cervical strain What Do You All Think About These C&p Findings

[WVSERVER]

Just want to post my exams to see what you guys and gal think, these exams were from Friday

Mental Disorders
(other than PTSD and Eating Disorders)
Disability Benefits Questionnaire

Name of patient/Veteran:

SECTION I:
----------
1. Diagnosis
------------
a. Does the Veteran now have or has he/she ever been diagnosed with a mental
disorder(s)?
[X] Yes[ ] No

If the Veteran currently has one or more mental disorders that conform to
DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Major Depressive Disorder with Anxious
Distress
ICD code: 296.32

b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): n/a

2. Differentiation of symptoms
------------------------------
a. Does the Veteran have more than one mental disorder diagnosed?
[ ] Yes[X] No

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
[ ] Yes[X] No[ ] Not shown in records reviewed

3. Occupational and social impairment
-------------------------------------
a. Which of the following best summarizes the Veteran's level of
occupational
and social impairment with regards to all mental diagnoses? (Check only
one)

[X] Occupational and social impairment with reduced reliability and
productivity

b. For the indicated level of occupational and social impairment, is it
possible to differentiate what portion of the occupational and social
impairment indicated above is caused by each mental disorder?
[ ] Yes[ ] No[X] No other mental disorder has been diagnosed

c. If a diagnosis of TBI exists, is it possible to differentiate what
portion
of the occupational and social impairment indicated above is caused by
the
TBI?
[ ] Yes[ ] No[X] No diagnosis of TBI

SECTION II:
-----------
Clinical Findings:
------------------
1. Evidence review
------------------
a. Medical record review:

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?
[X] Yes[ ] No

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?
[ ] Yes[X] No

If no, check all records reviewed:

[X] 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
[X] 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
[X] Other:
previous exam, decision narrative

b. Was pertinent information from collateral sources reviewed?
[ ] Yes[X] No




MENTAL STATUS:
Appearance: casually dressed, adequately groomed
Activity: normal, no psychomotor agitation or retardation
Attitude: pleasant, polite, cooperative
Speech: fluent, coherent
Mood: depressed
Affect: worried, mood congruent
Perception: no hallucinations
Thought flow: logical, goal directed
Thought content: no delusions
Thoughts of harm: no suicidal/homicidal ideation
Level of consciousness: alert
Oriented: to all spheres
Attention: fair

Current Suicide Risk Factors:
_X____ Does not have thoughts of suicide or self harm at this time
_X____ Does not express feelings of hopelessness or helplessness at
this
time

Current Suicide Assessment:
_X____ Low: Patient judged NOT to be at significant risk for self-harm

d. Relevant Legal and Behavioral history (pre-military, military, and
post-military):
Denied


e. Relevant Substance abuse history (pre-military, military, and
post-military):
Denied


f. Other, if any:
n/a

3. Symptoms
-----------
For VA rating purposes, check all symptoms that actively apply to the
Veteran's diagnoses:

[X] Depressed mood
[X] Anxiety
[X] Panic attacks that occur weekly or less often
[X] Chronic sleep impairment
[X] Disturbances of motivation and mood

Behavioral observations:
worried

4. Other symptoms
-----------------
Does the Veteran have any other symptoms attributable to mental disorders
that are not listed above?
[X] Yes[ ] No

If yes, describe:
reduced concentration, restlessness, irritability, fatigue

5. Competency
-------------
Is the Veteran capable of managing his or her financial affairs?
[X] Yes[ ] No

6. Remarks (including any testing results), if any:
---------------------------------------------------
On August 4, 2014, VA published an interim final rule, RIN 2900-A096 -
Mental
Disorders and Definition of Psychosis for Certain VA Purposes to update
regulations in accordance with the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5). The publication of this interim
final rule indicates that a diagnosis of a mental disorder must conform to
the standards set in the DSM-5.

As of August 28, 2014 all examinations must be conducted utilizing DSM-5.
Examiners no longer need to comment on DSM-IV diagnostic criteria if DSM-5
diagnostic criteria is not met.

