Was My Exam Just A Dream? - Knee Rom 5260/5261

[K_C]

The Experience: Just had my first C&P on Monday and was able to read the report yesterday. The doctor was polite and seemed genuinely compassionate, but the exam felt hurried. In fact, I was called on my mobile phone fifteen minutes after the exam, by the doctor himself, to come back because he forgot to perform an important part of it. I'm grateful he called me back in rather than scheduling or just using his imagination to conjure something up. There are many errors and oversights, though some are in my favor, most are unfavorable. The report is more inaccurate than it is accurate. Although I was prepared for this by HadIt (Thank You!) and my other research, it's nonetheless frustrating. I have already prepared my rebuttal to perceived mistakes so my account of the exam is freshly documented. I am also considering a call to the Patient Advocate office per the advice of my VSO--but, I'm on the fence about it. I just can't help but ask myself, jokingly, if I am completely delusional, because it certainly would be the case if I believed what's on the report actually took place.

Medical History & The DBQ: I have substantial pain in both of my knees, it's why I was discharged. Historical and continuous chondromalacia/patellafemoral and IT band syndrome diagnoses. During range of motion testing, the doctor was able to lift both legs to full extension. It was obviously painful and he apologized for causing the pain. In active range of motion, there's no question that I lacked full extension and suffered even greater pain. However, his report contrarily indicates full range in every motion and "no pain" on each measurement. (Side note: He actually used a goniometer, unlike many of the stories I've read here). He also indicated no scars, which is false. How could he know if my legs were clothed the entire exam?

Question: My question is regarding the knee range of motion testing. Never mind that he wrongly indicated no pain despite having apologized for such, I'm looking for clarification on painful vs actual range of motion for both passive and active. Is painful ROM to be considered in the actual measurement, in degrees, of passive range of motion? What about active range of motion? I ask because I read in another post here, if I understood it correctly, that for DC 5260 and DC 5261 (knee range of motion), the Mitchell criteria is that painful ROM is disregarded in measurement. This conflicts with everything I had read previously, and also with my own sensibilities, but nevertheless could be true. Just looking for clarification.

Thank you to everyone here in the HadIt community. Your posts have guided me to a great deal of information and greater understanding of the VA claims process.

* EDIT: I found a few unofficial documents that seem to state any reduction in ROM due to pain should be described by the examiner, if feasible. However, if pain in motion exists where ROM is not deemed as limited, then 10% is justified. Does that sound accurate? If so, does anyone know if the below indications from the doctor tie into the rating based on pain (10%), rather than ROM? I'm of course still confused how in one part the examiner can say there's no pain but in the other say that there is.

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] Pain on movement [ ] Right [ ] Left [X] Both

[X] Disturbance of locomotion [ ] Right [ ] Left [X] Both

[X] Other, describe:

crepitus

Edited September 13, 2014 by whalenkcj (see edit history)

[Navy04]

Sounds like you had a good exam to me bud. Good luck and post the exam report on here when you get a chance. God Bless

[K_C]

Just got the call from the Patient Advocacy Supervisor. He said he's "got my back" and that this will go to the director in charge of C&P examinations, who will then do some "fact-finding," then I'll speak to that person as well, then it will go to the hospital director for review. I foresee retaliation as more likely than anything positive coming of it. However, I'm not worried. For some reason it feels like the appropriate response to the experience. Additionally, based on almost every secondhand experience I've heard, regardless of whether one voices grievance or not, there's going to be a fight for any benefits sought, no matter how straight-forward a claim seems.

There's a new-found realization that it may very well be necessary to make a decision to either dig in and take the small advances over the long haul or to turn around and go home. Although the former seems long and tedious, the latter doesn't even feel like a legitimate option.

[Navy04]

I just got back from my C&Ps today, and they went ok I guess. It was an older Vietnam Vet General Medicine MD. I went for both Knees, Back, and Shoulder along with other conditions, so he had Plenty of Measuring ROM to do today. I really don't know what to think of the Exams. The Doc was nice, quite, yet went over the same conditions a few times, I think to try to catch me off guard or to see if I was somehow cured within the last 30 minutes.

[K_C]

Congrats on getting that round behind you and here's hoping the report is true to the examination.

[Navy04]

Thanks bud, and wish you the best too.

[K_C]

Meant to post earlier, but life has been incredibly busy--mostly related to the daddy role.

I ended up getting a personal call from the C&P physician. He spent half an hour with me going over each point, explaining the why then the what he could do for some of it. He wrote an addendum that little doubt increased the rating I received. I ended up with 30% combined (Right knee chondromalacia, vertigo, tinnitus).

I'm very grateful to the patient advocacy office and the C&P physician who tried to be reasonable and correct what he could. One thing that piqued my interested was the C&P physician's comment about the DBQ for knee range of motion. He said there is "no such thing as objective evidence of pain," and that prevents him from reporting where painful range of motion begins. He said the DBQs were problematic in this way. Not sure where to go with that.

[Navy04]

Congrats on the 30% bud. As far as the knee the Doc is full of crap. I have had multiple knee surgeries and when I was Medically Retired last year the VA awarded SC for R Knee at 0% due to ACL/MCL surgery residuals. So I put in for an increase last Sep 13 and instead of the VA increasing the 0% SC, they awarded me 10% for R Knee due to Painful Motion. So my recent claim that completed last week the VA denied my 0% R Knee Increase, and the L Knee as Secondary to 0% denied too. So when I submitted my 3rd FDC last week, I requested L Knee Secondary to the R Knee 10% painful motion SC rating. I have multiple conditions that the VA denied as one condition, changed the wording and granted SC %. My Asthma was denied even though it is documented due to Black Spots on my lungs from my 5 years in OIF/OEF exposed to the SH** fires along with other chemicals. I have never smoked by the way. So what I did, instead of reopening the claim for Asthma, I claimed it as Dyspnea secondary to my 70% PTSD rating, as I do suffer from Panic and Anxiety attacks. I am not as good at the Regs as a lot of good folks on here, but when the Condition is legitimate and is well documented, there is always a way around the VA wording. God Bless

[Fat]

"NEVER GIVE UP"

[Berta]

If you google the 'DeLuca Factor hadit.com 'you will find posts here on how VA considers pain as a factor in many disability situations.