Just completed my second VA exam. This one was for all of my physical stuff. Joints, muscles, etc. I have extreme limitation in my back and hips. Mutliple surgeries etc. During my exam, I was in a lot of pain just standing there. Can not sit in the chair they had there. The examiner asked me questions and saw how much pain I was in. The examiner did not have me do any ROM movements for any of my physical claims. She said she wasn’t going to make me do it because I’m in so much pain. What does this mean? Will this hurt me? My ROM would have shown extreme limitations. Should I be concerned?
VA Exam Not asked to do ROM
- Thread starter Jayk
- Start date
This was not a good decision on her part as it does not provide an objective basis for assessing your current degree of impairment. In some cases, it can result in existing ratings being lowered to a 10% disabling rating due to pain upon motion. It would very much be in your best interests to see if it is possible to revisit her and perform the range of motion- honestly, the more pain that you are in, the more limited your range of motion will be. This can only benefit your disability rating. Never decline a range of motion exam, as the consequences of such a decision can be quite profound. I realize that this was not your call, but you need to do your best to rectify her well-intentioned error.
If a patient is in pain at 0 ROM, what is the point of a ROM test? The examiner should note pain at 0 range of motion and move on.
I keep thinking about it and I am going back and forth. I feel like it could benefit me, but on the other hand I see the perspective of johnbgately. I am in the med board process so I’m not sure if I should just let it ride or say something now. I’m being boarded for bilateral hips and back issues. Any other opinions would be appreciated.
The answer is straightforward- these ratings are driven by ROM. If there is no available data, the agency interprets that as meaning that the only limitation on motion is due to pain. If you are in the IDES process, your disability rating will be assigned by the VA D-RAS and that will be based upon your ROM as shows on the VA C&P exam. If they do not have that evidence, then the affected joint or spinal segment will be rated at 10% disabling and you will have done yourself a marked disservice if you have less than a full range of motion. Example- if your lower back is limited to 28 degrees on forward flexion,t hat is worth 40%. If there is no ROM establishing this limitation, then you will receive a maximum of 10% disabling under the VA Code 5237 series as they would have no basis for awarding you more.
Well that’s not good. What about functional loss or flare ups? Those apply here as well.
Flare-ups are not the equivalent of incapacitation- a term that requires a scrip for bed rest each time by your providers and is rarely given by doctors nowadays. An SIQ chit is insufficient- it will have to specifically read that bed rest is required. Functional loss, a term of art defined by 38 CFR 4.40, in this setting is defined by your range of motion in the absence of ankylosis. Without a range of motion assessment or proof of actual incapacitation documented by scrips for bed rest, you will be relegated to 10% ratings for each condition under 38 CFR 4.59.