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Monday, May 12, 2014

Rating Arthritis for Military Disability

Determining a military disability rating for arthritis can be frustrating, to say the least. I’m just going to get this out of the way right off the bat: It totally makes me feel like this guy.


There are all sorts of tricky rules in the VASRD that must be considered when rating arthritis. And having other conditions affecting a joint in addition to arthritis just complicates things even more. If you are a disabled American veteran with arthritis, I will do my best to help you understand how your arthritis should be rated.

First rule that you must understand: All joints will only receive ONE rating for the overall condition of that joint, regardless of the number of conditions that affect it. So, if you have arthritis and a meniscus condition in your knee, you can only receive a rating for one of the two conditions, whichever gives the higher rating. So, if your arthritis gives a higher rating than the meniscus condition, then it is rated, and the other is ignored. Only one rating per joint.

There are a couple of conditions that are an exception to this rule, but if you have one of these conditions, our discussion about that condition on our site will clearly say that you can rate it in addition to other conditions that affect that joint. If it doesn’t clearly state this, then it doesn’t apply. Only one rating for the entire joint.

Now that we understand that, let’s jump into arthritis. The VASRD rates two main types of arthritis: Degenerative Arthritis (code 5003), and Rheumatoid Arthritis (code 5002). All other types of arthritis or similar conditions are rated analogously as degenerative or rheumatoid, whichever is the most similar.

If your condition is Rheumatoid Arthritis or is rated as Rheumatoid Arthritis, it’s your lucky day! The ratings for Rheumatoid Arthritis are fairly straightforward. No serious complications or confusion for you. Just follow the instructions on our site, and you’ll be pretty good to go. Woo-hoo!

If your condition is Degenerative Arthritis or is rated as Degenerative Arthritis (by far the most common), it is not your lucky day. You have to hang in there with me as I explain things step by step. Sorry.

All right, Degenerative Arthritis… Let’s start off with assuming that only ONE joint has arthritis in the entire body. The key to Degenerative Arthritis is that if there is any limited motion AT ALL in the affected joint, then the condition MUST be rated on limited motion of that joint. So, if you have arthritis in your knee, and you cannot bend it all the way, then it is rated once on limited motion of the knee, code 5260. That is the one and only rating, and you are done.

Now if you have trouble both bending and straightening your knee all the way (they are two different codes for the knee), then you would pick the code that would give you the higher rating. So if the inability to bend gives a higher rating than the inability to straighten, then that is what is rated, and you are done.

Side Note: Because limited motion is so vital to rating arthritis, it is essential that your physicians record the exact range of motion measurements for your affected joints. If these measurements aren’t properly recorded, you will not receive the correct ratings you deserve. Physicians often don't know how things are rated, and so they may not realize this. Be proactive to make sure this is done. It is vital for both your DoD Disability and your VA Disability

Now, if you don’t have limited motion, then your condition is rated as Degenerative Arthritis under code 5003. Here is the most confusing part of rating Degenerative Arthritis: all joints in the body that are rated as Degenerative Arthritis are combined, and only one rating given for all the joints. (If you just screamed “What the heck?!” – don’t worry, I did too.)

So let’s jump to having multiple joints with Degenerative Arthritis. This will best be explained by using an example.

Joe has four joints that have Degenerative Arthritis or conditions that are rated as Degenerative Arthritis, his right elbow, his right wrist, his left knee, and his left ankle. All the conditions must first be rated on limited motion if there is any, and if they have limited motion, then they can each be rated SEPARATELY. So, both his elbow and his ankle do not have any limited motion, but his wrist and knee do. So, he receives one rating for limited motion of the wrist, and a second for limited motion of the knee. These both are finished.

Since his elbow and ankle do not have any limited motion, then they are both rated as Degenerative Arthritis under code 5003. Under this code, these joints will be combined, so they will only receive ONE rating for both of them. Carefully read how code 5003 works, and this should make sense.

Ultimately, Joe will only have a total of three ratings for his four conditions, instead of four separate ratings.

That’s it. Hopefully that didn’t just create more questions than it answered. Carefully read our discussions of Degenerative Arthritis and Rheumatoid Arthritis, and hopefully this will make sense to you. Rating arthritis is second only to rating TBI in its complexity, so take it slow.


Hopefully I have been able to help!

265 comments:

  1. Hi Dr Johnson... How is RA rated if it is controlled well by meds and the incapacitating episodes aren't occurring due to treatment?

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  2. Rheumatoid Arthritis is only ratable if you have symptoms of some sort. No symptoms = no disability. Without incapacitating episodes, then the symptoms can be rated separately. So if you have limited motion, then it would be rated on limited motion of the affected joint. As long as you have pain with motion, each joint affected qualifies for a 10% rating. Check out our discussion of rating rheumatoid arthritis on our site:

    http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#d

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  3. I have started the process and I have exams of all of my issues and they show degenerative arthritis. They also add the limitation of thigh. Will the limitation of thigh be rated differently? From what I read I have both knees and right/Left Hip. Will these all be combined and it will rate at 20%? Or do you get 20% for each joint?

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    1. Hi Erica -

      Arthritis is rated first on limited motion of the affected joint, so if you have limited motion in your knees and hips, then each joint will be rated separately as limited motion. I think that is what you were referring to as "limitation of the thigh", correct?

      For any of the joints that do not have limited motion, then those are combined and given a single rating under the degenerative arthritis code. So if you have limited motion in one hip, but none in the other three, then you would get one rating for the limited motion, and then one other rating of 20% for the three remaining joints combined. Two total ratings. The 20% rating is NOT for each joint.

      Does this answer your question?

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    2. I am wondering if you could clarify something? With the limited motion, if I had pain on movements would I get the painful motion rule first and then arthritis? Also, if so would they give 10% to both knees, and then both hip's?

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    3. The Painful Motion principle is only used if you do not qualify for any other rating in that joint. It just guarantees that you at least get something if you have pain.

      They'd first look at each joint separately and determine (1) if there is limited motion and (2) if there is pain with motion.

      If there is limited motion, then each joint is rated on that, and that's it. No additional rating for painful motion or arthritis. If there is no limited motion, but there is pain, then the painful motion principle takes affect, and a 10% would be given for that joint, and that's it. If arthritis is rated instead, then no rating for limited motion would be given. Limited motion is only if nothing else is rated.

      Does this clarify it?

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    4. I received a rating of 10% for traumatic arthritis, right knee status post ACL repair with residual scar (claimed as right knee condition). I was wondering my condition I have been told the only fix I can do now is osteotomy or full knee replacement if I have either operation would it be bumped up.

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    5. It depends on the surgery and the result of it. The minimum rating for a total knee replacement is 30%. See code 5055:

      http://www.militarydisabilitymadeeasy.com/kneeandleg.html#knee

      The osteotomy would just depend on any remaining symptoms that were left after you healed from the surgery, so it's impossible to really predict what your rating would be for that.

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    6. Thank you for the answer I am leery to do the osteotomy as the Dr. warned the condition would still be present and need to replacement in the long run. I was wondering if the ACL repair would fall under any other conditions in the VASRD or since it was a replacement it now becomes a non issue.

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    7. ACL repair is rated as arthritis under limited motion, so there isn't another condition in the VASRD for that. With the replacement, though, the entire knee would just be rated for that.

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    8. Dr. Johnson I was 0% SC for a shoulder strain trapezius , but recently about 4 months ago I was referred to an Orthopedic and he discovered I have osteoarthritis in my left shoulder w/Subacromial bursitis. I'm requesting a increase for my shoulder and I was given a C&P exam and the VA examiner stated the same in her findings. So my question to you does this warrant an increase and if so how much?

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    9. It all depends. You most likely will qualify for the minimum 10% rating since you probably have pain with motion, but otherwise that, you won't get higher unless your range of motion has decreased. Shoulder strain and osteoarthritis and bursitis are all pretty much rated on the same things, the number one being limited motion. So unless your shoulder's ROM has become more limited, you probably will not get an increase above 10%.

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  4. My husband is currently rated at 40% for both ankles, one knee-(they service connected the other), and a wrist.

    Due to current surgery on both knees he filed a claim, and we noticed today they gave him another 10% for the service connected knee, and gave him a rating of 0 for the scars on his knees, wrist, and 0 for a testicular surgery. His codes are 5014 and 5024.

    Shouldn't his new 10% rating for the other knee make is overall rating go up?

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    1. Hi -

      You have a very good question, and I'm not exactly sure if I understand everything correctly.

      Basically, you are experiencing the wonderful dichotomy of VA Math.

      VA Math is a system the VA came up with to add ratings together without actually adding them together. Instead it's called "combining."

      When you combine ratings using VA Math, you don't just add the percentage to the other (40 + 10 = 50). Instead, you add the percentage of what is LEFT. This is a tricky concept to understand, and I won't go into all the details here since we thoroughly cover it on our VA Math page: http://www.militarydisabilitymadeeasy.com/vamath.html.

      The reason I'm not sure if I understand everything correctly is that, even with the oddities of VA Math, if he had a 40% total rating and was just given another 10% rating, then his rating should go up to 50% (40 + 6 = 46 rounded to the nearest tenth = 50). --Again, visit the VA Math page to be guided through what I just did there.--

      Was his overall rating before the new 10% really 40%, or did miss something? The only time a 10% won't raise it is once the overall rating is 60% (60 + 4 = 64 rounded to the nearest tenth = 60). So, basically, if he had a 40% overall rating and then got an additional 10%, it should have been increased to 50%.

      I know this may seem confusing, but please check out our VA Math page to understand exactly how VA Math works. It is complicated, but we walk you through it step by step. Hopefully you'll understand what's going on in your husband's case. I hope this helps. Let me know if you still have any questions.

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  5. Hi Dr. Johnson, I completed my C&P exam earlier last month and was unable to straighten or bend completely during the ROM portion of the exam. In the knee and lower leg section of this website it states: "Now if the knee can move, but cannot either bend all the way or straighten all the way, then it can be rated TWICE—once under code 5261, and once under this code 5260." Is this possible ?

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    1. Absolutely. The VASRD allows for two ratings to be given for limited motion of the knee if the knee cannot bend AND cannot straighten all the way. One rating under code 5261 for limitation of extension (straightening), and another under code 5260 for limitation of flexion (bending).

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  6. Hello Dr Johnson, I suffered a hairline fracture on my rt ankle back in 2000 while serving. I've been struggling to loose weight with jogging/walking because Now I've been diagnosed with Rheumatoid Arthritis, chin splints and Bursitis(really bad with limited range of motion) by my physician. Can I claim this as secondary to the ankle injury? Including the inability to loose weight because of all of this

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    1. Hi Bryan -

      The VA will consider any condition that can be medically proven to be caused by your condition as service-connected and thus ratable. Looking at just what you've mentioned, you will definitely not get the inability to lose weight (there are other exercise options that are easier on the ankle) or the shin splints (not directly connected), but you might be able to get the arthritis or the bursitis, but not both. These are logical conditions to be caused by previous damage to the joint. I'm assuming both the arthritis and the bursitis are in the right ankle? If so, then only one of those is ratable since it will be close to impossible to separate the symptoms of the two. What you need is for a physician to diagnose arthritis (or bursitis) as secondary to your hairline fracture and then submit a claim for it.

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    2. Sorry if I wasn't clear Doc, No Bursitus in the ankle, just Arthritus.The Hairline Fracture was located just above the rt ankle area. I have Burcitus in the RT Hip. That's why I'm believing it's secondary

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    3. Okay, the arthritis in the ankle will most likely be considered connected. I'd be surprised if they didn't give you that. The bursitis, however, since it is in the hip, there is a higher likelihood that they won't consider it secondary. Your case will be strongest if you have a physician state that he believes there is a connection in his medical reports. I definitely recommending applying for both and seeing what happens. Bursitis can develop without an injury like that, just with age, etc., so depending on the exact facts of your case, they may not consider it connected. All you can really do, though, is submit the claim and see what happens.

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    4. I hope so because the ankle area where the Fracture was hurts if you apply a little pressure. Malunion maybe! Can't stand or walk for more than 35-45 mins. And it hurts at any given moment without walking or touching. I'm getting shin splints only on that leg and now Burcitis. Doc it seems all connected especially since it's only that side. When I was running, my wife would tell me I run funny.

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    5. Also the Burcitis is getting worst as well as the leg and Chin issues. My Physician believes it's connected

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    6. Definitely apply. It does sound like you have a case. Definitely worth a shot.

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    7. I have been diagnosed with degenerative arthritis in both knees. They both have pain and clicking and popping constantly they also swell really bad after actives which limit motion during swelling. There is always some swelling which limits motion a little but not a lot. I was also diagnosed with a lower left leg issues I keep getting stress fractures with long distance or continues running. I am planning on getting out and my doctor asked about a med board. What percentage am I looking at?

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  7. I was recently informed that the PEB needed clarification on why left sciatica was listed as a boardable condition and not right as well. In the end, My narsum Doctor wrote that the left side was more significant and did not warrant the right side to be listed. He also stated that the measurements listed on my VA exam do not support my medical history? Discrediting my VA examiner. Will this impact my case or ratings at all? Thank you for your time

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    1. This is regarding ROM for Lumbar Spine.

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    2. There are a few things happening in your case that should be addressed individually.

      First, the nerves are rated in addition to a spine condition, so you should be receiving at least two, if not three, different ratings. One for the spine, and one (or two) for the sciatic nerve.

      I always recommend listing EVERY condition you have when going through the boards and on your VA Disability Claim. The fact that the PEB came back to your physician to ask about the right sciatica means that the physician should have just included it in the first place. Ultimately, it is not your physician's job, but the PEB's job, to determine which conditions make you Unfit for Duty and thus qualify to receive disability from the DoD. That was a definite error on your physician's part that may cost you a rating for the right sciatic nerve. Now, if the physician had submitted it, the PEB may have ended up deciding that it wasn't unfitting, but again, it is the PEB's job to make that decision, not the physician's.

