POSSIBLE PSA/ RA NEW DIAGNOSIS

[Mikey]

Hello all, I'm currently rated for osteoarthritis and djd with loss of ROM  in multiple joints from spine to feet. My pain management Dr. recommend to be tested for RHUMATOID arthritis/ Psoriatic arthrits. Blood work neg for RA, PSA still possible. X-rays show positive for arthritis. I've developed psoriasis after service so I was never treated while active for it.  Is it possible to have been misdiagnosed all these years?  If PSA is confirmed would it be wise to file for it, and would it be considered pyramiding?  Could it be considered new diagnosis? I've read that they don't base RA/PSA on ROM just immune criteria.  All this new information has my head spinning. Any input would be greatfull. 

[Buck52]

I would say being you have been S.C. for Arthritis  disease established...the RH has a different rating Code  but it is is the same category as your already S.C. Arthritis Condition so need to watch pyramiding the symptoms.

 

§4.14   Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

check the combined ratings for muscle injuries CFR .4.55 or

4.71 (a)

  However

if you put in a claim and they send you to a C&P Exam

 If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

	Rating
5000   Osteomyelitis, acute, subacute, or chronic:
Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms	100
Frequent episodes, with constitutional symptoms	60
With definite involucrum or sequestrum, with or without discharging sinus	30
With discharging sinus or other evidence of active infection within the past 5 years	20
Inactive, following repeated episodes, without evidence of active infection in past 5 years	10
Note (1): A rating of 10 percent, as an exception to the amputation rule, is to be assigned in any case of active osteomyelitis where the amputation rating for the affected part is no percent. This 10 percent rating and the other partial ratings of 30 percent or less are to be combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening, etc., subject, of course, to the amputation rule. The 60 percent rating, as it is based on constitutional symptoms, is not subject to the amputation rule. A rating for osteomyelitis will not be applied following cure by removal or radical resection of the affected bone.
Note (2): The 20 percent rating on the basis of activity within the past 5 years is not assignable following the initial infection of active osteomyelitis with no subsequent reactivation. The prerequisite for this historical rating is an established recurrent osteomyelitis. To qualify for the 10 percent rating, 2 or more episodes following the initial infection are required. This 20 percent rating or the 10 percent rating, when applicable, will be assigned once only to cover disability at all sites of previously active infection with a future ending date in the case of the 20 percent rating.
5001   Bones and joints, tuberculosis of, active or inactive:
Active	100
Inactive: See §§4.88b and 4.89.
5002   Arthritis rheumatoid (atrophic) As an active process:
With constitutional manifestations associated with active joint involvement, totally incapacitating	100
Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods	60
Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year	40
One or two exacerbations a year in a well-established diagnosis	20
For chronic residuals:
For residuals such as limitation of motion or ankylosis, favorable or unfavorable, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.
Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.
5003   Arthritis, degenerative (hypertrophic or osteoarthritis):
Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations	20
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups	10
Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.
Note (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive.
5004   Arthritis, gonorrheal.
5005   Arthritis, pneumococcic.
5006   Arthritis, typhoid.
5007   Arthritis, syphilitic.
5008   Arthritis, streptococcic.
5009   Arthritis, other types (specify).
With the types of arthritis, diagnostic codes 5004 through 5009, rate the disability as rheumatoid arthritis.
5010   Arthritis, due to trauma, substantiated by X-ray findings: Rate as arthritis, degenerative.
5011   Bones, caisson disease of: Rate as arthritis, cord involvement, or deafness, depending on the severity of disabling manifestations.
5012   Bones, new growths of, malignant	100
Note: The 100 percent rating will be continued for 1 year following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. At this point, if there has been no local recurrence or metastases, the rating will be made on residuals.
5013   Osteoporosis, with joint manifestations.
5014   Osteomalacia.
5015   Bones, new growths of, benign.
5016   Osteitis deformans.
5017   Gout.
5018   Hydrarthrosis, intermittent.
5019   Bursitis.
5020   Synovitis.
5021   Myositis.
5022   Periostitis.
5023   Myositis ossificans.
5024   Tenosynovitis.
The diseases under diagnostic codes 5013 through 5024 will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002.
5025   Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms:
That are constant, or nearly so, and refractory to therapy	40
That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time	20
That require continuous medication for control	10
Note: Widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

 

Also this may help you  lot of reading I realize, but knowledge is power.

http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html

Maybe all this will help you figure out what you need to do.

I kinda think you will get a higher evaluation and if the RH Warrants an increase then they will probably rate that at a higher rating than what you have now. Or infrerr the TDIU P&T IF the R.H (Arthritis) is severe enough  that keeps you from working or doing any type of employment...

Also possible SMC Could be if they say the R.H. IS A SEPARATE   CONDITION RATED 60% OR HIGHER.  WITH YOUR 90% YOU HAVE  AT PRESENT, THIS NEW RATING SHOULD WARRANT THE SMC.

Good Luck!!!

Edited July 25, 2018 by Buck52

[Mikey]

BUCK, you are correct knowledge is power.  I Thank you for your input. I will be seeing a few Docs in the next few days. In the meanwhile I will continue to educate myself.    ****** 07.27 Diagnosed with psoriatic arthritis put on meds for next three months trial basis. More than likely related.  Happy I received some proper care. On to the next mission. 

Edited July 28, 2018 by Mikey
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