C@p Results For Shoulders. Opinions Please

[killemall]

Shoulder and Arm Conditions
Disability Benefits Questionnaire

Name of patient/Veteran:

Indicate method used to obtain medical information to complete this
document:

[ ] Review of available records (without in-person or video telehealth
examination) using the Acceptable Clinical Evidence (ACE) process
because
the existing medical evidence provided sufficient information on which
to
prepare the DBQ and such an examination will likely provide no
additional
relevant evidence.
[ ] Review of available records in conjunction with a telephone interview
with the Veteran (without in-person or telehealth examination) using the
ACE process because the existing medical evidence supplemented with a
telephone interview provided sufficient information on which to prepare
the DBQ and such an examination would likely provide no additional
relevant evidence.
[ ] Examination via approved video telehealth
[X] In-person examination

Evidence review
---------------
Was the Veteran's VA claims file reviewed?
[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the
Veteran's VA claims file:

REC0RDS PROVIDED BY THE VETERAN AND SUBMITTED WITH THIS REPORT
CPRS/VISTA IMAGING/VISTAWEB

If no, check all records reviewed:

[ ] Military service treatment records
[ ] Military service personnel records
[ ] Military enlistment examination
[ ] Military separation examination
[ ] Military post-deployment questionnaire
[ ] Department of Defense Form 214 Separation Documents
[ ] Veterans Health Administration medical records (VA treatment
records)
[ ] Civilian medical records
[ ] Interviews with collateral witnesses (family and others who have
known the Veteran before and after military service)
[ ] No records were reviewed
[ ] Other:

1. Diagnosis
------------
Does the Veteran now have or has he/she ever had a shoulder and/or arm
condition?
[X] Yes [ ] No

Diagnosis #1: BILATERAL SHOULDER STRAIN
ICD code: 719
Date of diagnosis: 2003
Side affected: [ ] Right [ ] Left [X] Both

Diagnosis #2: ARTHRITIS
ICD code: 710
Date of diagnosis: 2013
Side affected: [X] Right [ ] Left [ ] Both

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
shoulder and/or arm condition (brief summary):
THIS IS A CLAIM FOR ORIGINAL SERVICE CONNECTION FOR:
BILATERAL SHOULDER CONDITIONS WITH MEDICAL OPINION.

HE HAD MULTIPLE VISITS DURING MILITARY SERVICE COMPLAINING
ABOUT BILATERAL SHOULDER PAIN.

HE STATES THAT SINCE EARLY 2000 HE HAS HAD SHOULDER PAIN.
INJURIES NONE BUT HE HAD WEAR AND TEAR DUE TO PUSH-UPS
HE HAS CURRENT PAIN 7-8/10
MEDICINE: MOTRIN
HE WAS SEEN BY ORTHOPEDICS FOR BILATERAL SHOULDER IMPINGEMENT
11/23/2003
THE CONDITION WAS ALSO INCLUDED IN HIS FIRST C&P EXAM IN 2004.
MORE RECENTLY HE HAS SEEN DR NEUDORF, ORTHOPEDIST
DR NAKAMURA AND PHYSICAL THERAPIST REBECCA ELBARE.
DR OKAMURA DIAGNOSED BILATERAL SHOULDER IMPINGEMENT
HE HAD MRI OF RIGHT SHOULDERS AND THE RIGHT WRIST AT PALI MOMI
HOSPITAL
IN SEPTEMBER 2013.
RIGHT SHOULDER MRI: 09/2013
TENDINOSIS OF THE SUPRASPINATUS AND SUBSCAPULARIS
ARTHROSIS OF THE AC JOINT

b. Dominant hand:
[X] Right [ ] Left [ ] Ambidextrous

3. Flare-ups
------------
Does the Veteran report that flare-ups impact the function of the shoulder
and/or arm?
[X] Yes [ ] No

If yes, document the Veteran's description of the impact of flare-ups in
his or her own words:
PAIN 7-8/10
MEDICINE: MOTRIN

4. Initial range of motion (ROM) measurements
---------------------------------------------
a. Right shoulder flexion

Select where flexion ends (normal endpoint is 180 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

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 [ ] 90 [ ] 95 [ ] 100
[ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

b. Right shoulder abduction

Select where abduction ends (normal endpoint is 180 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

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 [ ] 90 [ ] 95 [ ] 100
[ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

c. Left shoulder flexion

Select where flexion ends (normal endpoint is 180 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

