Definition: Moderately Severe Versus Markedly Severe

[imzdo]

Got my latest rating a few months ago with a combined 90% rating (50% right hip replacement; 50% left hip replacement; and 20% right ankle fusion). The question that I have been wrestling with is whether or not to file a NOD on the Hip Replacement ratings (Diag Code 5054) and request an increase to the next higher increment (70% for each hip). The 50 rating is for Moderately Severe limitation of motion and pain and the 70 rating is for Markedly Severe limitation of motion and pain. I can find no where in any of the VA regs where Moderately severe or Markedly severe are defined or compared and would like to know if anyone is aware whether this is an arbitrary decision on the part of a RO in making the decision between Moderately and Markedly Severe.

I have pretty restrictive ROM in both my hips based on the C&P.

Hip ROM ROM Standard My Right Hip My LeftHip Variance %Flexion 0-125 degrees 80 degrees 75 degrees 36 - 40

Extension 0-30 degrees 15 degrees 10 degrees 50 - 67

Adduction 0-25 degrees 20 degrees 20 degrees 20 - 20

Abduction 0-45 degrees 45 degrees 45 degrees 0 - 0

Ext Rotation 0-60 degrees 30 degrees 30 degrees 50 - 50

Int Rotation 0-40 degrees 7 degrees 5 degrees 82.5 – 87.5

And in addition: the C&P Doctor commented "Mr McGinty has increased pain as well as obvious decreased ROM in the hips bilaterally". He also noted that I have difficulty sleeping and requires frequently changing position to deal with pain and discomfort. I also need a dressing stick, sock aid, elastic laces on my shoes and a long handled sponge to take care of my daily grooming. Also, My left hip has dislocated once post-operativerly.

If you have some experience with this type of thing I would welcome your feedback as to whether or not to rock the VA's boat on this as it mean the difference between 90 and 100% rating.

IMZDO

[imzdo]

The C&P ROM testing results are included in the attached word document.

chart.doc

[john999]

Rock the boat! You might need A&A and you need a 100% schedular to get anything. There may be a standard rating for hip replacement, but depending on the outcome you should ask for as much as you can possibly get. Keep appealing. Are you getting TDIU now or are you retired military trying to get concurrent receipt? I take it you are not working?