Dro Appeal Denied Ssoc Has A Cue

[les]

I received my ssoc today. I was denied for limited motion of left shoulder secondary to 0% sc of fractured clavicle. What can I do now since there is a obvious cue? My decision states a 0 percent evaluation is assigned unless arm motion is limited at the shoulder level which would warrant a rateing of 20 percent. I was awarded 0% sc for this in 2004. ssoc reasons and bases: The evidence reviewed in connection with your appeal does not demonstrate that a higher evaluation is warranted at this time. VA examination results show range of motion of the left arm as follows: flexion 0 to 180 degrees (normal), adduction 0 to 90 degrees (normal), abduction 0 to 180 degrees (normal), external rotation 0 to 90 degrees (normal), internal rotation 0 to 90 degrees (normal). What this DRO appeals person is stating is the NORMAL MOTION OF AN ARM (not my range of motion)! Does anyone beleive this ingnorance could actually happen after waiting years for a decision! This c&p I had was from 5/15/2007. PHYSICAL EXAMINATION: Using goniometry, I measured mild passive and active range of motion of shoulder, and normal range of motion was measured at 0 degrees with opposition, forward supiatination, and pronation, and they were normal. Shoulder rotation was measured with arm abducted to 90 degrees, able to flex to 90 degrees, and shoulder forward flexion was from 0-180 degrees. veteran has problems at 90 degrees, started having pain at 90 degrees. Shoulder abduction was 0-180 degrees, and veteran had pain again at 90 degrees in the left shoulder. Shoulder external rotation was 0-90 with pain at 60 degrees. Shoulder internal rotation 0-90 degrees, but veteran had pain at 60 degrees. Repetitive range of motion of the shoulder in forward flexation, at least three repetitions were done, and veteran had again problems at forward flexation at 90 degrees and shoulder abduction at 90 degrees. also, external rotation and internal rotation limitation was at 60 degrees where he said that he has pain. He was repeating more than three in all these directions. IMPRESSION: Midshaft deformity of left Clavicle related to prior healed fracture. Addendum The result of MRI from 5/16/07 was reviewed. There is full thickness tear at distal suprospinatous tendon attatchment at humeral head plate. The tear is at least as likely as not related to the clavicle injury in military exercise at 1973. If I am wrong about this appeal decision please tell me. If I am right by thinking there is a CUE please help me as I don't really know how to aproch this. Thanks so much! LES

Edited July 6, 2007 by les

[les]

Thanks everyone for your quick replys to this ssoc of mine. Perhaps this mri interpretation will help. MRI left shoulder without contrast: History: left shoulder pain. Technique: Multiplanar gadolinium arthrogram. There is no prior study for comparison. Findings There is abnormal appearance of the distal supraspinatus tendon at the attachment or footplate on the humeral head. There is no left supraspinatus tendon or muscle retraction.

The reminder of the rotater cuff stuctures appers normal. There are mild degenerative changes at the AC joint without evidence of impingement syndrome. There is a tiny amount of fluid present in the subdeltoid bursa. There is no significant joint effusion.

The biceps tendon is normal in position and appearance. The glenoid labrum appears grossly normal without intra-articular fluid or gadlinium present.

The visualized bone marrow signal and surroundings soft tissue appear unremarkable.

IMPRESSION:

1. Abnormal appearance to the distal supraspinatus tendon at the attachment/footplate on the humeral head suggestive of full thickness tear. No tendon or muscle reaction.

2. Very small amount of subdetoid bursa fluid and fluid adjacent to the distal subraspinatus tendon.

3. No other acute or significant findings.

DD: 05/14/2007 LBS Dictated By: BOYD, JR., MD, Charles

DT: 05/14/2007 15:22 Signed by: BOYD, JR., MD, CHARLES

[les]

Thanks I now understand this decision canot be a cue. However it is still a unmistakeable error. Being the dro only showed the full range of motion of a (normal arm). They did not look at my range of motion from my c&p which stated shoulder forward flexion was from 0-180 degrees veteran has problems at 90 degrees starting having pain at 90 degrees shoulder abduction etc. I never lifted my arm further than when the pain started. I am now wondering if the c&p doctor made a mistake saying I lifted my arm the whole way to 180 degrees which I did not. Now I got to figure this one out. Very confusing!

[Berta]

The BVA cases might help you -ROM confuses me-

This case contains a lot of info on how they measure and determine ROM-

http://www.va.gov/vetapp06/files2/0602150.txt

The veteran was denied on two aspects of her claim as to higher rating-but she did succeed in getting a partial grant of higher rating for a certain period of time.

The one aspect of her claim - all should consider this-

when you pop in "shoulder" at the BVA search -most of the claims are for a right shoulder SC as causing a NSC left should problem or vice versa-

it is an established medical fact that a person with shoulder problems can use their other arm a lot to overcompensate for the disabled shoulder-

many if these claims succeed-

just like knee claims- I have seen many of them- Right knee SC and then VA has to at some point SC as secondary the veterans left knee-

due to aggravating problems and deoendence on the good knee due to the SC one.

As I mentioned in another post-

in situations like the above BVA vet- it pays to get even a "0" SC rating on anything that could potentially raise to the compensable level -as the SC would be established already-

so the VA would only have to consider the medical evidence as to the level of disability and it's association to the SC one.

[Vike17]

Les,

"Being the dro only showed the full range of motion of a (normal arm). They did not look at my range of motion from my c&p which stated shoulder forward flexion was from 0-180 degrees veteran has problems at 90 degrees starting having pain at 90 degrees shoulder abduction etc. I never lifted my arm further than when the pain started. I am now wondering if the c&p doctor made a mistake saying I lifted my arm the whole way to 180 degrees which I did not. Now I got to figure this one out. Very confusing"

If the SOC stated what you posted in your previuos post, such as the actual C&P findings, then the DRO did look at your decreased range of motion. Even if the DRO didn't for some reason take into account your decreased range of motions due to pain ect..., the rating proabably wouldn't have change because these are boderline between a 0% and a 20% evaluation. If you still feel this rating to be incorrect, then simply fill out the VA Form 9 stating why you thing the VA rated you wrong and send it to your regional office. If you do so, MAKE SURE YOU FILE IT WITHIN 60 DAYS OF THE SOC!!!!! Maybe the BVA will be more liberal in their interpretation of your range of motions?

Vike 17