The GAF score is not used in DSM-5.

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

Medical Opinion
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? Yes

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

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

a. Opinion from general remarks: Is the Veteran's recurrent major depression
a continuation of the complaint/note in service?

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

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: Veteran's current symptoms are the same symptoms noted while
in
the service. His symptoms are ongoing and are considered a continuation of
the same disorder.

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

-------------------------------------------------------------------------

=========================================================================
Date/Time: 19 Sep 2014 @ 1300
Note Title: COMPENSATION AND PENSION EXAMINATION
Location: MARTINSBURG VAMC
Signed By: CANETE,LUCILA Z
Co-signed By: CANETE,LUCILA Z
Date/Time Signed: 19 Sep 2014 @ 1600
-------------------------------------------------------------------------

LOCAL TITLE: COMPENSATION AND PENSION EXAMINATION
STANDARD TITLE: C & P EXAMINATION NOTE
DATE OF NOTE: SEP 19, 2014@13:00 ENTRY DATE: SEP 19, 2014@16:00:13
AUTHOR: CANETE,LUCILA Z EXP COSIGNER:
URGENCY: STATUS: COMPLETED

Fibromyalgia
Disability Benefits Questionnaire

Name of patient/Veteran:

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

[X] In-person examination

Evidence review
---------------
Was the Veteran's VA claims file (hard copy paper C-file) reviewed?
[X] Yes[ ] No

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

vbms efile; VAMC


1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with
fibromyalgia? (This is the condition the Veteran is claiming or for which an
exam has been requested)
[X] Yes [ ] No

[X] Fibromyalgia
Date of diagnosis: 2005

2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
fibromyalgia condition:
33 years old USAirforce veteran from 2000 to 2006, is here for a
C&P
evaluation on his current condition of fibromylagia.
In 2003, he started coming unexplained fatigue which described
coming with similar symptoms when one suffers from flu-like symptoms
when one developes generalized muscle soreness, insides of both legs,
thighs, shoulder and neck areas and medial side of both arms and
achiness of both hands (described it as fatigue feeling). When he
would wear the body armour, he feels that his entire body feels sore
and touch of the armor which is heavy makes him feel the soreness.
More noticeable over the medical surfaces of the thighs. During his
active service he worked with Nuclear Program at Minot, Airforce
Base,
North Dakota he is on strict monitoring due to the sensitivity
concern
of the program. (Perosonal Reliability Program).
Around the same year 2003 the Base physician and several times
2003-2004. He was tried on Amytriptylline 25 mg po hs which helped X
2
months only to return back to his initial symptoms. 6 months before
he
left the USAirforce, he had sleep study done which confirmed sleep
apnea which he wears CPAP to date. It seemed to help his drowsiness
during the daytime but it has not affected his sensation of muscle
soreness. He had a medical board but was honorably discharged. He was
recommended not eligible to re-enlist and or serve the remaining 2
years of inactive reserve.
He has been coming here at Martinsburg VA since 2012 for scheduled
Compensation & Pension Evaluation. He has been placed on
Sertraline
for depression which did not help his body pain. It has been
discontinued and not on any medications. He sees the Pain Mgmt for
his
neck complaints and have an appointment for PT regarding the rest of
his body pains.
Reviewed vbms STRS efile:
11/10/2005: Routine Physical Examination
Note on his active problem list: Mylagias/Myositis
(Non-specified)
Multiple progress notes/Behavioral Clinic: Mild
Depression 2003/ Major Depression 2005/ Involutional Melancholia
2005.
Medications: Amitriptylline 25 mg po qd (prescribed to
problems with Depression) No specific mention that this was given for
fibromyalgia.
1/25/2005 Progress notes: Mentioned that member was seen prior for
fibromyalgia which responded well to Elavil a hs. Mention about
implication for his work statys (PRP) using Elavil. There as a
discussion with Dr. Higgins who mentioned that the medication causes
no limiting side effects, and is not being used for anti-depressant
purposes, that this case does not automatically require PRP
suspension.
Memorandum from XXXXwritten by TODD P Huhn,
CAPT, USAF, MC
XXXXXhas been seen for symptoms consistent with
fibromylgia, a condition of chronic muscle pain. He responded very
well to medication for this which he takes at night. This is not
being
used as an anti-depressant medication. After conferring with the
AFSPC PRP medical consultant, Lt. Col Higgins, we concurred that Sra
XXX was medically cleared to take this medication and maintain his
PRP clearance.
Routine H&P by an outpatient primary care provider at Martinsburg
VA 7/18/2014:
LOCAL TITLE: PHYSICIAN, PRIMARY CARE/OUTPATIENT CLINIC
STANDARD TITLE: PRIMARY CARE PHYSICIAN NOTE
DATE OF NOTE: JUL 18, 2014@08:59 ENTRY DATE: JUL 18,
2014@09:01:34

