S/C for L ankle but R foot/ankle is in appeal status - now I am having surgery on R - need help!

[Navy4life]

Good morning;

I posted in another forum regarding temporary convalescence assistance BUT I have some questions:

1.  Currently my left ankle is S/C and I had surgery on it and my toe this past June 2015

2. Currently my right foot/ankle is under appeals (NOD) since December 2015 after being denied S/C for it.  My SMR's clearly show sprain to the right foot/ankle while on AD so I am not sure why it got denied.

On Christmas Eve I fell down the stairs when my left ankle/foot gave out, causing my right foot to receive two fractures to the 5th Metatarsal (transverse/spiral).  I am scheduled for surgery tomorrow. Since it's my Right Foot I am not able to drive and will be immobile for 3 months in a cast after surgery. My VA Podiatrist indicated that the Left ankle is the reasoning for my fractures to my right foot. This is in MyHealthyVets documents.  My Podiatrist is willing to write a letter to support the temporary convalescence.

Here are my questions:

1. Can I receive temporary convalescence for a non-S/C contention if that contention issue was a DIRECT result from a S/C contention?

2. Since I am in "appeals" status for my right foot, should I supply this documentation to back up my appeal?  My left ankle is the reason I now have this issue with my right foot.

3. Should I file for an increase to my left foot?

A bit confused here...

Please see my X-ray from my fall.

 

[Vync]

Hiya Navy4life,
A properly worded letter or statement from your VA podiatrist will be very helpful as long as the medication rationale is clear. Terms like "probably" or "possibly" are not strong enough for the VA. The VA likes terms like "caused by" (100% likely) or "due to" (100% likely) are the most beneficial.

1. I have never filed for temporary convalescence, but the VA web page (http://www.benefits.va.gov/COMPENSATION/claims-special-convalescence.asp) states this as a requirement: "The evidence must show the surgery or treatment was for a service-connected disability". I like the fact that your podiatrist is willing to state the cause and effect relationship (SC left ankle failure --> fall --> broken right foot --> surgery --> convalescence), but do not know enough about VA convalescence to state they will approve with certainty. What have you got to lose? I recommend filing for it.

2. I recommend submitting it. If the podiatrist is sympathetic to your issue, consider asking him to look at your service treatment records for your right foot/ankle injuries that are on appeal. Maybe he can opine in your favor for your existing claim simultaneously, which would be a big plus. Worst case scenario, if he doesn't want to do that, at least the convalescence letter might help qualify as secondary claim instead of a direct claim.

3. If you meet the rating criteria for a higher rating percentage, then sure. I copied the current rating criteria for ankle and foot ratings (further) below.

 

4. Also consider other possible secondary issues which might result from a fall. If you hit your head or tried to brace yourself with your arms/hands, you could have problems in the near future or later in life. Remember that old song "the knee bone is connected to the thigh bone"? It is all connected together, so be mindful about knee, hip, spine, etc... Take pictures of any bruises. Also, ask any friends of family who might have been present to write a buddy letter describing what they saw either directly or when they found you, and what happened afterwards.

 

Here is the criteria for the ankle:

	Rating
5270   Ankle, ankylosis of:
In plantar flexion at more than 40°, or in dorsiflexion at more than 10° or with abduction, adduction, inversion or eversion deformity	40
In plantar flexion, between 30° and 40°, or in dorsiflexion, between 0° and 10°	30
In plantar flexion, less than 30°	20
5271   Ankle, limited motion of:
Marked	20
Moderate	10
5272   Subastragalar or tarsal joint, ankylosis of:
In poor weight-bearing position	20
In good weight-bearing position	10
5273   Os calcis or astragalus, malunion of:
Marked deformity	20
Moderate deformity	10
5274   Astragalectomy	20

 

Here is the criteria for the foot:

The Foot

	Rating
5276   Flatfoot, acquired:
Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances
Bilateral	50
Unilateral	30
Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities:
Bilateral	30
Unilateral	20
Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral	10
Mild; symptoms relieved by built-up shoe or arch support	0
5277   Weak foot, bilateral:
A symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness:
Rate the underlying condition, minimum rating	10
5278   Claw foot (pes cavus), acquired:
Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:
Bilateral	50
Unilateral	30
All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads:
Bilateral	30
Unilateral	20
Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads:
Bilateral	10
Unilateral	10
Slight	0
5279   Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral	10
5280   Hallux valgus, unilateral:
Operated with resection of metatarsal head	10
Severe, if equivalent to amputation of great toe	10
5281   Hallux rigidus, unilateral, severe:
Rate as hallux valgus, severe.
Note: Not to be combined with claw foot ratings.
5282   Hammer toe:
All toes, unilateral without claw foot	10
Single toes	0
5283   Tarsal, or metatarsal bones, malunion of, or nonunion of:
Severe	30
Moderately severe	20
Moderate	10
Note: With actual loss of use of the foot, rate 40 percent.
5284   Foot injuries, other:
Severe	30
Moderately severe	20
Moderate	10
Note: With actual loss of use of the foot, rate 40 percent.

