Metatarsal Arthritis

[oldvet]

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

[rentalguy1]

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.

[oldvet]

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

[rentalguy1]

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.

[JB3AFSP2]

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.

[oldvet]

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

[oldvet]

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.

One more question though Does the fact that only the 1st metatarsal joint has arthritis change anything? The code says two or more joints.

oldvet