      Now for the VA exam. Are the findings recorded in the VA exam significantly different than your actual symptoms? The DoD only rates a condition on its severity at the time of separation, so regardless of your history, if the VA physician recorded your range of motion and sciatic symptoms correctly, then he did his job correctly. This exam will definitely have a big impact on your ratings since it is the closest exam to your date of separation and so best shows the severity of your condition right now. If the VA exam did not properly record the severity of your condition as it is right now, then that is a problem that needs to be addressed.

      The PEB realizes that the physician's opinion is just that, an opinion. While they will consider it, they will look more closely at all the facts and determine your case based on facts, not opinion.

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    3. Dr. Johnson,

      Thank you very much for the clarification. Here is my situation in a nutshell, I've been in the service for 6 1/2 years and initially injured my back in 2010. After successful treatment and physical therapy, I was good to go for a good 4 years. PCSing to two different duty stations during this time. In April 2014, I again, re-injured my lower back conducting a physical fitness exam, which intern started all of my problems. After this event, I went to physical therapy, chiropractor, pain management and opted to receive 3 lumbar epidural injections. On top of all this I have a wide range of medications, a TENS unit and a home lumbar traction unit. Things began to get worse after receiving the LESI injections. Today, I'm unable to walk for long periods or even bend over to tie my shoes (without pain or back giving out). My current C&P exam recorded the correct Range of Motion and the doctor listed that both legs have sciatica based on the tests she conducted and how I described the pain. It boggles my mind because the NARSUM DR. stated "it didn't seem credible because at his last physical therapy appointment he showed normal range." What I find interesting is that, the last time I was in physical therapy was over 9 months ago. Dr. Johnson, I cant thank you enough for this website and all your guidance.

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    4. Spine conditions can deteriorate very quickly, so the fact that you had normal range of motion at the pt exam, but then 9 months later, have more serious restrictions is not that abnormal. The PEB will know and understand this, so I think you'll be okay, even though your doctor made that odd statement. I've seen cases deteriorate very quickly in just a few weeks, so 9 months is plenty of time.

      Ultimately, I wouldn't worry too much. I think the PEB will have the insight necessary to make the appropriate decisions about your case. Hopefully, they will also consider the right leg sciatica as well.

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  8. Good afternoon Dr. George P Johnson,

    I have a question, I have the been diagnosed with RA thru my doc here at the VAMC, he has me on Plaquenil, Methotrexate Sodium, and Folic Acid. In the morning is when I feel the stiffness in my joints along with long periods of standing/sitting, I also notice the weather has a great impact as well. I have read some of your post and when you refer to episodes which do you refer to? (stiffness?) I would like to see if Service Connected how ever not sure how to answer the questions. (I was a StoreKeeper in the Navy for 10yrs, as I am seeing Pain Clinic for other areas in my body which prompted the RF blood test).

    Thank-you in advance for any advise you have for me. :)

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    1. Hi Lynnette -

      "Incapacitating episodes" refers to far more than just stiffness. There is no hard-fast rule regarding the definition of this term in relation to arthritis, but the overall idea is that there are periods where the symptoms are severe enough to make it impossible to function in your job or your daily life.

      As for service-connection, since this was diagnosed after service, it may be pretty difficult to prove service-connection. Do you have any medical records from your time in the service that record any RA or symptoms? If not, you probably won't be able to prove service-connection. There are other ways, so check out our Service-Connected page for more info: http://www.militarydisabilitymadeeasy.com/service-connected.html

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  9. My husband (age 69) served in Viet Nam (boots on the ground). He was also stationed at Camp Lejeune in the late 60's.
    He currently has been awarded 50% for PTSD but nothing physical. He also had a bout with a very rare cancer of his sebaceous gland on his face and I believe he also suffered from Chloracne through most of his life with severe blackheads and boils.
    Over the past few years he has been diagnosed with degenerative bone disease of the spine and peripheral nerve disorder. He has undergone several surgery's including cervical spine, carpal tunnel. He continues to have pain, tingling, numbness in his hands, arms and legs. His legs jerk uncontrollably while he sleeps. (about every 20 seconds) that I can't even sleep in the same bed. He can't sit still for long periods of time because his legs bother him so much.
    Any advise would be greatly appreciated.
    ...and thank you for what you do for all of our vets!

    Carol

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    1. Hi Carol -

      Sorry to hear about your husband's conditions. Why hasn't he applied for additional VA compensation for conditions other than PTSD? If he was in Vietnam between 1962 and 1975, he would qualify for exposure to Agent Orange. With that, he would get compensation for chloracne, and possibly his cancer (no guarantee on that one, but since it is rare, they may approve it). Check out our VA Presumptive List page for a list of ratable conditions from Agent Orange exposure:

      http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#herbicide

      His spine and nerve disorders would not be considered service-connected due to Agent Orange exposure. Did he have any history of spine conditions while in the military? If so, and you have the medical records documenting it, then they might also qualify for VA Disability.

      What you need to do is submit a VA Disability Claim for his conditions. Make sure to include proof that he was on the ground in Vietnam during that time period and any medical records showing spine problems if you have them. Full instructions on submitting a VA Disability Claim can be found at:

      http://www.militarydisabilitymadeeasy.com/vadisabilityclaim.html

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    2. Lejeune also had contamination to water. Check what are listed as presumptive by Va

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    3. Yes, you are correct. You can check out our article on that:

      http://news.militarydisabilitymadeeasy.com/2016/01/va-to-offer-full-disability-benefits.html

      Note, however, that the Camp Lejeune presumptive list does NOT entitle you to disability benefits, only to healthcare coverage for the conditions listed. Still a great benefit, but you won't get additional disability compensation.

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  10. Hi Dr. Johnson, while I was in basic training I started having knee pain, I went to get it checked out a couple times but the nurse always refused to give me treatment, a month later the other knee and my lower back started with pain, I went back but every one refused to treat me, when I got back home I went to my doctors and they diagnosed me with rheumatoid arthritis and a pinched nerve in my spine. Would I be able to get anything for this?

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    1. Hi Jackie -

      With only knowing the facts as stated here, you will probably be able to get VA Disability for them. The key is being able to prove service-connection. Since you went to the doctor for the conditions, even though they didn't properly treat you, you should have medical records that document the complaints. This should be enough to show service-connection even though you weren't officially diagnosed at that time. When you were diagnosed, were you still technically in the military, or did you separate before? If you were still in, then you shouldn't have a problem at all. If you weren't, then it makes your case a bit weaker, but still not impossible.

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    2. Yes sir, I'm actually still in I was diagnosed around May but my appointment with the specialty doctor isn't until October.

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    3. Then you won't have any problem at all getting both DoD and VA Disability for these conditions. They'll be properly documented in your service medical records, which is what matters the most when proving service-connection.

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    4. Okay thank you, would you recommend getting out with disability before my contract is over or wait?

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    5. The only way to get out with disability is if your conditions are severe enough that you are unable to perform your job (Unfit for Duty). If this is the case, then you really wouldn't have much of a choice. If your condition doesn't make you unfit for duty, then all you would qualify for is VA Disability, in which case, I suggest waiting. If they do make you Unfit, then definitely talk to your physician and have him start the process if you want to get out.

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  11. Hello Doc, I had this Hairline fracture in my right ankle from Mil training back in 99, at this juncture there is pain in the area especially if you apply pressure. My Doc believes I may have stress Fractures. Could this be worth a claim

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    1. Hi Bryan -

      Definitely worth a try. I'd wait until your current condition is fully diagnosed before submitting the claim, but since you have the original injury documented while on active duty, you should be able to prove service-connection, especially if your current doc states that the current condition is most probably caused by weakness in this area from the previous injury.

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  12. Hello Dr. Johnson, I'm Mark. Served in the Marine Corps from 1980-2000. During Boot Camp and throughout my 20 career and even now, I suffer from lower back pain. I have a 10% disability rating under VA Code 5235. I know for a fact the lower back pain I experience today is a direct result of the trauma, wear and tear and misuse of my back during my military career. I recent MRI shows (Mild facet hypertrophic changes with congenital shortening of the lumbar vertebral pedicles resulting in mild narrowing of the neural foramen at the L3-4 through L5-S1 levels bilaterally. The central canal is patent throughout the lumbar region). My Doctor mentioned this being Degenerative Arthritis. I'm trying to determine file a secondary claim for this under my current disability or approach the Degenerative Arthritis as a separate claim seeing the limited motion has already established?

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    1. Hi Mark -

      Sorry for the delay in getting back to you. We've had an inundation of inquiries lately, so we are a bit behind.

      Since the VA is already rating you for your spine, you do not need to submit a new claim for the arthritis. No matter the cause of your spine condition, it will be rated on exactly the same requirements, so the diagnosis itself doesn't really matter in this case.

      Degenerative Arthritis is always rated on limited motion of the affected joint if there is any, which there is in your case. Your spine is already rated on limited motion. So ultimately, submitting another claim for degenerative arthritis would not benefit you at all. The only way to get your rating increased is if your range of motion is more limited than the range of motion the VA based the 10% rating on, or if you develop nerve symptoms, etc. Since you now have a new diagnosis and new information, you could set up another C&P exam with a VA physician and have them re-examine you for re-evaluation of your rating. If they find anything that would qualify for an increase (like a more limited range of motion), then your rating would be updated automatically.

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  13. Sir,

    First off, thank you for this online service you provide. The disability system can be daunting and you seem to be the only person trying to clear things up.

    I have two questions. Firstly, does a partial meniscectomy rate under Code 5259? Secondly, if both knees have separate conditions (Code 5258 for left, and 5259 for right) does only one condition apply for the joint group? Or since they are separate knees, do both conditions apply?

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    1. Hi Amanda -

      Yes, a partial meniscectomy would be rated under code 5259 at 10%. And, yes, both knees are considered separate joints, not one joint group. The knees are major joints, so they stand alone. Only minor joints (like the knuckles) are grouped. You would get two separate ratings for them, plus you would get an additional 10% for the bilateral factor since both knees are affected.

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  14. Al oct 8 , 2015 ,

    Sir , i was awarded service connection DDD and lumbar spine at 20% and radiculopathy , left lower extremity associated with degenerative disc disease, lumbar spine . This was two years ago . Since then , my va doctor and outside doctor had me due back injections because of the pain and was put on gaberpentin . My primary care doctor took me off the job twice for 6 weeks each . Both doctors wrote letters saying i should medically retire because of chronic pain . Because of a prevous blood clot i received during getting injections i can now no longer get shots and the pain has progressed . My question is : as a secondary , can i claim migrains and insomnia because i cant sleep because of pain , both knees and hip is hurting because of putting pressure on one side and i believe arthiritis has moved into these regions as well as upper back as well as limited range of motion in these areas . Recent mri showed herniated and bulging disc , s-1 , l-4 & l-5 issues, and narrowing of spine .
    Thank you for your time

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    1. Hi Al,

      I recommend submitting a claim for all of these conditions as secondary to your DDD, but I'd be surprised if they gave you all of them.

      Specifically, I doubt they are going to give you migraines and insomnia since there are other probable causes of migraines, and insomnia is never rated separately anyway. You almost definitely won't get these.

      As for the knees, hip, and upper back, it would depend on the medical evidence you submit and the opinion of your physicians. If they claim that these conditions are directly caused by your DDD, you may very well get them all.

      Regardless, you might as well submit a claim for everything. Can't hurt.

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  15. Dr. Johnson, I served 23 years as a fulltime National Guard Airman/Soldier. I retired in 2007. Back in 2005, I first noticed a twinge in my left hip while preparing for a PT test. I kept running. When it continued, I went in to my ortho doc, and he gave me some anti inflammatory meds, and told me to come back in 3 months. I went back at the 3 month mark with the same pain. He did X-rays, and said I had moderate to sever Osteoarthritis in the left hip, and mild osteoarthritis in the right hip. He told me I couldn't run anymore, and he wrote a note requesting that I be put on a permanent profile not to run and to either walk or ride a bike. About a year and a half later I retired, and went to work as a competitive gov't employee. Pan forward to 2013. My pain got worse in my left hip, I started having knee issues, and my right hip started hurting form time to time. Now, here at the end of 2015, My ortho has told me I have bone on bone in my left hip with femoral head collapse and no space. The right hip has severe arthritis " Focal examination of the right hip demonstrates range of motion hip flexion/!intemal rotation/external rotation:
    85/0/30. Notable test include a positive Stinchfield exam, positive impingement test and minimal tenderness to palpation over the greater trochanter. Gait is normal. The patient has marked limitations in range of motion on the left hip, positive Stinchfield, positive impingement on that side. X-RAYS : I ordered and interpreted the following films AP and lateral views of the left hip demonstrate severe
    osteoarthritis of the left, deformity with collapse of the femoral head and marked osteophyte formation. There bone-on-bone changes. AP and lateral views of the right hip demonstrate the patient has severe osteoarthritis, there is some preservation of the joint space, osteophyte formation are noted. subchondral sclerosis"., The pain in my hips has gone up dramatically, Not to mention my knees now ache and so does my lower back. Do you think, in your opinion, that I will have a hard time in getting a disability rating for all these joints. And if so, how do you think it will be rated?

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    1. Hi John -

      You will definitely get compensation for both of your hips since they were clearly diagnosed while you were still in the military. The question is whether or not your back and knees will qualify. It seems pretty logical that your knees and back are a result of your hip problems, and thus should also be considered service-connected, but I am currently working on a similar case where the VA has denied the additional joints. And then again, I've seen cases where they haven't, and everything did get rated.

      So, I recommend that you get a statement from your physicians linking the knees and back to the hip conditions. Then submit a VA Disability Claim for everything. Hopefully it will be successful.

      As for the rating, I don't have enough information to determine this exactly. The hips would qualify for two ratings each: one for the joint itself, and another for the impinged nerves. The nerve rating will depend on which nerves are affected and the symptoms they cause. The joint rating will either be for limited motion or for the deformity of the femoral head, whichever gives the higher rating with your symptoms. Again, without knowing more, I can't say exactly what the ratings will be.

      If the VA grants service-connection for the back and knees, then they will each be rated on any limited motion they cause. If there isn't any real limited motion, they will be given at least 10% for pain with motion.

