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.

[WBrennan]

VA said SOC Was sent out on 10/29/2019.  I still haven't received it so I called them yesterday.  Was told it is waiting on the narrative and rating decision.  I think this might be good news...  I was told if I don't have it by the 15th to call back.  Fingers and toes crossed....

[WBrennan]

Looks like they bumped me only 10%. Waiting on the BBE to do another appeal.  The bump moves me from 20% to 30%

[Vync]

9 hours ago, WBrennan said:

Looks like they bumped me only 10%. Waiting on the BBE to do another appeal.  The bump moves me from 20% to 30%

Any increase is good, but it always helps to ensure they rated you correctly so you don't get low-balled.

[paulstrgn]

On 11/9/2019 at 11:20 AM, WBrennan said:

I was told if I don't have it by the 15th to call back.

If your decision was sent oit on 10/29/2019 then you only need to wait 10 business days 11/13/2019 was day 10. You can call the 800 number and they will fax you a copy of the decision.

[Richard1954]

On 10/30/2019 at 12:25 PM, Vync said:

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.

Excellent information..... 

[WBrennan]

Ok BBE envelope sent on 11/14 and I received it today.  I still think they owe me 10% for the range of motion.  They lumped everything under the frequent swelling, locking part. (5258). Before I was rated only at 10% total  for the arthritis and meniscus tear only. I wasn't rated at 10% under 5261.  Weird

Below you will find their reasoning. 

You have filed a Notice of Disagreement with the evaluation of the left knee. You expressed concern over the ranges of motion listed on the exam report. You said that the examiner told you your extension was to 11 degrees but it was reported as being 0. You also reported that your surgery dates were omitted for your knee. You asked that we use the measurement the examiner told us and we consider your surgical history. Please understand that we are aware of your multiple surgeries and your medical history has been considered. Also, your range of motion on the second exam was reported as being 10-80 degrees. Measurements are put into the system rounded to the nearest degree. A reading of 11 does not change the evaluation.

 

A review of your August 2018 exam shows that your range of motion was reported as 0-60/0140 (normal range is completely straight knee joint to fully bent knee joint.) There was pain on motion. There was no instability. The exam results supported the separate evaluations (0% and 10%) for your knee.

During your June 2019 exam said that you have had a total of 4 arthroscopies on the knee, most recently in 2017. You complained of fairly constant pain in the left knee described as aching. You take Naproxen 3-4 days per week which helps some. You also reported stiffness in the knee on first arising and after prolonged sitting. You wear a brace if you anticipate much walking. You reported You were diagnosed with left knee OA and possible meniscal tear. You said that you have pain flares unpredictably 3-4 times per week. Flares last

1-3 days. You typically take Naproxen for flares. You note decreased range of motion during flares. You must avoid running and stairs and you are limited in walking. There was tenderness of the medial joint line. There was crepitus. The examiner noted that your severity of the meniscus condition was: Meniscal tear, Frequent episodes of joint "locking,"

Frequent episodes of joint pain, and Frequent episodes of joint effusion. You have persistent pain, limitation of range of motion. Radiology report shows tricompartmental OA with bone spurring. There is evidence of pain when the left knee is used in non-weight bearing. Your range range of motion was reported as 10-80 with pain. Strength was normal. There was no instability or ankylosis. 

Neither your private treatment nor outpatient VA records provide information we need to evaluate your condition.

We have discontinued the two separate conditions for your left knee (10 percent under diagnostic code 5010-5261 (limitation of extension) and 0 percent under diagnostic code 5260 (limitation of flexion)) in order to combine your symptomatology under one diagnostic code which results in a higher evaluation for you. We will now evaluate your condition under the rating criteria for semilunar cartilage, diagnostic code 5258.)

Service connection for meniscectomy residuals, left knee mensical and ligament tear with osteoarthritis and limited motion and pain (previously rated under DC 5010-5261 and 5010-5260) has been established as directly related to military service. (38 CFR 3.303, 38 CFR 3.304)

An evaluation of 20 percent is assigned from May 14, 2018, the date we received your Intent to File form as you formalized the claim within one year of submitting it and as preserved by the appeal process. (38 CFR 3.155 and 38 CFR 3.400) We have assigned this evaluation for the entire appeal period and resolving any doubt in your favor.

We have assigned a 20 percent evaluation for your meniscectomy residuals, left knee mensical and ligament tear with osteoarthritis and limited motion and pain (previously rated under DC 5010-5261 and 5010-5260) based on.

• Dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint

Additional symptom(s) include:

• X-ray evidence of degenerative arthritis

• Limitation of extension of 10 to 14 degrees

The provisions of 38 CFR *4.40 and *4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown and Mitchell v. Shinseki, have been considered and are not warranted.

This is the highest schedular evaluation allowed under the law for degenerative arthritis. (38 CFR 4.71a)

Additionally, this is the highest schedular evaluation allowed under the law for dislocated semilunar cartilage of the knee. (38 CFR 4.7 la)

Additionally, a higher evaluation of 30 percent is not warranted for limitation of extension of the knee unless the evidence shows:

• Limitation of extension of 20 to 29 degrees. (38 CFR 4.71a)(DC 5261)

(An evaluation of 0 is for extension limited to 5 degrees; an evaluation of 10 percent is assigned for extension limited to 10 degrees; and evaluation of 20 degrees is assigned for extension limited to 15 degrees.)

Additionally, a higher evaluation of 30 percent is not warranted for limitation of flexion of the knee unless the evidence shows:

.Limitation of flexion limited to 15 degrees. (38 CFR 4.71a)(DC 5260)