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Range Of Motion (Rom)


K_C
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Question

Hi all,

I know this topic has been addressed several times in these forums and elsewhere, but I'm looking for some more definitive insight and clarification.

Background:

  • I have knee pain, both knees, currently only service connected for the right. My rating for the right is 10% and not based on ROM, but rather the fallback 38CFR §4.40, §4.45, and §4.59 sections (functional loss and painful motion), according to the decision letter. I have relatively full range of motion, especially passive, but with pain.
  • In the C&P exam report, the examiner notes "No objective evidence of painful motion" and therefore cannot indicate in the DBQ where painful range of motion begins. This is despite having measured the range of motion with a goniometer and acknowledging my pain both verbally and in the report in a section further down, 6. Functional loss and additional limitation in ROM. Additionally, under the item b. Mitchell criteria: Can pain/weakness, fatigability or incoordination significantly limit, the response was (x) It is not possible to determine without resorting to mere speculation because there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions
  • I was able to speak to the examiner after the fact because of a complaint I filed. In our conversation, he stated there is no such thing as objective evidence of pain, which meant he had to select the box on the DBQ mentioned about, which further means he cannot indicate painful range of motion on the standard location in the form. Although I do see what he's saying about the wording (objective), I think it's silly and misleading not to indicate the painful range of motion where the rater would expect to see it, where it is specifically asked for. Additionally, I think it hurt my rating by preventing the rater from seeing where painful ROM exists.
  • As a work-around for his problems with the DBQ wording, the examiner added in an addendum "For knee exam . Veteran appeared to be in pain throughout my entire exmaination (entire ROM)of his knee ." Though, this doesn't seem to have had any increase impact upon the rating decision.

Questions:

  • Are range of motion limitation ratings only applicable where a joint literally cannot be forced beyond a certain point, either passively or actively?
  • Is painful motion supposed to be equated into range of motion limitation ratings, rather than only a basic and minimum "painful motion" rating without regard to ROM limitations due to pain?
  • More specifically, is it to be considered with no weight on range of motion, with full weight (i.e. pain starting at 20° extension = 20° extension limitation), or with partial weight with all evidence (i.e. pain starting at 20° extension, in context of all the other evidence of the condition, might garner a rating for 15° limitation in extension)?
  • This one goes way above and beyond and is definitely not expected, but highly appreciated: With regards to any answers given, any direction to the specific regulations, case law, or other documentation supporting the answer, with excerpts or direction to specific sections or paragraphs would be very much appreciated. And of course, any clarification for the layman will be very helpful and is also appreciated.

Thanks for your time, shared experience, and knowledge. Good luck to you!

Cheers

KC

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