Painful motion and meds

[SPO]

I have posted stuff in other topics about this, but I'm looking for some direct advice on this matter that isn't buried in my other posts.  I have psoriatic arthritis which I am submitting a claim secondary to my service connected psoriasis.  I'm not sure if I will get a C&P for this since I am submitting a DBQ from my dermatologist.  How do I handle the C&P if my condition isn't at its worst and my medication reduces symptoms. This is indicative and how bad it can be and the progression of the disease. My concern is that the diagnostic code says "Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion."  I do have painful motion, but not all the time because of meds and the disease isn't the same every day.

[broncovet]

When you go to a C and P exam, its perfectly legit to report symptoms on your worst day, since "virtually all" of us have "good days and bad days".  So, when the c and p doc asks, "How are you today?"   

You should have your response memorized.  Dont say, "fine", the usual response.  Instead, say, "Today is much better than last Thursday"...then go on to describe your worst day on Thursday.   It is not exaggeration to describe your "worst day's symptoms".    Remember the motto, "be honest", and you should do fine.  Still, a c and p exam is not the place where you want to minimize your symptoms, else you will likely minimize your benefits.  If you were arrested for domestic violence last month due to PTSD, then its perfectly ok  to report that to your c and p examiner.  When we turn on the news, they dont report the 364 days last year when you drove to work without incident.  However, the day you got into a wreck and rolled your car WILL likely be reported.  Your insurance is unlikely to write you a letter thanking you for 364 days of safe driving...instead, your insurance will likely be cancelled if you get ONE DUI in the year . 

[SPO]

Thanks,  I figured that would be the course to take.  Will they take that as objective evidence though?  I have had VA examiners that were great and did what they could to write the exam report to get what I deserved.  I've also had others who pushed my joints through range of motion even though I said it hurt.  Should I tell them the point when it normally hurts during range of motion, or give them the pain indicators they are looking for, like wincing?

[broncovet]

If it hurts, say so.   If it does not, likewise, so state.  By complete honesty, you should be confident your benefits wont be reduced in the future..and you should sleep well.  The examiners are trained to spot malingering, and its pretty easy for them to trick you.  

Hypothetical example:  

The doc puts one of those devices on you which measures your number of degrees you can bend your knee.  Remember, he can see the number of degrees, while you can not.  

If you report "pain at 38 degrees", then he repeats it and you dont report pain until 90 degrees, then something fishy is going on.  

I see this in the hearing tests also.  I have had more than 6 audio exams in the past 16 years.  All of my exams are consistent.  (This does not mean they are exactly the same..not at all!   It means the 6000 htz is within a fairly narrow "range" of 40 to 55 decibels.)   My hearing has shown a progressive decline since the 1998 exam first measured it.  It has declined by about 5% each 2 or 3 years.  I simply try to accurately report what I can/can not hear each time.  

My audiologists can figure this out, and all have given me favorable exams.  

[SPO]

So you're saying if it doesn't hurt that day, let them know that is where it normally hurts, but don't try to give them other indications other than saying it?

[GeekySquid]

1 hour ago, SPO said:

How do I handle the C&P if my condition isn't at its worst and my medication reduces symptoms. This is indicative and how bad it can be and the progression of the disease. My concern is that the diagnostic code says "Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion." 

I am going to suggest you try what seems like a novel approach to this particular problem. Psoriatic Arthritis, like all forms or arthritis, tends to ebb and flow. it is not one constant level of pain, swelling or discomfort.

So consider, and i don't know if the C&P or Rater will accept this, filming yourself on the 'worst' days. Make it a habit on those days to record any swelling, range of motion limitations and any other visible symptoms or indicators.

Qualified Docs will know that it ebbs and flows so unless they don't believe you for some reason it really should not be that major a barrier, but consider the video idea. you will have to figure out how to add a perspective to the view to show degree of swelling or limits on motion. i would also consider having a third party or parties do this and have them write a statement about that day and how your life was affected that day.

If you make them contemporaneously, you create a believable record of events as they occur. So even if the doc and rater don't give you the highest rating you will have a record to submit during your appeal. 

 

Good luck

[vetquest]

This whole conversation brings into mind buddy letters.  A spouse or other loved one can write a letter explaining your issues.  You may report that you are doing well today but there have been issues when the weather changes.  Your buddy letter would state the same and add credibility to your statement.  These letters have been a great help in my situation where the symptoms vary day to day.