Walk With A Cane

[huskerfanfl]

I went to a C&P exam last month. I am still waiting on my copy, but I do know that the PA noted that I have lost even more motion in my back, right knee, and right ankle. She said that there was a lot of loss of mobilty in my right ankle due to fatigue (after 5 repetitions). She also noted that I walk with a cane and an abnormal gait. I was only able to bend over slightly before pain in my back started and bend knee slightly before pain. Currently rated at 10% for both my back and knee, and 0% for the ankle. I know that this is not much detail, but it is all I have at this point.

[spike]

What I am looking to find out Larry J is if there is a bi lateral factor here? I completely agree with what you are saying. I have bi lat knee problems and the doc told me its typical when one side of the body that the other side is affected. Thats why i recommended mri/xray. I'm curious to the bilat r leg and back condition/ and how it might related to the left. Here is the thing. I am in no way shape or form suggesting a claim a disability you don't have. Just a suggestion to check for yourself.

[sixthscents]

The use of a cane in an of itself means nothing, howevere as a portrait as part of functional loss, I believe that it does play a role, however minor in the raters opinion...

§4.10 Functional impairment.

The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Whether the upper or lower extremities, the back or abdominal wall, the eyes or ears, or the cardiovascular, digestive, or other system, or psyche are affected, evaluations are based upon lack of usefulness, of these parts or systems, especially in self-support. This imposes upon the medical examiner the responsibility of furnishing, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of disability upon the person’s ordinary activity. In this connection, it will be remembered that a person may be too disabled to engage in employment although he or she is up and about and fairly comfortable at home or upon limited activity.

I think this clearly SUGGESTS that a cane or other device to aid in self-support would be considered... further:

§4.40 Functional loss.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.

And again here it SUGGESTS that an aid device be it a hearing aid, cane or brace would be considered under functional loss. In fact I know of a case where the veteran was rated 100% loss of use of both legs, due to the functional loss, also evidenced by the neurological studies and multiple cooresponding evidence. Now I am not saying that this suggestion of mine that a cane or other assistive device speaks to functional loss is FACT, only that is how I interpret this portion of CFR 38 to suggest such, and I have had some experience with it since I was the veteran with the 100% rating..

I think, again only my opinion, but I think that some raters will consider it while considering a claim, and some wont... its a grey area, and of a sort that has spurred much debate of late.... I wont admit to any certaintude, its just my opinion that most raters will consider, braces, canes or other orthopedic implements in a part of the whole functional loss picture....

Now I havent addressed anything other than the cane, but if you wish I will offer my opinion as to the rest of the information at hand.... with the knowlege that it is my OPINION, unless I specifically say otherwise and provide specific regulatory guidance.....

Until then, to summarize, I think the rater MUST consider these devices, but how MUCH weight they place on them will depend upon the rest of the picture - but they are a part of the picture...

Bob Smith

Edited April 19, 2007 by sixthscents

[huskerfanfl]

I understand and agree with all of your posts, but do feel that there may be some advantages to having the fact that I walk with a cane and an abnormal gait recorded in the C&P results. If nothing else, it sure cannot hurt. The woman that did my examination knows how much it hurts to bend over and bend my leg, she tied my shoes for me (she offered and I accepted)

The C&P was also to examine my left knee for increase (currently 0%). So, there is a possibility of bilateral.

All comments are welcome and appreciated. That is how I learn.

[sixthscents]

No it cannot hurt a claim, but I dont think I'd get one just for a claim... I'm not saying that for you man...no way, but I wouldn't want to suggest it however "offhanded".

I havent raed all of the prior posts again, I did yesterday but to be honest I'm firing on about 6 of 8 cylinders, so I dont remember, but... if you do have ANY rating for both knees then a bilateral factor will of course apply... but 5 times out of 10 it seems to get missed.

And here, as pissed off at raters as I am today, I gotta defend em, it's hard to catch everything, and this one for a less experienced rater in a complicated claim would be easy to miss. I'd sure make sure I targeted in on it in the NOD though.

I have come to the conclusion that I have written a NOD for every single claim that I have handled, when the veteran wanted to fighht the rating.. EVERY SINGLE ONE... I started to count em, but some of the claims I have typed over 15 seperate letters adressing differing items, additional advise, NODs, addressing SOCs or SSOCs.... I quit at over 200...

And I dont file claims for tenuos stuff, only things that we can prove, with lay and professional evidence... and that we can establish service-connection for...

So, as it is the raters are getting buried, they have to be.....

the answer... freaking hire MORE raters, but its not gonna happen...

Bob Smith

[carlie]

crap - i just posted to husk & it didn't go thru.

Will do it again later,

carlie

[huskerfanfl]

Bob,

It sounds like you are doing great things for veterans, I salute you.

Like you, I would not suggest getting a cane just for the purpose of a C&P. I have been using mine full time for over a year now and before that it was well over 50% of the time. Like shoes, you can tell when a cane has been used and I would like to think that examiners know that as well. When I first joined the army, there was a soldier who walked on a cane during the duty day and played basketball in the evening, that sickened me.