C&P Exam Report Rating Question

[RBrogen]

Hello Everyone,

I'm new to the forum and wanted to see if anyone could shed a little light or thoughts on what they think the rating would be from this C&P exam report.  I have been out since '91, current disability is 20% for Chronic Lumbosacral Strain and they originally denied some of these incorrectly.  I'm also a bit confused on conditions that are potentially Bilateral (Ankle, Knee and Shoulders ... potentially rediculapathy?)  Lastly there is also Ulnar nerve mild paralysis on right side along with meniscus issues in both knees.  Any thoughts would be greatly appreciated.

Condition 1:  Ankle Condition Left
TAB A B C D E, (veteran is claiming 2nd to knee but not SC for knee at this time and STRs have complaints of left ankle) also complaints of Achilles tendon. Veteran also has a parachute badge, please consider this as well.   

b. Indicate type of exam for which opinion has been requested: ankle 

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ]

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 left ankle x-ray today does show degenerative bone in possible old injury areas of the ankle. The veteran was in the service, jumped and marched and no injury outside of the service, only rolling of the ankles from time to time. The initial trauma to this joint more than likely as not was while on AD from repetition with marching and jumping. Medical nexus is established. 

Condition 2:  Ankle Condition Right
TAB A B C D E, (veteran is claiming 2nd to knee but not SC for knee at this time) also complaints of achilles tendon. Veteran also has a parachute badge.  

b. Indicate type of exam for which opinion has been requested: ankle
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ]

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's right ankle also has signs of previous repetitive trauma in the ankle joint via radiograph. The veteran did not have any other ankle injuries post-AD. He continues to have rolling and instability of both ankles after AD and since injuring the ankles while in service. More than likely as not, the veteran's initial trauma to the right ankle was in the    service from jumping and marching so much. The ankle is a weight bearing joint and excessive weight with repetition can cause long lasting effects and damage to the joint.

Condition 3:  Knee Condition Right
TAB A B C D E, there is also a direct complaint about R knee in STrs. 

b. Indicate type of exam for which opinion has been requested: knee    
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION]

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's right and left knee were injured while in the service. There are noted injury of "MCL" strain of right knee in 1990.  Veteran did not have a very physical job outside of AD. Veteran did do jumps and marching while in the service which would affect the weight bearing joint on AD. Surgery done on the right knee for meniscal tear in 1997, more than likely than not began with initial injury in 1990. Medical nexus is established.

Condition 4:  Knee Condition Left
TAB A B C D E, there is also a direct complaint about R knee in STrs.  

b. Indicate type of exam for which opinion has been requested: knee    
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ].

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: Left knee was injured prior to AD, as per veteran, while playing football. The veteran was not seen for this injury. Veteran had an asymptomatic knee on entrance exam into the service. While in the service, he states that he injured the knee- silent STR's for this. Veteran eventually did have surgery on the left knee in 1996. Unclear of the etiology of the knee surgery for a meniscal tear. May have been due to high school injury. Without records to bridge the gap from AD to 1996 and no record of left knee issues in the service, it's hard to connect the left knee to AD. But, more than likely, the veteran reinjured an already weak left knee while doing parachute jumps and marching while on AD. No injury to the left knee after AD. The veteran's PCP wrote a letter stating (3/10/2009) that the veteran's joint and back issues were related to service. The knees are a weight bearing joint, my point is that the veteran would worsen an old injury or easily create a new injury due to the wear and tear of the service. Medical nexus is established.

Condition 5:  Neck Condition
Additional remarks for the examiner: veteran was previously denied, claiming 2nd to back which veteran is SC for, but also has a parachute badge, please consider.

TAB A B C D E    
b. Indicate type of exam for which opinion has been requested: neck    
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] .

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 current neck diagnosis at C4-5 is suspected to be an old injury as per neurosurgeon’s note from 1/18/2019. The veteran did have an abnormal MRI of the cervical spine in 2009 as well. Veteran is having surgery in a few weeks due to the issues with his spine. Veteran has probable cause to have damage to his neck after doing 5 jumps and marching with a heavy pack on his back. There is no STR documentation of a neck issue, but this type of injury is due to wear and tear or a direct fall onto the neck such as    landing from a jump. Medical nexus is established as there was no other trauma to the neck other than the service.

Condition 6:  Shoulder Condition Bilateral
TAB A B C D E, veteran is also claiming degenerative disc disease cervical spine with radiation to right shoulder and arm which he was previously denied, but if there is a positive opinion due to the parachute badge, may need to assess with a PN DBQ as well.
    
b. Indicate type of exam for which opinion has been requested: shoulder    
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ]  
  
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: there is no medical documentation in the STR's for a shoulder condition, veteran jumped and rolled several times which can eventually cause an impingement type picture with the clavicle. The right side is his dominant side. No other right shoulder injuries since service, more than likely as not, the right shoulder issue is due to the jumping on AD

Condition 7:  Shoulder Condition Bilateral
TAB A B C D E, veteran is also claiming degenerative disc disease cervical spine with radiation to right shoulder and arm which he was previously denied, but if there is a positive opinion due to the parachute badge, may need to assess with a PN DBQ as well.

b. Indicate type of exam for which opinion has been requested: PN    
TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] 

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's cervical radiculopathy more than likely as not is due to (secondary to) the degeneration of the cervical spine. The veteran is having surgery on the spine due to this discomfort. Medical nexus is established. Cervical stenosis is a narrowing of the spine due to arthritis causing tightness of the spinal cord and pinching which can cause pain into the upper extremities.

Edited February 26, 2019 by RBrogen
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[RBrogen]

2 minutes ago, megajunk said:

Any update?

Hey Mega ... I got 80% which I'm very excited about.  I have several outstanding elements that are still being reviewed to go so hopefully it will go higher.

[megajunk]

Congrats! 

[RBrogen]

7 minutes ago, megajunk said:

Congrats! 

Thanks Mega.

[Proudvet]

Congrats!