Range of motion ratings. Anyone?

[Rivet62]

I need someone keen on range of motion ratings.  I'm updating my back issues with physical therapy findings. VA sees records dated 4 years ago, but things have changed.

I've had recent physical therapy. The files are below. I've got to be more than 10% now, but when I look at the CCK infographic on back pain issues, and range of motion (https://cck-law.com/infographic/va-ratings-for-back-pain-infographic/) it has me swimming on how to interpret my own physical therapist's observations. 

I have service-connected underlying conditions and according to the SOC I just received, they're relying on range of motion from years ago (which. according to them, has me at 10%).

The physical therapist has notes sprinkled throughout the files. To me it looks like 20% at least. Anyone have an opinion otherwise? I'm about to file supplemental claims in about 30 days.

 

Edited January 21, 2022 by Rivet62
Deleted uploads to save space on server

[Carl the Engineer]

First, when you see your doc or theropist, they don't use a tool for measuring you motion, they do their own thing.  They use their own language to gauge your improvement, or lack there of, to compare to past and future exams.  So, these exams or sessions have nothing to do with what you will be rated on a scale, etc.  But, you can get some information from them.

So, from what I am reading, your condition has worsened from when you got rated.  And you have no idea what will happen if you claim an increase.

Only one thing to do.  Claim an increase for your back condition.

And then, and only then, can you (we) see what the C&P examiner saw and sends to the rater and then what you get rated for.  And then, you can accept, appeal or punt.

I spun my wheels for about a year thinking I didn't have all my ducks in a row and it cost me the difference between 90 and 100 percent x 12.  $14,000.00 ++.  Well, not only were "my" ducks in a row, but the VA slipped a couple duckies in without me knowing.

Stupid is, as stupid does,

Hamslice

Claim, claim, claim and worry about little things later.

 

 

Edited January 20, 2022 by Hamslice
cause I can

[Rivet62]

6 hours ago, Hamslice said:

First, when you see your doc or theropist, they don't use a tool for measuring you motion, they do their own thing.  They use their own language to gauge your improvement, or lack there of, to compare to past and future exams.  So, these exams or sessions have nothing to do with what you will be rated on a scale, etc.  But, you can get some information from them.

So, from what I am reading, your condition has worsened from when you got rated.  And you have no idea what will happen if you claim an increase.

Only one thing to do.  Claim an increase for your back condition.

And then, and only then, can you (we) see what the C&P examiner saw and sends to the rater and then what you get rated for.  And then, you can accept, appeal or punt.

Ok.  This makes sense.

6 hours ago, Hamslice said:

I spun my wheels for about a year thinking I didn't have all my ducks in a row and it cost me the difference between 90 and 100 percent x 12.  $14,000.00 ++.  Well, not only were "my" ducks in a row, but the VA slipped a couple duckies in without me knowing.

What went wrong?  You were anticipating one thing and VA had you at another? What happened?

[Vync]

@HamsliceI have had VA physical therapy and some used the goinometer to measure range of motion, while others did not. My non-VA physical therapists always used a goinometer and made very careful notes about their findings. Although the progress notes from each visit did not specifically state using it, I have used the presumption of regularity approach to tell the VA that government employees are assumed to have done their jobs properly.

@Rivet62, @Hamsliceis right about filing for an increase. Get your treatment records from the past 12 months and look at them carefully. Next, go look at the spine rating criteria. The back ratings include factors other than just pure ROM. Things like abnormal spine curvature or gait (how you walk) are factors, too. Keep in mind that the VA is supposed to factor in flare ups which can help justify why some visits have less ROM than others. Pain can also be a factor in functional loss which can reduce ROM during flare ups. If you have proof that you qualified for a higher rating within the past 12 months, it might be worth considering filing an increase. The VA might send you to a C&P doc depending on the circumstances, but I have heard of other veterans being granted increases without one because it was justified by what was in their medical records.

[Rivet62]

12 minutes ago, Vync said:

@Rivet62, @Hamsliceis right about filing for an increase. Get your treatment records from the past 12 months and look at them carefully. Next, go look at the spine rating criteria. The back ratings include factors other than just pure ROM. Things like abnormal spine curvature or gait (how you walk) are factors, too. Keep in mind that the VA is supposed to factor in flare ups which can help justify why some visits have less ROM than others. Pain can also be a factor in functional loss which can reduce ROM during flare ups. If you have proof that you qualified for a higher rating within the past 12 months, it might be worth considering filing an increase. The VA might send you to a C&P doc depending on the circumstances, but I have heard of other veterans being granted increases without one because it was justified by what was in their medical records.

Yes. I think I'm on that path now. Covid interrupted a lot. Now I'm enrolled at a VA CBOC, but when I first moved to Bama I was on the outside struggling with authorizations in the Veterans Community Care system, which had all but broken down during Covid and the near simultaneous transition from TriWest to Optum. Just wow.

Anyway, I'm getting my appointments and updating my record to show what's happening now. I'm making good use of MyHealth eVet messaging once again.

I used to be at a VAMC and it was overwhelmed. Consistently got 5 stars in JCAHO inspections and see-sawed between being rated number 1 or number 2 in VA rating (I'm not sure what populated that rating), but it was a very good VAMC. We had people from other states coming on all the time and parking was on the grass nearly to the street.  Well that's all good, but my very good primary care doctor was...I'd say overwhelmed. Now I've got a very good primary care doctor here in Bama at a VA CBOC and she has so much more time and she's on my side to document my record.

Since 2018 my ankylosis has increased. I am now seen as having kyphosis and reverse lordosis. There are symptoms of pinched nerves in the C-spine and L-spine. I think L5 is involved in what may be Trendelenberg Gait (I need more proof). I am at the supplemental claims stage following a recent SOC (received about a week ago, attorney involved going the supplemental claims path). The SOC sees everything back in 2018 and one radiculopathy noted in 2020 (partial grant) and stops there. So, I think I may be in the prime position of arming supplemental claims with what's going on with me now.

[Vync]

@Rivet62I remember when the Gadsden CBOC opened around 1996. Needed an x-ray and had to drive all the way to Birmingham simply because they didn't have a machine there at the time. The CBOC records had fancy handwriting fancy I could barely read.

C and L spine issues are no fun at all. When I filed again in 2008, those claims were denied but I kept them alive in appeals until granted a few years later. I also requested SC for secondary issues and was granted for GERD (from years of NSAID use) and bilateral radiculopathy on both arms and legs.

[Rivet62]

1 minute ago, Vync said:

C and L spine issues are no fun at all. When I filed again in 2008, those claims were denied but I kept them alive in appeals until granted a few years later. I also requested SC for secondary issues and was granted for GERD (from years of NSAID use) and bilateral radiculopathy on both arms and legs.

I may be following your path, everything except the NSAIDs. I've been toughing it out. The pain has gotten so bad it has me stammering. BUT I discovered something that might surprise people. I picked up on the benefits of bone broth. We have a dairy farm that is organic. A real working dairy farm with all the federal labeling yada yada. Well, I don't particularly care for cow meat or the bones, but let me tell you I was PAIN FREE for days after using just half a cup's worth of the bone broth I made in throw-together un-thickened stew. As soon as I thickened it, using corn starch, my pain symptoms went off the chart. I was writhing in pain. So, for me it's starch (which converts to sugar in the body) that really sends my pain off the charts. Problem is...I can't stand the taste of it, the cow bones anyway. I'm still looking for a beef farm in my area for beef bones.