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What % For Knee C&p Exam Do You Think I Will Get?
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Navy04
I am currently 0% SC for Right Knee. I had 2 knee surgeries while in and will have 1 soon. I never had a C&P for my Knee originally, the VA just granted 0% SC. Below is the exam information. Thanks in advance
Does the Veteran now have or has he/she ever had a knee and/or lower leg
condition?
[X] Yes [ ] No
Diagnosis #1: Patellar tendinosis
Date of diagnosis: 1/2014
Side affected: [ ] Right [ ] Left [X] Both
Diagnosis #2: chondromalacia patella
Date of diagnosis: 1/2014
Side affected: [ ] Right [X] Left [ ] Both
Diagnosis #3: osgood schlatter disease
Date of diagnosis: 4/2012
Side affected: [ ] Right [X] Left [ ] Both
2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's knee
and/or lower leg condition (brief summary):
Veteran is a US Navy veteran that served between 8/2004-2/2013. He was
medically separated for Crohn's disease. He was granted a service
connection for his right knee based on medical documentation showing
he
had two arthroscopic surgeries while on active duty, but a C&P
exam was
never conducted. He also reports having left knee problems while on
active duty, but states he didn't know he could claim any
conditions
that weren't part of his medical board. Review of CPRS and cfile
shows
he had evidence of left knee osgood schlatter disease in April 2012
while he was still on active duty.
Veteran reports having arthroscopic meniscal repairs on his right knee
in 2005 & 2007. He just had bilateral MRIs performed in January
2014 by
Dallas VAMC. Right knee MRI showed evidence of prior arthroscopy, mild
proximal patellar tendinosis, and a small joint effusion. The left
knee
MRI showed mild proximal patellar tendinosis, evidence of old osgood
schlatter disease and chrondromalacia patella. Veteran reports having
pain, stiffness, decreased range of motion that is aggravated by
bending, standing, walking, cold weather. His right knee bothers him
more than the left. He reports his right knee pain is mainly on the
medial aspect and his left knee is more generalized. He states that
when he last saw Dallas VAMC orthopedics, they have recommended
physical therapy and non surgical intervention at this time. Veteran
is
currently unemployed. He reports difficulty in basic movements and
uses
a cane for ambulation most of the time.
3. Flare-ups
------------
Does the Veteran report that flare-ups impact the function of the knee
and/or
lower leg?
[ ] Yes [X] No
4. Initial range of motion (ROM) measurements
---------------------------------------------
a. Right knee flexion
Select where flexion ends (normal endpoint is 140 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[X] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
Select where objective evidence of painful motion begins:
KIEFER, ANTONIO L CONFIDENTIAL Page 8 of 45
[ ] No objective evidence of painful motion
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[X] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[ ] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
b. Right knee extension
Select where extension ends:
[X] 0 or any degree of hyperextension (check this box if there is
no
limitation of extension)
Select where objective evidence of painful motion begins:
[X] No objective evidence of painful motion
c. Left knee flexion
Select where flexion ends (normal endpoint is 140 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[X] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
Select where objective evidence of painful motion begins:
[ ] No objective evidence of painful motion
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[X] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[ ] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
d. Left knee extension
Select where extension ends:
[X] 0 or any degree of hyperextension (check this box if there is
no
limitation of extension)
Select where objective evidence of painful motion begins:
[X] No objective evidence of painful motion
e. If ROM does not conform to the normal range of motion identified above
but
is normal for this Veteran (for reasons other than a knee and/or leg
condition, such as age, body habitus, neurologic disease), explain:
No response provided.
5. ROM measurements after repetitive use testing
------------------------------------------------
a. Is the Veteran able to perform repetitive-use testing with 3 repetitions?
