Bottom line up front: I am requesting an increase for my shoulders based on limited range of motion, now rated at 10% each. Range of motion testing using a goniometer isn't something doctors do for diagnosis and treatment , so I don't have the medical documentation to make this a simple, fully-developed claim. Should I submit the request with no supporting documentation and await a C&P, or try to find a physician who would see me to document the limited ROM?
I have an orthopedic surgeon (and another where I used to live,) but as many of us know, our doctors' concern and job is treating our problems, not participating in administrative processes. Going to see him because I feel terrible and then asking, "oh by the way, can you help me with this form?" seems like it would be awkward and like the real reason I'm there. It's not. Documentation of injuries and attribution to specific events, times, etc. (in line with the notion of a C&P exam being not at all about treatment,) seems to be a niche field, and not handled by many physicians. But that's just an impression I now have. For all I know, lawyers who handle SSDI claims have Rolodexes full of these guys. My own experience, and what I've read here, certainly suggests it's a widespread problem among VA (and SSDI?) claimants.* I have added a bit more detail below, but in short, the issue is documenting reduced range of motion.**
I am rated 10% for each of my shoulders, based on different VA-recognized conditions. Because the rather limited list of conditions in the schedule doesn't include my issues, they are both rated as:
5003 Arthritis, degenerative (hypertrophic or osteoarthritis)
When I claimed the conditions, I could abduct my arms higher than shoulder level (I think to 120 degrees, with normal being 180.) I have long been unable to abduct my left arm to shoulder level (to 90 degrees.) Now, I meet the criterion under this section:
5201 Arm, limitation of motion of:
Midway between side and shoulder level 30 (major) 20 (minor)
At shoulder level 20 20
Abduction on the left side ("major," as I am left-handed,) is permanently limited to well below the shoulder, and on my best days, the right side ("minor") may reach shoulder height. Good day or bad, it's 30 and 20.
* I do not use the VA for my care, but it seems those of you who do have the same problem. The "claims" aspect of medicine is one they treat like it's radioactive. Getting an IMO or DBQ involves paying out of pocket or being fortunate enough to have a close relationship with a rare and special care provider.
** I guess a potential question is whether it's due to the S/C conditions, but I don't think it will be a problem. For the left side, VA only lists acromioclavicular (AC) joint degeneration, but the first MRI was done in-service, and the second was done in conjunction with a C&P. The readout for both diagnosed damage to both the AC and glenohumeral joints. The right side has not been imaged by MRI, but I am S/C for rotator cuff tendinopathy (a glenohumeral joint condition.) It was diagnosed in service, and diagnosed and treated post-service. If VA said left side limitation is not due to AC joint degeneration but a glenohumeral joint condition, I would just say OK, call it a new claim if you want, but glenohumeral joint damage is documented in the SMR andin VA's prior decision, and the compensable condition is "limitation of motion."
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glarus
Bottom line up front: I am requesting an increase for my shoulders based on limited range of motion, now rated at 10% each. Range of motion testing using a goniometer isn't something doctors do for diagnosis and treatment , so I don't have the medical documentation to make this a simple, fully-developed claim. Should I submit the request with no supporting documentation and await a C&P, or try to find a physician who would see me to document the limited ROM?
I have an orthopedic surgeon (and another where I used to live,) but as many of us know, our doctors' concern and job is treating our problems, not participating in administrative processes. Going to see him because I feel terrible and then asking, "oh by the way, can you help me with this form?" seems like it would be awkward and like the real reason I'm there. It's not. Documentation of injuries and attribution to specific events, times, etc. (in line with the notion of a C&P exam being not at all about treatment,) seems to be a niche field, and not handled by many physicians. But that's just an impression I now have. For all I know, lawyers who handle SSDI claims have Rolodexes full of these guys. My own experience, and what I've read here, certainly suggests it's a widespread problem among VA (and SSDI?) claimants.* I have added a bit more detail below, but in short, the issue is documenting reduced range of motion.**
I am rated 10% for each of my shoulders, based on different VA-recognized conditions. Because the rather limited list of conditions in the schedule doesn't include my issues, they are both rated as:
5003 Arthritis, degenerative (hypertrophic or osteoarthritis)
When I claimed the conditions, I could abduct my arms higher than shoulder level (I think to 120 degrees, with normal being 180.) I have long been unable to abduct my left arm to shoulder level (to 90 degrees.) Now, I meet the criterion under this section:
5201 Arm, limitation of motion of:
Midway between side and shoulder level 30 (major) 20 (minor)
At shoulder level 20 20
Abduction on the left side ("major," as I am left-handed,) is permanently limited to well below the shoulder, and on my best days, the right side ("minor") may reach shoulder height. Good day or bad, it's 30 and 20.
* I do not use the VA for my care, but it seems those of you who do have the same problem. The "claims" aspect of medicine is one they treat like it's radioactive. Getting an IMO or DBQ involves paying out of pocket or being fortunate enough to have a close relationship with a rare and special care provider.
** I guess a potential question is whether it's due to the S/C conditions, but I don't think it will be a problem. For the left side, VA only lists acromioclavicular (AC) joint degeneration, but the first MRI was done in-service, and the second was done in conjunction with a C&P. The readout for both diagnosed damage to both the AC and glenohumeral joints. The right side has not been imaged by MRI, but I am S/C for rotator cuff tendinopathy (a glenohumeral joint condition.) It was diagnosed in service, and diagnosed and treated post-service. If VA said left side limitation is not due to AC joint degeneration but a glenohumeral joint condition, I would just say OK, call it a new claim if you want, but glenohumeral joint damage is documented in the SMR and in VA's prior decision, and the compensable condition is "limitation of motion."
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