Rating of non-degenerative arthritis and ROM

[Dingodab]

Hi all,

Sure wish I would have known about these forums years ago, it would have helped me a lot along the way with my journey with the VA!

Anyhow, I have a SC auto-immune disease (dermatomyositis) that has caused me quite a few issues.  I have some secondary SC issues that the VA has granted me compensation for.  Most recently I had a C&P exam for arthritis(synovial hyptertrophy)/arthlagia secondary to my SC disease.  I haven't received my rating yet but I have been able to view the exam on the Healthevet site.  Arthritis seems very complicated to understand as far as rating goes.  I was wondering if anyone here might be interested in giving their two cents regarding me exam?  Please see below:

RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Is the veteran's both ynovial hypertrophy and proliferative synoviumof bilatearl wrists at least as likely as not proximately due or the result of amyopathic dermatomyositis b. Indicate type of exam for which opinion has been requested: writs TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition. c. Rationale: Review of medical literaure cite that a nonerosive polyarthritis which include claimed synovial hypertrophy and Proliferative synovium can be presnt in dermatomyositis. There is inflmmation of the synovium which is a membrane that lines the joints, and is associated with inflammatory and/or injury. UpToDate states 30 percent of dermatomyositis patients can have the anti- synthetase syndrome which acute onset of weight, loss , fever, Raynauds, mechanics hand aand nonerosive arthritis. The claimed synovial hypertrophy and proliferative synovium is part of the findings in in nonerosive arthritis which is also included in ANTI-SYNTHETASE Syndrome ( weight loss,fever Raynaus, mechnics hand and nonerosive arthritis)

I briefly spoke to my DAV rep who said that it will likely be rated under rheumatoid arthritis because it is not degenerative arthritis but rather inflammatory arthritis.  I also have limited ROM in both wrists in two joint groups in my right wrist and three joint groups in my left wrist (per the C&P exam report).  There is also pain, stiffness, and flares (two in the past 6 months that were incapacitating and two that were non-incapacitating).  There is also restricted ROM in all of my fingers, but I'm not sure those will be rated since the synovial hypertrophy is only present in my wrists....unless that restricted ROM in my fingers is due to my wrists? I'm not really sure.  I have no reduced muscle strength. The examiner also noted that this condition impacts my work and normal daily activities on a regular basis because I can sometimes have difficulty holding and gripping objects and intense pain during flares.

So, if I'm rated under 5002 I think it's possible I get 20-40%.  If rated under 5002 would I also be rated for limited ROM in my wrists? Or will I be rated under limited motion and 5002 and given the higher rating of the two?

 

 

[broncovet]

Whenever someone asks, "What will VA do when....blank happens", the answer is always the same.  Nobody knows but the decision maker.  

The VA is supposed to follow regulations, but, if they did that consistently, then all the BVA judges, as well as  the CAVC judges would be out of a job and have to find other work.  

We are not in much danger of them laying off judges because there is no work for them to do.  To the contrary, there is currently about a 5 year backlog on BVA appeals..and that is before you even file for a CAVC appeal.  

It sounds like you have the magic "nexus" statement, and also you have a diagnosis.  

So, if "none" of the 3 paragraphs above, applies to you, then you should be down to a disability percentage.  

A favorite of VA (other than delays and denials), is lowballing you, which, of course they did to me.  Maybe you will have a more favorable decision maker, lets hope.  

Mostly, VA ratings are supposed to reflect the "average" amount they affect your employment.  For example, if you cant work at all due to sc disabiliities, then you should get 100 percent schedular or tdiu.  

Im not sure of the degree that your arthritis affects your employment, but it sounds like its at least "some".  

Im not gonna speculate on a disability percentage..almost any number is likely to be wrong.  However, your numbers do appear to be in the ball park of what I have seen.  

IN my case, I fractured my leg in service, developed knee arthritis, which eventually needed a total knee replacement last fall.  

My rating?  NSC (0 percent).  Yea, I could fight that, but it seems to mostly be moot right now.  And, since I would rather have all my teeth and toenails pulled out without pain meds than to fight VA again, I wont do it unless I am pretty sure it would result in additional compensation.  Since I doubt that, I will let it ride.  For now.  

