ROM or functional loss?

[Magilla]

I will be going through the MEB process here in 2 months for an ankle injury sustained last year. Severe tears to my peroneal tendons and the overlaying ligaments. Had another surgery a month ago to remove bone spurs that came about from the injury and recovery. My ankle was far worse than they anticipated when they did the 1st surgery to repair the tendons and ligaments, as there was far more scar tissue than expected, and my peroneal tendon was about 50% dead necrotic tissue. They repaired it as best they could but it is still in horrible condition. ROM is far less than it used to be, but more than that, I've had to change how I walk as walking normally will cause my ankle to give out, so I walk with my right foot pointed out to my side. Even still, every step is made in pain that worsens through the day. And 10-20 times a day the tendon in my ankle will pop and leave me clutching nearby objects to keep from falling over in pain.
I'm Trying to get an idea of whether I'll be getting medically separated or retired on account of it, but I'm unsure as I don't know if they'll rate my ankle as a ROM issue, or a functional loss. ROM would give me a max of 20% if I've read the 38CFR correctly, whereas a functional loss rating would be 40%.
I've given serious thought to an elective amputation as every day is a constant pain of walking and moving about that doctors have said will probably never improve.
Can anyone give me some advice on whether they rate ankle issues primarily on ROM, or in certain cases do they opt for a functional loss rating?

Thanks for any help and advice!

- Sean

 

[Jason Perry]

Can anyone give me some advice on whether they rate ankle issues primarily on ROM, or in certain cases do they opt for a functional loss rating?

Thanks for any help and advice!

- Sean

Sean,

Sorry to hear of your disabilities, injuries, and issues as result of your service.

Not to sound curt, but your question is very easy and the answer is clear.

Under a case, Deluca v. Brown, the VA is required to rate based on functional loss and, (by extension) the military is required to rate based on functional loss.

 

[Magilla]

Curt and easy, or long and painful, an answer is an answer, Thank you very much! I'll look into that case as I've never heard of it in all honesty, but it's nice to know they'll look at it as a functional loss rather than just ROM, and thereby making my post military life a little more easy to plan.

Thank you again for the help and quick and curt response! Still have 2 months before my MEB starts so I'll be sure to check back in should I need any more help!

 

[Warrior644]

I will be going through the MEB process here in 2 months for an ankle injury sustained last year. Severe tears to my peroneal tendons and the overlaying ligaments. Had another surgery a month ago to remove bone spurs that came about from the injury and recovery. My ankle was far worse than they anticipated when they did the 1st surgery to repair the tendons and ligaments, as there was far more scar tissue than expected, and my peroneal tendon was about 50% dead necrotic tissue. They repaired it as best they could but it is still in horrible condition. ROM is far less than it used to be, but more than that, I've had to change how I walk as walking normally will cause my ankle to give out, so I walk with my right foot pointed out to my side. Even still, every step is made in pain that worsens through the day. And 10-20 times a day the tendon in my ankle will pop and leave me clutching nearby objects to keep from falling over in pain.
I'm Trying to get an idea of whether I'll be getting medically separated or retired on account of it, but I'm unsure as I don't know if they'll rate my ankle as a ROM issue, or a functional loss. ROM would give me a max of 20% if I've read the 38CFR correctly, whereas a functional loss rating would be 40%.
I've given serious thought to an elective amputation as every day is a constant pain of walking and moving about that doctors have said will probably never improve.
Can anyone give me some advice on whether they rate ankle issues primarily on ROM, or in certain cases do they opt for a functional loss rating?

Thanks for any help and advice!
- Sean

Welcome to the PEB Forum!

Please by all means consider all options prior to any potential ultimate amputation request. Believe me, I totally comprehend dealing with severe daily pain (e.g. ALIF L4-5 lumbar disc fusion failed surgery with numerous automobile incidents/accidents thereafter) plus ongoing chronic behavioral health medical conditions.

To that extent, I am definitely a "medical challenge" for any military and/or civilian healthcare provider, but I have decided against having any additional low back pain (LBP) elective surgeries to try to potentially remedy the physical challenges.

Overall, it's not a good situation for me since my activities of daily living (ADL) are truly a daily challenge. But, I shall continue to persevere for myself and more importantly my family.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[Magilla]

I'm definately looking into all options. They've had me in a hard cast the last 3 weeks now to completely immobilize the tendons and, according to the doctors, try and let them self heal.