AUTHOR: VU,PETER D EXP COSIGNER:

URGENCY: STATUS: COMPLETED

CHIEF COMPLAINT: chronic neck strain w/ headache

PRESENT ILLNESS: said
he has chronic neck strain and occasional tension headache w/o any
trauma or
injury. pt said he needs clearance to participate in walk for
wellness at home.
pt gained some wt w/ BMI >35. Today,PT denies any SI or
HI,fever,chills,sob,cp,
productive cough, n/v,abdominal pain,vision problems, weakness,
dizziness,headache, change of bm,orthopnea, palpitation,syncope, LOC,
urinary or
stool incontinence, hematuria or hematochezia.

PAST HISTORY:
Active problems - Computerized Problem List is the source for the
following:

1. Recurrent major depression (SNOMED CT 66344007) 09/30/13
ASGHAR,ALI
2. Nonallopathic lesions of rib cage
3. Pain in Thoracic Spine 05/09/13
NEFF,SHAWN M
4. Somat Dysfunc Thorac Reg 05/09/13
NEFF,SHAWN M
5. Somat Dysfunc Cervic Reg 04/09/13
NEFF,SHAWN M
6. Cervicalgia 04/09/13
NEFF,SHAWN M
7. Headache
8. Hyperlipidemia 01/24/13
VU,PETER D
9. SUBJECTIVE TINNITUS 01/23/13
SHALLIS,JULIE
B
10. Depression 01/18/13
VU,PETER D
11. GERD 01/18/13
VU,PETER D
12. Anxiety 01/18/13
VU,PETER D
13. Cholelithiasis 01/18/13
VU,PETER D
14. Hx of tobacco user in remission 01/18/13
VU,PETER D
15. OSA on c-pap 01/18/13
VU,PETER D
16. Hx of tinnitus
01/18/13
VU,PETER D
17. Irritable Bowel Syndrome

PHYSICAL EXAM:
GENERAL: ambulatory, awake, alert, oriented x3,nad, pleasant,obese
young man.
HEENT: PERRLA. Clear oropharynx and tympanic membrane. no sinus
tenderness.
no cervical adenopathy.
NECK: No bruits or stiffness. Good ROM w/o difficulty but mild
discomfort on
rotation and moderate trapezius muscle stiffness on palpation.
CHEST: Chest normal shape and symmetrical.No masses,tenderness or
other
abnormalities
LUNGS: Clear, no crackles, wheezing, or rhonchi.
HEART: RSR, no murmurs, no gallop
ABDOMEN: obese. Soft, non tender, positive bowel sounds, liver and
spleen are
not palpable. No rebound tenderness to palpation.
BACK: No cva tenderness or point tenderness.slr negative.
EXTREMITIES: No edema. Good ROM w/o pain or difficulty. Good muscle
strength
and tone plus well developed muscle. nl sensation and good radial
pulse and capillary refill.
NEUROLOGICAL: Cranial nerve intact, no focal deficit, ambulatory w/o
difficulty.

