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Help With Dc 5019 - Please


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2 replies to this topic

#1 carlie

 
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Posted 13 May 2006 - 05:20 AM

My brain is fried right now from doing so much research so I really need some input here
The following is info from M21-1.
Does this mean that if you are already service connected for diagnostic code 5019
you should be receiving a compensable minimum of 10 percent ?
Thanks so much for your help everyone, I sure do appreciate it.
carlie

************************************************************


e. Rating Cases with DC 5013 Through 5024 Use the table below to rate cases that use DC 5013 through 5024.

If the DC of the case is … Then …
gout under DC 5017 rate the case as rheumatoid arthritis, 5002.
• 5013 through 5016, and
• 5018 through 5024 evaluate the case according to the criteria for limited motion or painful motion under DC 5003, degenerative arthritis.

Note: The provisions under DC 5003 regarding a compensable minimum evaluation of 10 percent for limited or painful motion apply to these diagnostic codes and no others.

Reference: For more information on 10 and 20 percent ratings based on x-ray findings, see 38 CFR 4.71a, DC 5003, Note (2).


#2 Berta

 
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Posted 13 May 2006 - 06:50 AM

I think- they mean a minimum of 10% with both limited motion and also pain.

This claim might help you- but it is dated 1997 and I dont know if any of these regs have changed-dont think so-
http://www.va.gov/ve...es3/9722700.txt

It makes the point that they rated the DC 5019 condition under the 5003 provisions.

'The veteran’s right shoulder and left shoulder disabilities
have been evaluated under Diagnostic Code (DC) 5019 for
bursitis. This Code provision states that bursitis is to be
evaluated under DC 5003 as for degenerative arthritis.
38 C.F.R. § 4.71a, DC 5019.

DC 5003 states that degenerative arthritis established by x-
ray findings will be rated on the basis of limitation of
motion under the appropriate diagnostic codes for the
specific joint involved. When however, the limitation of
motion of the specific joint or joints involved is
noncompensable under the appropriate diagnostic codes, a
rating of 10 percent is to be applied for each such major
joint or group of minor joints affected by limitation of
motion. Limitation of motion must be objectively confirmed
by findings such as swelling, muscle spasm, or satisfactory
evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. "

#3 carlie

 
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Posted 13 May 2006 - 08:11 AM

Berta and all,

On my 2002 C & P, VA Doc put " insertion of the Trapezius muscle on the right is
very tender to palpation -- I think there is a rule, can't find it now but it refers to
pain on palpation and that this pain must also be considered.

How about this one here ? It just refers to 5019 evaluated at 10 %, . (I am not using this as an example of painful palpation).


http://www.va.gov/ve...es2/0415517.txt



III. Compensable rating - Bursitis of the left shoulder

The veteran seeks a compensable rating for his service-
connected bursitis of the left shoulder. Disability
evaluations are based upon the average impairment of earning
capacity as contemplated by the schedule for rating
disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part
4 (2003). In order to evaluate the level of disability and
any changes in condition, it is necessary to consider the
complete medical history of the veteran's condition.
Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).
However, where an increase in the level of a service-
connected disability is at issue, the primary concern is the
present level of disability. Francisco v. Brown, 7 Vet.
App. 55 (1994). In cases in which a reasonable doubt arises
as to the appropriate degree of disability to be assigned,
such doubt shall be resolved in favor of the veteran.
38 C.F.R. § 4.3 (2003). Where there is a question as to
which of two evaluations shall be applied, the higher
evaluation will be assigned if the disability picture more
nearly approximates the criteria required for that rating.
38 C.F.R. § 4.7 (2003).

When evaluating musculoskeletal disabilities, the Board must
also consider whether a higher disability evaluation is
warranted on the basis of functional loss due to pain or due
to weakness, fatigability, incoordination, or pain on
movement of a joint under 38 C.F.R. §§ 4.40 and 4.45 under
any applicable diagnostic code pertaining to limitation of
motion. See DeLuca v. Brown, 8 Vet. App. 202 (1995).

