Painful motion rule

[SPO]

I'm looking at a copy of my last c&p exams for arthritis.  I was denied for no diagnosis, which is an issue I am appealing because I have more than one.  However, the examiner checked the block "Pain noted on exam but does not result in / cause functional loss" for many of my joints with varying Ranges of motions( such as flexion or exetension).  Would this qualify as the objective evidence of pain for the painful motion rule?

[Vync]

@SPO Keep in mind that x-ray evidence doesn't always show everything. With my TMJ, they did the usual panorex and head x-rays, but found nothing visibly wrong. They had to do an arthrogram in order to identify the problem. That's like an x-ray done under a flouroscope. The radiologist injected contrast into the joints and observed it under movement. At that point, he was like, "Yep, you have some problems".

I like @Hamslice's comment. Try to get SC first. If you are still at 0%, you can file for an increase via supplemental claim. All you would need to do is have proof. It would be great to get everything done in one shot, but otherwise it might take time for them to get your rating percentages correct. 

 

[SPO]

@VyncI think part of my denial problem stems from an xray issue. I was granted a few joint that showed X-ray evidence and denied on the ones that don’t.  my reading shows my arthritis (psoriatic arthritis) can be rated analogous to rheumatoid (dc code 5002) or degenerative (dc code 5003).  I’m wondering if the examiner said no diagnosis because there was no X-ray evidence, but the m21 says rheumatoid doesn’t require x-ray evidence to substantiate a diagnosis.  I have an appeal hearing and wondering if I can use that as an argument?
Hopefully this link works.

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014195/M21-1,-Part-III,-Subpart-iv,-Chapter-4,-Section-B---Musculoskeletal-Diseases-and-Muscle-Injuries#1

 

[Vync]

@SPO I am not too familiar with the codes for arthritis and how they are handled. My only other joint claims were spine related. X-ray didn't show anything either, but they showed up clearly on an MRI.

Also, don't discount secondary claims and radiculopathy nerve issues. Spine pain can lead to pain into your extremities. If you have a bad knee, it can change your gait and that can lead to problems with other nearby joints on the same or your other leg. It's like that old song, the hip bone is connected to the thigh bone.

You are definitely on the right track. You are doing your homework and research before your appeal hearing. It is worth the effort to be informed and prepared.

[SPO]

Just got off the phone with DAV, and they are telling not to argue about how if the x-ray is or isn't necessary to substantiate a diagnosis.  They said don't try to talk about orders, rules, and regulations to the judge.  The only thing they want to point out is that my doctor who is a specialist diagnosed me and their examiner who is a nurse practitioner said i don't have a diagnosis, so the specialist should have overruled.  So frustrating, I have now idea what I'm supposed to do when the hearing comes.

 

[Vync]

@SPO That is definitely a factor. The one I won earlier this year was very similar. I had an IMO from my non-VA board certified specialist. The VA's nurse practitioner  noted it on the evidence list, but said it was not SC. I filed an HLR and won. In my case, it was because the VA's NP erred by focusing solely on a heart rhythm issue and completely ignored my heart attack. 

[SPO]

Interesting. I also noticed that she kept listing the evidences reviewed as “dermatology associates” not rheumatology. Wondering if she thought the other doc wasn’t the right specialty.  So many what if’s and maybes.

I found at least one decision on BVA that a person was granted even though the va nurse practitioner didn’t agree with the diagnosis, but their private rheumatologist did.  They were also lacking X-ray evidence in some joints.