NEED HELP WITH POSSIBLE FINDINGS/RATINGS?

Put on MEB for repaired ruptured left achilles, DVT left leg (post surgery) and hallux limitus left and right foot (bunionectomy and screws inserted). I also claimed left hip, right index finger, back, neck, sleep disturbance, headaches, neck, knees and ringing in the ears and eyes. I had two MRI's for my hip and back which resulted in SEE BELOW; I can't have surgery for one year as of December 1 2011 because I had the blood clot (DVT) which I developed after I had surgery to repair left rupture achilles. There is no present DVT but i still have pain in that leg in the same area from the the DVT. I was on coumadin and lovenox for three months. Which I became immobilized and everything went down hill from there. I'm still rehabing but showing little to no progress. The screws in my feet also need to be removed, torn labral tear in the left hip and tear in L4 and bulging disk L4/5 and disk narrowing L4/5 with possible tear L4/5. I was prescribed seroquel for my sleep disturbance (combat related) and diagnosed with anxiety. I have 14 years active duty and 4 inactive reserve Marine SSgt. Package was sent to DC on 120123. I still attend physical therapy and now pain management with getting steriod shots into my hip to help with the pain until i can have it surgical repaired. Does anyone have any assistance or guidance? Thanks in advance. Let me know if you need further information to answer as well.


HIP = focal tear involving the anterior/superior labrum. Flexion 0 - 125 degrees AROM 0-78 degrees with complaint of pain. Extension 0 - 15 AROM 0-15. Abduction 0 - 45 AROM 0-12.

Back = L4/5 disc desiccation w/small posterior projecting disk material w/prob annular tear. L3/4 minimal broad based disk bulge, L4/5 broad based disk bulge causing effacement of ventral sac. moderate to severe bilateral neural foraminal stenosis and narrowing of the lateral recesses and tin annular tear.
Thoracolumbar Spine Exam Range of Motion: Flexion 0-90 AROM 50 degrees, Extension 0-30 AROM 15 degrees, Right lateral bending 0-30 10 degrees.
Cervical Spine Exam: Flexion 0-45 AROM 10 degrees, right lat bending 0-45 AROM 30 degrees, left lat bending 0-45 AROM 30 degrees, right rotation 0-80 AROM 55 degrees, left rotation 0-80 AROM 45 degrees.
 
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NEED HELP WITH POSSIBLE FINDINGS/RATINGS? RESULTS I SHOULD SAY.

Just searching to see if someone else has had a similar situation and what their outcome was/is. Trying to get a ball park figure.
 
kjune said:
Put on MEB for repaired ruptured left achilles, DVT left leg (post surgery) and hallux limitus left and right foot (bunionectomy and screws inserted). I also claimed left hip, right index finger, back, neck, sleep disturbance, headaches, neck, knees and ringing in the ears and eyes. I had two MRI's for my hip and back which resulted in SEE BELOW; I can't have surgery for one year as of December 1 2011 because I had the blood clot (DVT) which I developed after I had surgery to repair left rupture achilles. There is no present DVT but i still have pain in that leg in the same area from the the DVT. I was on coumadin and lovenox for three months. Which I became immobilized and everything went down hill from there. I'm still rehabing but showing little to no progress.
Click to expand...

Need to know more about your DVT disability to offer any ideas.

Use of compression hose? Swelling? Skin changes/eczema? Elevation needed? Pain?

Also, you may have other rateable conditions based on your foot disability/disabilities.


I was prescribed seroquel for my sleep disturbance (combat related) and diagnosed with anxiety.
Click to expand...
PTSD? Sleep apnea?



HIP = focal tear involving the anterior/superior labrum. Flexion 0 - 125 degrees AROM 0-78 degrees with complaint of pain. Extension 0 - 15 AROM 0-15. Abduction 0 - 45 AROM 0-12.
Click to expand...