ASSESSMENT:
- Hx of chronic neck strain: discussed and full explaination about
his
condition
and booklet about neck given w/ instruction for home exercise.
increase flexeril
to 10mg qhs prn w/advise of side effects and continue heating pad
alternate
w/icepack. pt already was tx by PT, chiropractor and pain school in
past. pt
said he does not want to be on pain medication. pt had xray of neck
in
past was
negative.
-hx of IBS: Discussed and tx w/ bentyl 10mg bid and metamucil and
f/u GI as
directed.
-hx GERD: on prilosec
-hx Depression/anxiety: stable and denies any SI or HI. f/u w/ MHC as
directed.
-hx of OSA:stable on C-pap

b. Is continuous medication required for control of fibromyalgia symptoms?
[ ] Yes [X] No

c. Is the Veteran currently undergoing treatment for this condition?
[ ] Yes [X] No

d. Are the Veteran's fibromyalgia symptoms refractory to therapy?
[X] Yes [ ] No

3. Findings, signs and symptoms
-------------------------------
Does the Veteran currently have any findings, signs or symptoms attributable
to fibromyalgia?
[X] Yes [ ] No

a. Findings, signs and symptoms (check all that apply):

[X] Widespread musculoskeletal pain
[X] Fatigue
[X] Sleep disturbances
[X] Headache
[X] Depression
[X] Irritable bowel symptoms

For all checked conditions, describe:
Musculoskeletal symtpoms: 1) constant sensation of 'muscle
fatigue/sore'on both anterior thighs, skin feels sore over the medial
portion of both thighs, localized sensitivity(soreness) over the
specific medial portion of both arms, bilateral scapular muscles and
back of his neck.
2) Feels tired even if he has not done anything but can still do his
routines both at home and at work.
3) He feels no motivation, problems with concentration, crying for no
reasons, feels anxiety and hx/o bouts of panic attack and chest pain
while in the active service. Diagnosed with Depression while in the
active service and was not placed on medication because he wants to
continue working with Nuclear Program. Taking a anti-depressants will
disqualify him from that program. He was evaluated by a psychologist.
He was receiving regular psychological therapy while in the active
service.
He is currently seen by psychologist here at Martinsburg VA and
received Cognitive Therapy and currently on the HOPE Program (Group
Therapy). No medications for depression given to date.
4) Hx/o IBS and is service connected for IBS. Takes Dicyclomine BID.
He
said his current meds seem to help him.


b. Frequency of fibromyalgia symptoms (check all that apply):

[X] Constant or nearly constant

c. Does the Veteran have tender points (trigger points) for pain present?
[ ] Yes [X] No

4. Other pertinent physical findings, complications, conditions, signs
and/or
symptoms

-----------------------------------------------------------------------------
Does the Veteran have any other pertinent physical findings, complications,
conditions, signs or symptoms related to any conditions listed in the
Diagnosis section above?
[ ] Yes [X] No

5. Diagnostic testing
---------------------
Are there any significant diagnostic test findings and/or results?
[ ] Yes [X] No

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

7. Remarks, if any:
-------------------
He now works both patroling
and now in the office. He has so far able to carry on his duties as a
security officer.
Physical examination today revealed: (-) direct tenderness on palpation
over the occipital, supraspinatus, sternal, knees.
He points to overall sensation of soreness on his neck area, and
localized sensitivity on the bilateral thigh muscles and linear medial
thigh bilaterally and medial areas on both arms. Strength 5/5 all
throughout. Sensory are all WNL both upper and lower extremeties.

