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Post C&p Exam, What To Expect?


TideWarrior

Question

First time on here so hoping to get some idea what will happen and what to expect.

July 2011 I was seen at the VA(Asheville NC) for my right knee and was issued a brace to wear and since I was moving was told once I have seen my PCP that they could schedule an ortho appt..August 2011 I applied for a claim for right knee. Nov 2011 I added an addendum to the claim for artrits. All this via a VSO. In Dec 2011 I had xray and MRI done on the right knee. All ordered by my PCP and next was scheduled for an Ortho appt in Jan. They did an exam that basically ended up being like the C&P exam and also agreed with the findings of arthritis in the knee. In Feb. they started a regiment that every 6 months I will get an injection to help lubricate the knee.

Now when I submitted the claim I submitted my SMR records that showed the injuries and treatment on my right knee while stationed at Okinawa and Camp Pendleton. I also included private medical records for the two knee surgeries in 1997 and 2000, that were to repair torn meniscus. On those records the doctor in 1997 said their is evidence of a prior tear that had healed. Also submitted photos from both surgeries.

At the end of March I received a letter from the VA regarding my claim. It said a decision, dated March 2 2012,

... We determined that the following condition was not related to your military service, so service connection could't be granted....

Denial reason no link could be found.

Explanation

We received your medical evidence which discusses the symptoms of your medical condition. Service connection for this condition requires a nexus(link) between your current knee condition and your knee injuries while on active duty. A medical opinion from your doctor stating that your current knee disability is at least as likely as not a continuation of the knee problem you experienced while on active duty would provide the required nexus(link between your knee conditionthen and now.

So I called my PCP the next day since he is who I see and told what I needed. Now understand my PCP at the VA was a former C&P examiner and knew exactly what needed to be said short and sweet. The sweet part being:

It is more likely than not that his current condition is directly related to those injuries described.

So the beginning of April I met with my VSO and we resubmitted the claim with the nexus letter. Now the end of May and I am glad the C&P called to let me know that had my C&P the following week. The C&P exam in Durham are held a t the C&P clinic at the Durham VA. Never received a letter about the appt until the day of and after I took the exam. So I go to the exam which last about an hour. I was told that in 3 weeks I could get a copy of the exam in my records and did so today. Here are the results.

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ROM

Flexion right knee 100 and after repetative use 90

Extension right knee 10 and after repetative use 10-(but at the ortho clinic I was limited to 15, so this may have to be something I appeal if not happy because it is the difference of 10 to 20%)

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Functional Loss and Additional limitation in ROM

Do the Veteran have additional limitation in ROM--yes

Does the Veteran have functional loss and/or functional impairment--yes

Right knee less movement than normal and pain on movement

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Does Veteran have tenderness or pain to palpation for joint line or soft tissue--yes

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Muscle strength 4/5 active movement against some resistance on both flexion and extension

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This one concerns me because not sure how this will be used to determine ratings or will it now

Anterior instability(lachman test), Posterior instability test(posterior drawer test), and Medial-lateral instability---all three was unable to perform the test because of pain

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Patellar sublaxion--no

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additional conditions-no

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Meniscal conditions and surgery

Has Vet now have or has had any meniscus(semi-lunar cartilage) condition---yes

If yes indicate

Meniscal tear

Frequent episodes of joint "locking"

Frequent episodes of joint pain

Has Vet had a meniscectomy---yes 1997, 2000

Does Vet have any residual signs and/or symptons due to a meniscectomy---yes

If yes indicate and describe residuals-- weakness and pain

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Joint replacement--no

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Does the patient have scars-yes

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Assistive device

Does the Vet use any assistive device--yes

If yes indicate frequency--constant

ACL/PCL brace issued by the Asheville VA for right knee stability

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Diagnostic testing

Arthrits

Have imaging studies been performed--yes

Is degenerative arthritis documented--yes

MRI was also doen

Impression from MRI

1. Untact ACL

2.Superficial and partial thickness cartilage abnormality of the patellofemoral and medial compartments consistent with early osteoarthritis

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In short for her rationale( I could write the whole thing, but it basically sums up every I have posted and the timeline again)

It would be more likely than not that condition to the right knee is service connected.

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So now my question is how will this get rated assuming I get the right knee service connected.

Looking at the different codes it can be confusing. I have also read they can give seperate ratings for the knee joint specifically.

Arthritis it seems to have some relationship with the actual findings on the knee if rated a % or not. A little unclear here.

5257-Not sure how they will rate this is based on recurrent subluxation or lateral instability and I was unable to perform any of the test and was noted due to pain

5258-Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint(not sure here either but was recorded those 2 in bold but not sure if all need to be there in the findings) understand this rating is 20% if granted

5259-Cartilage, semilunar, removal of, symptomatic- two meniscectomy surgeries-10%

5260- Leg, limitation of flexion of-I understand I would not get a % since I was only at 90 degrees for limitation

5261- Leg, limitation of extension of-10 degrees would be 10% (but in the ortho clinic it was 15 degrees which should be 20% and may be a reason for an appeal on the decision)

So if anyone has an idea of what to expect it would be helpful.

Does it appear I will be granted service connection for the right knee? I do have a nexus letter in supprt of it from my PCP and it appears the C&P examiner also supports my claim. I understand it could still go against me.

If granted what should I expect and how would they rate it? Would their be mutliple ratings or do they take the highest rating among the codes?

Also how will it affect my claim since I was unable, due to pain, to do the stabilibilty test?

How is arthritis calculated, is it seperate or does it up the rating overall?

Also will wearing a brace the ortho clinic at the VA issued, will it factor in the determination process?

Again thanks for any help with this and apologize for the long post but I figured the more I posted the better I can be helped. If you need anymore info just let me know.

Semper Fi

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Welcome,

From what you've posted my guess is SC at 20 percent with perhaps

an additional 10 percent for the surgical scar but only if the scar is problematic

like malnourished, painful, keloid formations, etc...

Also - please update your profile to show what your current SC'd evaluation

(percentage level) is.

Thanks

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First thing you should do, today, is apply for the clothing allowance, which is awarded in late Aug or Sept. You missed last yrs payment, already. Although it's only about $600+/-, it helps. I believe you go thru the prostheses clinic and don't let them talk you out of it. Make the application no matter what they "tell" you!!!

I think the max for a knee is 40% (?) so that's the most you'll get for the knee, if that. Now, if the knee causes other problems, you could get something for that. Remember, the VA uses the combined ratings table (CRT), so it's not just added to you current percentage.

pr

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I have a 30% rating. Both knees arthritis, patellar syndrome in the right and varicose veins in right leg. My guess is you would get 30% and 30% gets you health care.To my surprise I found out last week optometry is covered, also.

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