Not enough info to hazard a guess. Here is the rating criteria for hip/thigh:

"THE HIP AND THIGH
Rating
5250 Hip, ankylosis of:

Unfavorable, extremely unfavorable ankylosis,
the foot not reaching ground, crutches necessitated 90
Intermediate 70
Favorable in flexion at an angle between 20º and 40º and
slight adduction or abduction 60

5251 Thigh, limitation of extension of:

Extension limited to 5º 10

5252 Thigh, limitation of flexion of:

Flexion limited to 10º 40
Flexion limited to 20º 30
Flexion limited to 30º 20
Flexion limited to 45º 10

5253 Thigh, impairment of:

Limitation of abduction of, motion lost beyond 10º 20
Limitation of adduction of, cannot cross legs 10
Limitation of rotation of, cannot toe-out more than 15º,
affected leg 10

5254 Hip, flail joint 80

5255 Femur, impairment of:

Fracture of shaft or anatomical neck of:

With nonunion, with loose motion (spiral or oblique fracture) 80
With nonunion, without loose motion, weightbearing preserved
with aid of brace. 60
Fracture of surgical neck of, with false joint 60

Malunion of:

With marked knee or hip disability 30
With moderate knee or hip disability 20
With slight knee or hip disability 10"



Thoracolumbar Spine Exam Range of Motion: Flexion 0-90 AROM 50 degrees, Extension 0-30 AROM 15 degrees, Right lateral bending 0-30 10 degrees.
Click to expand...

If unfit, looks like a 20% rating. Still, I would question whether they adequately accounted for pain or other "Deluca" factors in measuring your ROM.


Cervical Spine Exam: Flexion 0-45 AROM 10 degrees, right lat bending 0-45 AROM 30 degrees, left lat bending 0-45 AROM 30 degrees, right rotation 0-80 AROM 55 degrees, left rotation 0-80 AROM 45 degrees.
Click to expand...

Sounds like 30% based on this:

"Forward flexion of the cervical spine 15 degrees or less; or, favorable
ankylosis of the entire cervical spine 30"

I am assuming 10 deg. forward flexion. Again, I would question if they measured your ROM correctly.
 
Sorry for the late response but as for the DVT, I still use the compression stocking which offers little to no relief, no swelling or skin discoloration but constant pain like a 3 out of 10 with spasms. My leg still havn't regain the full strength and gives out on me. I had my VA physical and couldn't do majority of the ROM on the left side of body and my MRI was schedule after the physical which discovered the tear. I later had steroid injections into my hip because I can't have surgery (because of the DVT for one year) and with increase activity the pain increases so I was sent away from physical therapy until I got pain under control. Also I had my back MRI after my VA physical as well.
 
UNFIT is the ruling so just waiting on ratings. Anyone has a timeframe since I had 19 claims?
 
kjune, I had a very similar situation. Ruptured my Achilles (Rt) in Jan 2009, had surgery end of Feb 09. In May 09, developed DVT in right groin (with clots all the way down to back of knee). On coumadin, then had clot-busting surgery in June 09. Was on coumadin for some time, then reduced to plavix, then down to baby aspirin per day (which I still am). Went thru extensive physical therapy with not much improvement. In Jun 2010, had reconstructive surgery again on my Achilles, and again, extensive physical therapy to no avail. In early 2011, went thru my first MEB with a "return to duty" determination as my condition had not yet stabilized and was hoping for improvement. Mid-2011 I vol'd for a special-duty assignment and got accepted...this brought up all the med issues again and my assignment was cancelled. New med appts identified nerve damage, plantar faciitis, diabetes (due to inability to exercise and added weight), sleep apnea, associated pain in both legs/hips due to altered mechanics of walking, GERD (from all the meds I had been on), and a few other things (ends up being 12 VA claims in all). I informed the Med folks that since I was not able to deploy (local profile), or do any elements of AF physical fitness testing (local profile), and not medically qualified for re-assignment, that I wish to have another MEB performed. My wish was granted and the the process started back in mid Nov 11. I have since attended all my VA appts, and my package was prepared to go down to San Antonio on 9 Feb. Was told to expect 60-75 day turnaround, so that puts me about mid-April to first of May. Seems your turned around pretty quick tho! Keep us updated on your dates and findings/ratings. Hope it all works out the way you want it to. Take care.
 
UNFIT but I Have 19 claims, here is the most updated info I have: not all claims are listed below. As I get more info I will post the results.

-Headaches
-Hallux Limitus (Bunionectomy) L/R lose hardware on left
-Primary Insomnia; adjustment disorder w/Anxiety
-DVT to left leg, coumadin for 11 weeks, DVT has dissolved but still have posterior thigh pain. Still undergoing test and treatment.
-Ringing in the Ears (bilateral intermittent tinnitus)
-Rupture left achilles (musculoskeletal: evidence of pain at the achilles tendon region, especially at the site of repair but also distal at the insertion on the left. ROM of the ankle on the left is 0 degrees of dorsiflexion with the knee extended in the frontal plane and the the foot supinated compared to contralaterally being at 10 degrees of dorsiflexion with the knee extended in the frontal plane and the foot supinated with plantarflexion at 10 degrees bilateral.