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  16. I have been diagnosed with degenerative arthritis in both knees. They both have pain and clicking and popping constantly they also swell really bad after actives which limit motion during swelling. There is always some swelling which limits motion a little but not a lot. I was also diagnosed with a lower left leg issues I keep getting stress fractures with long distance or continues running. I am planning on getting out and my doctor asked about a med board. What percentage am I looking at?

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    1. With the limited information you've provided, and I think you're looking at a 10% for each leg. Degenerative arthritis is primarily rated on limited motion, but since you don't have constant, significant limited motion, I can't imagine you'll rate much here. The lower leg bone issues are also rated on how they affect the joints, and so unless they add additional limited motion, nothing extra will be given for this. Does this cause any problems in the ankle? If so, you may qualify for an additional rating for the ankle. The minimum rating for pain with motion in any joint is 10%. Since both legs are affected, you would also qualify for an extra 10% for the bilateral factor.

      So using VA Math, without ankle involvement, I predict you'll get 20% overall.

      They won't let me add links to my comments, so to understand what I mean by bilateral factor, VA Math, etc., you'll have to search on the site.

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  17. Dr. Johnson, let me first THANK YOU for the valuable service of information you are providing. I received an injury to my left thumb (Game Keeper's Thumb) during my Army service and had surgery to repair it while on active duty. I got out in 1989 but wasn't aware that I qualified for disability benefits until 2004. In 2004 I applied for that injury and hearing loss. I was granted service connection and 10% for the thumb injury and is listed as (avulsion of ulnar collateral ligament left thumb status post open reduction and internal fixation with residual surgical scar). I was also granted service connection for hearing loss, left ear, 0% and Tinnitus 10%. My conditions have worsened over the years and as such I have applied for a rate increase for my thumb and secondary connections of arthritis, joint pains,tendonitis, muscle pain. My thumb is painful to move and I do have some limited range of motion. My grip has weakened over the years and is causing pain and fatigue in my wrist. I have not received any medical care for these symptoms other than self-medicating with ibuprofen and using a thumb brace when the pain is severe. As a result I don't have any medical evidence to support my claims. What can I expect from the VA is assessing my claims?

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    1. The VA is going to have you come in for a medical exam before they determine your new ratings, so it's not a big problem that you don't have current medical records. They will examine you and base your ratings on the findings of that exam. If they do find that your conditions have worsened and now qualify for a higher rating, they will then adjust your ratings accordingly.

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  18. Sir,

    This past November the VA re-evaluated a 10% rating for my ankle condition from 2007. I tried to get a rating increase but they kept me ay 10%. The condition is for a bi-malleolar injury (broken ankle/fibula) based on moderate limitation of ankle motion. The VA also identified and confirmed x-ray evidence of traumatic arthritis in the ankle as well. Below is the whole write-up from the VA.

    Issue:
    lateral collateral ligament sprain with degenerative arthritis, left ankle (previously rated as status post bi-malleolar injury, left ankle)
    Percent Continued: 10%

    Explanation:
    The evaluation of lateral collateral ligament sprain with degenerative arthritis, left ankle (previously rated as status post bi-malleolar injury, left ankle) is continued as l0 percent disabling.

    We have assigned a l0 percent evaluation for your status post bi-malleolar injury, left ankle based on: Moderate limitation of motion of the ankle based on dorsiflexion less than 15 degrees. Moderate limitation of motion of the ankle based on plantar flexion less than 30 degrees’ Additional symptom(s) include: X-ray evidence of traumatic arthritis.

    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. A higher evaluation of 20 percent is not warranted for traumatic arthritis unless the evidence shows: X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. A higher evaluation of 20 percent is not warranted for limitation of motion of the ankle unless the evidence shows: Marked limitation of motion of the ankle based on dorsiflexion less than 5 degrees or plantar flexion less than 10 degrees. We reviewed the evidence received and determined your service-connected condition(s) hasn't/haven't increased in severity sufficiently to warrant a higher evaluation.

    My question is can the diagnosis of the arthritis be classified as a secondary service connected disability that developed as a result of the and worsened by the broken ankle/fibula? I looked up 38 CFR 3.310 Disabilities that are proximately due to or aggravated by service connected injury and I’m not clear if my situation would be applicable to this regulation. Also what about the "Painful Motion Principle" 38 CFR 4.59 where a joint has arthritis and is painful to move I hear it can be rated a minimum of 10% if proven, a possible secondary condition? Any info you all can provide would be appreciated.

    I did read what you posted "All joints will only receive ONE rating for the overall condition of that joint, regardless of the number of conditions that affect it. So, if you have arthritis and a meniscus condition in your knee, you can only receive a rating for one of the two conditions, whichever gives the higher rating. So, if your arthritis gives a higher rating than the meniscus condition, then it is rated, and the other is ignored. Only one rating per joint". I just want to make sure I’m understanding this right and if I have a chance to file a claim for my arthritis as a secondary condition.

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    1. Yes, you unfortunately do understand it right. Regardless of the presence of arthritis, you can only receive ONE rating for your ankle. Arthritis will only give a single joint a 10% rating, so even with arthritis, you won't get a higher rating than your moderate limited motion, which does seem to be correct based on the noted range of motions and additional evidence. So, although it isn't what you want to hear, based on the laws that are in place and the evidence you've supplied, your ankle is correctly rated at 10%. The only way that rating can be increased is if the range of motion because more severely limited or if an additional joint is also diagnosed with arthritis.

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    2. Sir,

      Thank you so much for the clarification, its so hard to get a straight answer from my VSO at the VFW but I know he is very busy. I have another question, since I broke my fibula can I get a rating under diagnostic code 5262 fibula, impairment with moderate/slight ankle disability?

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    3. Sorry for the delay in responding - the notification got misfiled.

      Basically, no. Again, the ankle symptoms, regardless of their cause, can only be used to provide you with one rating, so if that is limited motion or arthritis, then the ankle cannot also then be used to rate the fibula since it has already been rated. The rule that dictates this is called Pyramiding, and the VA is pretty strict about it.

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    4. Dr. Johnson, again thanks for your clarification.

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  19. Dr Johnson, I served the military from 2002 through 2006. During this time I experienced some minor joint pain, but it was until 2010 when pain started to get more severe. The same year I was diagnosed with reumathoid arthritis, my question is if I can still put in a claim for disability and if you think I would qualify. Thank you Dr Johnson

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    1. Hi Humberto -

      It all depends on your medical records. Were you seen for joint pain at all while in the military? If not, then the VA will most likely not consider this service-connected, and thus it won't qualify. The VA has to have proof that it started in the military, and without medical records, you don't have any. If, however, you do have medical records showing complaints of joint pain in the affected joints, then you do qualify. Go ahead and submit a claim.

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  20. Dr thank you so much. I had been seen while in the military for my knees and right tibia, but now my situation is to the point that I will need a right total hip replacement. I did two tours to Iraq, I don't know if this had something to do with me getting RA? If not, do you think I can relate the knees and right tibia to RA? Have you seen a case like this before? Thank you for your time.

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    1. There is no concrete proof that your deployments caused RA, so that won't be a successful factor. It is possible that your other conditions contributed to RA, but you'll want one of your specialists to look at the entire picture and record an expert opinion on that. The VA needs as much solid proof as possible; just loose relationships aren't enough. Ultimately, only the VA can really make that determination after looking at all the facts. More often then not, I've seen similar cases not succeed, but some have. It depends on the proof you can provide, and specialist opinions will help with that. Really, all I can recommend is get the opinions and apply. It's worth a shot.

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  21. Dr. Johnson,

    I have been diagnosed with the following condition in my right elbow: advanced chronic degenerative disease in the lateral joint, superimposed on mild generalized degenerative joint disease. Pathologic changes at the radial-capitellar joint may be chronic posttraumatic resulting in several chronic osteochondral lesions. I have already been awarded disability for degenerative changes and tendinitis in my right shoulder (10%), degenerative changes left shoulder (10%) and degenerative changes of the thoracolumbar spine. Can I get a 10% rating for my right elbow condition based solely off the MRI and X-ray conducted on my elbow?

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    1. Possibly. This does officially diagnose arthritis, and as long as you have pain with motion, it's an automatic 10%. They will still want to do further examinations before rating this condition, however, since arthritis is rated on limited motion first and they'll need to test your range of motion. If you don't have limited motion, then they'll rate it on pain with motion.

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    2. Do you think my elbow condition can be a secondary for my degenerative conditions in both my shoulders? I ask this question because, I was not treated for the elbow condition while on active duty; however, during my retirement physical, I reported and listed the pain for my elbow. The doctor annotated the following on my report of medical history: "Also reports pain for 1 year. He has not sought medical eval." Even though I was not treated for the elbow pain, will the statements on the medical history report be suffice to have it be deemed service connected? Thank you for the previous reply.

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    3. Normally, yes. The VA usually takes conditions that develop within the 1st year post-separation as service-connected, so they will most likely consider this since you had it recorded right around retirement. This is a little bit of a gray area, so its hard for me to say anything definitively, but you have a good chance, and it's definitely worth submitting a claim for your elbow.

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  22. I don't believe your take on the rating of arthritis is completely correct. The General Counsel Opinions related to this topic (VAOPGCPREC 23-97, VAOPGCREC 9-98, VAOPGCPREC 9-2004) allow for multiple ratings for arthritis to be assigned to each affected joint (this is not considered pyramiding) with numerous BVA decisions supporting these ratings (Citation Number 1017323) that assign separate diagnostic codes for each condition to accurately describe the disability. So you can have a rating for arthritis in addition to limitation of motion.

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  23. VAOPGCPREC 9-2004 stated “Where additional disability is shown, however, a veteran rated under DC 5257 can also
    be compensated under DC 5003 and vice versa”.

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    1. Thanks for your comments and for submitting additional evidence.

      Yes, both VAOPGCPREC 23-97 and VAOPGCREC 9-98 state that compensation can be given for DC 5257 in addition to a code for arthritis (DC 5003), but DC 5257 is for instability of the knee, not limited motion. Instability of the knee is the exception to the pyramiding rule in all instances and is clearly noted as such. This is not limited motion.

      VAOPGCPREC 9-2004 is strictly for doubling up on limited motion codes and does not address arthritis at all.

      It is supported in all instances that limitation of motion rating cannot be given in addition for a rating under DC 5003 for arthritis, but yes, DC 5257 for instability of the knee can be given.

      Hope this helps clarify things. Thanks for bringing this up.

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  24. Hello Dr. Johnson, first I would like to commend you for your years of service, and your commitment to helping us who still serve.

    I am at a tough point in my life. I have been in the Marine Corps for 17yrs and tested positive fo a RA Factor; this arthritis has changed my life very quickly. I was referred to a clinic out in town but have not went because I fear of being med-boarded before I can officially retire. I don't sleep, my joints are always tingling and stiffing, most of the time I am depressed because of this. I don't know what to do. If it is not documented properly I will not receive the claim I deserve when I do retire, furthermore I am sucking all of this up on utilizing pain killers. Dealing with this without receiving treatment for the next 3 yrs seems overwhelming. Can you please let me know your professional opinion regarding my situation?

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    1. Yes, you are in a tough position. I definitely understand your desire to make it to 20 years, but you are correct that you are harming yourself in the meantime and in receiving the proper compensation after service. If your condition is as severe as it sounds, you may qualify for a 30% or higher disability rating, which gives you full retirement benefits, so you might as well medically retire now. Now I can't say that officially without knowing all the details, including your range of motion for all of your affected joints, so you may not qualify for that high of a rating. Ultimately, the choice is yours, but I recommend getting the treatment you clearly need and then going from there.

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  25. Dr. Johnson,

    I was rated at 10% for achilles tendinitis for the left and 10% for the right. My right achilles was surgically repaired due to a rupture. The VA did not rate me for the repair at all. Since then I have developed a heel spur and arthritis in my right ankle. My right foot will spasm and lock up. Both ankles get stiff if I sit too long. My right foot, because of the heel spur hurts after walking for a period of time. I have been given inserts to try to correct the issues because both feet have arch problems. Is there anything I can do to get my rating % raised?

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    1. Hi Derrick -

      The VA doesn't give ratings just for having a procedure done, just on any remaining symptoms, so that's why your right was rated the same as your left. It sounds, however, like your right symptoms have progressed quite a bit, and yes, they should raise your ratings to reflect your worsening symptoms. You need to go in and have the VA perform another C&P Exam so that can record your new symptoms, and then submit VA Form 21-0966 to have your rating increased. Make sure to submit all the new evidence that shows your worsening condition with that form.

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  26. Dr. Johnson,
    I am a retired USAF veteran, & I served 22.5 years on active duty, retiring on Jan 1, '01.
    Are major joint replacements treated to the "VA math" when both bilateral joints are replaced? That is, if both hips are replaced, are they subject to the VA math? Or, are they treated differently because they are "major joints"? I have been told by a fellow vet the "VA math" doesn't apply to major joints, but from what I read in the CFR, the VA math still applies.
    FYI, I recently had both of my hips replaced; & I do have documented mil med records of degenerative arthritis (26 entries). My THR experience has been largely outstanding. I had no VA rating prior to the surgeries (I didn't ask for one). I'm now simply trying to understand how the ratings may go...I'm awaiting the final disposition.
    Thanks for your service!
    Barry

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    1. Hi Barry -

      Not sure where the vet got that information, but VA Math always applies. There are no exceptions. With that, you do definitely get the extra 10% for the bilateral factor since both hips are affected.

      Since you just had your hips done, you will get a 100% rating until the 1-year mark of your surgery. Then they'll reevaluate your condition and give you another rating based on any remaining symptoms. So for long term, it's impossible to say what rating you'll receive, but for now, you'll get a 100%.

      For more info on hip replacement ratings and VA Math, check out:

      http://www.militarydisabilitymadeeasy.com/hipandthigh.html#hip
      http://www.militarydisabilitymadeeasy.com/vamath.html

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  27. Dr. Johnson,

    8 years ago I received my bilateral ankle service connected disability (20%), I recently had a VA appt. with radiology and they diagnosed me with degenerative joint disease (both ankles). Can I apply for this as secondary and what do you think my total will be if granted?

