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    • I believe the correct acronym here is "BOHICA" as in Bend Over Here It Comes Again. I know some nice and very knowledgeable nurses, but do not like the idea that the VA could hypothetically use them for our treatment or in the C&P process, but then deny us based on a Drs opinion who didn't even see or treat us.  To me, it seems like another scandal waiting to happen. Just think of what the whole claims and compensation picture would look like, if the VA just did the right thing, the first time, because it is the right thing to do, and we Veterans have already paid for and earned the right to be compensated.
    • Just dealing with the VA in general will drive you crazy! Ebennies just pushes you over that cliff! As for the additional $ you can receive, you have to think about the multiple amputees and those with TBIs so severe that they function at or below a young child. Pretty much those that can't care for themselves or live on their own, wheelchair bound and such. I knew a Vet who was receiving over $6K a month, but he had full on Parkinson's from AO, was severely overwhelmed with PTSD from 2.5 years in a VC bamboo outdoor living structure...that he couldn't do anything on his own.  His Parkinson's was severe enough that he couldn't drive, cook, tie his shoes, much less button his shirt.  I was good friends with one of his sons, and saw the effect it had on him, with his Dad spending more time in the VAMC than he did at home. So...unless you need the extra $, because you are that disabled, nobody really wants to trade places with those Vets. Semper Fi
    • the one thing that this whole "FDC" bullshit does is make me irritated at an already egregious system. it's a slight bit fear mongering to cause panic and disorder to a Vet, WHO obviously needs help since we're signing up for Disability and all. guess what, you don't NEED a year to put together a well thought out and itemized claim. That whole, you better do it in a year or your screwed thing is B.S. The only system i've EVER seen take nearly a year to get paperwork filed is THE GOD DAMN VA  take your TIME, you'll be fine. never allow anyone to send anything to anywhere without you at least triple checking it. Good Luck
    • I am rated at 70%.  It is my understanding once you reach 50% you can get treated free for non service connected problems at the VA in the US.  Under the FMP you cannot.  You get treated free only for service connected problems.   Could someone please explain the logic of such a policy?  I live in Thailand and medical care is much cheaper here.  I would think it would be to their benefit to have everything treated under FMP as well.   Thanks.
    • Contacted Glenn Johnson at FMP by phone and he approved the PM procedure.  Could have flown to the US and had it done under Medicare or VA, but thought I would give it a shot.  If by some reason they don't pay it will be a much more bitter pill to swallow knowing I could have gotten this done for little or no cost in the US.  The only reason I did not have it done in the US is because they said they would pay. Had the procedure done by a government hospital in Bangkok at half to a third of what it would have cost at a private hospital in Bangkok.  Everything went well.  I had to pay out of pocket.  Could have used Bangkok Hospital who would have billed FMP direct and no out of pocket, but would have been 2 to 3 times more expensive.  The government doctor was trained in the US and worked in both private and government hospitals.  She stated that if I had the procedure done at the private hospital she worked it would cost 2 to 3 times. Sent the bill for reimbursement in March by registered mail.  After 4 months of no news sent email to check status.  The response was they had no record of having received.  There was another bill I had sent by registered mail also in March.  Same response.  No record of my claim.  They requested I send again, so sent by email.  Received email confirmations, so know they have in house.  I have tried sending claims by email, regular mail, and fax.  All have their own problems.  Doctor I used in Bangkok said so much of what he was mailing to VA on behalf of his patients was getting lost.  Started sending by fax and that seemed to work.  Still waiting on reimbursement.  If they do not pay, it will be an expensive lesson.       

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oldvet

Metatarsal Arthritis

12 posts in this topic

How is VA supposed to rate this? As arthritic joints or a foot injury? I have been cited as having a "foot injury" under 5284. and therefore rated as a 0 because it does not meet the moderate condition. If the Xray shows arthritis of the metatarsal joints shouldn't that be rated as such?

Thanks,

oldvet

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I can think of three different dx codes that they could legitimately rate this condition under. The codes are 5003 (Arthritis, degenerative), 5017 (Gout), and 5020 (Synovitis). 5003 and 5020 use the same rating criteria. 5017 uses a different rating criteria that would be more advantageous to you, but doubtful that you could get the VA to rate it under this code as "analagous," since you have a actual diagnosis that matches a ratable diagnostic code. The rating criteria is:

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):

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 or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:

With X-ray evidence of involvement of 2 or more major joints

or 2 or more minor joint groups, with occasional incapacitating

exacerbations 20

With X-ray evidence of involvement of 2 or more major joints

or 2 or more minor joint groups 10

Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.

Note(2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic code 5013 to 5024, inclusive.

For the other two codes:

The diseases under diagnostic codes 5013 through 5024 Will be rated on limita­tion of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002.

5002 Rating criteria:

5002 Arthritis rheumatoid (atrophic) as an active process

With constitutional manifestations associated with

active joint involvement, totally incapacitating 100

Less than criteria for 100% but with weight loss and anemia

productive of severe impairment of health or severely

incapacitating exacerbations occurring 4 or more times a year

or a lesser number over prolonged periods 60

Symptom combinations productive of definite impairment of

health objectively supported by examination findings or

incapacitating exacerbations occurring 3 or more times a year 40

One or two exacerbations a year in a well-established diagnosis 20

For chronic residuals:

For residuals such as limitation of motion or ankylosis, favorable or unfavor­able, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.

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Why would VA give me a zero percentage and say that I was rated under 5284 Foot injuries, other?

The examiner showed traumatic arthritis of the first metatarsophalangeal joint. The code on the worksheet shows 5299-5284. Am I missing something ?

Thanks,

oldvet

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Yeah...they played with the codes. You need to file a NOD and tell them to change the code to 5002 with at least a 10% rating. Tell them that this is a erroneous code, as the diagnosis has it's own code in 38 CFR 4.71a, and does not need to use a analogous code. Also tell them that 38 CFR 4.13 allows for chaging of erroneous codes.

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rentalguy1,

I believe that I need to go a similar route with my case except I'll use diagostic code 5003 due to traumatic injury. Is there a way that I can request and get a copy of my examiner's report? X-rays were taken of my hand and I'm interested in seeing whether or not any arthritis was noted. I have a suspicion that since I didn't specifically request compensation due to arthritis, even though I complained of pain, they may have ignored it and simply based their rating on what I put on the claim form...left hand fracture.

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Yeah...they played with the codes. You need to file a NOD and tell them to change the code to 5002 with at least a 10% rating. Tell them that this is a erroneous code, as the diagnosis has it's own code in 38 CFR 4.71a, and does not need to use a analogous code. Also tell them that 38 CFR 4.13 allows for chaging of erroneous codes.

Thanks rentaguy1 ! Appreciate the help!

oldvet

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