-Skin cond = acne keloid represents 20% of exposed and 6% of total body
Back
-Thoracolumbar Spine Exam =
ROM: flexion 0-90 deg/AROM 50 deg
Extension: 0-30 deg/AROM 15 deg
Right Lateral bending 0-30 deg/AROM 10 deg
Left Lateral bending 0-30 deg/AROM 15 deg
right rotation 0-30 deg/AROM 40 deg
left rotation 0-30 deg/AROM 35 deg

-Cervical Spine Exam =
Flexion 0-45 deg/AROM 10 deg
Extension 0-45 deg/AROM 00
right lateral bending 0-45 deg/AROM 30 deg
left lateral bending 0-45 deg/AROM 30 deg
right rotation 0-80 deg/AROM 55 deg
left rotation 0-80 deg/AROM 45 deg
still receiving injections in my back/hip and having no signs of improving
-HIP=
right hip left hip
flexion 0-125 deg/AROM 0-100 deg 0-125 deg/AROM 0-78 deg
extension 0-15 deg/AROM 0-15 deg 0-125 deg/AROM 0-15 deg
abduction 0-45 deg/AROM 0-30 deg 0-45 deg/AROM 0-12 deg cannot cross left leg
Focal tear involving the anterior/superior labrum (left labral tear)
Very frustrating process and I can't have any surgeries because of the DVT I developed after the last surgery.
 
Twiztid said:
kjune, I had a very similar situation. Ruptured my Achilles (Rt) in Jan 2009, had surgery end of Feb 09. In May 09, developed DVT in right groin (with clots all the way down to back of knee). On coumadin, then had clot-busting surgery in June 09. Was on coumadin for some time, then reduced to plavix, then down to baby aspirin per day (which I still am). Went thru extensive physical therapy with not much improvement. In Jun 2010, had reconstructive surgery again on my Achilles, and again, extensive physical therapy to no avail. In early 2011, went thru my first MEB with a "return to duty" determination as my condition had not yet stabilized and was hoping for improvement. Mid-2011 I vol'd for a special-duty assignment and got accepted...this brought up all the med issues again and my assignment was cancelled. New med appts identified nerve damage, plantar faciitis, diabetes (due to inability to exercise and added weight), sleep apnea, associated pain in both legs/hips due to altered mechanics of walking, GERD (from all the meds I had been on), and a few other things (ends up being 12 VA claims in all). I informed the Med folks that since I was not able to deploy (local profile), or do any elements of AF physical fitness testing (local profile), and not medically qualified for re-assignment, that I wish to have another MEB performed. My wish was granted and the the process started back in mid Nov 11. I have since attended all my VA appts, and my package was prepared to go down to San Antonio on 9 Feb. Was told to expect 60-75 day turnaround, so that puts me about mid-April to first of May. Seems your turned around pretty quick tho! Keep us updated on your dates and findings/ratings. Hope it all works out the way you want it to. Take care.
Click to expand...
ok I got rated 20% rupture achilles and 0% (7121) DVT, post. Once I receive the full report I will post it for you. The rating for the DVT is incorrect so I will appeal and request for FPEB.
 
Jason said:
Need to know more about your DVT disability to offer any ideas.

Use of compression hose? Swelling? Skin changes/eczema? Elevation needed? Pain?

Also, you may have other rateable conditions based on your foot disability/disabilities.



PTSD? Sleep apnea?





Not enough info to hazard a guess. Here is the rating criteria for hip/thigh:

"THE HIP AND THIGH
Rating
5250 Hip, ankylosis of:

Unfavorable, extremely unfavorable ankylosis,
the foot not reaching ground, crutches necessitated 90
Intermediate 70
Favorable in flexion at an angle between 20º and 40º and
slight adduction or abduction 60

5251 Thigh, limitation of extension of:

Extension limited to 5º 10

5252 Thigh, limitation of flexion of:

Flexion limited to 10º 40
Flexion limited to 20º 30
Flexion limited to 30º 20
Flexion limited to 45º 10

5253 Thigh, impairment of:

Limitation of abduction of, motion lost beyond 10º 20
Limitation of adduction of, cannot cross legs 10
Limitation of rotation of, cannot toe-out more than 15º,
affected leg 10

5254 Hip, flail joint 80

5255 Femur, impairment of:

Fracture of shaft or anatomical neck of:

With nonunion, with loose motion (spiral or oblique fracture) 80
With nonunion, without loose motion, weightbearing preserved
with aid of brace. 60
Fracture of surgical neck of, with false joint 60

Malunion of:

With marked knee or hip disability 30
With moderate knee or hip disability 20
With slight knee or hip disability 10"





If unfit, looks like a 20% rating. Still, I would question whether they adequately accounted for pain or other "Deluca" factors in measuring your ROM.




