post discectomy and disc spacer placement with mild endplate spondylosis with small posterior projecting osteophytes. No significant posterior disc protrusion. There is a small amount of abnormal tissue circumferentially about the thecal sac at the L5-S1 disc space level with asymmetric increased tissue in the left lateral recess and left neural foramen which results in moderate central canal stenosis. Abnormal tissue in the epidural space at L5-S1 favors granulation tissue, though exam is limited without IV contrast, which extends into the bilateral neural foramen resulting in moderate right and moderate to severe left neuroforaminal stenosis and mass effect on the exiting L5 nerve roots. IMPRESSION: Postoperative changes status post L5-S1 laminectomy and posterior fusion and L5-1 discectomy and disc spacer placement. Abnormal epidural tissue at the L5-S1 level favoring granulation tissue results in moderate canal stenosis at the L5-S1 level and moderate right neuroforaminal narrowing and moderate to severe left lateral recess and neuroforaminal narrowing with mass effect on the exiting L5 nerve roots.”
  5. Hello all. This is my first post but I have been lurking for a while and appreciate all the great advice from this network. I received a copy of my C&P exams and was hoping for opinions on my spine ROM measurements. The examiner indicated my forward flexion ends at 60 degrees with pain at 40 degrees. On the section marked "Is there functional impact of ability to work?" he marked <YES> stating "The impact of the thorocolumbar spine condition on the claimants ability to work is moderate impairment for physical work and mild for sedentary work". In the remarks section he indicated "There are contributing factors of pain, weakness, fatigability, and/or incoordination and there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. The degree of ROM loss during pain on use or flare-ups is approximately 20 degrees for flexion, 10 degree thorocolumbar extension and all other directions". I guess my question is, will examiners read all the remarks on these exams and use the ROM in the remarks section? Or will they use the data in the 'initial range of motion' section? I'm not sure why the doc indicated 20 degree forward flexion in the remarks section but marked it differently on the 'initial range of motion'. I realize I won't know how it's read until I get my final rating but just wanted to see if anyone else has had prior experience with this type of issue. Additional info: I've have three other ROMs (one from the VA and two from the military docs), I submitted with my claim so hopefully those will help my case (they were all under 30 degrees for forward flexion). Thanks :) - Julie
  6. I Finally got a C and P exam for my claims from 2003 which were deferred every since then. my claim was for left hip disorder which while I served I was diagnosed with left and right hip strain. I have a copy of the C and P exam from a month ago. I cant figure out how to understand what all this means. Does the veteran now or has he ever had a hip condition Yes 2003 Diagnosis hip strain side both Does the veteran report flair ups yes ROM Measurements for right side right hip extension 20 right hip external rotation 30 normal end point 45 painful motion begins 30 right hip abduction 25 normal end point 50 right hip adduction 15 ROM left side left hip extension 15 painful motion begins 15 Is adduction limited so veteran can not cross legs yes left leg left hip internal rotation 25 normal ends 45 painful motion begins 25 left hip external rotation 25 normal ends 45 evidence of painful motion begins 25 left hip abduction 25 normal is 50 painful motion begins 25 left hip adduction 15 normal is 25 painful motion begins 15 is the veteran able to perform repetitive test 3 times no because of pain any additional limitation of range of motion of hip following testing yes functional impainment to hip or thigh yes less movement weakend movement painful movement Opinion condition is at least as likely as not due to or a result of service in the army Where do I stand?
  7. Does anyone know if Wrist Ankylosis would change while ROM stayed the same?
  8. 1. Diagnosis: Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? YES If yes, provide only diagnoses that pertain to thoracolumbar spine (back) conditions: Diagnosis #1: Low back strain and degenerative disc disease Date of Diagnosis: UNKNOWN 2. Medical history: The veteran stated during his military service in the Army, he was playing football when he injured his head, low back, and his left shoulder. He was tackled and he was knocked out for about 30 min. He was transferred to the hospital. He said that his first memory was woke up in the field. He had x-rays on his back and his shoulder. Since then, he has been complaining recurrent low back pain due to suspected pinch nerve and osteoarthritis. He has been seen or ER at VAMC because of his back. He also recalled that he had Physical Therapy during his Army time. He also recalled that during his Desert Storm, he was hit in the head but had no LOC. He denies any other accident or trauma, he still having cognitive problem and memory issues. From his left shoulder, he is having pop all the time, some weakness and LOM. He is having a constant 4/10 on pain intensity but its depend on activities. Sometimes is a zero but sometimes is an 8/10. From his lower back, he is having a constant back pain about 4/10 on pain intensity. His worse pain is a 10/10 on pain intensity once a year. He is on Naproxen with fair response. 