C&p Exam Today On 4 Year Old Appeal!

[JayBrown1]

I had my C&P exam for a 4 year old appeal today on my joints. The doctor gave me severe on all questions

pertaining to my knees. I am still puzzled on how they will rate this because I had two surgeries on my knee

in the past two years. Are they going to look at my condition in it's present state or are they going to look at

the fact that my condition was so bad that I needed surgery?

I am confused.

[vmo]

I'm s/c for both knee's. They look at lateral instability, arthritis, pain, torn meniscus(not just torn but flaps ,clicks, or separated), excessive or restrictive fore and aft movement(ligament damage). An MRI and xrays showing any or all of the above sure helps.

[JayBrown1]

My left knee is fused in a straight position with no bend and my right knee has been replaced and my range of motion in my right knee is only 40 degrees. My right knee is deformed as stated by the doctor and my left knee is twice the size of my right.

[JamesBreckenridge]

Knees can have a separate evaluation for limitation of extension (in degrees) under diagnostic code 5261, limitation of flexion under DC 5260, and lateral instability (mild, moderate or severe) under DC 5257. If a veteran doesn't have lateral instability and their limitation of motion is not enough for the minimum compensable rating, the fallback is to see if there's ANY joint pathology AND painful motion, in which case you can service connect the knee at 10 percent under 38 CFR 4.59, and you give the criteria for the next higher evaluations for 20% under 5260, 5261, and 5257 so that the veteran will know how much worse his knee will have to be to qualify for the next higher evaluation.

If I were presented with two service connected knees, left knee frozen (ankylosed) at full extension and right knee with range of motion limited from 0 to 40 degrees (normal flexion is 0 to 140 degrees) and moderate instability, I would rate it like this:

Left Knee: (intro about when we got your claim) (something about what your service treatment records show, and other stuff to show service connection) On thus and such date at VAMC Wherever you were examined. The examiner noted that your left knee was fully ankylosed at full extension of 0 degrees. Service connection has been established for your left knee. An evaluation of 30 percent is assigned effective (probably date of claim). A higher evaluation of 40 percent is not warranted unless the knee is ankylosed to a more unfavorable angle between 10 and 20 degrees.

Right Knee: (intro) (STRs) (VA medical exam) The examiner noted that you had flexion from 0 to 40 degrees. Normal is 0 to 140. Service connection has been established for your right knee. An evaluation of 10 percent is assigned for flexion less than than or equal to 45 degrees but greater than 30 degrees. A higher evaluation of 20 percent is not warranted unless flexion is limited from 0 to 30 degrees or less. The examiner found your right knee to be moderately unstable. A seperate evaluation of 20 percent is assigned for moderate instability or subluxation of the right knee. A higher evaluation of 30 percent is not warranted unless the instability/subluxation is severe.

I wouldn't address limitation of flexion/extension/instability in your left knee since it's frozen, and I wouldn't address limitation of extension on your right knee because you can in fact extend it all the way out (although you're extending it from 40 to 0 degrees instead of from 140 to 0 degrees).

That's how I'd do it, anyway. Of course, I don't have the file with the service treatment records and the VAMC records and the C&P exam in front of me. The 4 year old appeal is going to muddy the waters a little bit. Why has it been on appeal this long? What was the first decision? What was the evidence we had then, versus what is it now? In any case, I'm only going to consider what the medical evidence says your knees are like right now. Maybe they were better in the past, maybe they were worse, but how am I supposed to know without good medical evidence? As far as I'm concerned, you're claiming a chronic knee problem, your records show a chronic knee problem, I ask a doctor how bad the problem is right now (and in some cases if I'm not sure I ask the doctor to tell me if the problem is chronic and/or related to service with a medical opinion), and I use what the doctor tells me to assign an evaluation from the rating schedule.

In your case, if your effective date is prior to your surgeries, I would infer claims for 100 percent temporary convalescense for your surgery(ies?), and give you 6 months or so of temp 100 percent, and then drop you back down to whatever 30+20+10 is. 50 percent if I'm doing the calculation right. Your rating specialist may not infer those claims for temp 100 percent for convalescence. Which means you will have to.

Did that make any sense?

[Pete53]

James:

Thanks for your reply and welcome to Hadit.

[JamesBreckenridge]

Ah, hell, I knew I forgot something. Knee replacements is worth a minimum of 30 percent, and that's after one year of temp 100 percent for convalescence, under diagnostic code 5055.