    Thank you

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    Replies
    1. DJD is a form of arthritis and so cannot be given a second rating to a rating you are already receiving for your ankles. Each ankle can only receive one rating. Now depending on how your ankles are currently rated, you may be able to get a higher rating under the arthritis rating options. If you are currently rated on limited motion, then you won't be able to get a higher rating unless your motion is more limited than it was when you first received your rating. If this is the case or a rating for arthritis would be higher than your current 20%, then you just contact the VA, submit the new evidence regarding your new diagnosis (and new range of motion) and ask for the case to be reviewed for increase.

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  28. Dr. Johnson,

    I don't know if this is true or not but I read an article from an employment law firm that stated if a veteran has two or more non-compensable service connected disabilities, the VA can grant a overall 10% rating. Do you know anything about this?

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    1. That's definitely not standard practice. The VA doesn't offer a minimum rating just because you have multiple service-connected conditions. The conditions have to be serious enough to limit your functioning in order to qualify for compensation, and having a bunch of conditions that don't limit your functioning doesn't suddenly create a single condition that does limit your functioning. Yes, it isn't great to not be receiving compensation, but as long as the VA considers your conditions service-connected, you are receiving medical benefits and will receive compensation if they ever worsen in the future.

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  29. Good morning Dr. Johnson,

    I am active duty and soon to retire with over 20 years of service. I was diagnosed with Rhumatoid Arthritis. From the RA specialist physical exam, he has indicated impacts to the bilateral shoulders, elbows and wrists. I have pain in those joints, as well as biceps and hands. I don't think I've had severe enough flare ups, based on my interpretation of the rules, so I would expect to be rated for each impacted joint only. My question - do I need Xrays and MRIs to prove joint and muscle damage? (Or is the RA physical exam sufficient?). I believe I read that pain alone was not enough proof for normal arthritis, that the damage needed to be significant enough to show on an X-ray. If so, will those tests be ordered at the C&P Exam or do I need to request them from my primary care provider (a military PA) before I submit my claim to the VA? (Getting the military to pay for MRIs and X-rays may be a problem).

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    1. Hi Sam -

      Good questions. MRI and x-ray evidence isn't required for RA like it is for degenerative arthritis. This is because there was a movement in 2010 that changed the accepted diagnostic criteria to diagnose at an earlier stage before joint destruction that can be seen on imaging occurs. So since you have been officially diagnosed with RA by a specialist, you should be good to go. What all did he do during the exam to diagnose you? Did he use the Rheumatoid Arthritis Classification Criteria? Did he do a blood test? If so, and he diagnosed you with RA, then that should be clearly noted in your medical records and no further evidence should be required. If, however, they do decide that they need further evidence at the C&P Exam, then they can order it at that time. Again, shouldn't be necessary as long as your military medical records clearly diagnose you with RA.

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  30. Thank you very much for the response Doctor Johnson! To answer your question, I was originally diagnosed with RA several years ago by blood tests and a very in depth physical exam by an RA specialist. And again by a new RA specialist last year. So the disease is well established and diagnosed. The damage to the shoulders are easily established as well by pain, limited ROM and MRI. What is not well established is the pain in my elbows, wrists and hands which is nearly always present, but at the time of the physical exams, show limited inflation and full ROM. Unlike the shoulders, the joint damage isn't that bad yet, to consistently present in a meaningful way at the time of physicals (me stating that I have pain when I flex my elbow is not enough objective evidence, from what I understand). Physical signs of joint involvement /damage are difficult for a physician to "see" during the early stages of RA. Especially while taking NSAIDs and a battery of other RA drugs.) Now if there were a function performance test, say lift a 10 lb dumbbell in a torquing motion, then the damage impact to these joints and tissues would be very evident in my case. But there is no such pratical test. My understanding is that at the time of the C&P Exam or VA Specialist exam, my symptoms must be obvious to the examiner. Which will be hit or miss unless I stop taking my RA meds and allow more damage. Not a good idea as this disease is hard. You mentioned a movement in 2010 that changed the way RA was evaluated, which sounds like what I am dealing with. Do you happen to have a reference that I can research or maybe key words that I can google to learn more? Thanks again for already answering my biggest question. We are very appreciative of your website with the information and insight that just can't be found anywhere else!
    Sam

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    1. Hi Sam - Just Google "Rheumatoid Arthritis Classification Criteria", and information on the 2010 changes will pop up.

      Your understanding of the C&P Exam is both true and false. First, the VA examiner does not need to diagnose a condition that has already been firmly diagnosed, like yours. It's already been diagnosed by more advanced methods than a simply physical exam, so if the doc really feels the need to challenge the diagnosis (he won't), he can order another blood test which will ultimately reveal the same diagnosis.

      Now, it is true that symptoms should be recorded as thoroughly and correctly as possible. Here is the trick for this: it is clear that you are taking necessary meds to suppress your symptoms. On the whole (there are some exceptions, but not really in this case), if a symptom is properly treated by medications, then it does not qualify for compensation. Now this isn't true for all conditions, but for example, the rating requirements for many endocrine conditions state that if there are symptoms despite taking medication, it is rated 30%, but if the medication controls the symptoms so that there are none, it is 0%. Basically, we compensate for disability. No symptoms = no disability. So, in your case, you don't need to worry about this for diagnosis, but not having symptoms in a particular joint MAY cause a lower rating to be given overall, depending on the rating option used (there are more than one for RA). Don't just stop taking your meds, though. That would be detrimental to your health and so not worth it in the long run.

      So, how do you maximize your ratings? First, rating options. Since you don't have a history of incapacitating episodes, they will rate each individual joint that is affected (with the exception that fingers are rated on the motion of the entire finger, not individual knuckle joints; the spine is rated on lumbar vs cervical, not individual vertebrae, etc.). These ratings will be based on limited motion of the part, with a minimum of pain with motion. So the most important thing the VA examiner will do is take detailed range of motion measurements of every joint involved and will record if there is any pain with motion.

      Now, you're right, if it is a good day with few symptoms, this could cause you to get a lower rating than if the exam falls on a bad day. Because of this, you might try to get numerous range of motion measurements from other sources as well, hoping that some will fall on a bad day. While the Rating Authorities will place a lot of emphasis on the C&P exam, they do consider exams that show pertinent information that are also close to this same time period. So if you have range of motion measurements from a physical therapist and one from your physician showing fairly limited ranges of motion, then they will most likely rate you on one of those even if the C&P exam shows little, since more evidence points to more severe symptoms.

      Ultimately, since the meds are controlling your symptoms fairly well at this stage, you may not get a very high initial rating. The good news, though, is that as this condition worsens over time, the VA will update your rating to reflect the worsening symptoms.

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  31. Thank you so much for interpreting the soup of information. It is very comforting to have some knowledge of how the system works, and its applicability on individuals. Best regards!

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  32. Doctor,

    I am 23 and was medically separated from Air Force BMT due to osteoarthritis in my ankle. However, i am not in pain and was made to be medically examined because i was sore after a run day and prolonged stay in my boots during second week of training. I am upset by the fact that i was sent home with 0 chance of returning to serve my country, so my question is can this condition truly keep me from serving? is it that bad?

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    1. First off, I want to give you props for wanting to serve your country. That is very admirable, and I respect you for it.

      Although your osteoarthritis is not a problem now, it is a degenerative condition, which means that it WILL get worse with time, no question. The harder you are on that joint in the meantime will increase how quickly it worsens.

      The physical demands of a military lifestyle will cause your arthritis to worsen much more quickly than normal. With proper care, your condition could take 20 years to worsen to a point where it causes you significant problems, but in the military, it could be 5 years, or 2.

      While it isn't what you want to hear, a military career would have a negative impact on your physical health for the rest of your life because of this condition. It's not that your condition is that bad right now, it's that it will be bad if you remained in the military.

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    2. Thank you sir! You are the first person to give me an honest and upfront answer. I'll Take this as the closure i needed and i'll pursue another career. God Bless

      Delete
  33. Hello Dr Johnson, I have a va rating for 10% on my knee even after I had a lateral release surgery. The surgery has caused arthritis and am now told the only option is knee replacement but I cannot get one until the cartilage wears out completely. This is active duty related but is causing me more and more issues in the National Guard and was looking at medical retirement but not sure what kind of rating I will get for it or what else I can do for it. Thank you very much!
    Josh

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    1. Hi Josh -

      Until you get the knee replacement, you will be rated for arthritis, which is primarily based on the limited motion of the knee. Without knowing your exact range of motion measurement, I can't tell you what rating you would receive, but you can find that information on our site:

      http://www.militarydisabilitymadeeasy.com/kneeandleg.html#limo

      Really there isn't much else you can do for it right now. Just keep with physical therapy and other exercises that will help it stay as good as possible for as long as possible.

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  34. Hello, I have a 30% rating 10% each for my back, hip, and knee. I was constantly seen throughout my time served and was diagnosed with stress fracture, problems with knee and back. This is almost 8 years and I still can't run or even walk fast for long periods. I would get instant pain in my hip and knee. Would I be able to file for a higher rating? Also my claim was denied for enlarged cysts. During my time I was seen 2-3 times for this. But each time it had already ruptured, when I went for the examine at the VA they said they saw nothing..which of course it is only enlarge and cause pain right before cycle. Can I do anything about this? Thank you

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    1. Hi Denise -

      If your conditions have worsened since they were originally rated, then you can definitely apply to have their ratings increased. Just schedule another C&P Exam to have your conditions reevaluated. Do note that if they haven't actually worsened, the ratings won't change.

      As for the cysts, are you on any medications for them? If not, they aren't severe enough to warrant a rating. For ovarian conditions, they have to require constant treatment in order to qualify for the minimum rating of 10%.

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  35. Hi, my husband is being treated for RA at a va hospital. He has tried to claim va disability benifits however they were denied. He has episodes everyweek where he can hardly walk ir use his right shoulder and wrist. Why was he denied benifits? He does get 10% disability for one of his shoulders due to loss of range of motion for a completely seperate reason. I'm at a loss for what I can help him with. His quality of life has diminished so much in the past year its upsetting. Thank you for any help. .

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    1. Hi Staci -

      When was your husband diagnosed with RA, and when was he separated from the military? It may be that it has been too long since his separation for RA to be considered service-connected. Normally, anything that develops more than a year after separation is not service-connected unless it can be directly proved to have been caused by service or is on the presumptive list for exposure to things like Agent Orange, etc.

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    2. He is being treated for ra for almost a year now seperated from army in febuary of this year, national gaurd reserves.

      Delete
    3. Hi Staci -

      The key is probably that he was a Reservist. Conditions are only considered service-connected for Reservists if they occur directly in the line of duty. I don't know the details of his case, but for them to deny it, it makes me think that he was not on active duty when diagnosed or at least was not active enough during the period that his RA developed in order for it to be clearly caused by his service.

      Delete
  36. Hello, Dr. Johnson

    I am currently rated at 40% for patellofemoral syndrome pain in both knees, DDD in lower back, and right hip pain. I had to stop my new pending claims (bilateral chondromalacia patellae, chronic pain syndrome, secondary condition depression) due to going back on active duty service (National Guard). My question is is it worth it to file my other back claims (narrowing of foramen/foraminal stenosis, sacroiliac dysfunction) or should I request an increase in my back rating due to the above mentioned other issues? That is the same question for my knees since I am solely being rated for Patella femoral pain in both knees. Should I file chondromalacia patellae as new claim or request an increase in bilateral knee rating due to other issues?

    Signed,
    Duncan

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    Replies
    1. Hi Duncan-

      Everything is going to be put on hold since you're going back on active duty. You might want to wait until the end of this service period and then submit everything all at once. For the knees and the back, a single rating only is given for them unless there are new separately-ratable things like instability in the knee or nerve involvement in the back. So based on the limited information I have, the best way would probably be to submit for an increase instead of submitting a new claim. Since these are new diagnoses, however, you can still submit them as a new claim, they just may not be rated since those body parts already have ratings. If you do it this way, though, if you do have something, like instability or nerve involvement, that is separately ratable, then that will be properly rated.

      Delete
  37. Dr. Johnson,
    Thank you for such an informative website. I am service connected for all fingers and thumbs. Rated at 10% for bilateral long and index fingers since the gap between the pad and transverse palm line is 4.5 mm. The award letter stated that if I experienced "painful motion of two or more of the following: thumb, index finger and long finger" a higher evaluation of 10% would be warranted. Based on that, I submitted a claim for both thumbs. I have received steriod injections in both CMC joints, wear braces at tnight and have difficulty and pain when grasping items and trying to open jars. This would have been documented in the C&P eval in addition to ADL impacts. I just received a denial letter which had the standard language "based on the evidence received your service connected condition hasn't increased in severity sufficiently to warrant a higher evaluation." (from 0% to 10%). I was surprised and now wonder what increased severity means, recognizing that is a very subjective statement. When I submitted the claim, I had received the first round of injections and have had another round of CMC joint injections. My hand surgeon has discussed having reconstructive surgery on the CMC joints. I am considering submitting a NOD just to get another set of eyes to evaluate my claim. Do you have any suggestions or insight that might be helpful?
    Appreciatively, Robert

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    Replies
    1. Hi Robert -

      The key to painful motion in the fingers is that the two or more fingers must be on the same hand, so submitting a claim just for your two thumbs doesn't count, unfortunately. But you still should qualify if all your fingers are affected. If you have pain with motion in your thumbs and your index and/or long fingers on both hands, then you can submit for that and should receive 10% for each hand. Just make sure that painful motion is clearly recorded in your medical record for those fingers and your appeal should be successful.