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 [ ] 90 [ ] 95 [ ] 100
[ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

d. Left shoulder abduction

Select where abduction ends (normal endpoint is 180 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

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 [ ] 90 [ ] 95 [ ] 100
[ ] 105 [ ] 110 [ ] 115 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

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 shoulder or arm
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 shoulder post-test ROM

Select where 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

Select where abduction 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

c. Left shoulder post-test ROM

Select where 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [ ] 160 [X] 165 [ ] 170
[ ] 175 [ ] 180

Select where abduction 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 [ ] 120 [ ] 125 [ ] 130 [ ] 135
[ ] 140 [ ] 145 [ ] 150 [ ] 155 [X] 160 [ ] 165 [ ] 170
[ ] 175 [ ] 180

6. Functional loss and additional limitation in ROM
---------------------------------------------------
a. Does the Veteran have additional limitation in ROM of the shoulder and
arm
following repetitive-use testing?
[ ] Yes [X] No

b. Does the Veteran have any functional loss and/or functional impairment of
the shoulder and arm?
[X] Yes [ ] No

c. If the Veteran has functional loss, functional impairment and/or
additional limitation of ROM of the shoulder and arm 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] Weakened movement [ ] Right [ ] Left [X] Both
[X] Pain on movement [ ] Right [ ] Left [X] Both

7. Pain (pain on palpation)
---------------------------
a. Does the Veteran have localized tenderness or pain on palpation of
joints/soft tissue/biceps tendon of either shoulder?
[ ] Yes [X] No

b. Does the Veteran have guarding of either shoulder?
[ ] Yes [X] No

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

Shoulder abduction:

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

Shoulder forward 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


9. Ankylosis
------------
Does the Veteran have ankylosis of the glenohumeral articulation (shoulder
joint)?
[ ] Yes [X] No


10. Specific tests for rotator cuff conditions
----------------------------------------------
a. Hawkins' Impingement Test (Forward flex the arm to 90 degrees with the
elbow bent to 90 degrees. Internally rotate arm. Pain on internal
rotation
indicates a positive test; may signify rotator cuff tendinopathy or
tear.)
[X] Positive [ ] Negative [ ] Unable to perform [ ] N/A

If positive, side affected: [ ] Right [ ] Left [X] Both

b. Empty-can test (Abduct arm to 90 degrees and forward flex 30 degrees.
Patient turns thumbs down and resists downward force applied by the
examiner. Weakness indicates a positive test; may indicate rotator cuff
pathology, including supraspinatus tendinopathy or tear.)
[ ] Positive [X] Negative [ ] Unable to perform [ ] N/A

c. External rotation/Infraspinatus strength test (Patient holds arm at side
with elbow flexed 90 degrees. Patient externally rotates against
resistance. Weakness indicates a positive test; may be associated with
infraspinatus tendinopathy or tear.)
[ ] Positive [X] Negative [ ] Unable to perform [ ] N/A

d. Lift-off subscapularis test (Patient internally rotates arm behind lower
back, pushes against examiner's hand. Weakness indicates a positive test;
may indicate subscapularis tendinopathy or tear.)
[X] Positive [ ] Negative [ ] Unable to perform [ ] N/A

If positive, side affected: [X] Right [ ] Left [ ] Both

11. History and specific tests for instability/dislocation/labral pathology
---------------------------------------------------------------------------


a. Is there a history of mechanical symptoms (clicking, catching, etc.)?
[ ] Yes [X] No

b. Is there a history of recurrent dislocation (subluxation) of the
glenohumeral (scapulohumeral) joint?
[ ] Yes [X] No

c. Crank apprehension and relocation test (With patient supine, abduct
patient's arm to 90 degrees and flex elbow 90 degrees. Pain and sense of
instability with further external rotation may indicate shoulder
instability.)
[ ] Positive [X] Negative [ ] Unable to perform [ ] N/A

12. History and specific tests for clavicle, scapula, acromioclavicular (AC)
joint, and sternoclavicular joint conditions
----------------------------------------------------------------------------
a. Does the Veteran have an AC joint condition or any other impairment of
the
clavicle or scapula?
[ ] Yes [X] No

b. Is there tenderness on palpation of the AC joint?
[ ] Yes [X] No

c. Cross-body adduction test (Passively adduct arm across the patient's body
toward the contralateral shoulder. Pain may indicate acromioclavicular
joint pathology.)
[ ] Positive [X] Negative [ ] Unable to perform [ ] N/A