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

Neck (Cervical Spine) 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:

vbms efile; VAMC

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 been diagnosed with a cervical
spine (neck) condition?
[X] Yes [ ] No

Cervical Spine Common Diagnoses:
[ ] Ankylosing spondylitis
[X] Cervical strain
[ ] Degenerative arthritis of the spine
[ ] Intervertebral disc syndrome
[ ] Segmental instability
[ ] Spinal fusion
[ ] Spinal stenosis
[ ] Spondylolisthesis
[ ] Vertebral dislocation
[ ] Vertebral fracture

Diagnosis #1: Cervical Strain (Cervicalgia)
ICD code: 847.0
Date of diagnosis: 2002-2003

2. Medical history
------------------
Describe the history (including onset and course) of the Veteran's cervical
spine (neck) condition (brief summary):
33 years old USAirforce veteran from 2000 to 2006, is here for a C&P
evaluation on his neck condition.
In 2002-2003, he start noticing when he works out his posterior neck
feels sore. He said he has problems wearing the ballistic helmet. He feels
localized soreness on the back of his head and also localized sensation of
soreness over the parietal portion of his head.
He was referred while in the active service to PT. In 10/25/2004. MRI
of his neck was carried out which showed very minor disc bulge C5-C6 and
C6-C7 levels, not felt to be of significance. Stretching exercises while
in
PT helped. But sit-ups and turning it wrong and bending it a lot seems to
accentuate the neck soreness. He described his constant low level soreness
2-3/10. It feels tight most of the time.
He has upcoming schedule for PT related to the neck but also to his
complaints of his wholebody pain.


3. Flare-ups
------------
Does the Veteran report that flare-ups impact the function of the cervical
spine (neck)?
[ ] Yes [X] No

4. Initial range of motion (ROM) measurements
---------------------------------------------
a. Select where forward flexion ends (normal endpoint is 45 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 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 or greater

b. Select where extension ends (normal endpoint is 45 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 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 or greater

c. Select where right lateral flexion ends (normal endpoint is 45 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 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 or greater

d. Select where left lateral flexion ends (normal endpoint is 45 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 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 or greater

e. Select where right lateral rotation ends (normal endpoint is 80 degrees):
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [X] 70 [ ] 75 [ ] 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 [ ] 75 [ ] 80 or greater

f. Select where left lateral rotation ends (normal endpoint 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 [ ] 75 [ ] 80 or greater

g. If ROM does not conform to the normal range of motion identified above
but
is normal for this Veteran (for reasons other than a cervical spine
(neck)
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. Select where post-test forward flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

c. Select where post-test extension ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 or greater

d. Select where post-test right lateral flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [X] 40 [ ] 45 or greater

e. Select where post-test left lateral flexion ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20
[ ] 25 [ ] 30 [ ] 35 [ ] 40 [X] 45 or greater

f. Select where post-test right lateral rotation ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [X] 70 [ ] 75 [ ] 80 or greater

g. Select where post-test left lateral rotation ends:
[ ] 0 [ ] 5 [ ] 10 [ ] 15 [ ] 20 [ ] 25
[ ] 30 [ ] 35 [ ] 40 [ ] 45 [ ] 50 [ ] 55
[ ] 60 [ ] 65 [ ] 70 [X] 75 [ ] 80 or greater

6. Functional loss and additional limitation in ROM
---------------------------------------------------
a. Does the Veteran have additional limitation in ROM of the cervical spine
&

[Navy04]

I see 10% for Mental, maybe 30%. 10-30% for IBS, and good % for the Fibro. My Docs want to test me for Fibro too, as I have a lot of the same symptoms. Never thought of it before, but it makes sense. Good luck and keep us posted

[john999]

Get your initial ratings and then get IME's/IMO's to try for increases on appeal. If you go just by VA exams you most likely get low ball ratings.

[Navy04]

Sad thing is John is probably right. I just had my C&Ps today for my 3rd claim in the last 2 years, and there always seems to be a catch in the end. Good luck

[WVSERVER]

unfortunately this went back to gathering of evidence today, I figure there was something they did not like about the C&P because I all ready downloaded all the evidence I had VIA ebeenies along with a statement in support of claim. I almost got lucy had my C&P on Friday went to prep for decision on Monday then to Gathering of evidence on Tuesday

[Navy04]

What a Roller Coaster bud

[WVSERVER]

Did I scrub these too much for anyone else to weight in