      Delete
  38. DR Johnson,
    I have been rated at 40% due to having brachial neuritis. I tried to get this increased back in 2013 due to my left shoulder and left shoulder blade always acting like I've pulled a muscle. The came back and said no increase due to X-rays that found what they have called traumatic arthritis. I am in the process of seeing private doctor to either have new X-rays taken or have him send me to have an MRI done. As of today after two weeks ago of working in the yard I still have a dull ache and at times shooting pains in the left shoulder and shoulder blade area. If this info from my doctor and start a new claim for this problem what do you think I could get for a rating from the VA.
    Thanks Dennis

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    Replies
    1. Hi Dennis -

      It's impossible for me to say with this limited info just what you might be rated. There are a few things at play. First, what code is used to rate the brachial neuritis? Nerves CAN be rated separate from arthritis, but only if you can clearly separate the symptoms. A single symptom cannot be rated more than once. Arthritis is primarily rated on limited motion, so if pain is limiting motion, it has to be clear that that is separate from the nerve pain. Now, it might be, and if so, then you should receive a rating for limited motion of the shoulder in addition to the nerve rating. I can't tell you what it would be without knowing your exact range of motion measurements, but as long as there are definitely separate symptoms, you should get a second rating.

      Delete
    2. Dr. Johnson thanks for the reply but I got a question where do I find that code you are talking about? The VA rating letter just tells me that I'm rated at 40% for the neuritis with the degenerative left shoulder tied too the neuritis.

      Delete
    3. If the code isn't on the letter, then you should be able to find it via your eBenefits portal. If not, contact the VA office and they should be able to look it up.

      Delete
  39. Dr. Johnson

    I feel very lucky to have run into your blog :-), my issues are in regards of some disabilities I claimed during my retirement physical over 10 years ago. My records did not show supporting documentation possibly because of the unit misplacing of some records. I was a combat arms soldier and deployed into combat right before retirement because of the stop loss (involuntary extension of a service ) during combat operations. When I was allowed to retired, I just left the military and never really looked back. The unsupported claims have now become a health issue and have no idea how can I fight this.
    Is there a way to request a copy of my medical records?
    Towards the end of my career I had a profile for a couple of months because of bilateral plantar fasciitis and bilateral patellofemoral knee syndrome, but it seems as there is no mentioned of it in my records. Would there be X-ray records archive somewhere that I can look up any possible records? Thanks in advance!!!

    ReplyDelete
    Replies
    1. Dr. Johnson
      Quick follow up….right after posting yesterday, I search around the internet I found a way to order my medical records, I followed the process and I got a call today from the local DAV that they had just printed out the records and I could pick it up, which I did. I just went over 300 pages of records and found many days which I was seen for shoulder (left and right), knees issues, plantar fasciitis and ankles problems. Which all were denied and entered as “not service connected”. I don’t remember getting any test done corroborating my claims after I submitted those issues. And yes I also found profiles for some of the issues as well. Should I resubmit a claim for those issues or see my primary care to get a current diagnosis?

      Delete
    2. If you did not submit these medical records with your original claim, then the VA would have denied it simply because you didn't have any proof of service-connection. Now that you have this proof, they will correct this and perform exams before they rate your conditions. Just submit a claim with this new evidence and they will reopen the case. Then you can contact your local VA and schedule your C&P Exams, and you should be good to go.

      Delete
  40. I was recently surprised when the VA initiated a reexamination of two injured joints more than 6 years after I was initially examined and given some disability. Have you ever heard of this? My original letter said I would be re-evaled in 3 years. Title 38 says C&P reevaluations are not normally initiated when a vet is over 55 yrs old "except under unusual circumstances". Title 38 also says re-evals are done 2 to 5 years after the initial evaluation. I did an inquiry and the VA basically blamed the "unusual circumstances" on their backlog. Hopefully I won't be downgraded because I have seen very little improvement since I retired. I even had to have an additional surgery on my knee. My left tibial plateau was crushed along with a fractured fibia, and I have patella femoral syndrome. The other re-exam was on an elbow that was broken and refused to fully straighten.

    ReplyDelete
    Replies
    1. Although Title 38 gives general timelines, these aren't set in stone. The VA has the ability to call a re-eval any time, technically. Basically, the first re-eval normally happens within 2-5 years, regardless of age. If this first re-eval isn't done within that time (because of the backlog or whatever), then it can still be done later. The other limitations are normally for additional re-evals after the first. So, after the first re-eval, they rarely decide to do another one unless there are unusual circumstances. Ultimately, they are legally able to do a re-eval on your conditions, and the circumstances really aren't all that uncommon since everything is behind right now.

      As for your rating, is sounds like your conditions haven't improved enough to warrant a lesser rating. You should be fine.

      Delete
    2. You were right. I just got my determination letter today and was not downgraded, noting that there has not been enough improvement. The VA also stated "Although the evidence of record shows some improvement, as you are over the age of 55 a future review examination will not be scheduled." In the process, I learned a lot and found where I need to apply for additional benefits. I have requested a DAV representative to help me through it this time. I wish I had used a representative the first time around because the error may have been caught several years ago. I recommend that to anyone going through examination. But your blog is very reassuring.

      Delete
    3. Glad we could help. Sounds like things are going working well for you. Best of luck with your DAV rep.

      Delete
  41. Hi Doc,
    I was diagnosed with R shoulder,severe degenerative, end of stage, osteoarthritis. I had read that it can be termed as a service connected disability after years of seperation from sevice. Is that true? Are there conditions when substantiating claim. Or is this a grey area to decipher?
    Thanks, S. Klees

    ReplyDelete
    Replies
    1. Hi -

      Yes, arthritis, including osteoarthritis, can sometimes be considered service-connected, but only if it satisfies one of the requirements on the VA Presumptive List.

      http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html

      It is included under the Chronic Diseases category, but it would have to have developed within 1-year post-separation in order to qualify here. It also could qualify if you're a Gulf War vet who contracted brucellosis.

      Basically, you have to meet the requirements for one of the categories on the VA Presumptive List in order for it to qualify.

      Delete
  42. Hello, I am a 39 yo female being medically boarded. I received my DA 3947 and am waiting to see legal before sending back. I am being found unfit for Duty due to moderate to severe DDD/osteoarthritis/spinal stenosis, etc, throughout my cervical and lumbar spine with radiculopathies. Surgical candidate. I was still found fit with the Migraines that started around the same time as many other worsening issues, even though they greatly inhibit me for many things; but one problem is that there were several medical documents that were never included in the PEB packet that were supposed to be in there for the arthritis and migraines. I had been diagnosed with sacroilitis & have bone spurs/spurring in the SI joint. My main question is, would my SI joint be considered another joint to Rate if I decided to appeal and have it added to my claims? I tried telling them to add it to my form, but they never did. Would it even be worth it to include my SI? I am pending xray results for my knees, but we're assuming osteoarthritis/bursitis also, but no ROM limitations for examination (just have limitations during flareups or running/excessive walking, so not sure if worth adding these either. Thanks for any help!!! V/R, Holly

    ReplyDelete
    Replies
    1. Hi Holly -

      The PEB only rates conditions that make you Unfit for Duty, and it sounds like your knees do not. The SI joint might, depending on how bad your symptoms are, but this is rated on limited motion of the lumbar spine, which is already being rated, so it wouldn't add anything extra unless it also caused limited motion in the hips. Unless it does that, I wouldn't worry about this either. While not having them for the PEB isn't a huge issue, definitely make sure that they are all included when you submit for VA Disability. The VA will rate everything, not just stuff that makes you unfit, so it is essential to include it all.

      Delete
  43. Hello Dr. Johnson,

    I have a few questions, first is pertaining to Gastroesophageal Reflux Disease (GERD). I have been prescribed the NASID’s Meloxicam tablets and Voltaren topical gel for pain and inflammation of my left ankle which has osteoarthritis (OA). I am currently rated 10% for my ankle and over the past four months since I been taking those NASID’s I been getting really bad bouts of acid reflux. I went to see my PCM and he said I have the symptoms of GERD and prescribed me Prilosec. I want to file a claim for GERD as secondary to the use of NSAIDs for my treatment of the service connected disability from my ankle. What evidence do you think I will need to show the VA in support of this claim? I know I will need my medical records but to you think I will need an Endoscopy or an Ambulatory acid (pH) probe test? I have a few friends who said they just told the VA they had GERD and their medical records showed prescribed medication but they never had any tests done and they were rated 20% for GERD.

    My second question is the VA form statement is support of claim. Do you think it’s wise to include VA Appeal Orders on this form? For example, I found several appeal orders for service connection for GERD as secondary to use of NSAIDs for treatment of service connected musculoskeletal disabilities was granted. Below is a link to one of them.
    http://www.va.gov/vetapp03/files/0310420.txt Citation Nr: 0310420, Decision Date: 05/30/03 Archive Date: 06/02/03

    ReplyDelete
    Replies
    1. You don't need those specialized tests as long as your physician clearly diagnosed you with GERD and you are being medicated for it. As for the appeal orders, definitely do not submit them with your claim. Doing things like that on an initial claim is basically telling the Rating Authorities how to do their job, and as most people wouldn't, they rarely appreciate that. You don't want to insult them right from the get go. Now, if they decide that your GERD is not connected, then you can submit an appeal and include those other appeal orders as evidence in support of your appeal, but I wouldn't do it right off the bat. Give them a chance to make the correct decision on their own.

      Delete
    2. Thank you Sir, I appreciate your advice.

      Delete
  44. Disappointed in Initial C&P exam yesterday. I have verified RA and taking all the meds and localized injections. Impacts shoulders (bursitis), elbows, wrists and knees. I additionally have 3 cervical discs HNP which the neurosurgeon recommends replacing, and bulging lumbar disc. Have been on continuous PT for the last 9 months and limited duty at work. I sat in a chair while the doc sat at the computer asking questions and typing. His physical exam consisted of me raising my toes about an inch raising his hand offering no resistance (with my boots on), then raising his hand about an inch with my knees with token resistance without bending my knee (all while I was still sitting in a chair). He stated the exam was complete. I asked him about taking measurements and checking my joints for pain. He stated that he did By him observing me during the exam (sitting in a chair) and my ROM and gate was normal. I explained my gate is normal walking slowly on a flat surface, but not on an incline or walking up steps. So that was it. I've got no joke joint issues and real pain, and I walked away with a 0 rating. Over the last year, I've been examined over and over by 2 RA specialists, 2 orthopedic surgeons, a neurosurgeon and 2 PHysical therapists, who all came to the same conclusions. this is not any kind of performance function test or any other physical manipulation. All I want is to be fairly and properly evaluated. By this standard, I would have to come crawling and yelling into the office to be considered to have pain, Additionally, the VA had not given him any records to review. He is a contracted civilian doc in the next state under the Lockhead Martin gig. Questions: is this really considered a legitimate evaluation given this scenario (is this an acceptable way to conduct the exam)? If not, what recourse do I have? I'm retiring next month and this is my initial C&P exam. Thanks Doctor!

    ReplyDelete
    Replies
    1. Hey, I'm not the doctor, but read your post with interest. I hope you submitted copies of all your medical histories with your claim. If you didn't, you should still be able to upload them to the eBenefits website or submit them to the VA. The opinion of the expert doctors who have seen you over a long period of time will carry much more weight than your 1-hr visit with the C&P examiner. I just went through a similar re-eval--same thing, the C&P doctor only saw me under ideal conditions; not when I am sitting at home with an ice pack on my knee because I was on my feet too long that day. However, the info I submitted from my civilian doctors carried me through and prevented a downgrade on my ratings. If your specialists have painted a clear picture of the problems you are having, the VA will honor that.

      Delete
    2. Hi Sam -

      Nitrogen Narcosis is correct in that the VA will look at this condition using all of your medical records. That being said, they do put a lot of weight in the C&P exam because in most instances, it is the most current. If they already gave you a 0% rating, it sounds like this is what happened.

      If you could have your PT conduct another overall eval with complete range of motion measurements and fully recording your pain with motion, then submit that, it could help with an appeal since they gave you a 0%. Each joint should have received an entire range of motion exam using a goniometer to measure the precise measurements. Since this didn't happen, you do have grounds to appeal to have a new exam conducted by a different physician and your ratings updated using the new evidence. Regardless of range of motion, however, you should at least receive the minimum 10% for painful motion in each joint. If they gave you 0%, then he didn't even record that it hurts to move. You definitely have an appeal case, so I suggest getting a thorough exam from the PT and then appealing for a new C&P exam and updated ratings.

      Delete
    3. Good morning Doctor, and Nitrogen Narc - thank you very much for the suggestions.

      To clarify my comments - I have not yet received the official rating from the VA. I am assuming I received 0 percent rating, given his response to my questions about measurements, as he said "your fine". I did not show pain as all I did was walk in the office and sit in a chair. My knee popped and he asked what the sound was. But otherwise I didn't show symptoms. You commented that I should have a case for appeal. Doesn't that take years to receive a determination? Given that the VA is still in the final rating determination process (my exam was on May 25th) and I've heard no further communications, should I contact them now and request a new exam? Or is it better to just see the final rating before raising the issue?

      Thanks again!!
      Sam

      Delete
    4. Hi Sam -

      Trying to request a new exam at this point could cause pretty serious problems with the system and delay the process excessively. I recommend just waiting to see what their decision is. While some appeals can take years, some take weeks. I doubt yours would take a terribly long time. Ultimately, they might rate in your favor based on the other evidence you submitted, so it's worth it to just wait and find out. If you have to appeal, hopefully it won't be too long.

      Delete
  45. Good Morning Dr. Johnson

    When I left the military I was given a 0%"service connected" for lumbosacral strain, after many years of back problems I submitted a new claim and was given 20% for lumbar spine degenerative changes with minimal degenerative joint space narrowing at L4-S1) (previously rated as lumbosacral strain DC5237). What would the "previously" comment means?, would the lumbosacral strain will go away from the list of disabilities? Are they saying that conditions was misdiagnosed?...The only reason "I think" they gave me this rating was because I provided an MRI, I have always had back problems since in the military, but they never went further than X-rays. Should I go back and try to claim that this condition was always as recently diagnosed?

    ReplyDelete
    Replies
    1. Good questions. Unfortunately, they VA can legally only rate based on the evidence at hand, so regardless of whether or not the condition was the same then as now doesn't matter. There isn't proof from that time to show that the condition warranted a 20% rating, so they cannot legally back date that rating for you.

      That being said, both lumbosacral strain and lumbar degeneration are both rated on the same rating factors: range of motion. So regardless of the diagnosis, both ratings were assigned based on your range of motion recorded at that time. Your range of motion wasn't limited enough at the beginning to warrant more than a 0% rating, but now is restricted enough to justify a 20%.

