Knee Rating Help

[WBrennan]

I am currently rated 10% for my left knee.

My ratings are:

Left knee meiscal and liagment tear with osteoarthritis 10%

Residuals, mediscetomy , left knee 0%

In the first c&p exam the examiner told me my extension (edit: originally posted flexion) was 60 to 10 and 10 to 60 entered 60 to 0 and 0 to 60.

I filed my appeal and received a new C&P exam. Doctor entered 80 to 10 and 10 to 80.

So this should get my DX under 5261 for limited Flexion at 10%

Then I have the xrays proving the arthritis so that is 10%

Stability is fine so nothing for that.

For the meniscus tear this is from the DBQ

8. Meniscal conditions
----------------------
a. Does the Veteran now have or has he or she ever had a meniscus (semilunar
cartilage) condition?
[X] Yes [ ] No
If yes, indicate severity and frequency of symptoms, and side affected:
Left Side:
[X] Meniscal tear
[X] Frequent episodes of joint "locking"
[X] Frequent episodes of joint pain
[X] Frequent episodes of joint effusion

 

So I should get 20% under 5258.

It is also documented that there is pain on movement which should be 10%.

Now with all the VA Math and anti-Pyramiding I think my knee should be rated at 30% under 5261 and 5258.  I get confused on the arthritis and painful motion. Since I should be 10% for 5261, this should include the arthritis.  What is everyone's thoughts?

 

Edited July 19, 2019 by WBrennan
Put Flexion instead of Extension.

[vetquest]

I agree with your assessment, 20% for 5258 and 10% for 5261.  5258 includes pain so I see that covering the arthritis and 5261 is rated by extension.  Now, how will the rater say it is he might just say 5258 and skip over the extension issue.  We can only guess what they will do at this point.  

[Richard1954]

4 hours ago, WBrennan said:

Doctor entered 80 to 10 and 10 to 80

It sounds to me like the doctor is saying your range of motion is 80% 

Code 5260: If the knee can straighten, but cannot bend all the way, then it is rated under this code. If the knee can only bend to 15°, then it is rated 30%. If it can bend to 30°, it is rated 20%. To 45°, it is rated 10%, and anything 60° or more is rated 0%.

4 hours ago, WBrennan said:

Then I have the xrays proving the arthritis so that is 10%

Just because you have xrays does not mean you will get a rating.. a doctor will have to make a statement that the arthritis is service connected.. I fought the VA hard on this one... and finally won.. two years later.

Knee Buckling is rated 

Code 5257: The knee can also have too much motion (instability) from side to side or dislocate regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. If there is only slight instability, then it is rated 10%. If there is more instability that might cause the knee to buckle or dislocate every now and then, then it is rated 20%. If, however, it is so unstable that it gives out or dislocates regularly, it is rated 30%.

Edited July 19, 2019 by Richard1954

[WBrennan]

I already have the 10% for the Arthritis/Meniscus tears.  In the first C&P (this above post was the second) they service connected the Arthritis.  There is no instability with the knee. Weird I know.  The issue I have is the Extension, my bad for putting in Flexion. Been a long week. My left knee can only extend to 10 and flex to 80

[WBrennan]

As of Today I am at the Statement of Case.  I will update everyone once the BBE shows up. No rating change in ebenefits.

[broncovet]

Deluca says that pain must be condered in the rating.  When you get the envelope let us know.  A SOC indicates you are still in legacy appeals. 

[Vync]

10 minutes ago, broncovet said:

Deluca says that pain must be condered in the rating.  When you get the envelope let us know.  A SOC indicates you are still in legacy appeals. 

I'll add that Deluca should include a couple of ROM measurements in degrees. First, the degree where painful motion begins. Second, the max ROM that you can move, even if it is beyond where the painful motion began. When they rate via the Deluca ruling, they are supposed to use ROM where pain began.