My Exam Today

[tec]

i think went like crap, but then maybe not..

I had a lot of conditions, this was a local subcontracted dr....nice guy but very quick. only time he touched me was reflex hammer test and drawers which naturally was negative.

He did note subluxation in the right knee, and put 20 deg and 10 deg loss of extension on the left and right knee. I asked him at the end and told him to get 40 percent on left knee i needed 30 degrees or more loss....which when I extended it for him had to be at least -40, but he eyeballs these things and put 20...finally he agreed and did change the 20 to 30 and the 10 in the right to 15 which will be 40 percent in left and 20 in right for ROM. I just hope he does not rechange it later. I don't think so..but if he does we will appeal based on the fact that a goniometer was not used. I have fibro and when he touched me most of the time I jumped..he said i was very sensitive to pain. CFS was the last thing and he kind of got frustrated and said he could not diagnose CFS, what were my symptoms, and I told him, he felt lymph nodes and moved on..no idea what he put...

don't know what he put on ROM of hips, ankles, wrists, lumbar and neck but I know that they did not go all the way, so if he eyeballed them i may be appealing because no use of the meter. He also knew that I was guarding on the ROM and told me so..I know where the pain gets bad and so on. So I don't know what he will do. He mentioned at the end that he would prob put a note that I should see a specialist(s) as it was hard for him to diagnose my conditions due to his lack of expertise in areas and my sensitivity to pain....

Any ideas what will happen then? He did agree and I watched him change the ROM on the knees, so maybe VA will look at his eval first.

Would I have the opportunity to see and accept VA's rating based on whatever he did, and decline a specialists if the rating was what we wanted? Or would they force me to a specialist? I mean he put the measurements all down and has my paperwork I filled out for him...maybe va will go with that? any thoughts? thanks..t

[Pete53]

Don't know the answer but looks to me like you helped yourself. Did you request a copy?

Good Luck

[tec]

thanks..no did not ask for a copy....figured i was pushing it talking him into an extra 10 degrees...and when he said that they send him a letter that he is not allowed to discuss the numbers and ROM's with the patient, i figured it best not to push the issue.

But for having 10 or 11 things he went thru it fast...

Just what he said at the end bugged me about him saying that it was hard to impossible for him to diagnose all of the things...

but surely he will finish his form and send it in instead of sending a note saying he could not evaluate anything, to find someone else or a specialist

also he was frustrated because with fibro everytime he touched me i flinched and it was hard for him to tell diff between the actual joint pain and the fibro...fibro is not service connected, that may hurt...but i am hoping to get it connected to the traumatic injury originally to the knees and when they were to do arthroscopic surg on one i had an allergic reaction and almost died.

...t

but him giving me the 10 may have been guilt too, I asked him when i first went in how i can prove to va that I have bilateral knee instability and he did not know and asked why..i told him when i saw him 3 years ago that they took it away from me, and i was wondering if the drawers test was the only way they judged....he did not know but apologized all the way thru the exam saying he hoped he did not put anything down to get it taken away...t

Edited November 1, 2005 by tec

[Wings]

i think went like crap, but then maybe not..

I had a lot of conditions, this was a local subcontracted dr....nice guy but very quick. only time he touched me was reflex hammer test and drawers which naturally was negative.

He did note subluxation in the right knee, and put 20 deg and 10 deg loss of extension on the left and right knee. I asked him at the end and told him to get 40 percent on left knee i needed 30 degrees or more loss....which when I extended it for him had to be at least -40, but he eyeballs these things and put 20...finally he agreed and did change the 20 to 30 and the 10 in the right to 15 which will be 40 percent in left and 20 in right for ROM. I just hope he does not rechange it later. I don't think so..but if he does we will appeal based on the fact that a goniometer was not used. I have fibro and when he touched me most of the time I jumped..he said i was very sensitive to pain. CFS was the last thing and he kind of got frustrated and said he could not diagnose CFS, what were my symptoms, and I told him, he felt lymph nodes and moved on..no idea what he put...

don't know what he put on ROM of hips, ankles, wrists, lumbar and neck but I know that they did not go all the way, so if he eyeballed them i may be appealing because no use of the meter. He also knew that I was guarding on the ROM and told me so..I know where the pain gets bad and so on. So I don't know what he will do. He mentioned at the end that he would prob put a note that I should see a specialist(s) as it was hard for him to diagnose my conditions due to his lack of expertise in areas and my sensitivity to pain....

Any ideas what will happen then? He did agree and I watched him change the ROM on the knees, so maybe VA will look at his eval first.

Would I have the opportunity to see and accept VA's rating based on whatever he did, and decline a specialists if the rating was what we wanted? Or would they force me to a specialist? I mean he put the measurements all down and has my paperwork I filled out for him...maybe va will go with that? any thoughts? thanks..t

§4.45 The joints.

As regards the joints the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations:

(a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.).

(B) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.).

© Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.).

(d) Excess fatigability.

(e) Incoordination, impaired ability to execute skilled movements smoothly.

(f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

Edited November 2, 2005 by Wings