13. Joint replacement and/or other surgical procedures
------------------------------------------------------
a. Has the Veteran had a total shoulder joint replacement?
[ ] Yes [X] No

b. Has the Veteran had arthroscopic or other shoulder surgery?
[ ] Yes [X] No

c. Does the Veteran have any residual signs and/or symptoms due to
arthroscopic or other shoulder surgery?
[ ] 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?
[ ] 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. Remaining effective function of the extremities
---------------------------------------------------
Due to the Veteran's shoulder and/or arm conditions, 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)

[ ] Yes, functioning is so diminished that amputation with prosthesis would
equally serve the Veteran.
[X] No

16. Diagnostic Testing
----------------------
a. Have imaging studies of the shoulder been performed and are the results
available?
[X] Yes [ ] No

If yes, is degenerative or traumatic arthritis documented?
[X] Yes [ ] No

If yes, indicate shoulder: [X] Right [ ] Left [ ] Both

b. 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):
RIGHT SHOULDER MRI: 09/2013
TENDINOSIS OF THE SUPRASPINATUS AND SUBSCAPULARIS
ARTHROSIS OF THE AC JOINT

17. Functional impact
---------------------
Does the Veteran's shoulder condition impact his or her ability to work?
[X] Yes [ ] No

If yes, describe the impact of each of the Veteran's shoulder conditions
providing one or more examples:
MODERATE NEGATIVE EFFECT ON USUAL OCCUPATION AND DAILY ACTIVITIES
DUE TO PAIN AND DECREASED MOBILITY

18. REMARKS
-----------
a. Remarks, if any:
THERE WAS NO FURTHER LIMITATION OR PAIN WITH INITIAL OR REPEATED EFFORTS
WITH REGARD TO LIMITATION IN RANGE OR JOINT FUNCTION FOLLOWING THREE
REPETITIONS, THERE WAS NO ADDITIONAL CHANGE DUE TO PAIN, FATIGUE,
WEAKNESS,
LACK OF ENDURANCE OR INCOORDINATION IN THE SHOULDERS.
THERE WERE NO FURTHER LIMITATIONS AS MEASURED IN DEGREES OF ADDITIONAL
ROM
LOSS
DUE TO PAIN ON REPEATED USE OR DURING FLARE-UPS.



b. Mitchell criteria:
MITCHELL: DOES NOT APPLY:
THERE WERE NO FURTHER LIMITATIONS AS MEASURED IN DEGREES OF ADDITIONAL
ROM LOSS
DUE TO PAIN, WEAKNESS, FATIGABILITY OR INCOORDINATION ON REPEATED USE OR
DURING FLARE-UPS.

MEDICAL OPINION SUMMARY
-----------------------
RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: DOES THIS VETERAN HAVE A BILATERAL SHOULDER
CONDITION DUE TO HIS MILITARY SERVICE ?

b. Indicate type of exam for which opinion has been requested: DBQ SHOULDER

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE
CONNECTION ]

a. The condition claimed was at least as likely as not (50% or greater
probability) incurred in or caused by the claimed in-service injury, event
or
illness.

c. Rationale: THIS CONDITION IS DOCUMENTED IN THE SERVICE TREATMENT RECORDS
AND
IN THE SUBSEQUENT MEDICAL RECORDS FROM VA AND PRIVATE HEALTH CARE.

[georgiapapa]

Only a guess.

R-Shoulder: 10% to 20%

L-Shoulder: 0% to 10%

[killemall]

Im new to this stuff. Can you tell me why you guess ten% or so

[Tampabud]

It looks like a possible 10% to me. Your flexion/abduction results are within +-10% on your right shoulder which is the one that has the identified problems right? I have had shoulder surgery myself, and have severe pain that limits my ability to move my arm altogether. The max rating I could foreseeably receive is 40%. You seem to have decent movement and mobility of your arm, thus the possible 10%.

Since you are right arm dominant, that may be a factor in the rating as well. Does it bother your sleep patterns? My shoulder issues have destroyed my sleep pattern due to pain.

[killemall]

There are months when they kill me everyday to the point that I cant sleep or be comfortable in the movie theater and there are weeks were they bother me very little at all.

I have to sleep with them a certain way thats for sure.

[Tampabud]

I have the same issue with the sleeping and pain, only it is a daily issue. Pain in the butt that is for sure. The shoulder is the only joint in the body that has such massive amount of flexibility and movement... so any tears or issues are devastating.