      Yes, this new diagnosis officially replaces the lumbosacral strain, but no, you won't be successful in having them change your earlier rating.

      Delete
  46. Retired in 1997, Arth in both knees, R. great toe. Denied for back "arthritis". I filed as back pain as my last exam stated chronic back pain". Denied because took xrays only, not shown in svc med records, but treatment for back pain was. Continued to have pain, which my Dr later diagnosed as Sacroiliac Joint Pain. I filed another claim listing this as secondary to my right knee as the pain always on my lower right side, EVEN IN SVC. The VA cannot seem to shake the term "Back Arthritis" and continue to deny even though I sent in info from my Dr and they again based on another xry taken in '02, which NOW shows I have back arthritis. Now having problems with my right foot. This has been ongoing since 2007. How can I get them to notice the difference between the two diagnosis. Appealed and REMANDED back, but they don't seem to get it.

    ReplyDelete
    Replies
    1. To really understand your case and everything that is going on, I'd like to have us take a look at the VA's rating decision letter so we can know exactly what they are thinking and guide you on how best to contest it. Would you email us at admin@militarydisabilitymadeeasy.com? I think that would work better than the blog setting, although I'll be happy to come back and post again after we've figured things out a bit for other visitors' reference.

      Delete
  47. Hello Dr. I received my x-rays back from the VA stating that "findings: Right knee 3 compartment productive changes are noted. Mild left knee patellofemoral productive changes. No fracture or dislocation is identified. There is no osseous lesion that suggests metastasis or primary aggressive bone tumor.

    I did my C&P exam, I haven't seen the paper trail on them. My knees makes grinding noises and locks up on me often. More often the left one gives out on me when I am walking resulting in me using the cane they gave me, and or the knee braces while I am around the house. Originally I had a 10% rating for my left knee, 10% for my right knee, and 10% for the mild laxity in my left knee. Due to my results now and limited range of motion do you think it's likely that I will get a rate increase?

    ReplyDelete
    Replies
    1. Also the xray detected osteoarthrosis in both knees.

      Delete
    2. Hi Barbara -

      It sounds like the laxity rating isn't likely to increase unless it has worsened, which it doesn't seem to have yet. So I'm assuming you'll still get a 10% for that. For the other two 10% ratings, they MIGHT increase, but I can't determine that for sure. Even with the arthritic diagnoses, they'll be rated on limited motion, so without your exact range of motion measurements for both knees, I can't tell you what your rating will be. You can figure it out on our website, however:

      http://www.militarydisabilitymadeeasy.com/kneeandleg.html#limo

      Delete
  48. Dr. Johnson,

    I have a question but not related to arthritis though. Back in 2007 the VFW filed my claim for a "scar" on my left knee which the VA gave me a service connected 0% rating. Ever since I have had the injury and over the years the scar has given me pain. I was not aware that I could file for a painful scar under diagnostic code 7804. How does the VA verify that you have a painful scar? During the C&P eval do they press on it or judge how it affects motion? On the VA form 21-526b should I file the claim as an "Increased Evaluation" or a "Secondary" to my existing service connected disability due to the pain from the scar.

    Thank you

    7804 Scar(s), unstable or painful:
    Five or more scars that are unstable or painful............................................................. 30
    Three or four scars that are unstable or painful............................................................ 20
    One or two scars that are unstable or painful............................................................... 10
    Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.

    Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars.

    Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable.

    ReplyDelete
    Replies
    1. What you need to do is submit for an increase. You already have a rating (although 0%) for this scar, so submitting again would just complicate things. The painful part is just a symptom. Then contact the VA and set up another C&P Exam for reevaluation. They'll examine the scar and try to verify that it is painful. This is based both on examination and history. Once the exam is complete, if they determine that it is a painful scar, then you'll receive a 10% rating under code 7804.

      Delete
  49. Dr Johnson,
    You do a great job at helping folks out. I just wanted to let folks know there is a closed Facebook group called "Veteran to Veteran" that is available to help folks out with questions about any rating issues (not just arthritis). I have found it full of experienced folks with lots of great advice. It is a closed group called Veterans to Veterans. Here is the link: https://www.facebook.com/groups/626936820727015/

    ReplyDelete
  50. Dr. Johnson,
    I would like your take on this issue re: 5003. I am a retired (2014) servicemember with:

    1. A documented history of chronic plantar fasciitis of the left foot that dates back to just after commissioning to the present.
    2. A documented history of right foot pain with a more recent history of chronic plantar fasciitis.
    3. A documented history of low back pain, sacrolilitis, and right leg pain (radiating from the back) while on active duty.

    When I filed my initial claim at retirement, I claimed a bilateral foot condition, bilateral ankle condition, left hip condition, and low back condition. All were denied with the same language: “while your service record reflects complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supports the conclusion that a persistent disability was not present in service. The evidence does not show a current diagnosed disability.

    However, I was rated at 10% for arthritis of the lumbar vertebrae, multiple involvements of the interphalangeal, metatarsal, and tarsal joints of the left foot and multiple involvements of the interphalangeal, metatarsal, and tarsal joints of the right foot.

    So, if I am reading and understanding your explanation of 5003 correctly, they basically used it as a “catch all” for my low back/sacroilitis/right leg pain, left foot pain, and right foot pain because they had x-ray evidence but did not have clinical evidence that they were currently disabling at the time of retirement.

    OK, fast forward to now. I am currently having significant and chronic low back pain (the same as when on active duty), chronic plantar fasciitis of the right foot, and chronic plantar fasciitis of the right foot. I am beyond the appeal window from the original decision.

    I intend to file for an increase above 10% for the back based upon current and chronic low back pain and increase for chronic right foot pain (plantar fasciitis). If I understand 5003 correctly, there would need to be limitation of motion in my back AND in my feet to warrant separate evaluation for the back, left, and right foot. That is fairly straightforward for the back but the nature of plantar fasciitis isn’t really a range of motion kind of problem; it is an inflammation kind of problem (hence the “itis”).

    So, all that being said, I did find treatment records for plantar fasciitis of the LEFT foot that I do not believe were available when the original decision was rendered. These records clearly show that plantar fasciitis of the left foot was service connected and I believe that I can show that it is currently disabling. Thus, my questions for you are:

    With regard to the left foot, would it be better to request that the VA reopen my claim for left foot condition based upon the new records being available;

    OR

    Should I just include the left foot records that were not considered as a part of the request to increase the initial 5003 arthritis disability of 10%?

    Sorry this was so long; hopefully it makes sense. As you said, 5003 seems to make things unnecessarily complicated and I want to make sure that I make the best decision possible.

    Thanks in advance and thanks for putting together such outstanding resources on these topics!

    Ben

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    1. Hi Ben -

      You'll definitely want to reopen the left foot claim with the new evidence, not submit it along with the increase since they are two separate issues. You're trying to increase an existing rating in one and prove service-connection in another. Two separate issues. Submitting it together would create a lot of confusion and problems. So definitely submit separately: reopen the claim for the left foot with the new evidence, and submit for an increase for the rest.

      For the increase: as long as you have limited motion in any of the affected joints, it will be rated separately under its own code. So since the back now has limited motion, that will get its own rating, and the rest will still be rated together under 5003.

      Delete
    2. Thank you, Dr. Johnson. This was a huge help and I really appreciate the time you took.

      Delete
  51. Dr. Johnson,

    I left the military in 2004 and was rated 10% for bursitis and tendinitis for my left shoulder and rated at 0% for flat feet and a knee condition. I just recently reopened my VA claim on my shoulder and added secondary neck condition for arthiritis in my neck and a bulging disk. The doctor also thinks I may have Rheumatoid arthiris. I filed additional claim for lower back pain for arthiris that is present and disc issues. While in the military, I went to the doctor on several occasions for back related issues. My question concern the neck and back issues. What is the probably that the neck and spinal arthritis diagnosis that I received will be considered service connected as a secondary condition to my shoulder issues and also what is the changes of this happening with my back arthritis being determined to be service connected since I did see the doctor in the military about back issues? I hope my question makes sense.

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    Replies
    1. Tough questions. It's hard to predict what the VA will ultimately decide for secondary conditions since it is very difficult to prove that your neck was unquestionably caused by your shoulder, etc. I can't give you a probability, but I can say that your chances will increase greatly if you get an official statement from a specialist that claims that your neck is directly caused by your shoulder.

      As for your back, it depends on what the "back issues" were that you were seen for while in the military. If it was just back pain, then there is no proof at all that that had anything to do with arthritis and they will not consider your current issues service-connected. If, however, you were more thoroughly diagnosed with a back condition that can be more directly linked to your current issues, then they might. Ultimately, this one is going to be pretty tricky and I'd be surprised if they did grant it. Again, though, it depends on what was officially recorded while on active duty.

      Delete
  52. I have been out of the Military for 13 years now, I now have arthritis in both of my knees. Limited range in motion in my right more than my left but still bad. I have been diagnosed by a dr, so I know this to be the case. My question is this, I injured my knees several times while serving, which is also documented in my medical record..Will it be difficult to receive disability and proving that the arthritis that I now have is due to me injuring my knees while I was in?

    ReplyDelete
    Replies
    1. It'll definitely be a challenge, but worth a try. You need to have your specialist that is currently treating you write a statement that your current arthritis is "more likely than not" caused by the injuries in your military medical records. Then submit a claim with all the evidence, and hopefully the VA will agree.

      Delete
  53. Hello Dr. Johnson,
    I had a quick question. I filed a claim for my right and left knee when I was discharged from the army. I receive 10% for my left knee and nothing for my right. During the time I was in the military I received physical therapy for both knees for mal alignment of both knees. They have denied my claim for the right knee at least twice. I went to the va to see the doctor about my right knee again. He said you have mild arthritis. They have never stated or even acknowledged that they even saw arthritis in that knee. Should I file a claim again since the doctor now stated it. This knee gives out on me and hurts quite often. I am wondering if I should see a civilian doctor . Not sure which steps to take next. Thank you for your time in advance.

    ReplyDelete
    Replies
    1. Had to sign back in for notification when you answer.

      Delete
    2. Hi Crystal -

      Sorry for the delayed response. What is the exact reason for their denial? I mean, what is actually written on their decision letter? The reason for the denial will determine the best course of action.

      Delete
  54. I was discharged from service in 1982 with no known issues with arthritis. I started having pains in my thumbs 10 years later. these pains have gotten progressively worse to the point that I often cant hold a pen write with had to alter my grip to use my fist rather than using the the thumb and finger grip that is most often used. A few years back the VA diagnosed me with Degenerative Arthritis in my knees, ankles which are limited in range and motion but not severely. I have injured my knees a few times in the Army and wore a cast a few times. I hurt my hands a few times during my service but never severely enough to be treated. I specifically remember smashing my right hand once when a piece of equipment fell on it but don't recall seeing a doc at the time. I also have diagnosed with Degenerative Arthritis in my fingers and the trapeziometacarpal joints in both hands. I have near constant stiffness and low grade pain in my fingers, but my thumbs suffer severe pain when stressed and often of pain spasms for no known reason. Use of a splint or brace has not helped, neither has physical therapy. I have surgery pending to remove the trapeziometacarpal in both hands. I have applied for disability for depression and arthritis 3 years ago when I first started going to the VA, I was approved for the depression but they denied the arthritis to be service related. Other than my military service I have never hurt my hands and have held low stress office jobs. I can't see why else I would have this problem. No one else in my family has had any sign of Degenerative Arthritis as early as I have. I will ask the VA Doctor who is doing the surgery if he would state that the Arthritis is "more likely than not" service related. Any thoughts or advise would be appreciated.

    ReplyDelete
    Replies
    1. Hi Mike -

      Sorry to hear about your arthritis. Unfortunately, since it developed so long after service and there is no record of it in service at all, the VA simply will not consider it service-connected. It does not meet the requirements the law has set in order for a condition to be considered service-connected. And there isn't anything you can do about it. No matter how much you fight, they aren't going to rate your arthritis, even with your doctor's statement. Sorry I can't offer a more satisfactory answer, but that's just the way the system works. Check out our service-connected page for more info:

      http://www.militarydisabilitymadeeasy.com/service-connected.html

      Delete
  55. Im a Marine reservist that was called to active duty desert shield. was part of SWATG in stumps for the full presidential term. I took a pretty nasty spill hooking up a water buffalo and landed on my left hip. i reported this to the Corpman, in which i was told at the time it was just a hip pointer. over the course of several years after discharge i have documented heavy pain that i assumed was was ciatica only to find out recently i have severe degen osteoporisis in the affected hip, which will require a total hip replacement 22AUG16. i do have a few former marines that can attest to the massive bruising back then in 90-91. i havent reviewed my medical but am pretty sure it was never reported as we were deep in training as we were the next rotation to kuwait. I have no family history of such a disease. Also, I started having heavy hypertension after my enlistment, including the DEP program, which i now have somewhat control of. My question is this: do you think in your professional opinion would i rate a qual percentage based on the info stated above.

    ReplyDelete
    Replies
    1. Without clear medical documentation of the original incident there is simply not enough evidence to suggest that that incident caused your current arthritis. Without that evidence (testimonies won't cut it), they are not going to consider it service-connected, and so they won't rate it. You can always try to submit a claim for it, but more likely than not, it will be denied. Sorry for the delayed reply, but I hope the surgery went well yesterday.

