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C&P exam results and feedback on knee Range of Motion
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Question
Jeromy
Just looking for some feedback on possible outcomes of results of my C&P for my knee. I am service connected for my right knee (10% for the scar and 10% for the arthritis). Here are the Nurse Practitioners notes who did my exam:
1. Diagnosis
------------
a. List the claimed condition(s) that pertain to this DBQ:
Right Knee Arthritis
b. Select diagnoses associated with the claimed condition(s) (Check all that apply):
[X] Arthritic conditions
[X] Arthritis, traumatic
Side affected: [X] Right [ ] Left [ ] Both
ICD Code: M17.10
Date of diagnosis: Right 8/2017
c. Comments (if any):
No response provided
d. Was an opinion requested about this condition (internal VA only)?
[ ] Yes [X] No [ ] N/A
2. Medical history
------------------
a. D
escribe the history (including onset and course) of the Veteran's knee
and/or lower leg condition (brief summary):
Veteran is service connected for knee arthritis status post post right
patellar dislocation and arthroscopic knee surgery. Veteran had surgery to
the knee in 2005. Since the last compensation exam he reports stability
issues and pain to the right knee. He states knee gives out and he has
fallen upstairs and down stairs. He states he has a permanent limp.
Locates pain to lateral knee and below the knee cap. He states the pain is
constant, aggravated by prolonged sitting and standing,
ascending/descending stairs. He was seen by Orthopedic in July 2017 and
given a Synvasc injection. He uses a knee knee brace. He reports loss of
sensation to the top of the knee cap.
b. Does the Veteran report flare-ups of the knee and/or lower leg?
[ ] Yes [X] No
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?
[X] Yes [ ] No
If yes, document the Veteran's description of functional loss or
functional impairment in his or her own words:
I try to maintain with cycling and swimming. I can only hike a mile
before I get pain and tired in the knee - it seizes and locks up.
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 90 degrees
Extension (140 to 0): 90 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 but does not result in/cause functional loss
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):
Tender to palpation over lateral knee and infrapatellar region
Is there objective evidence of crepitus? [ ] 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? [X] Yes [ ] No
Select all factors that cause this functional loss:
Pain
ROM after three repetitions:
Flexion (0 to 140): 0 to 85 degrees
Extension (140 to 0): 85 to 0 degrees
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
Able to describe in terms of range of motion: [X] Yes [ ] No
Flexion (0 to 140): 0 to 85 degrees
Extension (140 to 0): 85 to 0 degrees
Right Knee
----------
In addition to those addressed above, are there additional contributing
factors of disability? Please select all that apply and describe:
Swelling
Please describe additional contributing factors of disability:
Mild medial swelling noted
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
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?
[X] Yes [ ] No
If yes, is the muscle atrophy due to the claimed condition in the
Diagnosis Section?
[X] Yes [ ] No
For any muscle atrophy due to a diagnosis listed in Section 1.,
indicate
side and specific location of atrophy, providing measurements in
centimeters of normal side and corresponding atrophied side, measured
at
maximum muscle bulk.
[X] Right lower extremity (specify location of measurement such as "10cm
above or below the knee"):
Location: No location specified
Circumference of more normal side: 47cm
Circumference of atrophied side: 45cm
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 ankyloses
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: [ ] None [ ] Slight [X] 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
----------------------
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: Arthroscopic Lysis of Adhesions, Medial
Patellofemoral
Ligament Repair
Date of surgery: 2 February 2005
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, is there objective evidence that any of these scars are
painful,
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: Anterior Right Knee
Measurements: length 10.0cm X width 0.5cm
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?
[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 [X] Regular [ ] Constant
b. If the Veteran uses any assistive devices, specify the condition and
identify the assistive device used for each condition:
Veteran uses a knee brace to support the knee for the right knee condition.
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?
[X] Yes [ ] No
If yes, indicate knee: [X] Right [ ] Left [ ] Both
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):
Exm Date: AUG 10, 2017@16
Report: Right knee MRI
There are susceptibility artifacts related to tendon anchor is within
the medial aspect of the patella which correlates with findings on
prior radiographs. This is likely related to prior medial retinacular repair.
This makes evaluation of the medial facet of the patella very difficult.
The patellar cartilage along the lateral facet of the patella appears largely intact.
There is mild degenerative change of the patellofemoral
joint with spurring off the articular surfaces. The quadriceps tendon and patellar
tendon are intact. There is advanced degenerative chondrosis of the articular cartilage of
the lateral femoral condyle. There is reactive subchondral edema within
the lateral femoral condyle. There are reactive subchondral changes within the lateral tibial plateau as well.
There is degeneration of the lateral meniscus and partial extrusion of
the meniscus from the joint without definitive tear the medial meniscus
is intact. The anterior cruciate ligament and
the posterior cruciate ligament are intact. The medial collateral
ligament and lateral collateral ligamentous complex are intact.
Impression: There are postoperative changes of the patella without
visible complication related to surgery however there is susceptibility
artifact.
There is relatively advanced degenerative arthritis of the lateral
compartment of the knee without definitive meniscal tear.
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:
In regards to functional impairment related to occupations caused by knee
condition, veteran cannot perform tasks that require prolonged standing,
prolonged walking, any degree of running or any tasks that require
crawling, squatting, or stooping. These activities would aggravate their
current knee condition and veteran may not be able to do these activities
safely.
15. Remarks, if any:
--------------------
1. Is there evidence of pain on passive range of motion testing?
Yes
2. Is there evidence of pain when the joint is used in non-weight
bearing? t be performed Yes
3. If yes, is the opposing joint undamaged (i.e. no abnormalities)? Yes
See Exam above.
A goniometer was used for range of motion measurements.
****************************************************************************
Scars/Disfigurement
Disability Benefits Questionnaire
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes [ ] No
Edited by TbirdRemoved personal identification information
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