Tendons don't snap out hardly anymore, tho it is an occasional pain, and overall my pain level has decreased due to far less impact and movement on my leg. Just unneasy about getting the cast back off in 2 more weeks. It's already been well over a year and a half since the original injury so I doubt its going to heal much, and i don't want this 5 weeks in a hard cast to be like a hard reset on the tendons. Working my way back up to more severe pain and discomfort.

Sorry to hear about your spinal issues, but keep on keeping on man, not just for yourself as you said, but for your family. That's where my big worries are focused lately. Their betterment and well being.

 

[Warrior644]

I'm definately looking into all options. They've had me in a hard cast the last 3 weeks now to completely immobilize the tendons and, according to the doctors, try and let them self heal.

Tendons don't snap out hardly anymore, tho it is an occasional pain, and overall my pain level has decreased due to far less impact and movement on my leg. Just unneasy about getting the cast back off in 2 more weeks. It's already been well over a year and a half since the original injury so I doubt its going to heal much, and i don't want this 5 weeks in a hard cast to be like a hard reset on the tendons. Working my way back up to more severe pain and discomfort.

Sorry to hear about your spinal issues, but keep on keeping on man, not just for yourself as you said, but for your family. That's where my big worries are focused lately. Their betterment and well being.

I am pleased to read about your current healthcare treatment, and pray that it continues to offer extended relief.

Moreover, I appreciate your warm sentiments and agree with your statement "their betterment and well being" which remains my daily focus of inspiration. That said, we are definitely "brothers of pain" indeed!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!

 

[2013GO]

This is where the water gets muddy. "Functional loss" = ?? My DDD claim appears to have been decided strictly on ROM...for if you look at the rest of the C&P exam in regards to what I could and couldn't do they don't match up. My ROM is in the 10% range.....but the rest of the exam makes it look like it was a totally different person...

 

[Magilla]

That sucks about your exam, and how they made it out like it was someone else and whatnot. Get my 2nd cast off on Monday and hoping they don't put me back into another one. Range of motion sucked before they put me in it 5-6 weeks ago, it was abysmally worse in the hour and a half between getting old cast off and new one on, but I can surely attribute most of that to immobility, which will only be more pronounced with this last 3 weeks locked up in a cast.

Keep talking to guys in my unit going thru the process already and they're all of them telling me that the army side, PEB, is only handing out 20% for leg injuries unless its massive and extensive damage. So I'm thinking my situation will end up being just medical sep with 10-20% disability despite my inability to even walk correctly and constant and increasing pain.

I realize Uncle Sam is lookin to shed a lot of service members and spend as little money in the process as possible, but rubber stamping nearly every leg issue with 20% or less is an affront to men and women who volunteered to serve their nation during a time of conflict.

 

[Warrior644]

That sucks about your exam, and how they made it out like it was someone else and whatnot. Get my 2nd cast off on Monday and hoping they don't put me back into another one. Range of motion sucked before they put me in it 5-6 weeks ago, it was abysmally worse in the hour and a half between getting old cast off and new one on, but I can surely attribute most of that to immobility, which will only be more pronounced with this last 3 weeks locked up in a cast.

Keep talking to guys in my unit going thru the process already and they're all of them telling me that the army side, PEB, is only handing out 20% for leg injuries unless its massive and extensive damage. So I'm thinking my situation will end up being just medical sep with 10-20% disability despite my inability to even walk correctly and constant and increasing pain.

I realize Uncle Sam is lookin to shed a lot of service members and spend as little money in the process as possible, but rubber stamping nearly every leg issue with 20% or less is an affront to men and women who volunteered to serve their nation during a time of conflict.

Again, I am pleased to read about your current healthcare treatment, and pray that it continues to offer extended relief.

In reference to your observation about the USAPDA PEB, I potentially agree from a behavioral health perspective with the 38 CFR 4.129 post-TDRL adjudications.

From an U.S. Army perspective while within the DoD IDES MEB/PEB process, the Chief attorney at NCRPEB stated that the trend for Ivan Walks and Associates (IWA) TDRL re-evaluation is resulting in lower rating for PTSD by the USAPDA PEB. To that, it's understood there exist an abundance of external factors specific for each re-evaluated TDRL participant, but the leverage converts back to the DoD (Army) which more likely than not that an accurate military disability rating would be determined; in my opinion.

Simply stated as based upon the trend for a significantly lower disability rating on TDRL re-evaluations, I am definitely not looking forward to my TDRL six-month re-evaluation with IWA then potentially new lower non-DoD IDES process rating determination by the USAPDA PEB.

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!