      Delete
  56. Hello Dr. Johnson,
    I'm receiving 10% for patella spur of right knee. At my initial C&P exam I informed the examiner that my knee gives way, swelling behind knee, and locking up. VA orthopedic doctor advised PT which I have done several times with little success. Current physical therapist said I have something torn in knee. went back to VA orthopedic due to knee buckling causing pelvic/hip pain to where I couldn't walk. VA orthopedic told me to try cycling! I could barely walk up and down stairs I said, I would like an MRI performed. MRI showed partial torn ACL, baker's cyst, and Enthesopathy of distal quadriceps tendon is present. Now with the MRI results, can I go for increase because I being telling these VA doctors & physical therapist that something else more was going on but they refuse to believe me. I read that knees get rating on Functional loss, Instability, and Pain. I was rated on pain due to Arthritis.
    Thanks in Advance

    ReplyDelete
    Replies
    1. Absolutely. You can definitely submit for an increase. Even though you have multiple things going on, you may ultimately receive only two ratings: one for the overall knee condition, and the other for instability. Instability is the only thing that can be rated in addition to other conditions of the knee. Most likely, the overall knee rating will be based on limited motion, so depending on your exact range of motion, you may or may not get an increase from the 10%. Ultimately, they'll pick the code that gives you the highest rating. Without knowing all your symptoms, measurements, etc., I can't determine what code that will be, but based on the info I do have, I predict you'll get one rating for limited motion and another for instability. Check out our Knee page for the exact codes and ratings:

      http://www.militarydisabilitymadeeasy.com/kneeandleg.html

      Delete
  57. Dr. Johnson,

    I can't believe you take the time to answer all these questions! Thank you!

    I am currently making my first VA claim. I'm not worried about proving service connection: I have an active duty LOD with a surgeon's report diagnosing an ATFL tear in my right ankle and discussing surgery, which I declined. Five years later I'm out of the military and have developed traumatic arthritis in the same ankle. Two VA surgeons made exactly the same diagnosis as the military surgeon, with the addition of the arthritis and joint instability that wasn't noted after the initial injury. 2 MRIs and 2 X-rays confirmed their diagnosis. Because the ankle is degenerating and losing function, both surgeons strongly recommended surgery to prevent the need for an ankle replacement down the road. I feel like that's a pretty clear nexus.



    I have two concerns with the C&P exam:

    1) I only have pain after running at all or walking for more than two hours. Because I didn't do any of those things during the exam, my examiner only found swelling and a slight limp and possibly a little crepitis. ROM was basically intact and I had no pain at that time. She did take a very thorough history, though. The history included instability and joint locking in addition to my problems with weight-bearing and high-impact activities. Will the VA assign compensation on history and imaging alone?

    I'm also worried that the VA will rate me at 0% because I don't have limited motion. I have limited weight bearing, and that's limited only by pain (6/10 when I try to push through it). It does impede my ability to work, but I can't find any claims codes that directly address weight bearing as opposed to motion. Does the VA count inability to bear weight on a joint for more than 2 hours counts as a compensatable disability? I don't expect or want more than 10%, but that 10% would make a real difference for me.

    2) My examiner confused the word invert with evert, to the point of correcting me. Since she's the one with the education I deferred to her, but when I looked it up I found that I was correct. It's probably just a brain fart -- I get those too -- but I'm worried that her findings will seem to contradict all the rest of my medical records and the VA will choose to reject my claim on that basis.

    Again, I'm really grateful that you've taken the time to answer all these questions. If you could answer mine, it would ease my mind while I wait for the VA to make a determination. My VA is one of the slowest to process claims, so it might be a long wait.

    Thank you,
    Lauren

    ReplyDelete
    Replies
    1. Hi Lauren -

      You've got a tough situation. The laws are pretty clear about rating ankle conditions. Unless there is a clear deformity caused by broken bones or you've had an entire ankle replacement, the only rating option limited motion. Regardless of weight bearing and other problems, if you do not have at least a moderately limited range of motion clearly recorded in your medical records, you are not going to qualify for a rating higher than 0%. The only way to get a higher rating would be with Painful Motion (automatic 10%), but if no pain was recorded, that doesn't seem promising. If pain with motion is recorded clearly and regularly enough in your history, the rater MAY consider it enough, but it is unlikely since it wasn't recorded at the exam.

      Sorry my answer wasn't very satisfactory, but it seems unlikely that you will be rated more than 0% at this time.

      Delete
  58. Dr.Johnson I just reviewed my Narsum and va assessment summary. I was diagnosed with djd in every joint as well as abnormal range of motion in each each joint. I also have djd in upper and lower spine as well as sciatic nerve disease on both sides. The doctor also stated that my conditions would progressively worsen and stated that all my conditions were concurrent with my claims. Should I expect to get a rating for each joint and do they all fall under the bilateral factor

    ReplyDelete
    Replies
    1. Yes, each joint will be rated on limited motion individually unless the motion isn't limited enough to warrant a rating. All joints that don't get a rating under limited motion will then be combined together and given a single rating under arthritis.

      The bilateral factor applies to the different limbs, not to each condition. So no matter how many conditions you have, if you have a ratable condition in the right arm and another in the left arm, you get 1 bilateral factor for the arms. Similarly, if you have one condition in the left leg and another in the right leg, you get 1 bilateral factor for the legs. So, in your case, you'll have the 2 bilateral factors applied: one for the arms and one for the legs.

      Delete
  59. Good Day Dr. I had multiple shoulder dislocations while on Active duty 1998-2000. I was rated 10% non dominant for impingement, though I am ambidextrous, only do 1 thing left handed primarily which is write. All sports i was right handed or right side. I eventually had right shoulder surgery in 2001, bank-hart labrum reconstruction, capsule shrinkage. PT for 7 months got to about 90%, 2nd surgery 11 months later for rotor cuff and bone spur removal same shoulder. Surgeon noted degenerative changes in my shoulder in that period, and multiple cortisone injections and multiple surgeon consults for potential options. All surgeons say 1 thing worst shoulder they've ever seen. I was counseled about needing shoulder replacement but need to wait until older. I was told this at 25. Arthritis at 25 yrs old shows on basic x ray. I was increased to 20% at 28. I am now 36, shoulder wakes me up at night, can't have any repetitive motion, ROM is non existent away from body. I started to experience muscle spasms in upper right back and neck, chiropractor says its from fatigue of muscles in shoulder, and tightness due to my arm only moving from TRAP pulling arm. I have a few spasms a year. VA wants us to go to DR all the time but that cost money and with my shoulder I've seen 6 surgeons and all say the same thing.. no options until im older!!! I can't pick up anything with right arm, right arm is smaller than left especially at bicep. What is the best option for increase? I have 1 functioning arm, its like my right arm is non existent as I protect it.
    I also worked in a building in 2005 in Afghan that at the end of the deployment they provided a memo saying we were exposed to long list of low calculated chemicals, though that reading was done prior to building be disturbed and the building be disturbed daily. A few of the low items, barrium, asbestos, heavy metals, lead paint....like 20 different things it was an old Russian building. I came home from that deployment and have since been on an inhaler for sports induced/chemical induced asthma. Should i place a claim? i have an unproductive cough tight chest especially in mornings,can't catch breathe, hot showers make it worse, work colleagues call it my afghan funk because i have a dry cough that i didn't realize happens often through out the day.

    Thanks
    Michael

    ReplyDelete
    Replies
    1. Hi Michael -

      So if I understand correctly, you are currently rated at 20% for the right shoulder. If you cannot lift it away from your body at all, then it should be rated 30% (non-dominant) under 5201. This is the highest rating you can get with your condition until you have a shoulder replacement since the humeral bone isn't really involved. I know it seems that you should qualify for a higher rating with your level of limitations, but with the laws as they are, 30% is the highest option available.

      As for dominant hand, for rating purposes, the law defines that dominant hand as the one your right with, regardless of whether or not you do other activities with your other hand, so you are left-handed for rating purposes.

      Now, if you are only rated 20%, you should be able to have them increase it to 30% based on your limited motion. Just submit to have it increased, and you should be good to go. As for your medical care, this is a service-connected condition, and so all medical care should be covered.

      You MAY qualify for an asthma rating if you can prove that you were indeed exposed to the conditions you noted, although without taking medications to control your symptoms, it won't be rated very high, if at all. It's still worth a shot to submit a claim even to just get it officially claimed as service-connected, because then if it worsens in the future, the VA can increase the rating easily. Now, it may be difficult, if not impossible to prove service-connection. When submitting the claim, submit any and all evidence you have regarding the conditions you were in while deployed. If you can provide solid enough proof, they may grant service-connection.

      Delete
  60. I am getting ready for an exam at the VA to evaluate my lower back, feet, right ankle, right knee, and hip. I have documented stress fractures in my right ankle, and fractured vertebrae in my back. I went to medical while enlisted for my feet and was told I had plantar fasciitis in both feet. This has not gone away and now my knee and hip are in pain because of my limp. I was never seen for my knee or hip while I served, will this be included in my exam and could I receive compensation for them?

    ReplyDelete
    Replies
    1. Hi Jeffrey -

      If you listed the knee and hip on your VA Disability Claim, they will be evaluated during the exam. Regardless of whether or not they developed during service, since they are secondary, you definitely want to include them in your claim. The VA will exam every condition you have and then determine which of the claimed conditions qualify for compensation. If there is enough medical evidence connecting the knee and hip to your feet, then it is definitely possible that the VA will consider them service-connected and compensable. But you have to include them on your claim.

      Delete
  61. I have a question, I was service connected for my mental secondary of anxiety and depression, it was secondary to migraines, TBI and my chronic back pain, will I get 3 ratings for secondary or just one? I linked it 3 times to all 3 for a secondary, I saw in my c&p it was service connected by they are still working on other things, but will it just be an over all rating for anxiety and depression? or say migraines will go up cause I have a secondary and TBI and my back or they will say for example 50% for anxiety and depression?? Please help I cannot find this answer anywhere

    ReplyDelete
    Replies
    1. Every individual condition is only rated once, and conditions that have overlapping symptoms (most mental health disorders) cannot be rated separately. This is known as the Pyramiding Principle:

      http://www.militarydisabilitymadeeasy.com/vasrdprinciples.html#pyram

      Since Migraines, TBI and Back pain are your main three service-connected conditions, they should all receive separate ratings. The Anxiety and Depression, however, will only add one additional rating. Because they are both mental disorders, you will only receive one rating for your overall mental health. The rating will reflect all of your mental health symptoms.

      http://www.militarydisabilitymadeeasy.com/mentaldisorders.html

      So, overall, the most you will receive are four ratings: migraines, TBI, back pain, and one mental disorder. The main three will remain the same and just a fourth added for the mental disorders.

      Delete
  62. Good afternoon.

    My question is, if I have been referred to MEB for spondylosis of my lumbar region and spinal enthesopathy of my thoracic region, are they rated separately or together? I am wondering what to expect when receiving my ratings. My range of motion test was fairly difficult, as I have a significant amount of pain during flexion, but I am not sure how far I was able to bend. Bottom line up front, I just want to know if these two conditions will count for separate rating when it comes to DoD ratings or if it will be rated as one. Thanks!

    - D.C

    ReplyDelete
    Replies
    1. Hi David -

      The thoracic and lumbar spines are rated together as the thoracolumbar spine. So you would receive one overall rating that would combine the symptoms of both conditions. The VASRD rates the cervical spine and thoracolumbar spines separately, but the thoracic and lumbar are grouped together. You can see the spine ratings here:

      http://www.militarydisabilitymadeeasy.com/thespine.html

      Delete
  63. I have degenerative disc disorder, herniated discs, bulging discs, and I am in constant pain moist days. I have been told I just have standard arthritis, and I meet all of the sysmptoms except nodules thus far of rheumetoid arthritis. How do I get the VA to check for the Rheumetoid arthritis? what evidence can I get to substantiate that or tests that need to be done to diagnose that?

    ReplyDelete
    Replies
    1. Rheumatoid arthritis is an autoimmune disorder that affects numerous joints throughout the body, not just the spine. DDD, including your symptoms, is not usually caused by rheumatoid arthritis, especially when other joints are not involved. Rheumatoid arthritis can also affect other parts of the body, including organs and the skin. With just the symptoms you've described, it is logical to have you diagnosed with degenerative arthritis, not rheumatoid arthritis.

      To officially diagnose rheumatoid arthritis, blood tests are performed. It is unlikely for a physician to order these tests without multiple joint involvement throughout the body with signs indicating rheumatoid arthritis, particularly in your hands and feet. You can talk with your doctor about having these tests performed, but again, just based on the limited information I have, it does not seem that rheumatoid arthritis is indicated.

      Now, I do not have a complete list of your symptoms and so could definitely be missing important information. Ultimately, you need to discuss your symptoms with your physician and then decide together whether to order a test for rheumatoid arthritis.

      Delete
  64. Dr. Johnson,

    Sorry for this question being off the topic of arthritis but I am going to submit a claim for painful scars and have a question. Back in 2007 I was given a service connected rating of 0% for a scar on my left knee and a 0% for scars related to post open reduction of left ankle fracture. These scars have always given me pain but I did not know until recently the VA gives compensation if the scar is painful under diagnostic code 7804. My question is should I submit the claim (on the VA Form 21-526b) as an "Increased Evaluation" for the disability I am already service connected or submit the claim as a "Secondary" to my existing service connected disability? I'm thinking perhaps it should be submitted as a secondary condition since the "pain" is a separate issue and the scars were not rated for pain (nor did I mention they were painful) in my initial claim back in 2007. Please advise, thank you.

    ReplyDelete
    Replies
    1. Pain is always a bit tricky. In general, it is just considered a symptom of a condition and not a separate thing on its own. It is true, however, that in the case of scars, and entirely separate code is given for a painful scar that can be rated in additional to the regular scar rating, so it seems like it is a separate entity. Overall, though, it is not. Because of this, the most technically correct way to apply would be for an increase, but they would probably accept it if you applied as a secondary condition. That being said, I recommend applying for an increase since you are technically just submitted additional evidence on a condition they are already rating, not a new condition.

      Delete
  65. Dr Johnson,
    I received my VA rating yesterday. I claimed Asthma and Sleep Apnea with CPAP. My condition is well established with solid rating criteria. From book, the ratings for asthma (by both meds and Pulmanary Function Test) rate at 30%. While CPAP SA is 50%. So I expected a combined 65% rating. Instead, the raters joined the two conditions into one -- Sleep Apnea to include Asthma and made a single rating of 50%. There is no medical evidence or activity that links these two deseases, in my case. Is it the VA's standard procedure to combined these two conditions into one? Thank you Sir!