Sounds like 30% based on this:

"Forward flexion of the cervical spine 15 degrees or less; or, favorable
ankylosis of the entire cervical spine 30"

I am assuming 10 deg. forward flexion. Again, I would question if they measured your ROM correctly.
Click to expand...
I was able to sit down with the VA and he pulled my report because we had so many questions. I got 20% DoD and 80% VA. Now I got boarded for DVT(post) 0%, rupture achilles tendon 20% and Bi Lateral Hallux Limitus 10% each foot. Now they removed the DVT and hallux limitus and made it a VA claim. The DVT was coded 7121 but the narrative fell under the 10% but I received 0%. Also on my VA claim for a left hip labrum tear once again it reads and says 10% now when they add it up they gave 0%. I'm still waiting to receive a copy of my findings from the peblo because we found numerous of errors. Can the PEB deny a claim if MEB said its unfit and they have all the documents to show why?
 
Category I: Unfitting Conditions
1. Achilles Tendon Rupture, Left Leg 5271 20%

Category III: Conditions that are not separately unfitting and do not contribute to the unfitting condiitions
2. Right Hallux Limitus/Rigidus (VA 10%)
3. Left Hallux Limitus/Rigidus (VA 10%)
4 . Status Post Deep Venous Thrombosis on the left (VA 10%)

Now I have three other unfit conditions that was rated by VA but was not viewed by the PEB because my MD never submitted my addendum but they are as follows:
-5322-5237 Trapezius strain (30%)
-5237 Low Back Strain (20%)
-5252 Right Hip Bursitis with painful flexion (10%)
-5253 Left Hip Labrum tear with Limited Rotation (10%)
I have requested a formal board and had the MD complete my addendum and continue to attend all medical appointments. My hip and back has since gotten worse and its all documented. My question is what other information do I need to gather for my case? I'm not asking for a VA reconsideration but for the PEB to view unfit conditions that was not reviewed. Any advice will be appreciated. Thank you.
 
can someone post the ROM and ratings for all muscles/bones. cant seem to find it on the VA site and just got all my ROM back from the VA
 

Attachments

can someone please help me figure this out. I got a copy of my C&P exam with my range of motion for my cervical spine, thoracolumbar spine, knees, and ankle (due to achilles rupture)

Cervical spine ROM reads
Active Motion
FLEXION: 0 TO 25 DEGREES
EXTENSION: 0 TO 35 DEGREES
LEFT LATERAL FLEXION: 0 TO 30 DEGREES
LEFT LATERAL ROTATION: 0 TO 40 DEGREES
RIGHT LATERAL FLEXION: 0 TO 30 DEGREES
RIGHT LATERAL ROTATION: 0 TO 40 DEGREES

THORACOLUMBAR SPINE ROM
ACTIVE MOTION
FLEXION: 0 TO 75 DEGREES
EXTENSION: 0 TO 15 DEGREES
LEFT LATERAL FLEXION: 0 TO 30 DEGREES
LEFT LATERAL ROTATION: 0 TO 30 DEGREES
RIGHT LATERAL FLEXION: 0 TO 15 DEGREES
RIGHT LATERAL ROTATION: 0 TO 30 DEGREES

ANKLE ROM
ACTIVE MOTION
LEFT DORSIFLEXION: 0 TO 10 DEGREES
LEFT PLANTAR FLEXION: 0 TO 10 DEGREES
RIGHT DORSIFLEXION: 0 TO 20 DEGREES
RIGHT PLANTAR FLEXION: 0 TO 45 DEGREES

KNEES ROM
LEFT FLEXION: 0 TO 110 DEGREES
LEFT KNEE EXTENSION IS NORMAL (0) DEGREES: YES
RIGHT FLEXION: 0 TO 110 DEGREES
RIGHT KNEE EXTENSION IS NORMAL (0) DEGREES: YES

Can someone please assist me with ratings giving the above ROM? Thanks in advance.
 
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