[X] Yes [ ] No
b. Right knee post-test ROM
Select where post-test flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[X] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
Select where post-test extension ends:
[X] 0 or any degree of hyperextension (check this box if there is
no
limitation of extension)
c. Left knee post-test ROM
Select where post-test flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 [ ] 85
[ ] 90 [ ] 95 [ ] 100 [ ] 105 [ ] 110 [ ] 115
[X] 120 [ ] 125 [ ] 130 [ ] 135 [ ] 140 or greater
Select where post-test extension ends:
[X] 0 or any degree of hyperextension (check this box if there is
no
limitation of extension)
6. Functional loss and additional limitation in ROM
---------------------------------------------------
a. Does the Veteran have additional limitation in ROM of the knee and lower
leg following repetitive-use testing?
No response provided.
b. Does the Veteran have any functional loss and/or functional impairment of
the knee and lower leg?
[X] Yes [ ] No
c. If the Veteran has functional loss, functional impairment or additional
limitation of ROM of the knee and lower leg after repetitive use,
indicate
the contributing factors of disability below (check all that apply and
indicate side affected):
[X] Less movement than normal [ ] Right [ ] Left [X] Both
[X] Pain on movement [ ] Right [ ] Left [X] Both
7. Pain (pain on palpation)
---------------------------
Does the Veteran have tenderness or pain to palpation for joint line or soft
tissues of either knee?
[X] Yes [ ] No
If yes, side affected: [ ] Right [ ] Left [X] Both
8. Muscle strength testing
--------------------------
Rate strength according to the following scale:
0/5 No muscle movement
1/5 Palpable or visible muscle contraction, but no joint movement
2/5 Active movement with gravity eliminated
3/5 Active movement against gravity
4/5 Active movement against some resistance
5/5 Normal strength
Knee flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Knee extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
9. Joint stability tests
------------------------
a. Anterior instability (Lachman test):
Right: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
Left: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
b. Posterior instability (Posterior drawer test):
Right: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
Left: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
c. Medial-lateral instability (Apply valgus/varus pressure to knee in
extension and 30 degrees of flexion):
Right: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
Left: [X] Normal [ ] 1+ (0-5 millimeters)
[ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters)
10. Patellar subluxation/dislocation
------------------------------------
Is there evidence or history of recurrent patellar subluxation/dislocation?
[ ] Yes [X] No
11. Additional conditions
-------------------------
Does the Veteran now have or has he or she ever had "shin splints"
(medial
tibial stress syndrome), stress fractures, chronic exertional compartment
syndrome or any other tibial and/or fibular impairment?
[ ] Yes [X] No
12. Meniscal conditions and meniscal surgery
Has the Veteran had any meniscal conditions or surgical procedures for a
meniscal condition?
[X] Yes [ ] No
a. Does the Veteran now have or has he or she ever had a meniscus (semilunar
cartilage) condition?
[X] Yes [ ] No
If yes, indicate severity and frequency of symptoms, and side affected:
[X] Meniscal tear [X] Right [ ] Left [ ] Both
b. Has the Veteran had a meniscectomy?
[X] Yes [ ] No
If yes, indicate side affected: [X] Right [ ] Left [ ] Both
Date of surgery: 2005/2007
c. Does the Veteran have any residual signs and/or symptoms due to a
meniscectomy?
[ ] Yes [X] No
13. Joint replacement and other surgical procedures
---------------------------------------------------
a. Has the Veteran had a total knee joint replacement?
[ ] Yes [X] No
b. Has the Veteran had arthroscopic or other knee surgery not described
above?
[ ] Yes [X] No
c. Does the Veteran have any residual signs and/or symptoms due to
arthroscopic or other knee surgery not described above?
[ ] Yes [X] No
14. Other pertinent physical findings, complications, conditions, signs
and/or symptoms
-----------------------------------------------------------------------
a. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
section above?
[X] Yes [ ] No
If yes, are any of the scars painful and/or unstable, or is the total
area of all related scars greater than 39 square cm (6 square
inches)?
[ ] Yes [X] No
b. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs and/or symptoms related to any
conditions
listed in the Diagnosis section above?
