Range of Motion Update

Discussion in 'Informal Physical Evaluation Board' started by jackgately, Jul 25, 2009.

  1. jackgately

    jackgately PEB Forum Veteran

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    Dear Friends:

    1. New development of concern to all of us: An issue arose in a case that I had two weeks ago that is critical to all of you who have suffered injuries to the thoracolumbar spine.

    2. Misinterpretation of Agency Guidance: Contrary to the guidance provided by the VA to its disability examiners regarding the assessment of range of motion of thoracolumbar spine, some PEB members and examiners are under the impression that it is not necessary to isolate out hip flexion when assessing this spinal segment.

    3. The Agency Response: When I brought this problem to the attention of Dr. Audrey Tomlinson, a senior medical advisor at USAPDA, because of the current Army guidance adopted by many other services does not expressly state that it is necessary to isolate out hip flexion, she very courteously and swiftly responded as follows:

    a. All Army MEB personnel have been instructed since 14 Oct 08 to follow the VA disability worksheet for assessing range of motion, a publication that expressly requires them to isolate out hip flexion.

    b. The current guidance memo on this issue is being pulled from the web site until it is updated to include this express instruction in the text itself.

    c. CAPT Noel Howard, the Senior Medical Advisor to the Navy PEB, is taking the same action.

    4. Why is this important?

    Example: suppose that you had a lumbar fusion. A normal range of motion on forward flexion in the thoracolumbar spine is from 0 to 90 degrees.

    a. With a fusion, your range of motion should be much more limited.

    b. However, if the examiner includes hip flexion, you could erroneously appear to have had a full range of motion. This could take you out of the disability retirement range into severance or being found fit.

    c. In my case, the examiner thought that my client had 105 degrees of forward flexion, 116% of normal after a fusion!

    d. Believe it or not, the board members thought that the DeLuca guidelines allowed for inclusion of hip flexion because the Army pub they were using (referenced above) did not expressly require them to isolate it out.

    e. This was because it was intuitively obvious to the folks at the USAPDA that the exam worksheet containing this instruction was attached as an enclosure and someone might actually READ it. Good luck on that one!


    5. My advice to anyone pending a range of motion assessment- go the va.gov web site, pull down the forms menu, go to the disability exam worksheets, pull up the latest range of motion assessment memo from June of this year, read it, learn it and ensure that the person conducting your exam follows its criteria . It will save you a great deal of grief.

    v/r

    Jack Gately
     
  2. xeno

    xeno Staff Member PEB Forum Veteran

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    Good Info to print out and take with your to your appointment.
     
  3. rothschildh

    rothschildh PEB Forum Veteran

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    Hello-

    Great info, however I am having a hard time finding it on the VA site. Could you put in a link? Thanks.;)
     
  4. jackgately

    jackgately PEB Forum Veteran

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    You will find it under the forms section using the following search terms:

    Spine, disability exam worksheet.

    I am on the road right now myself representing lcient in PEB cases, but will send the link when I have a free moment, as the wi-fi reception ins a little spotty in this rest area.

    v/r

    Jack Gately
     
  5. psblackburn

    psblackburn PEB Forum Regular Member

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    Hi, I'm having trouble finding it too. Can someone point me in the right direction. I put the Spine, disability exam worksheet in the search bar and under title/keywords under the VA forms page but have turned up nothing for June of this year. I have my 2nd ROM Test tomorrow morning. Any extra knowledge that I have before I go to my appointment will be extremely helpful :). Thanks so much for your help!
     
  6. Jason Perry

    Jason Perry Benevolent Leader Site Founder Staff Member PEB Forum Veteran

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  7. Jason Perry

    Jason Perry Benevolent Leader Site Founder Staff Member PEB Forum Veteran

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  8. psblackburn

    psblackburn PEB Forum Regular Member

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    Thank you so much!!! This information is really helpful.

    I do have one question, I already had one ROM test done and had a Forward Flexion of 30 degrees. My Jag lawyer says that rates me at 40%. I'm going in tomorrow to see another Ortho doctor for a 2nd opinion. Should I ask for another ROM test or not say anything since my 1st one right now gets me a decent rating and probably medical retirement. I know my Ortho doctor didn't go by that worksheet, in fact I don't think he measured the active and passive. He did use a Geniometer and this is what was wrote down in my medical records.

    C-Spine: Flexion-35 degrees; extension-40 degrees. T-spine: side bends L and R-30 degrees; L and R twist=45 degrees. L-spine: FF-30 degrees (fingertips to the knees), extension 5 degrees.

    It doesn't look like what other ROM results should look like. I'm afraid my Ortho doctor did it all wrong. I fly out to DC this month for my Formal Board, and would hate to hear that they can't use that ROM test because it was done incorrectly. What are your thoughts on this?

    Thanks so much for all of your help!
    Shaun
     
  9. Jason Perry

    Jason Perry Benevolent Leader Site Founder Staff Member PEB Forum Veteran

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    First, you should talk it over with your attorney. Since you already have a JAG, they should have your case file and are in a better position to give you advice.

    However, I think you have hit the relevant issue: does a new test help or hurt you? I can't speculate about what a new exam would say, so you have to weigh what you have against what you might have.

    Hope you get the outcome you want!
     
  10. smilingjoe

    smilingjoe PEB Forum Regular Member

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    Jack,
    Thank you for your advice. I wish I had read this. I was medevac'd from theater and sent to a WTB where I had L4,L5 & S1 fused. Recently had a physical with a VA contracted agency. They claimed I had full ROM !!
    Needless to say this is not the case. What serious options are there to appeal? I am considering going congressional. Any idea what rating would come from an L4,5&s1 fusion with full range of motion?
    Thanks for any more additional advice.
     
  11. rickman

    rickman PEB Forum Veteran

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    smilingjoe,

    While the fusion in itself would limit your range of motion to an extent, it could be rated at 0% if the findings show no restrictions during the test. The key is pain you may or may not feel while undergoing evaluation. When you had your test and performed the ROM measured, did you feel any pain? Feeling pain while bending and flexing should be an indication as to when you should stop moving.

    When the VA provides you with their findings, you are given a year to appeal:

    Under the provisions of 38 C.F.R. § 20.302, an appellant has one year from the date that VA mails notice of a decision to file a Notice of Disagreement

    Also, see the VARSD for the spine:

    http://www.pebforum.com/f61/vasrd-schedule-ratings-musculoskeletal-system-spine-1024/

    Hope this helps!
     
  12. smilingjoe

    smilingjoe PEB Forum Regular Member

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    They did annotate that I was in pain while attempting to bend. The thing is I didnt bend.
    Will request another test and possibly go congressional. Thank you for your in put.


    While the fusion in itself would limit your range of motion to an extent, it could be rated at 0% if the findings show no restrictions during the test. The key is pain you may or may not feel while undergoing evaluation. When you had your test and performed the ROM measured, did you feel any pain? Feeling pain while bending and flexing should be an indication as to when you should stop moving.

    When the VA provides you with their findings, you are given a year to appeal:

    Under the provisions of 38 C.F.R. § 20.302, an appellant has one year from the date that VA mails notice of a decision to file a Notice of Disagreement

    Also, see the VARSD for the spine:

    http://www.pebforum.com/f61/vasrd-schedule-ratings-musculoskeletal-system-spine-1024/

    Hope this helps![/QUOTE]
     

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