    ReplyDelete
    Replies
    1. Hi Sam -

      This issue at play here is the VASRD principle of Pyramiding (§4.14). This principle basically states that a single symptom can only be rated once. So if two different conditions cause the same symptom, that symptom can only be used to rate one of the conditions.

      Because of this principle, conditions that affect the same bodily system are often combined together since it can be very difficult to separate the symptoms. For example, two heart conditions are basically going to cause similar enough symptoms that it is impossible to fully separate the two. Instead, it is better to give a single overall heart rating under the condition that takes into account the most symptoms and gives the higher rating.

      In your case, asthma and obstructive sleep apnea are both forms of obstructive pulmonary conditions, although it is a bit easier to separate them at times. This is why they combined them and gave you the higher (50%) rating.

      Now it is pretty easy to argue that these conditions are different enough to warrant separate ratings since they take into consideration different things for rating purposes and have different treatments. Because of this, you MAY be successful if you try to appeal and fight to have them rated separately. If you base the case on the differences in rating requirements and treatments, you have a possibility of success. But know that they are technically justified in their decision because of Pyramiding, so you may not be successful.

      Delete
    2. Thank you, Doctor...That explains it. I'll probably make an appeal...maybe I can find a similar case that establishes a precedent to separate the conditions, as a reference in my request.

      Delete
    3. Hi Sam -

      I forgot to mention an important regulation for your case. In § 4.96, it states that codes 6602 (asthma) and 6847 (sleep apnea) cannot be combined with each other (used together). I totally forgot about this provision when replying earlier. I apologize. So, legally, they cannot give you both, but they can raise you to the next highest rating if they feel that your asthma is severe enough to warrant it (which they didn't).

      Here's a link to that reg:

      https://www.law.cornell.edu/cfr/text/38/4.96

      Delete
    4. Thank you for that extra information!

      Delete
  66. Have bilateral shoulder injury sc at 20 percent 10 each. Ask for increased after getting 4 set of injectors for frozen shoulder.also secondary elbow arthritis and bursitis could it be awarded

    ReplyDelete
    Replies
    1. Depending on the range of motion measurements for the frozen shoulder, you will probably qualify for an increase.

      As for the secondary elbow conditions, this will depend on whether or not there is enough proof that the elbow conditions are directly caused by the shoulder conditions. The most likely chance for success will come if you have statements from specialists clearly connecting the conditions. If you have these and submitted them with your claim, you have a high probability of success.

      Delete
  67. In 2012 my films showed complete sacralization of the L5 to S1, during my recent C & P my films only show partial sacralization of the L5. My question is that common or possible?

    ReplyDelete
    Replies
    1. Once something is fused, it is usually permanently fused.

      I'm thinking that one of the films was incorrect. Not always are film studies perfect, and if there is movement or other interference, it can produce false results. Were they MRI's or X-rays? MRI's are always more reliable when it comes to the extent of a condition since it can image the entire area in 3-D.

      I think it most likely that it was always partially fused, but there was an error in the first films that made it seem completely fused. Depending on the films, I might have additional studies done if I were your doc.

      Delete
    2. Thanks Dr
      I am going in for a MRI.

      Delete
  68. I was in the Army Reserve from 1981 - 2008. In 2000, and again in 2002, I had my right knee arthroscoped. I deployed to Iraq from January 2004 to January 2005. I was to have deployed again in 2008 but was retired due to having my knee arthroscoped. Over the last eight years of my career I completed PT tests and during my deployment was in the filed quite often wearing body armor. My disability claim was denied because the "surgeries did not occur while on active duty" and because "there is no evidence my knee condition worsened as a result of military service." It seems to me logic dictates that keeping myself fit for service and being deployed would have a negative impact on my knee. And, the Army retired me because of the knee. Does anybody have any thoughts?

    ReplyDelete
    Replies
    1. Hi Jerry -

      This is a tough one. The rules for the Reserves clearly state that the condition must have originally occurred while on active duty or active duty training or be aggravated by these active duty activities. While it may seem that it is connected, there is very little proof that it is. Keeping yourself fit is not a direct cause of service since you might have done that anyway. Basically, they have to see that your condition was clearly worse directly because of your periods of active duty service. Would the knee have progressed the same amount had you not been on active duty? With your condition, quite possibly. There simply isn't enough evidence to definitively state that your condition is more likely than not aggravated by your service.

      Delete
  69. Hello,

    I was recently diagnosed with ankylosing spondylitis. I'm am currently receiving 10% compensation on my back as chronic lower back pain. The VA doctors are starting me on Humria. Will my compensation increase with this new diagnosis?

    Thank you
    Andrea

    ReplyDelete
    Replies
    1. Hi Andrea -

      All spine conditions are rated on the same criteria regardless of the diagnosis. So your rating won't increase unless your range of motion becomes more limited. The more limited it becomes, the more your rating will increase. See the Spine's Rating Formula:

      http://www.militarydisabilitymadeeasy.com/thespine.html#form

      Delete
  70. Howdy Doc. I've been seen several times over the past year with what has been diagnosed as arthritis in neck, shoulders, knees, and possibly hips. Yep, fun times and me at the young age of 56. I'm a retired Army cat with a disability rating already so I'll be submitting a supplemental claim for the arthritis as soon as I get my paperwork together. Question: what should I ask my DR for to support my new claim? As always, thanks for your information on this blog. RJ

    ReplyDelete
    Replies
    1. Hi RJ -

      Sorry to hear about your conditions. The key to your claim will be proof that connects the arthritis to your service. Since it didn't develop while on duty, it might prove difficult. The best thing you can do is have your doc write a statement that says that the arthritis is "more likely than not" caused by either your military service or by one of your conditions that is already being rated by the VA.

      Delete
  71. Got it, thanks Doc. I have a follow on apt with my provider in a few weeks. Appreciate your input. v/r RJ

    ReplyDelete
  72. Dr. Johnson
    What is going on with the gulf war syndrome and why dont the VA want to grant compensation if you have the symptoms?

    ReplyDelete
    Replies
    1. Hi Jimmie -

      Not exactly sure what you are referring to. The VA does include Gulf War Syndrome on their Presumptive List:

      http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#gulf

      If you have proof that you served in the Gulf War and meet the remaining requirements for the list, then they will compensate. What issues specifically are you facing?

      Delete
  73. Should my ROM be rated under 5260 AND 5261? I hope this is enough info.

    2. Medical history
    ------------------
    a. Describe the history (including onset and course) of the Veteran's knee
    and/or lower leg condition (brief summary):
    Mr. Whipps is SC for DJD of the right knee with a history of right femur
    condylar fracture. He is claiming an increase due to daily pain and
    difficulty standing, walking and squatting. The pain is near constant.

    b. Does the Veteran report flare-ups of the knee and/or lower leg?
    [ ] Yes [X] No

    c. Does the Veteran report having any functional loss or functional impairment
    of the joint or extremity being evaluated on this DBQ, including but not
    limited to repeated use over time?
    [X] Yes [ ] No

    If yes, document the Veteran's description of functional loss or
    functional impairment in his or her own words:
    limits squatting, walking and standing


    3. Range of motion (ROM) and functional limitation
    --------------------------------------------------
    a. Initial range of motion

    Right Knee
    ----------
    [ ] All normal
    [X] Abnormal or outside of normal range
    [ ] Unable to test (please explain)
    [ ] Not indicated (please explain)

    Flexion (0 to 140): 0 to 25 degrees
    Extension (140 to 0): 025 to 0 degrees

    If abnormal, does the range of motion itself contribute to functional
    loss? [ ] Yes (please explain) [X] No

    Description of pain (select best response):
    Pain noted on exam but does not result in/cause functional loss

    If noted on exam, which ROM exhibited pain (select all that apply)?
    Flexion

    Is there evidence of pain with weight bearing? [ ] Yes [X] No

    Is there objective evidence of localized tenderness or pain on palpation of

    ReplyDelete
    Replies
    1. No. You'd only be rated under 5260 since you can straighten your leg all the way. You just can't bend it past 25 degrees. Just one rating.

      Delete
    2. Thanks for responding! I must have misinterpreted my research than, lol. So both ROM measurements do not matter in regards to a rating?

      Delete
    3. You didn't misunderstand it. The issue is that the range of motion measurements listed are exactly the same. There is only one limited range, not two. You'd get two ratings if you couldn't bend it all the way AND you couldn't straighten it all the way. But you can straighten it all the way, so only one.

      Delete
  74. Hello Dr George,

    I am now 3 years separated from service. The VA did an MRI of my lumbar for a condition and found degenerative arthritis as well as the condition they were looking for. My PCP had my neck, spine, knees, and elbows x-rayed and found I have arthritis everywhere. Am I able to service connect all this since it is so far out from service? I was not even aware of the issues. I spent 21 years as a 4N for a rescue unit. I appreciate you time, sir.

    ReplyDelete
    Replies
    1. Hi Dennis -

      Unless there is an injury or some clearly recorded aggravating incident during your military career that can be definitely linked to your current arthritis, it is unlikely that the VA will consider it service-connected. It is logical that the arthritis developed over the years you were in the military, but the rules in place dictate that either 1.) the condition must have been diagnosed officially within 1 year of separation or 2.) must be clearly connected to an incident or other service-connected condition in order for the VA to consider it service-connected.

      Delete
  75. Applied for an increase for both knees do to end stage djd. Wear braces and use a roller walker. VA sent me to a C&P and received a letter that the are proposing to reduce me benefits from combined 70% to 40% even though I am not a candidate for knee replacement or steroid injections do to diabetes. I am bone on bone in both knees. How should I proceed so as to keep my original rating

    ReplyDelete
    Replies
    1. What's your 70% rating breakdown? Codes? I need to know how they rated that exactly to figure out how they are trying to justify a decrease. Only when I know their reasons will I be able to best guide you on how to respond to it.

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  76. Good morning Doc. I have an initial rating of 10% for RT Knee(5024-5257) limitation of flexion back from '97. Was discharged because of this (MEB). Up until 2014, made multiple visits to my personal physician for knee and shoulder pain (which was documented while in the service), and ultimately had meniscectomy in my LT knee due to over use of my RT knee. Further, when I enlisted, I documented that I had suffered a severe concussion and a RT ankle fracture during my childhood. Went to the VA and made claims for both my knees and my shoulders, in addition to my migraines.

    In 2014, was rated with the following:

    * LT shoulder tendonitis w/bursitis 10%
    * RT knee limitation of flexion 10%
    * LT knee DJD w/chondromalacia 10%
    * RT knee-myoxoid, degeneration of
    medial & lateral meniscus, medial
    meniscus tear, small popliteal cyst 10%
    * bilateral hip conditions Not Service connected
    * RT shoulder condition Not Service Connected

    Summary & Question(s): Currently, I am having sever pain in both my hips and ankles, to the extent that it is painful to sit and on some occasions even walk. Additionally, I can't sleep due to the knee and hip pain, and am getting frequent migraines to the point where I have to go home and find a comfortable position to relax in and attempt to alleviate the pain. Because of having to leave work early on multiple occasions, I find myself stressing more and more having to take leave. My back pain is worsening and I'm not sure if it's due to the hip issues or something else which has developed...maybe from my knee problems. Also, I find my self constantly having to move my legs or shift in my seat while at work, driving, in bed, or any other time I sit for extended periods of time, as though I have acquired a case of restless leg syndrome. There are even times where I get a tingling feeling running up and down my outer thighs. Ultimately, I feel that because of these issues I have become obese and have acquired hypertension.

    My question is: should I submit claims for all of these issues I am having? Hips, RT shoulder, migraines, restless leg syndrome, back pain, stress, hypertension. Or should I file for secondary issues based on my initial ratings, or should I submit for increases for the ratings I already have? I read that the VA can compensate for arthritis due to strain in the joints as well as painful motion in the joints. Please advise. R/ JT

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    1. You can definitely submit a claim for these additional conditions, but the VA may not grant them. They have to determine that the new conditions are "more likely than not" caused by your service or your service-connected conditions. In some cases, I think they will determine this, but since they already denied your hips, I do not think that they will change this decision in your favor.

      Also, do not submit for any conditions that are not officially diagnosed by a specialist. For example, you mentioned that your legs have to move often like you have restless leg syndrome, but this has clearly not been officially diagnosed. You need to have it diagnosed by a physician first before the VA will acknowledge it as a legit condition. For example, stress is not a diagnosable condition and so should not be included on your claim.

      Also, for all of these conditions that have been diagnosed officially, a letter from the physician will clearly need to state that they believe that each separate condition is "more likely than not" caused by your service or one of your service-connected conditions. Without this statement, it is just as easy to assume that they were caused by another source and the VA will deny them.

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  77. I have a long question that I'd like to ask and we can take offline if possible. I got off active duty in 2002 and filed a claim (among other things) for knee pain that had been "diagnosed" by a shipboard medical corpsman as tendinitis. It had never been evaluated by an MD/DO using x-ray, ct, or mri, but had just gone along all those years taking 800mg ibuprofen to treat. During my exam I was asked "which knee" to which I replied "both" and the doctor told me to "pick the worst". So I have been locked in for 15 years with a right knee tendinitis that has been untreatable and gets excruciatingly painful whenever I have to stand or walk for an significant time exceeding 15 or so minutes. I never did file for back pain but I had also all along had excruciating lower and upper back pain when standing or walking. Long story short, after 15 years of complaining an orthopaedic doc finally ran x-ray, mri, and ct scans that showed only minor inflammation but nothing too abnormal for an almost-40 guy. He then referred me to a rheumatologist because he became aware that I had ulcerative colitis. So after agreement from the rheumatologist that he believed I was having arthritic pains related to the autoimmune nature of the UC, I resubmitted to have my rating reassessed as an arthritic condition rather than a simple tendinitis in my knees. So ... I have a C&P exam on the 13th of January and I have no faith that the evaluator will perform a thorough exam with my best interests at heart (think back to doctor telling me to "pick a knee"). I don't want to cheat the system, but I would like to be more familiar with the intricacies of rating arthritis so that I don't shoot myself in the foot like last time and tell the doctor that I feel fine, i.e. at 7am for my first C&P exam, I told him that I wasn't hurting which he immediately documented as "no pain".

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