Opinions please

[Kinfolk]

Wondering what potential rating can I expect?

 

    Knee and Lower Leg Conditions
                        Disability Benefits Questionnaire

  Name of patient/Veteran: 
  
    Is this DBQ being completed in conjunction with a VA 21-2507, C&P 
Examination
    Request?
    [X] Yes   [ ] No
    

    ACE and Evidence Review
    -----------------------
    Indicate method used to obtain medical information to complete this 
document:
    
    [X] In-person examination
    

    Evidence Review
    ---------------
    Evidence reviewed (check all that apply):
    
    [X] VA e-folder (VBMS or Virtual VA)

  1. Diagnosis
  ------------
  a. List the claimed condition(s) that pertain to this DBQ:
     b/l knee pain
     
  b. Select diagnoses associated with the claimed condition(s)  (Check all that
     apply):

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

  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 reports b/l knee pain for several years.  Imaging is negative.
     Treatment has included PT and NSAIDs.  Now, the knees hurt weekly.
     
  b. Does the Veteran report flare-ups of the knee and/or lower leg?
     [X] Yes   [ ] No
     
         If yes, document the Veteran's description of the flare-ups in his or
         her own words:
         "more activity causes more pain"
         
  c. Does the Veteran report having any functional loss or functional impairment
     of the joint or extremity being evaluated on this DBQ, including but not
     limited to repeated use over time?
     [ ] Yes   [X] No
     
  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 50 degrees
         Extension (140 to 0):         50 to 0 degrees

         If abnormal, does the range of motion itself contribute to functional
         loss? [X] Yes (please explain)   [ ] No
            If yes, please explain:
            difficulty with stairs 
            

     Description of pain (select best response):
       Pain noted on exam and causes functional loss
       
       If noted on exam, which ROM exhibited pain (select all that apply)?
         Flexion, 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):
        lateral, mild
        
        
     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 60 degrees
         Extension (140 to 0):         60 to 0 degrees

         If abnormal, does the range of motion itself contribute to functional
         loss? [X] Yes (please explain)   [ ] No
            If yes, please explain:
            difficulty with stairs 
            

     Description of pain (select best response):
       Pain noted on exam and causes functional loss
       
       If noted on exam, which ROM exhibited pain (select all that apply)?
         Flexion, 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):
        lateral, mild
        
        
     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? [ ] Yes   [X] No

     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

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

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

  d. Flare-ups
  
     Right Knee
     ----------
     Is the exam being conducted during a flare-up? [ ] Yes   [X] No
     
         If the examination is not being conducted during a flare-up:
         [ ] The examination is medically consistent with the Veteran's
             statements describing functional loss during flare-ups.
         [ ] The examination is medically inconsistent with the Veteran's
             statements describing functional loss during flare-ups.  Please
             explain.
         [X] The examination is neither medically consistent or inconsistent 
with
             the Veteran's statements describing functional loss during
             flare-ups.
             
     Does pain, weakness, fatigability or incoordination significantly limit
     functional ability with flare-ups?
     [ ] Yes   [X] No   [ ] Unable to say w/o mere speculation

     Left Knee
     ---------
     Is the exam being conducted during a flare-up? [ ] Yes   [X] No
     
         If the examination is not being conducted during a flare-up:
         [ ] The examination is medically consistent with the Veteran's
             statements describing functional loss during flare-ups.
         [ ] The examination is medically inconsistent with the Veteran's
             statements describing functional loss during flare-ups.  Please
             explain.
         [X] The examination is neither medically consistent or inconsistent 
with
             the Veteran's statements describing functional loss during
             flare-ups.
             
     Does pain, weakness, fatigability or incoordination significantly limit
     functional ability with flare-ups?
     [ ] Yes   [X] No   [ ] Unable to say w/o mere speculation

  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:
       Less movement than normal due to ankylosis, adhesions, etc., Disturbance
       of locomotion, Interference with standing
       
     Left Knee
     ---------
     In addition to those addressed above, are there additional contributing
     factors of disability?  Please select all that apply and describe:
       Less movement than normal due to ankylosis, adhesions, etc., Disturbance
       of locomotion, Interference with standing
       
  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:                      5/5
        Is there a reduction in muscle strength?   [ ] Yes   [X] No
        
     Left Knee:               Rate Strength:
        Flexion:                5/5
        Extension:                      5/5
        Is there a reduction in muscle strength?   [ ] Yes   [X] No
        
  b. Does the Veteran have muscle atrophy?
     [ ] Yes   [X] No
     
  c. Comments, if any:
     No response provided
     
  5. Ankylosis
  ------------
  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?
     [ ] Yes   [X] No
     

 

  b. For all checked boxes above, describe:
     No response provided
     
  9. Surgical procedures
  ----------------------
  No response provided
  
  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?
     [ ] Yes   [X] No
     
  c. Comments, if any:
     No response provided
     
  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?
     [ ] Yes   [X] No
     

  b. If the Veteran uses any assistive devices, specify the condition and
     identify the assistive device used for each condition:
     No response provided
     
  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?
     [ ] Yes   [X] No
     
  c. If any test results are other than normal, indicate relationship of 
abnormal
     findings to diagnosed conditions:
     No response provided
     
  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:
      difficulty standing long periods, walking long distances
      
      
  15. Remarks, if any:
  --------------------
  No response provided

 

    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: The veteran has b/l knee and shoulder conditions since the
    service.  The symptoms have continued since release from active duty.    

  

Edited November 11, 2016 by Kinfolk

[Berta]

I just replied to your other post and was going to add that knee, hip and back conditions can certainly have a strong nexus to any foot conditions such as severe flat feet......did you claim this that way or is there a separate inservice condition that caused this?

Either way both C & P exams state this:

"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.  "

I hope they rate this in conjunction with the foot disability,if that would be the most favorable way to rate it.

 

 

[Kinfolk]

bump

[Kinfolk]

anyone else

[Vync]

Compare your exam results to the rating criteria found in this link:

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

[Andyman73]

Odds are you will most likely get 10% for each knee, which will garner you the bilateral factor of an additional 10% added to the knee rating.  That looks a little something like this;

10% + 10% = 19 + bilateral factor 10% (1.9, rounded to 2) = 21%

May not mean much now, but can make the difference in pay rates if you're just below half way, since the VA rounds up or down from 5.  So 15 rounds to 20 for pay rate, and 14 rounds down to 10% for pay rate. If you have a couple rates that add up to just under 5(14,24,34,44 etc) then that 2 from the bilateral factor would put you over the hump to bump up to the next higher pay rate.