What % Will I Get For L Knee?

[Navy04]

Below is C&P exam results for L Knee secondary to R Knee. Can you guys help figure out what % I might get. Thank you so much and God Bless!!!

Knee and Lower Leg Conditions

Disability Benefits Questionnaire

ACE and Evidence Review

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

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

a. Evidence 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?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not

included in the

Veteran's VA claims file:

VA medical records.

b. Was pertinent information from collateral sources reviewed?

[ ] Yes [X] No

1. Diagnosis

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

a. List the claimed condition(s) that pertain to this DBQ:

Left knee condition

b. Select diagnoses associated with the claimed condition(s)

(Check all that

apply):

[X]Knee strain

Side affected: [ ] Right [ ] Left [X] Both

Date of diagnosis: Right 2000s

Date of diagnosis: Left 2000s

[X] Knee meniscal tear

Side affected: [X] Right [ ] Left [ ] Both

Date of diagnosis: Right 2000s

[X] Knee joint osteoarthritis

Side affected: [ ] Right [ ] Left [X] Both

Date of diagnosis: Right 2000s

Date of diagnosis: Left 2000s

c. Comments (if any):

No response provided

d. Was an opinion requested about this condition (internal VA

only)?

[X] Yes [ ] No [ ] N/A

2. Medical history

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

a. Describe the history (including onset and course) of the

Veteran's knee

and/or lower leg condition (brief summary):

The Veteran is service connected for his right knee currently;

he has had

two arthroscopies on that knee for meniscal repairs in 2005 and

again in

2007.

He also states that he did experience difficulties with his

left knee during

service, due to excessive strenuous physical activities.

After service discharge in 2013, the Veteran has continued to

have problems

with both of his knees, with stiffness, weakness, and

crepitance.

He also states that last year his left knee gave out on him.

Currently he wears bilateral knee braces and ambulates with a

cane for

bilateral knee and lower back stabilization and support.

b. Does the Veteran report that flare-ups impact the function of

the knee

and/or lower leg?

[X] Yes [ ] No

If yes, document the Veteran's description of the impact of

flare-ups in

his or her own words:

Stiffness/weakness

weakness/crepitus

c. Does the Veteran report having any functional loss or

functional impairment

of the joint or extremity being evaluated on this DBQ

(regardless of

repetitive use)?

[X] Yes [ ] No

If yes, document the Veteran's description of functional

loss or

functional impairment in his or her own words:

See (b) above.

3. Range of motion (ROM) and functional limitation

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

a. Initial range of motion

Left Knee

---------

[X] All normal

[ ] Abnormal or outside of normal range

[ ] Unable to test (please explain)

[ ] Not indicated (please explain)

Flexion (0 to 140): 0 to 140 degrees

Extension (140 to 0): 140 to 0 degrees

Description of pain (select best response):

Pain noted on exam on rest/non-movement

If noted on exam, which ROM exhibited pain (select all that

apply)?

Flexion

Is there evidence of pain with weight bearing? [X] Yes [ ] No

Is there objective evidence of localized tenderness or pain on

palpation of

the joint or associated soft tissue? [X] Yes [ ] No

If yes, describe including location, severity and

relationship to

condition(s):

Localized tenderness over the medial joint line and the

infrapatellar

area.

Right Knee

----------

[ ] All normal

[X] Abnormal or outside of normal range

[ ] Unable to test (please explain)

[ ] Not indicated (please explain

Flexion (0 to 140): 0 to 130 degrees

Extension (140 to 0): 130 to 0 degrees

If abnormal, does the range of motion itself contribute to

functional

loss? [ ] Yes (please explain) [X] No

Description of pain (select best response):

Pain noted on exam on rest/non-movement

If noted on exam, which ROM exhibited pain (select all that

apply)?

Flexion

Is there evidence of pain with weight bearing? [X] Yes [ ] No

Is there objective evidence of localized tenderness or pain on

palpation of

the joint or associated soft tissue? [X] Yes [ ] No

If yes, describe including location, severity and

relationship to

condition(s):

Localized tenderness over the medial joint line and the

infrapatellar

area.

b. Observed

repetitive use

Left Knee

---------

Is the Veteran able to perform repetitive use testing with at

least three

repetitions? [X] Yes [ ] No

Is there additional functional loss or range of motion after

three

repetitions? [ ] Yes [X] No

Right Knee

----------

Is the Veteran able to perform repetitive use testing with at

least three

repetitions? [X] Yes [ ] No

Is there additional functional loss or range of motion after

three

repetitions? [ ] Yes [X] No

c. Repeated use over time

Left Knee

---------

Is the Veteran being examined immediately after repetitive use

over time?

[ ] Yes [X] No

If the examination is not being conducted immediately after

repetitive

use over time:

[ ] The examination supports the Veteran's statements

describing

functional loss with repetitive use over time.

[ ] The examination contradicts the Veteran's statements

describing

functional loss with repetitive use over time. Please

explain.

[X] The examination neither supports nor contradicts the

Veteran's

statements describing functional loss with repetitive

use over time.

Does pain, weakness, fatigability or incoordination

significantly limit

functional ability with repeated use over a period of time?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

Not currently flared up.