 

I hope this helps! I hope your surgery goes well.

[Navy4life]

Are there any examples of good letters that I can use an example of?

Thank you very much for replying to me!  I am going to sit down with my podiatrist after surgery and we are going to go over the p/w and hopefully be able to get a good letter on my behalf!

Edited January 6, 2016 by Navy4life

[Vync]

2 hours ago, Navy4life said:

Are there any examples of good letters that I can use an example of?

Thank you very much for replying to me!  I am going to sit down with my podiatrist after surgery and we are going to go over the p/w and hopefully be able to get a good letter on my behalf!

Buck posted a sample nexus letter here:

It is possible to get SC with less than what is posted in that sample. It is an extremely thorough example that appears to cover all angles. Some VA raters are more stubborn than others and seem to try to find excuses to avoid granting SC.

 

[Andyman73]

Navy4life,

if your left ankle has been injured/disabled for several years or longer, it's a natural progression, that the right ankle can and will prematurely wear out.  Over the years of you limping and compensating for the pain, your right lower extremity has born the brunt of the effects of motion.

Therefor a claim for the R ankle secondary to the L ankle is legitimate.

I am currently waiting on a decision on a R ankle secondary to L ankle claim.  I was rated 10% for my L ankle as residual pain from injury back on 11/98.   I developed plantar fasciitis in my L foot in '97, and by the time I went for treatment, my L ankle was in major pain.  And according to the CFR charts my ROM for my R ankle is right at the 20% rating value. 

This past summer I was examined and DXd with pes cavus w/plantar fasciitis bilateral @ 30%. Which developed from the original injury in 1997.  While time is not on our side, sometimes it can be our friend(in a round a bout kind of way).

If you haven't yet, maybe file an intent to file claim to establish an EED for your R ankle secondary claim.

I wish you all the success in your claims!

Semper Fi.

Andyman

[Navy4life]

Hi there!

 

I had the surgery and I saw my doctor this morning for my first Post-Op appointment.  He gave me the attached letter to use for my appeal on my right foot.

Here are my questions:

1.  Can you tell me if the letter is good enough (SEE ATTACHED)?  If not, I would love your feedback because my doctor is willing to tweak it.

2. Should I file for Temporary Convalescence leave? Doctor indicates I can't drive for 2 months.

3. Should I file for an increase for the left ankle since it is the reason for my right foot injury?

4. Since i have an appeal in at NOD level (Dec 2014) - should i file to re-open the right foot/ankle or add all my documentation to the current NOD?

 

Thank You

VA letter -redacted.pdf

[Andyman73]

On 1/12/2016 at 11:34 AM, Navy4life said:

On 1/12/2016 at 11:34 AM, Navy4life said:

Hi there!

 

I had the surgery and I saw my doctor this morning for my first Post-Op appointment.  He gave me the attached letter to use for my appeal on my right foot.

Here are my questions:

1.  Can you tell me if the letter is good enough (SEE ATTACHED)?  If not, I would love your feedback because my doctor is willing to tweak it.

2. Should I file for Temporary Convalescence leave? Doctor indicates I can't drive for 2 months.

3. Should I file for an increase for the left ankle since it is the reason for my right foot injury?

4. Since i have an appeal in at NOD level (Dec 2014) - should i file to re-open the right foot/ankle or add all my documentation to the current NOD?

 

Thank You

VA letter -redacted.pdf

 

Ok, here's my 2 cents worth,

I see that the required phrase is there, but not worded exactly, so not sure if it is good enough.  At least it is written by a VA dr.  More likely equals 75% in your favor.

Yes, file for the temp con 100%.  All they can say is no...but they might say yes, too!

Not sure about the increase on the L since it hasn't gotten worse.  And if so, file, but not just because of the R being SC secondary.  At the bare minimum you should get 10% for the R ankle.

Not sure how that works, for the NOD, but if you have N&M evidence, and you do, file to reopen for the R ankle.

If anyone knows better or different please step up, I only have tiny crumbs of knowledge.

Hope this gives you a starting point.

Semper Fi.

Andyman