Trying to understand Knee ROM and Meniscus disability ratings.

[calgon]

Hello Everyone.

Appreciate you all for your service to our country. Thanks in advance for your help.

I recently had a C and P exam for a knee condition. 

Based on ROM, Meniscus, misc. notes below, could someone help me understand what this may mean as far as a rating?

Chuck

1. Diagnosis
------------
a. List the claimed condition(s) that pertain to this DBQ:
Torn Medial Meniscus, Chondromalacia femoral condyles, RIGHT knee
b. Select diagnoses associated with the claimed condition(s) (Check all that
apply):
[X] Knee meniscal tear
Side affected: [X] Right [ ] Left [ ] Both
Date of diagnosis: Right */*/2011 MRI
[X] Arthritic conditions
[X] Arthritis, degenerative
Side affected: [ ] Right [X] Left [ ] Both
Date of diagnosis: Left */*/13
[X] Arthritis, traumatic
Side affected: [X] Right [ ] Left [ ] Both
Date of diagnosis: Right */*/2011
 
b. Does the Veteran report flare-ups of the knee and/or lower leg?
[X] Yes [ ] No
If yes, document the Veteran's description of the flare-ups in his
or her own words:

right knee pain goes to 9/10 5-6 days out of the week

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:
Tries to avoid running when possible; has knee pain even when sitting,
had to take a break

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 60 degrees
Extension (140 to 0): 60 to 0 degrees
If abnormal, does the range of motion itself contribute to functional
loss? [X] Yes (please explain) [ ] No
If yes, please explain:
declines to flex knee more than 60 deg due to reported pain with ROM
Description of pain (select best response):
Pain noted on exam on rest/non-movement
If noted on exam, which ROM exhibited pain (select all that apply)?
Flexion, Extension
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):
medial and lateral knee tenderness

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: [ ] Right [ ] Left [X] 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):
*/*/2011 MRI Right knee

Impression:
1. Radial tear of the posterior horn medial meniscus near the root
insertion, with extrusion of the body segment within the medial gutter.
2. Small radial tear of the posterior horn lateral meniscus.
3. Mild cartilage abnormalities of the posterior surfaces of the
femoral
condyles; small, focal high-grade partial-thickness cartilage defect of
the medial femoral trochlea.
4. Bipartite patella with mild reactive edema the synchondrosis.
*/*/2013 Left knee

Impression:
Minimal retropatellar spurring. Otherwise grossly normal appearance of
the knee. Patellar enthesopathy incidentally noted.
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:
The right knee pain increases when he has to ride in a car after 20
minutes. Gets increased right knee pain after sitting 30 minutes, standing
30 minutes; walking 15 minutes

 

[broncovet]

I always suggest, prior to calculating up your disability percentages, retro pay, and what you are going to spend the money on, you make sure you have all 3 Caluza elements, first.  Why?

First, VA will do that.  They dont go calculating a disability percent until you are SC.  

Its just too easy to skip over the basic Caluza elements and go right on to percentages and effective dates, and completely forget you dont have a nexus.  

Denver Broncos did that one year.  We were "flying" in the playoffs.  We had won something like 14 games out of 16, and we were all getting ready trying to figure out who we would play in the Superbowl.  

Well, lets see...AFTER we beat Jacksonville here in Denver, who will we play next round?   

Guess what.  We did not beat Jacksonville.  We lost.  We didnt take care of business..but instead focused on who we would play after we mopped up Jacksonville, as we were so sure we would beat them in Denver.  

Now, we play "one game at a time", and we dont underestimate opponents.  I suggest you, too, focus on getting those Caluza elements and then try to figure out ROM's and disability percents.   That lesson was immensely painful for Broncos coaches, players and fans alike.  

Edited April 30, 2019 by broncovet

[calgon]

Thanks! I am currently service connected - 0%. This C and P was for an appeal of the original decision. I appreciate your insight and illustration. Makes good sense.

Chuck 

[broncovet]

Ok.  So your C and P was for an appeal, where you apparently disputed the disability percentage (0 percent).  

It sounds like you have knee radial and meniscal tears, as well as some traumatic and degenerative arthritis that have some limitations upon your work.  

My suggestion is you look HERE to see what disability percentage(s) are closest to YOUR symptoms, then appeal and fight for it:

http://www.danaise.com/understanding-rating-for-knee-injury/

It would appear you have been "lowballed" and you should get 10 to 20 percent, based on what you posted and Dr. Anaise article. 

 

[calgon]

Thanks broncovet!