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Someone Explain These In Layman Terms Please


SpcDearman

Question

I am getting ready for another C&P examination (number 3) for my shoulders and am doing a bit of research. I am getting tired of constantly being in pain and want to get this resolved correctly the first time. Can someone explain the following for me please? I am not the dullest pencil in the box but not the sharpest.

(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.

I have multiple tears in my supraspanatis (lol i KNOW i messed that one up) along with a rotator cuff tear and hills sachs deformitiy. I also have a bankhart lession on one shoulder and am attempting to see what type of rating is the minimum and maximum. I have below shoulder level raising of my arms and even that level is painful. Oh, and by the way, all of you Northerners need to take back this cold front. Its killing me. Fifty one degrees in Texas in the Fall. Unheard of.

Ok just this instant my shoulders started spasming. I know why. Stress. I barely made it to work this morning and just figured out that I have both sets of keys. Now to unlock this left knee and miss 1.5 hours of work. hey I can look at it as my rehab time lol.

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let me try and be more specific. This is actually the part that I need explained.

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.

Does this mean that if you have injuries to the shoulder (major) then it gives more clout than say carpaltunel (minor)?

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That whole paragraph relates to ratings for arthritis. Arthritis has ratings for range of motion, but also it can be rated on just having having it in multiple joints. That paragraph clarifies as what counts for a joint. The verbiage in it prevents you from counting two vertabral joints in the same spinal segmant as two joints for rating purposes. Another example would be the xray shows arthritis in two of my metatarsal joints (in same foot). That does not qualify me for a 10% rating, or the 20% rating with occassional incapacitating episodes.

The specific section from the rating schedule is:

5003 Arthritis, degenerative (hypertrophic or osteoarthritis): Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations 20 With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups 10 Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive.

Edited by 71M10 (see edit history)
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i really appreciate this. Now, please consider the below that I added. i have one more question. if i have arthritis and those deformities would they consider this two seperate issues or would this be pyramiding. my problem is not just the arthritis in the shoulder but actually nerve damage that spreads down to my fingers once I "pop (which is probably dislocating) " my shoulders. It actually feels as if something is grinding and catching and thats when thjere is a tingling sensation that radiates to my fingers. i apologize if I am being vague.

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i really appreciate this. Now, please consider the below that I added. i have one more question. if i have arthritis and those deformities would they consider this two seperate issues or would this be pyramiding. my problem is not just the arthritis in the shoulder but actually nerve damage that spreads down to my fingers once I "pop (which is probably dislocating) " my shoulders. It actually feels as if something is grinding and catching and thats when thjere is a tingling sensation that radiates to my fingers. i apologize if I am being vague.

I do apologize but i meant when i pop it there may be a relocating of my shoulder. I cannot even complete a circle with my arms. remember the exercise where you put your hands out parallel to the ground and rotate your arms in small shoulders? I would literally die from pain if I attempted that. Actually, i cannot do it due to my shoulder "locking up" at one point.

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It clearly states in the arthritis ratings section that you cannot get the 10% or 20% arthritis rating for a Joint or group of minor joints and a rating based on range of motion.

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The nuerological deficit is actually a secondary condition, so it will not be pyramiding. However, you will need a diagnosis, and a nexus statement conecting it to your SC injury.

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Great, I am attempting to get my ducks in a row for my C&P exam on the 19th. I figured that this may be why I am going to my 4th C&P exam since filing. the nexus should be no problem due to numerous issues in the Military and me not worrying about extra detail duty if I went on sick call. Even though I caught hell for it then I am glad that I did what I did. If you serach hadit for so confused about my shoulder injury you will see why I am asking so many vague questions. i have copied my MRi results for one shoulder there. I just had to stop typing for about 30 seconds to get my strength back. Imagine having to do that for 7.5 hours each day. Jobs starting to get upset.

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My belief, from personal experience, is that this is an adversarial environment, where your claim will likely be denied without an Independent Medical Opinion by a board certified physician in the relevant field supporting your nexus. Or a VA physician that does so initially (good luck with that).

the benefit of the doubt goes to the veteran but you must counter a negative VA opinion with your own

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  • HadIt.com Elder

A good IMO/IME can turn a claim around and transform a weak claim into a winner. A lot of times the VA will concede service connection but it is the IMO that gets you the highest rating. A good IMO is what can turn a claim that is swinging back and forth on needing the benefit of doubt into no doubt. If I had to depend just on the VA for medical evidence I would be crying.

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While I am a beleiver in IMO/IME's, I do know for many Vets this is not an opition. They just simply can not afford it. However, I do think there is an obvious alternative:

Example:

VA Doc "Smith" says your PTSD is unlikely related to service...that you had another incident he thinks caused it. (That is, Doc smith is "Veteran unfriendly"). Doc"Private Practice" will do a good IMO but he charges $4000 for it and you dont have 4 grand laying around gathering dust. What to do? Contact Doc Smith, and tell him you would like to change docs. In my VAMC, you put in a form and drop it in a box. Why would you really want to be treated by a doc that has interests more important than you, anyway?

So, they change you to another doc. You tell him WHY you changed. Remember, the VA does not like docs who are constantly being avoided by Vets...that means the other docs would have to take all their patients.

The bottom line: If you can not afford a private IMO, look for a VA doc who is Veteran friendly and will provide your nexus. Its just a suggestion.

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This is why I really appreciate Dot advising me to get an IMO. I really do think that I am about to be lowballed. For instance, i had my accident in the military in 1993. I went from Korea to Ft.Hood and had an even worse vehicle rollover in an M2A2 BFV. Now keep in mind that i CONSTANTLY complained about my shoulders hurting after the first and even more after the second. What am I diagnosed with you might ask? I am diagnosed with a freaking strained shoulder muscle. So I continue on with my career thinking such. I ets'd and did not work out nor indulge in any sports activities due to the constant nagging pain. I finally get with VA 15 years later thinking this cannot be a strained shoulder muscle for 15 years. keep in mind that i took about 1200 mg's of Ibuprofen daily to manage the pain. My stomach started hurting around 2010 so I decided to use the Va due to no health insurance. My PCP asked me why i kept rubbing my shoulders and i explained what happened. he advised me to file a claim. all of this is in my medical records. I have an xray and they alledgedly see nothing. I pushed for an MRi and NOW they see what the real issue is multiple tears and a rotator cuff from the second accident. its actually worse than that. I really screwed myself up on the second accident. Now, if they had done the MRI initially when i complained, i would have been medically discharged with benefits. This is why i wish that I could dispute this back to the date of seperation. if the Army had done its due diligence i would not be in the situation that I am in now. Well, I guess if i had insurance i could have started this sooner.

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