Just about everyone who ever served in the military has musculoskeletal pain. Musculoskeletal pain absolutely should be included in your VA Disability Claim. One of the most common questions from Wingman Med clients is, “How do I get my joint pain rated?” Wingman Med is prepared to help you with this!
Managing your Primary Care Provider Relationship
You will need your primary care provider to help you document all of your joint pain. So, please contemplate your relationship with primary care. Some primary care doctors are going to meet your needs, and others cannot. You won’t know how things will work with a new primary care provider until you have a discussion.
The first appointment you should make is to set an agenda. Let the primary care doctor know you want to see them to document all your musculoskeletal problems. Tell them up front you are not asking for individually prescribed treatment plans – that the documentation is the end state. With that established, you and your primary care physician should be able to come up with a strategy that works for both of you.
You should limit the topic of each visit to your primary care physician to a single set of joints: knees, elbows, shoulders, etc. Doing the type of examination required by the VA takes a bit of time. Since you aren’t the only patient in the clinic, you need to allow time for your physician to stay on schedule. If you try to put too many things into a single visit your physician will do one of two things: say no, or do poor quality work. Keeping each visit focused and concise will make you most successful. Think of the doctor’s notes for each visit as a Defense Travel System receipt – it must be organized and itemized to be useful.
Veterans Affairs Standard Ratings for Disability
Next, remember that the Veterans Affairs Standard Ratings for Disability (VASRD) is a federal law. The law is what it is. What I mean is, the law stands regardless of whether you think it makes sense or not. You can argue with the law, but it literally takes an Act of Congress to change the law. So instead of wishing for a different law, let’s look at the ways that understanding the VASRD will help you to get your highest true disability rating.
Your physician will need to document many types of range of motion (ROM) testing:
Active ROM, Passive ROM, Active ROM after repetitive use (after 3 repetitions). Active ROM is just what it sounds like: bend the joint in all directions while the provider watches. Passive ROM is when the provider bends the joint for you in all directions. Finally, your provider should document your Active ROM after several repetitions. For all these readings, your provider should use a goniometer, and state they used it in the note. A goniometer is like a protractor for the body.
For any pain limited ROM – your provider will need to quantify the deficit in degrees. Also, your provider needs to say what type of ROM test caused the pain: on weight bearing, on non-weight bearing, on active motion, on passive motion, at rest/non-movement. Your provider should also examine your joints for crepitus (popping/crunching sounds), guarding (muscle tension to protect the joint), and muscle spasms on movement.
Request x-rays of all your painful joints. Per the VASRD degenerative changes on x-ray associated with painful motion (i.e. arthritis) can be rated under the “Catch all Criteria,” VASRD Code Number 5003. Here are a list of common x-ray views you can request from your physician:
- Mandible and Temporomandibular Joint – Towne view, axiolateral oblique view
- Neck – Cervical Spine: AP, LAT, AP oblique, PA oblique, swimmer’s view, odontoid view.
- Lower Back – Lumbar Spine: AP, LAT, flexion/extension, obliques, focused lateral lumbosacral.
- Shoulder – AP, lateral, scapular Y view, AP glenoid.
- Left and Right Elbow – AP, lateral, internal oblique
- Left and Right Wrist – PA, lateral, oblique, scaphoid view, carpal tunnel view, clenched fist view, radial deviation view
- Left and Right Hand – PA, oblique, lateral, ball-catcher view
- Left and Right Knee – WEIGHT BEARING – AP, lateral, sunrise, intercondylar view, rosenberg’s view.
- Ankle – AP, mortise, lateral, horizontal beam lateral, AP stress, weight bearing AP, weight bearing mortise, weight bearing lateral.
- Left and Right Foot – DP, medial oblique, lateral, weight bearing DP, weight bearing lateral, canale view
- Left and Right Toes – AP, AP oblique, lateral, sesamoid view
Even if your x-rays are normal, and your range of motion testing is unlimited and nonpainful, you may still rate VA disability. The VA knows that veterans will have flare ups of pain in their joints from time to time. Therefore, one of the things you should have your physician document is your flare ups. Have you physician document
- Frequency of flare ups
- Duration of flare ups
- Exact symptoms/adjectives to describe pain
- Whether the flare ups are incapacitating or non-incapacitating
- Quantification of pain (1-10/10)
- Changes in Active/Passive/Repetitive use range of motion during flare ups.
- Causes of any loss of function during flare ups such as Pain, Fatigability, Weakness,
Lack of endurance, Incoordination, Other
- What specific limitations you experience during flare ups
These flare ups may merit a disability rating even when everything else in your exam is normal.
Your Know Your Body Best
The examining physician will put your body through tests, but these are based upon their training and experience. You ultimately are in charge of what the physician sees, so feel entitled to help out. After allowing the examining physician to do their typical exam, if they missed anything politely let them know. If you know a certain movement or position will cause you to have pain then tell the physician. Go through the movement, and Let the physician see how you react when you have that pain. That way the physician can document it in your record, and make sure you get the VA disability rating that best reflects your condition.