Navy04 Posted February 16, 2015 Share Posted February 16, 2015 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 Link to comment Share on other sites More sharing options...
0 Closure Posted February 17, 2015 Share Posted February 17, 2015 Maybe 10%. Link to comment Share on other sites More sharing options...
0 meghp0405 Posted February 18, 2015 Share Posted February 18, 2015 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 Link to comment Share on other sites More sharing options...
0 Navy04 Posted February 19, 2015 Author Share Posted February 19, 2015 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 Link to comment Share on other sites More sharing options...
Question
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
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