[ ] Yes [X] No
15. Assistive devices
---------------------
a. Does the Veteran use any assistive device(s) as a normal mode of
ocomotion, although occasional locomotion by other methods may be
possible?
[X] Yes [ ] No
If yes, identify assistive device(s) used (check all that apply and
indicate frequency):
Assistive Device: Frequency of use:
----------------- -----------------
[X] Brace(s) [ ] Occasional [X] Regular [ ] Constant
[X] Cane(s) [ ] Occasional [X] Regular [ ] Constant
b. If the Veteran uses any assistive devices, specify the condition and
identify the assistive device used for each condition:
No response provided.
16. Remaining effective function of the extremities
---------------------------------------------------
Due to the Veteran's knee and/or lower leg condition(s), is there
functional impairment of an extremity such that no effective function
remains other than that which would be equally well served by an
amputation with prosthesis? (Functions of the upper extremity include
grasping, manipulation, etc., while functions for the lower extremity
include balance and propulsion, etc.)
[X]no
17. Diagnostic testing
----------------------
a. Have imaging studies of the knee been performed and are the results
available?
[X] Yes [ ] No
If yes, is degenerative or traumatic arthritis documented?
[ ] Yes [X] No
b. Does the Veteran have x-ray evidence of patellar subluxation?
[ ] Yes [X] No
c. Are there any other significant diagnostic test findings and/or results?
[X] Yes [ ] No
If yes, provide type of test or procedure, date and results (brief
summary):
xam Date/Time
01/03/2014 12:03
Procedure Name
MRI KNEE(RIGHT) W/O CONTRAST
Clinical History
knee injuries while in military - has had multiple knee surgeries
on the
right side.
Impression
1. Evidence of prior arthroscopy.
2. Mild proximal patellar tendinosis.
3. Small joint effusion.
Report
MRI right knee
History: Chronic knee pain. Remote prior injuries and knee
surgery.
Technique: Axial and coronal fat-suppressed proton-density
weighted images
were acquired through the knee as well as coronal T1-weighted
images.
Sagittal proton-density, fat-suppressed T2, and gradient echo T2*
weighted
images were also obtained.
Findings:
Medial compartment: The meniscus and the medial collateral
ligament are
intact. No focal articular cartilage defect is identified.
Lateral compartment: The meniscus and the components of the
lateral
collateral ligamentous complex are intact. No focal articular
cartilage
defect is identified. The proximal tibiofibular articulation is
intact and
unremarkable.
Intercondylar Notch: The anterior and posterior cruciate ligaments
are
intact. A small amount of scarring is seen in the infrapatellar
fat from
prior arthroscopy.
Patellofemoral compartment: The quadriceps and patellar tendons
are intact.
Mild thickening and abnormal signal in the proximal patellar
tendon suggests
tendinosis. There is no significant patellar tilt or subluxation.
No focal
articular cartilage defect is identified. A small joint effusion
is present.
Facility: NORTH
Exam Date/Time
01/03/2014 12:03
Procedure Name
MRI KNEE(LEFT) W/O CONTRAST
Clinical History
knee injuries while in military - has had multiple knee surgeries
on the
right side.
Impression
1. Mild proximal patellar tendinosis. Evidence of old
Osgood-Schlatter
disease.
2. Chondromalacia along the median ridge of the patella.
Report
MRI left knee
History: Chronic knee pain with recent fall
Technique: Axial and coronal fat-suppressed proton-density
weighted images
were acquired through the knee as well as coronal T1-weighted
images.
Sagittal proton-density, fat-suppressed T2, and gradient echo T2*
weighted
images were also obtained
18. Functional impact
---------------------
Does the Veteran's knee and/or lower leg condition(s) impact his or her
ability to work?
[X] Yes [ ] No
If yes, describe the impact of each of the Veteran's knee and/or
lower
leg conditions providing one or more examples:
Veteran's bilateral knee conditions would prevent him from
high
impact activities, prolonged standing or walking
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