Right Knee

----------

Is the Veteran being examined immediately after repetitive use

over time?

[ ] Yes [X] No

If the examination is not being conducted immediately after

repetitive

use over time:

[ ] The examination supports the Veteran's statements

describing

functional loss with repetitive use over time.

[ ] The examination contradicts the Veteran's statements

describing

functional loss with repetitive use over time. Please

explain.

[X] The examination neither supports nor contradicts the

Veteran's

statements describing functional loss with repetitive

use over time.

Does pain, weakness, fatigability or incoordination

significantly limit

functional ability with repeated use over a period of time?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

Not currently flared up.

d. Flare-ups

Left Knee

---------

Is the exam being conducted during a flare-up? [ ] Yes [X] No

If no, does the Veteran report flare-ups? [X] Yes [ ] No

Frequency: Twice weekly

Severity: Moderate

Duration: 1 day

If the examination is not being conducted during a flareup:

[ ] The examination supports the Veteran's statements

describing

functional loss during flare-ups.

[ ] The examination contradicts the Veteran's statements

describing

functional loss during flare-ups. Please explain.

[X] The examination neither supports nor contradicts the

Veteran's

statements describing functional loss during flare-ups.

Does pain, weakness, fatigability or incoordination

significantly limit

functional ability with flare-ups?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

Not currently flared up.

Right Knee

----------

Is the exam being conducted during a flare-up? [ ] Yes [X] No

If no, does the Veteran report flare-ups?

[X] Yes [ ] No

Frequency: Twice weekly

Severity: Moderate

Duration: 1 day

If the examination is not being conducted during a flareup

[ ] The examination supports the Veteran's statements

describing

functional loss during flare-ups.

[ ] The examination contradicts the Veteran's statements

describing

functional loss during flare-ups. Please explain.

[X] The examination neither supports nor contradicts the

Veteran's

statements describing functional loss during flare-ups.

Does pain, weakness, fatigability or incoordination

significantly limit

functional ability with flare-ups?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

Not currently flared up.

e. Additional factors contributing to disability

Left Knee

---------

In addition to those addressed above, are there additional

contributing

factors of disability? Please select all that apply and

describe: None

Right Knee

----------

In addition to those addressed above, are there additional

contributing

factors of disability? Please select all that apply and

describe: None

4. Muscle strength testing

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

a. Muscle strength - 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

Right Knee: Rate Strength:

Forward flexion: 3/5

Extension: 3/5

Is there a reduction in muscle strength? [X] Yes [ ] No

If yes, is the reduction entirely due to the claimed

condition in the

Diagnosis Section? [X] Yes [ ] No

Left Knee: Rate Strength:

Forward flexion: 3/5

Extension: 3/5

Is there a reduction in muscle strength? [X] Yes [ ] No

If yes, is the reduction entirely due to the claimed

condition in the

Diagnosis Section? [X] Yes [ ] No

b. Does the Veteran have muscle atrophy?

[ ] Yes [X] No

c. Comments, if any:

No response provided

5. Ankylosis

Complete this section if the Veteran has ankylosis of the knee

and/or lower

leg.

a. Indicate severity of ankylosis and side affected (check all

that apply):

Right Side:

[ ] Favorable angle in full extension or in slight flexion

between 0 and

10 degrees

[ ] In flexion between 10 and 20 degrees

[ ] In flexion between 20 and 45 degrees

[ ] Extremely unfavorable, in flexion at an angle of 45

degrees or more

[X] No ankylosis

Left Side:

[ ] Favorable angle in full extension or in slight flexion

between 0 and

10 degrees

[ ] In flexion between 10 and 20 degrees

[ ] In flexion between 20 and 45 degrees

[ ] Extremely unfavorable, in flexion at an angle of 45

degrees or more

[X] No ankylosis

b. Indicate angle of ankylosis in degrees:

No response provided

c. Comments, if any:

No response provided

6. Joint stability tests

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

a. Is there a history of recurrent subluxation?

Right: [X] None [ ] Slight [ ] Moderate [ ] Severe

Left: [X] None [ ] Slight [ ] Moderate [ ] Severe

b. Is there a history of lateral instability?

Right: [X] None [ ] Slight [ ] Moderate [ ] Severe

Left: [X] None [ ] Slight [ ] Moderate [ ] Severe

c. Is there a history of recurrent effusion?

[ ] Yes [X] No

d. Performance of joint stability testing

Right Knee:

Was joint stability testing performed?

[X] Yes

[ ] No

[ ] Not indicated

[ ] Indicated, but not able to perform

If joint stability testing was performed is there joint

instability?

[ ] Yes [X] No

If yes (joint stability testing was performed), complete

the section

below:

- Anterior instability (Lachman test)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Posterior instability (Posterior drawer test)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters

- Medial instability (Apply valgus pressure to knee in

extension

and with 30 degrees of flexion)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Lateral instability (Apply varus pressure to knee in

extension

and with 30 degrees of flexion)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

Left Knee:

Was joint stability testing performed?