 

[Dingodab]

The disability impacts my job a bit, but really only during a flare.  I work as a photographer and have a very difficult time using my hands when symptoms flare up.  I usually get some prednisone and thins return back to normal in a few weeks.  I made this all very clear to the examiner and she seemed to document most of what I said correctly.  I may have lucked out.

How the VA rates arthritis is very confusing to understand.  So, first it's by limited ROM? If there's no qualification under limited ROM then it goes to 5002 or 5003 depending on symptoms? But even if under 5002 or 5003 they will rate each joint and see which is higher, and the higher rating is the rating that is given?

My auto-immune disease by itself get's me a pretty decent rating.  I'm hoping to get around 30% for my hands to make up some of my financial loses due to a service connected issue as a self-employed person, but I guess we'll see what happens. It scares me that a lot of what I read says the rater is given a certain amount of discretion when it comes to rating arthritis.

I'd like to say I can't believe the VA gave you NSC, but unfortunately, I can. I guess we always have to decide what is worth fighting and what isn't.

[broncovet]

Yes, the entire VA system is meant to be confusing.  

Deluca explains that they have to consider pain, also.  

Chris Attig knows well about Deluca.  

Here is VA's take on Deluca:

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000070971/DeLuca-v.-Brown,-Sep-22,-1995,-8-Vet.App.-202-(1995)

[ShrekTheTank]

On 5/2/2019 at 2:39 PM, Dingodab said:

The disability impacts my job a bit, but really only during a flare.  I work as a photographer and have a very difficult time using my hands when symptoms flare up.  I usually get some prednisone and thins return back to normal in a few weeks.  I made this all very clear to the examiner and she seemed to document most of what I said correctly.  I may have lucked out.

How the VA rates arthritis is very confusing to understand.  So, first it's by limited ROM? If there's no qualification under limited ROM then it goes to 5002 or 5003 depending on symptoms? But even if under 5002 or 5003 they will rate each joint and see which is higher, and the higher rating is the rating that is given?

My auto-immune disease by itself get's me a pretty decent rating.  I'm hoping to get around 30% for my hands to make up some of my financial loses due to a service connected issue as a self-employed person, but I guess we'll see what happens. It scares me that a lot of what I read says the rater is given a certain amount of discretion when it comes to rating arthritis.

I'd like to say I can't believe the VA gave you NSC, but unfortunately, I can. I guess we always have to decide what is worth fighting and what isn't.

So I am going to take a stab at this, because I did not realize how much of my pain I was covering by ignoring it and take a crap ton of OCM.  I had to come off of all the things I was doing to really feel the pain and accept what was happening to my body.  I was no longer the strong person.  I was no longer able to do hard physical labor.  My body rejected this type of work and has been kicking a screaming ever since.  

So If this is happening to you this often, it sound like RH

"Arthritis is usually classified as degenerative arthritis or rheumatoid arthritis. Degenerative arthritis, also known as osteoarthritis, occurs when cartilage between joints erodes over time resulting in joint stiffness, limited mobility, and pain. Rheumatoid arthritis occurs when the immune system malfunctions and attacks the membranes lining your joints causing inflammation and resulting in limited motion, stiffness, or pain. Both conditions can cause pain and symptoms may range from mildly disabling to debilitating."

Have you been diagnosed with either condition?  It looks like you don't?  I would get a doctors opinion on what you have.  You said they have power to give one or the other, you also have the ability to steer the ship in the right direction with the right help!

Rheumatoid arthritis can be evaluated at up to 100 percent if it results in complete incapacitation (e.g. bedridden). Lower ratings can be given for occasional incapacitating episodes. As with degenerative arthritis, a rating for limited range of motion cannot be given in addition to a rating for rheumatoid arthritis.

• Veterans experiencing totally incapacitating rheumatoid arthritis symptoms, no matter how many joints are affected, will be rated at 100%.
• Those suffering severely incapacitating episodes four or more times per year OR are experiencing weight loss, anemia, and a decline in health will be rated at 60%.
• Veterans facing a “definitive impairment” in overall health that is supported by exam findings OR experiencing three or more incapacitating episodes each year will be assigned a 40% disability rating.
• Veterans experiencing two or more incapacitating episodes per year who have an established diagnosis will be rated at 20%.

So from what I read above you should fall in the middle somewhere.  Also keep track of all episodes and how bad they are off the meds.  You need to understand how bad they are.  I am not say to not take your meds, just so you can really feel what is happening.