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How do I figure out what my rating should be?


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Question

I recently won connection on appeal for 2 disabilities. One of them is tinnitus so I know I should expect 10% for that.

The other is for right arm tenosynovitis. If it helps here is my decision https://www.va.gov/vetapp19/files12/19191030.txt . 

 

From memory during the C&P exam years ago my range of motion was within normal limits for my wrist. I have a scar on my forearm starting about a third of way down to a couple inches into my hand from the surgery. My records and everything show complaints of intermittent pain in forearm, wrist, and palm next to scar among other things. However during flare ups especially when I try to use hand for small dexterity things my entire hand and wrist cramp up and my range of motion is severely diminished until I rest it. I can't really use manual tools without problems, at my last job I typed a lot so I was in pain a good amount of time and had to take breaks. At current job I have issue when I handle small parts. My hand will sometimes shake and I've dropped them. I've had to buy motion isolated leaf blower at home to help reduce pain as well. Problem is most of time it's ok and during exams I haven't had flare up.

So I'm really confused on what code should even be used? When I'm given a rating how do I know they chose the appropriate one? 

 

The other thing that has me worried is that the VA.gov website shows this as the granted issue. 

  • Service connection, Limitation of arm motion

Does that mean forearm, wrist and hand? That's where my issues are and the combined all my other claims that included those because I wasn't sure how to claim it when I filed way back when.

 

 

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At this point IMHO, It is too early to tell what VA will do.  Yes, your claim (just scanned it, didn't read it) was granted by BVA. It now has to be rated by the local VARO which might (most likely) schedule you for new C & P exams(s) maybe one or more than one. Keep in mind that VA may service connect your scar if it is not service connected already. That would be a separate rating from your arm.

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. Under 38 C.F.R. § 4.71a, Diagnostic 5024, tenosynovitis shall be rated based on ... of disability specified are considered adequate to compensate for considerable ... 

Usually a 10%  /20% depends on the severity?

you may find more information in this link  as I understand your condition they have proposed a change ?

DC 5024, currently named, “Tenosynovitis,” to “Tenosynovitis, tendinitis, tendinosis, or tendinopathy.” These newly-added conditions are commonly seen in the veteran population and represent similar forms of disability. See Kelley's Textbook of Rheumatology, supra at 587-604. This update would assist rating personnel in more quickly identifying the appropriate DC. Non-substantive revisions to the criteria of DC 5024 are also proposed.

https://www.federalregister.gov/documents/2017/08/01/2017-15766/schedule-for-rating-disabilities-musculoskeletal-system-and-muscle-injuries

Edited by Buck52
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10 hours ago, pete992 said:

 

Thanks for the info so far I appreciate it. I went back and found the original dbq on the tenosynovitis and saw the said I didn't complain of flare ups or fatigability which I know I did. Hopefully the rater checks all my records and disagreements which clearly show I do and have complained of those issues. 

 

I am going to check out the above links though. At least 10% does sound like the right starting point because it does legitimately interfere with my work.

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Good answer, Buck.  I will add to consider "all" of the possible ratings you suggested (forearm, wrist and hand) and compare those to the rating you got.  Did the doc diagnose you with all 3 of these, or was it "just one".?

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This was first appointment from last VA Dr I really complained to about this before giving up on getting it better. This note below pretty much makes it clear IMO what the issues are. I also ended up asking later for occupational therapy who said they couldn't really do anything either. They said some ultrasound therapy that helps break down scarring could help but they didn't offer it there. 

There is another note saying how braces made it worse when I tried them. So my symptoms of the hand , fingers, wrist and forearm are linked to the tenosynovitis.

This 30-year-old right-hand man works as a dispatcher, often
doing computer work, and is referred by Dr. D for evaluation
of his right wrist. In 2006, while on active duty, he noted a 
painful swelling in the volar distal right forearm which 
eventually became painful. An MRI was negative, and he underwent
surgery in 2007. A "radical tenosynovectomy" was performed. The
pathology indicated "dense fibrosis without malignancy." 
He underwent therapy after this.
However, he has had ongoing symptoms in the right hand and 
forearm. It has worsened over the past year. The pain starts at
different places. For example, sometimes it begins at the volar scar, other times in the fingers or the thenar area. He also 
notes intermittent numbness of the radial 3 digits, sometimes at 
night. Other time, the ulnar 2 bother him.
He states because of this he has difficulty playing video games,
giving back massages 
and doing gripping activity such as brushing snow off his car. 
He has used anti-inflammatories in the past which have helped the
left, but sometimes made the right worse. He has had elevated 
liver function studies recently and thus has not been on any 
anti-inflammatories now.
The left hand has been bothering him, which he feels is due to 
compensating for the right. He has pain dorsally in the hand and
wrist with some popping. There is also some numbness of the left
hand.
PAST HISTORY/REVIEW OF SYSTEMS: He has a history of tobacco use,
hypertension, mitral valve prolapse.
Medications were reconciled.
PHYSICAL EXAM: He is a pleasant 30-year-old whose height is 70 
inches, weight is 210, and BMI is 29. There is a longitudinal 
incision over the right volar distal forearm extending across the
carpal tunnel which was released surgically. Flexion of the right
wrist is 80. Extension is 65. He has full motion of the 
fingers. There was no tenderness whatever in the region of the 
volar scar, volar forearm, dorsal carpal regions, snuffbox, 
radial styloid, basal joint. Tinel sign was negative, and Phalen
test was negative. Finger sensation was intact. The right elbow
fully flexed and extended. Ulnar nerve in the cubital tunnel was
sensitive. 
 The left elbow had full motion with some sensitivity 
at the cubital tunnel. Left wrist flexion was 80. Extension was
70. He had full motion of the fingers. There was no tenderness 
whatever in the left volar or dorsal forearm, carpal bones, or 
hand. Resisted extension of the wrist was not painful. Tinel 
sign was negative. Phalen test caused numbness of the ulnar 2 
fingers only. Phalen was negative on the right.
An x-ray of the right wrist from 01/16/15 was unremarkable.
Unfortunately, I do not have any answers. I explained if 
this had been something that was easy to fix he would have been 
better years ago. As it is, these symptoms have a 9-year head 
start and in fact are worsening. I cannot demonstrate any 
tenderness whatever today in either wrist/hand.
Although he had his right carpal tunnel released at the time of surgery, some of his 
symptoms do sound suggestive of carpal tunnel syndrome. I gave 
him bilateral wrist braces which he could wear at night and 
intermittently during the day such as if his hands flare up. I 
would typically use anti-inflammatories, but because of his 
elevated liver function tests I do not feel this is an option. 
I offered to send him to therapy for an exercise program, but he 
feels that he does not really want to do that now and will use the 
braces alone for now. He will make an appointment for 3-4 months
and will cancel it if he does not feel he needs it.
It appears that this is something that he is going to have to try
to live in harmony with because I really do not have any other 
suggestions for treatment. 
He apparently fractured his right arm 10 years prior to the onset 
of swelling, but I would not think it would be connected
to his present problem.

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I talked with "Peggy" and it sounds like I just have to wait and see if they screw up this claim again as i have no arm motion limitations and it's all centered on forearm, wrist, hand, fingers. So if/when they do screw it up again I guess it will at least give me an opportunity to switch out from this legacy appeals process and get into the new AMA process?

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