[X] Yes

[ ] No

[ ] Not indicated

[ ] Indicated, but not able to perform

If joint stability testing was performed is there joint

instability?

[ ] Yes [X] No

If yes (joint stability testing was performed), complete

the section

below:

- Anterior instability (Lachman

test)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Posterior instability (Posterior drawer test)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Medial instability (Apply valgus pressure to knee in

extension

and with 30 degrees of flexion)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

- Lateral instability (Apply varus pressure to knee in

extension

and with 30 degrees of flexion)

[X] Normal

[ ] 1+ (0-5 millimeters)

[ ] 2+ (5-10 millimeters)

[ ] 3+ (10-15 millimeters)

e. Comments, if any:

No response provided

7. Additional conditions

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

a. Does the Veteran now have or has he or she ever had recurrent

patellar

dislocation, "shin splints" (medial tibial stress syndrome),

stress

fractures, chronic exertional compartment syndrome or any other

tibial

and/or fibular impairment?

[ ] Yes [X] No

b. Comments, if any:

No response provided

8. Meniscal conditions

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

a. Does the Veteran now have or has he or she ever had a meniscus

(semilunar

cartilage) condition?

[X] Yes [ ] No

a. Does the Veteran now have or has he or she ever had a meniscus

(semilunar

cartilage) condition?

[X] Yes [ ] No

If yes, indicate severity and frequency of symptoms, and

side affected:

Right Side:

[X] Meniscal tear

b. For all checked boxes above, describe:

Arthroscopic surgery in 2005 and 2007

9. Surgical procedures

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

Indicate any surgical procedures that the Veteran has had

performed and provide

the additional information as requested (check all that apply):

Right Side:

[X] Meniscectomy, arthroscopic or other knee surgery not

described above

Type of surgery: Meniscal repairs times two

Date of surgery: 2005, 2007

10. Other pertinent physical findings, complications, conditions

signs,

symptoms and scars

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

-------

a. 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

b. 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 these scars painful or unstable; have a

total area

equal to or greater than 39 square cm (6 square inches); or

are located

on the head, face or neck? (An "unstable scar" is one

where, for any

reason, there is frequent loss of covering of the skin over

the scar.)

[ ] Yes [X] No

If no, provide location and measurements of scar in

centimeters.

Location: Right lateral knee

Measurements: length 1cm X width 0.1cm

c. Comments, if any:

Right medial knee (2)--1 cm by 0.1 cm each scar

11. Assistive devices

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

a. Does the Veteran use any assistive device(s) as a normal mode

of locomotion,

although occasional locomotion by other methods may be

possible?

[X] Yes [ ] No

If yes, identify assistive device(s) used (check all that

apply and

indicate frequency):

Assistive Device: Frequency of use:

[X] Brace(s) [ ] Occasional [ ] Regular

[X] Constant

[X] Cane(s) [ ] Occasional [X] Regular

[ ] Constant

b. If the Veteran uses any assistive devices, specify the

condition and

identify the assistive device used for each condition:

See above.

12. Remaining effective function of the extremities

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

Due to the Veteran's knee and/or lower leg condition(s), 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., while

functions for the lower extremity include balance and propulsion,

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 knee 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):

Bilateral knee MRIs performed on 1/3/2014

Right knee: Evidence of prior arthroscopy

Mild proximal patellar tendinosis

Small joint effusion

Left knee: Mild proximal patellar tendinosis

Patellar chondromalacia

Bilateral knee x-rays 4/30/2012: No DJD

Calcification about the left tibial

tubercle

c. Is there objective evidence of crepitus?

[X] Yes [ ] No

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

d. If any test results are other than normal, indicate

relationship of abnormal

findings to diagnosed conditions:

There is mild bilateral crepitus with movement of the knees

14. Functional impact

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

Regardless of the Veteran's current employment status, do the

condition(s)

listed in the Diagnosis Section impact his or her ability to

perform any type

of occupational task (such as standing, walking, lifting,

sitting, etc.)?

[X] Yes [ ] No

If yes, describe the functional impact of each condition,

providing one or

more examples:

The Veteran's current bilateral knee condition would limit his

ability to

perform repetitive climbing, squatting or kneeling.

15. Remarks, if any:

The Veteran is claiming service connection for a left knee

condition.

Opinion: It is as least as likely as not that the Veteran's

current left knee

condition is proximately due to or caused by military service.

Rationale: The C file was reviewed.

The Veteran had a C&P exam at the SE Lousiana VAMC in April 2012

while still on

active duty, and complained at the time of bilateral knee pain;

x-rays at the

time revealed evidence of left knee Osgood-Schlatter's disease,

with

calcification at the tibial tubercle, but no other DJD at all.

Clinical exam today is most consistent with chronic bilateral

knee PFS, right

greater than left.

Thus, the service connection is substaniated

[Closure]

Maybe 10%.

[meghp0405]

Don't believe it will be favorable on your part. The examiner stated that your left knee is favorable or normal in many of the testing. Normal is not a word you want to see or hear in a c/p exam.

JMHO

[Navy04]

Thanks for the info guys. What will the statement below grant me.

Clinical exam today is most consistent with chronic bilateral

knee PFS, right

greater than left