4. Initial range of motion (ROM) measurement: a. forward flexion ends: 60 Select where objective evidence of painful motion begins: 40 b. Select where extension ends: 15 Select where objective evidence of painful motion begins: 10 c. Select here right lateral flexion ends: 20 Select where objective evidence of painful motion begins: 20 d. Select where left lateral flexion ends: 20 Select where objective evidence of painful motion begins: 20 e. Select where right lateral rotation ends: 20 Select where objective evidence of painful motion begins: 20 f. Select where left lateral rotation ends: 30 Select where objective evidence of painful motion begins: <X) No objective evidence of painful motion 5. ROM measurment after repetitive use testing a. Is the Veteran able to perform repetitive-use testing with 3 repetitions? YES b. post test forward flexion ends: 60 c. post test extension ends: 15 d. post test right lateral flexion ends: 20 e. post test left lateral flexion ends: 20 f. post test right latereral rotation ends: 20 g. post test left lateral rotation ends: 30 or greater 6. Functional loss and additional limitation in ROM b. Does the Veteran h ave any funtional loss and/or functional impairment of the thoracolumbar spine (back)? YES c. If the Veteran has a functional loss, functional impairment and/or additional limitations of ROM of the thoracolumbar spine (back) after repetitive use, indicate the contributing factors of disability below: <X> Pain on movement 7. Pain and muscle spasm (pain on palpation, effect of muscle spasm on gait) a. Does the Veteran have localized tenderness or pain to palpation for joints and/or soft tissue of teh thoracolumbar spine (back)? YES If yes, describe: thoracolumbar paraspinal muscle b. Does the Veteran have guarding ofr muscle spasm of the thoracolumbar spine (back)? YES If yes, is it severe enough to result in: <X> Guarding and/or muscle spasm is present, but do not result in abnormal gait or spinal countour 10. Sensory exam Foot/toes (L5): Right and left Decreased 14. Intervertebral disc syndrome (IVDS) and incapacitating episodes a. Does the Veteran have IVDS of the thoracolumbar spine? YES b. If yes, has the veteran had any incapacitating episodes over past 12 months? NO 18. Diagnostic testing a. Have imaging studies of the thoracolumbar spine been performed and are the results available? YES If yes, is arthritis documented? YES c. Are there any other significant diagnostic test findings and/or results? YES If yes, provide type of test or procedure, date and results (brief summary): Report status: Verified Date Reported: Nov 10, 2011 Date Verified: Nov10, 2011 Impression: Frontal and Lateral Lumbar Spine 11/9/2011: No comparison lumbar spine. Preserved lumbar column alignment, vertebral body heights and disc spaces. Multilevel anterior osteophytic lipping. Normal sacroiliac joints. Posterior fusion anomaly at lumbosacral transition. Nonobstructive bowel gas pattern. Indeterminate renal outlines. No opacities to suggest biliary, pancreatic, or urinary tract stones. 19. Function Impact YES, He is on SSDI due to Mental and Physical condition. 20. Remarks, if any: C-File was reviewed. No evidence of back injury during service.
  9. I finally got a copy of my C&P exam and I am trying to interpret the results. I'm hoping to get some help understanding what I'm looking at so any and all feedback is appreciated. The ROM results are as follows; Cervical Spine ROM Flexion: 0 to 30 degrees. Extension: 0 to 39 degrees. Left Lateral Flexion: 0 to 30 degrees. Left Lateral Rotation: 0 to 60 degrees. Right Lateral Flexion: 0 to 30 degrees. Right Lateral Rotation: 0 to 60 degrees. Is there objective evidence of pain on active ROM? No. Additional limitation with repetitive motion; Is there objective evidence of pain following repetitive motion? No. Are there additional limitations after three repetitions of range of motion? No. Thoracolumbar Spine ROM Flexion: 0 to 60 degrees. Extension: 0 to 20 degrees. Left Lateral Flexion: 0 to 20 degrees. Left Lateral Rotation: 0 to 20 degrees. Right Lateral Flexion: 0 to 25 degrees. Right Lateral Rotation: 0 to 20 degrees. Is there objective evidence of pain on active ROM? Yes. Additional limitation with repetitive motion; Is there objective evidence of pain following repetitive motion? Yes. Are there additional limitations after three repetitions of range of motion? Yes. What is the most important factor? Pain. ROM After Repetitive Motion Flexion: 0 to 55 degrees. Extension: 0 to 25 degrees. Left Lateral Flexion: 0 to 15 degrees. Left Lateral Rotation: 0 to 5 degrees. Right Lateral Flexion: 0 to 20 degrees. Right Lateral Rotation: 0 to 5 degrees. Time lost from work during last 12-month period: 8 weeks. Cause: Con leave from back surgery. I didn't type every last word, I just wrote what I think matters. If I missed something or you have a question, please ask. The information regarding my cervical spine seems correct as I haven't had any issues with that part of my back until just recently. I'm getting epidural shots now and may need another surgery but that occurred after the C&P exam. If I'm reading the Thoracolumbar part correct, it seems that I should get a rating of 20% based on the Flexion ROM of 55 degrees or would it be; "Unfavorable ankylosis of the entire thoracolumbar spine......50?" But, since I had spinal fusion of T7-T8, I should get 60% because I missed 8 weeks of work and the VASRD states; "With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months ..... 60" It seems quite confusing to me, I hope someone can clear things up for me...thanks.
  10. I have an examination date for Jan 23, 2012. I am 20% for my Lower back. I recently received an MRI showing that my problem has gotten worse from my last MRI dated December 5, 2007. I know they base their decision on ROM. I should not exceed a foward movement of 30 degrees or more, otherwise, I would stay at 20%. My question is,What other movement, positions, etc, would they have me do in order to make their determination? Your cooperation in helping me with this question is greatly appreciated.
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