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Navy04

What % For Knee C&p Exam Do You Think I Will Get?

Question

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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10% each knee which equals 19% which they will round up to 20%. If they applied the bilateral factor which is an additional 10% it might be 27.1%. Which I believe they may round up to 30. If you had more decrease of ROM then you would have been rated a lot higher. Pain and limited ROM is another diagnosis code which would have given you another and increased rating. My guess is between 20 and 30%.

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Thanks Saints. I am 0%SC for Right Knee, I never submitted for Left Knee, but after this FDC is done, I will submit a New FDC for Left Knee, bilateral effect. Appreciate the help

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I have had 4 different surgeries on both knees with limited ROM and pain. I was only rated 10, 10, 10, 10 then bilateral factor of 10 all that totaled up to 40.9%. I have a claim in for an increase cause I wear bilateral knee braces all day everyday, my ROM and pain unbearable now and its affecting my lower back per ortho.

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Just remember its on your bad days!! Your limited ROM and limited ROM increases your rating. Just FYI.

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I have had 2 knee surgeries, and I am going to have 2 more on both in the next few months. I wear Metal Braces on both knees, and started to use Cane 2 months ago. I will also have back and neck surgery this year, and the Ortho Doc said it is due to my bad knees. I feel for you, just tough for me, because I am 31, and just 2 years ago, I was playing All Navy Football, Softball, and Basketball. Hard for me to accept my body falling apart. Instead of spending 5 years in OIF/OEF, the Navy should have been fixing me. Sorry for the rambling

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