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Dr. Notes - Range of Motion C&P Results explaination


Hobbes

Question

I recently had a C&P exam (5 Apr 16) for increased compensation.  I am currently SC at 50%: 10% patellar Tendonities left knee, 10% limited extension left knee, 10% bursitis - left hip, 10% right knee degenerative joint disease, and 10% bursitis - right hip as of March 2011.  I filed for an increase in 2013 and I was denied, but I disagreed with the results via a NOD given the C&P doctor did not do a range of motion test other than 'eyeballing' it when she contorted my knees in such a way, I left there sucking down motrin for six weeks before I kind of recovered, but still live day to day with chronic knee pain and issues.  Regardless, from my latest C&P,  I read the Dr.'s Notes and I was looking for help interpreting what the numbers mean and speculate approximate C&P increase, if. 

I've read the ROM information from VA and from http://www.militarydisabilitymadeeasy.com/kneeandleg.html.  However, when reading the Dr.'s Notes, the ROM extension values do not line up nicely to the information in these charts.  This is where I need help interpreting the results (Boldface - Yellow guess rating). 

Background:  All extension test were conducted from a seated position with my legs at 90 degrees (sitting on exam table).  I was only able to extend/lift either leg 10 degrees up or to about 80 -75 degrees given 0 degrees is completely horizontal with the floor.  During the exam, I stopped forward motion where the start of pain began (extreme pain)


******Snippet of Dr.'s Notes from C&P

3. Range of motion (ROM) and functional limitation
a. Initial range of motion 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 140 degrees
Extension (140 to 0): 140 to 130 degrees  (Diagnostic code 5261? Guessing 50% rating????)


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 but does not result in/cause functional loss
If noted on exam, which ROM exhibited pain (select all that apply)?
Extension Is there evidence of pain with weight bearing? [ ] Yes [X] 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): entire right knee joint, moderate, unclear

Is there objective evidence of crepitus? [ ] Yes [X] No

Left 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 140 degrees
Extension (140 to 0): 140 to 120 degrees (Diagnostic code 5261? Guessing 50% rating????)


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 but does not result in/cause functional loss

If noted on exam, which ROM exhibited pain (select all that apply)?
Extension Is there evidence of pain with weight bearing? [ ] Yes [X] 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): entire right knee joint, moderate, unclear

Is there objective evidence of crepitus? [ ] Yes [X] No

b. Observed repetitive use 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? [X] Yes [ ] No

Select all factors that cause this functional loss: Pain, Weakness ROM after three repetitions:
Flexion (0 to 140): 0 to 130 degrees
Extension (140 to 0): 140 to 120 degrees


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? [X] Yes [ ] No

Select all factors that cause this functional loss: Pain, Weakness ROM after three repetitions:
Flexion (0 to 140): 0 to 140 degrees
Extension (140 to 0): 140 to 110 degrees


c. Repeated use over time Right Knee Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No
Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation

Select all factors that cause this functional loss: Pain, Weakness Able to describe in terms of range of motion: [X] Yes [ ] No
Flexion (0 to 140): 0 to 140 degrees
Extension (140 to 0): 140 to 120 degrees


Left Knee Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No
Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation

Select all factors that cause this functional loss: Pain, Weakness

Able to describe in terms of range of motion: [X] Yes [ ] No
Flexion (0 to 140): 0 to 140 degrees
Extension (140 to 0): 140 to 110 degrees


d. Flare-ups No response provided

e. Additional factors contributing to disability Right Knee
In addition to those addressed above, are there additional contributing factors of disability?
Please select all that apply and describe: None
Left 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:
Flexion: 5/5 Extension: 4/5
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: Flexion: 5/5 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


Thanks! I appreciate translating the ROM values with VA Disability tables.

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