C@p Results For Right Wrist. Opinions Please

[killemall]

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 wrist condition?
[X] Yes [ ] No

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

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
current
wrist condition(s) (brief summary):
THIS IS A CLAIM FOR ORIGINAL SERVICE CONNECTION FOR:
RIGHT WRIST CONDITION WITH MEDICAL OPINION.

HE REPORTS RIGHT WRIST PAIN OFF AND ON FOR MANY YEARS
SEEN FOR RIGHT WRIST PAIN 12/14/1999 AND LATER ON


DECEMBER 27, 1999 AFTER A FALL.
CHRONIC PAIN 5/10-8/10
HE THINKS DOING LOTS OF PUSH-UPS CAUSED WEAR AND TEAR.
LEFT WRIST IS NOT CURRENTLY PAINFUL
HE HAD MULTIPLE VISITS DURING MILITARY SERVICE COMPLAINING
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 RIGHT WRIST PAIN AND WEAKNESS.
HE USES A RIGHT WRIST BRACE SOMETIMES AND TAKES IBUPROFEN


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

3. Flare-ups
------------
Does the Veteran report that flare-ups impact the function of the wrist?
[X] Yes [ ] No

If yes, document the Veteran's description of the impact of flare-ups
in his or her own words:
CHRONIC PAIN 5/10-8/10


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

Select where palmar flexion ends (endpoint of palmar flexion is 80
degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[X] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 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
[X] 60 [ ] 65 [ ] 70 or greater

b. Right wrist dorsiflexion (extension)

Select where dorsiflexion (extension) ends (endpoint of dorsiflexion
(extension) is 70 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[X] 60 [ ] 65 [ ] 70 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
[X] 60 [ ] 65 [ ] 70 or greater

c. Left wrist palmar flexion

Select where palmar flexion ends (endpoint of palmar flexion is 80
degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [X] 80 or greater

Select where objective evidence of painful motion begins:
[X] No objective evidence of painful motion
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 or greater

d. Left wrist dorsiflexion (extension)

Select where dorsiflexion (extension) ends (endpoint of dorsiflexion
(extension) is 70 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [X] 70 or greater

Select where objective evidence of painful motion begins:
[X] No objective evidence of painful motion
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 or greater

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 wrist post-test ROM

Select where palmar flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[X] 60 [ ] 65 [ ] 70 [ ] 75 [ ] 80 or greater

Select where dorsiflexion (extension) ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[X] 60 [ ] 65 [ ] 70 or greater

c. Left wrist post-test ROM

Select where palmar flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [ ] 75 [X] 80 or greater

Select where dorsiflexion (extension) ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [X] 70 or greater

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

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

c. If the Veteran has functional loss, functional impairment and/or
additional limitation of ROM of the wrist after repetitive use, indicate
the contributing factors of disability below (check all that apply and
indicate side affected):

[X] No functional loss for left upper extremity
[X] Less movement than normal [X] Right [ ] Left [ ] Both
[X] Weakened movement [X] Right [ ] Left [ ] Both
[X] Pain on movement [X] Right [ ] Left [ ] Both

7. Pain (pain on palpation)
---------------------------
Does the Veteran have localized tenderness or pain on palpation of
joints/soft tissue of either wrist?
[ ] 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

Wrist flexion:
Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist extension:
Right: [ ] 5/5 [X] 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 either wrist joint?
[ ] Yes [X] No

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

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

c. Does the Veteran have any residual signs and/or symptoms due to
arthroscopic or other wrist surgery?
[ ] Yes [X] No

11. 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?
[X] Yes [ ] No

If yes, describe (brief summary):
DIMINISHED RIGHT GRIP STRENGTH.


12. Remaining effective function of the extremities
---------------------------------------------------
Due to the Veteran's wrist 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

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

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

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 WRIST MRI: 09/2013
POSSIBLE TINY GANGLION CYST ALONG THE VOLAR ASPECT OF THE DISTAL
RADIUS
POSSIBLE SMALL FULL THICKNESS PERFORATION OF THE SCAPHOLUNATE
LIGAMENT


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

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


15. 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 WRISTS
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.





****************************************************************************


RESTATEMENT OF REQUESTED OPINION:

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

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

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.

[Navy04]

I agree with Georgia on this one bud. Good luck and keep us posted.