Bursitis is rated under Diagnostic Code 5019, which in turn
makes reference to Diagnostic Code 5003, for degenerative
arthritis. Diagnostic Code 5003 specifies that degenerative
arthritis of a major joint be rated under the criteria for
limitation of motion of the affected joint, with a minimum 10
percent rating assigned for such limitation. Limitation of
motion of the shoulder is rated under Diagnostic Code 5201,
which awards a 30 percent rating for motion of the arm
limited to 25º from the side, a 20 percent rating for motion
of the arm to midway between the side and shoulder level, and
a 20 percent rating for limitation of motion at the shoulder
level; these ratings apply to minor, that is, non-dominant
joints. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2003). In
every case where the requirements for a compensable rating
are not met, a zero percent evaluation may be assigned, even
if the diagnostic schedule does not provide for such a
noncompensable evaluation. 38 C.F.R. § 4.31 (2003).
According to the October 2001 VA examination report, he is
right-handed, and thus his left shoulder is a minor joint.
The Board notes that the position of an arm held out at
shoulder level is 90 degrees from the position of the arm at
the side. See 38 C.F.R. § 4.71a, Plate I (2003).

The veteran underwent VA orthopedic examination in October
2001. He reported a long history of left shoulder pain which
extends across his chest both anteriorly and posteriorly. On
objective examination, he was without edema, effusion,
redness, heat, or instability of the left shoulder joint.
However, he did report weakness and tenderness. He also had
abnormal movement and guarding of movement. Range of motion
testing of the left shoulder revealed forward flexion to
162?, abduction to 161?, external rotation to 84?, and
internal rotation to 82?. While pain, weakness, instability,
fatigability, and lack of endurance were noted, no additional
limitation of motion was attributed to these factors. X-rays
of the left shoulder revealed minor degenerative changes.
The final diagnosis was of degenerative joint disease of the
left shoulder, with loss function due to pain.

The veteran has also received VA outpatient treatment for
left shoulder pain. However, his outpatient treatment
records do not reflect any range of motion findings.

Based on the October 2001 examination findings, the veteran
does not have sufficient limitation of motion of the left
shoulder to warrant a compensable rating. According to
Diagnostic Code 5201, the veteran's left arm must be limited
to shoulder level movement in order for a compensable rating
to be warranted. However, the veteran has both forward
flexion and abduction of the left shoulder to 162º and 161º,
respectively, well in excess of shoulder level. Therefore,
the criteria for the award of a compensable rating are not
met, and a noncompensable rating must be assigned under
Diagnostic Code 5201.

However, the Board also notes that Diagnostic Code 5003,
referenced by Diagnostic Code 5019, awards claimants a 10
percent rating for each affected major joint, if the joint
does not have limitation of motion to a compensable degree,
but does have some limitation of motion. Therefore, because
the veteran has already been awarded service connection for
bursitis of the left shoulder, and has some limited and
painful motion of that joint, a 10 percent rating is
warranted for this disability under Diagnostic Code 5003.

Also considered by the Board were the provisions of 38 C.F.R.
§ 4.40 which requires proper consideration to be given the
effects of pain in assigning a disability rating, as well as
the provisions of 38 C.F.R. § 4.45 and the Court's holding in
DeLuca. However, there is no evidence in the present case
that there is any weakness, excess fatigability, or
incoordination due to flare-ups of the service-connected left
shoulder disability which would warrant increased
compensation. While the VA examiner noted in October 2001
that the veteran's left shoulder displayed pain on motion,
weakness, and tenderness, the examiner did not express this
additional impairment in terms of additional limitation of
motion. Therefore, a rating in excess of 10 percent under
38 C.F.R. §§ 4.40, 4.45 or under DeLuca is not warranted.

In conclusion, the preponderance of the evidence supports a
compensable rating of 10 percent and no higher for the
veteran's service-connected bursitis of the left shoulder.
As a preponderance of the evidence is against the award of an
increased rating in excess of 10 percent, the benefit of the
doubt doctrine is not applicable in the instant appeal. See
38 U.S.C.A. § 5107(:( (West 2002); Ortiz v. Principi, 274
F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet.
App. 49, 55-57 (1991).

specific joint involved. When however, the limitation of
motion of the specific joint or joints involved is
noncompensable under the appropriate diagnostic codes, a
rating of 10 percent is to be applied for each such major
joint or group of minor joints affected by limitation of
motion. Limitation of motion must be objectively confirmed
by findings such as swelling, muscle spasm, or satisfactory
evidence of painful motion. 38 C.F.R. § 4.71a, DC 5003. "
[/quote]

Edited by carlie, 13 May 2006 - 08:19 AM.