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Spanman

Seaman
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About Spanman

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    E-3 Seaman

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  • Service Connected Disability
    30%
  1. Spanman

    C&p Notes Review

    Not sure why it posted the "J" in lieu of the "]" end bracket. Anyway, I had a spinal stimulator installed in Feb due to my feet (and lower back) becoming more of a problem and no relief except for more Morphine. I had DAV do an request for an increase from 30% to 50% or at least a re-evaluation. Not sure what's written will help support that, but Hallux valgus is new as well as Hammer Toe (described as possible genetic)
  2. Spanman

    C&p Notes Review

    MEDICAL RECORD NOTE DATED: 04/07/2015 09:30 LOCAL TITLE: C&P REPORT STANDARD TITLE: C & P EXAMINATION NOTE VISIT: 04/07/2015 09:30 ANC CP GEN MED Foot Conditions, including Flatfoot (Pes Planus) Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review Progress Notes Indicate method used to obtain medical information to complete this document: [ J Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will Likely provide no additional relevant evidence. [ J Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would Likely provide no additional relevant evidence. [ J Examination via approved video telehealth [XJ In-person examination a. Evidence Review Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ J No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ J Yes [XJ No If no, check all records reviewed: [ J Military service treatment records [ J Military service personnel records [ J Military enlistment examination [ J Military separation examination [ J Military post-deployment questionnaire [ J Department of Defense Form 214 Separation Documents [ J Veterans Health Administration medical records (VA treatment records) [ J Civilian medical records [ J Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ J Other: [XJ No records were reviewed b. Was pertinent information from collateral sources reviewed? [ J Yes [XJ No 1. Diagnosis a. List the claimed condition(s) that pertain to this DBQ: Bilateral Plantar Fasciitis b. Select diagnoses associated with the claimed condition(s): [X] Hammer toes Side affected: Both Date of diagnosis: Right 2015 Date of diagnosis: Left 2015 [X] Hallux valgus Side affected: Both Date of diagnosis: Right 2015 Date of diagnosis: Left 2015 [X] Plantar fasciitis Side affected: Both Date of diagnosis: Right 2012 Date of diagnosis: Left 2012 c. Comments (if any): No response provided Progress Notes d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A 2. Medical history a. Describe the history (including onset and course) of the Veteran's foot condition (brief summary): Chronic foot pain prevents even moderate walking or standing. b. Does the Veteran report pain of the foot being evaluated on this DBQ? [X] Yes [ J No If yes, document the Veteran's description of pain in his or her own words: Burning pain after even moderate day of "normal" activity. Pain poorly relieved by orthotics or injections. c. Does the Veteran report that flare-ups impact the function of the foot? [ J Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the foot being evaluated on this DBQ (regardless of repetitive use)? [XJ Yes [ J No If yes, document the Veteran's description of functional Loss or functional impairment in his or her own words: Unable to walk without pain. Must use orthotics full time, even at night if he must get up to use the bathroom. 3. Flatfoot (pes planus) a. Does the Veteran have pain on use of the feet? [XJ Yes [ J No If yes, indicate side affected: [ J Right [ J Left [XJ Both If yes, is the pain accentuated on use? [XJ Yes [ J No If yes, indicate side affected: [ J Right [ J Left [X] Both b. Does the Veteran have pain on manipulation of the feet? [X] Yes [ J No If yes, indicate side affected: [ J Right [ J Left [XJ Both If yes, is the pain accentuated on manipulation? [XJ Yes [ J No If yes, indicate side affected: [ J Right [ J Left [X] Both c. Is there indication of swelling on use? [ J Yes [XJ No d. Does the Veteran have characteristic callouses? [X] Yes [ J No If yes, indicate side affected: [ J Right [ J Left [XJ Both e. Effects of use of arch supports, built-up shoes or orthotics: Tried But Remains Symptomatic Device Side Not Relieved: [X] Orthotics [ J Right [ J Left [X] Both f. Does the Veteran have extreme tenderness of plantar surfaces on one or both feet? [XJ Yes [ J No If yes, indicate side affected: [ J Right [ J Left [XJ Both Is the tenderness improved by orthopedic shoes or appliances? RIGHT - [X] Yes [ J No [ J N/A LEFT - [X] Yes [ ] No [ ] N/A g. Does the Veteran have decreased Longitudinal arch height of one or both feet on weight-bearing? [ J Yes [XJ No h. Is there objective evidence of marked deformity of one or both feet (pronation, abduction etc.)? [ J Yes [X] No i. Is there marked pronation of one or both feet? [ J Yes [XJ No j. For one or both feet, does the weight-bearing Line fall over or medial to the great toe? [ J Yes [XJ No k. Is there a Lower extremity deformity other than pes planus, causing alteration of the weight-bearing Line? [ J Yes [XJ No L. Does the Veteran have "inward" bowing of the Achilles tendon (i.e., hindfoot valgus, with Lateral deviation of the heel) of one or both feet? [X] Yes [ J No If yes, indicate side affected: [ J Right [ J Left [X] Both m. Does the Veteran have marked inward displacement and severe spasm of the Achilles tendon (rigid hindfoot) on manipulation of one or both feet? [ J Yes [XJ No n. Comments: No comments provided 4. Morton's neuroma (Morton's disease) and metatarsalgia No response provided 5. Hammer toe a. Which toes are affected on each side? RIGHT: [X] Fourth toe LEFT: [X] Fourth toe b. Comments: Asymptomatic, very slight and Likely is congenital. 6. Hallux valgus a. Does the Veteran have symptoms due to a hallux valgus condition? [X] Yes [ J No If yes, indicate severity: [X] Mild or moderate symptoms Side affected: [ J Right [ J Left [XJ Both b. Has the Veteran had surgery for hallux valgus? [ J Yes [XJ No c. Comments: No comments provided 7. Hallux rigidus No response provided 8. Acquired pes cavus (clawfoot) No response provided 9. Malunion or nonunion of tarsal or metatarsal bones No response provided 10. Foot injuries and other conditions a. Does the Veteran have any foot injuries or other foot conditions not already described? [XJ Yes [ J No If yes, describe the foot injury or other conditions (including frequency and physical exam findings) and complete question b. (severity and side affected). Carry of heavy equipment while wearing steel toe boots resulted in foot pain in service. Was seen multiple time with diagnosis of plantar fascial tear syndrome bilaterally. Worsened over the years. b. Indicate severity and side affected: [XJ Moderately severe [ J Right [ J Left [XJ Both c. Does the foot condition chronically compromise weight bearing? [X] Yes [ J No d. Does the foot condition require arch supports, custom orthotic inserts or shoe modifications? [X] Yes [ J No e. Comments: Custom orthotics help some what but still has pain with walking over 1/2 mile and unable to stand for more than 15 minutes without severe and Lasting pain in feet bilaterally. 11. Surgical procedures a. Has the Veteran had foot surgery (arthroscopic or open)? [X] Yes [ J No If yes, indicate side affected, type of procedure and date of surgery: [X] Right foot procedure: Plantar fascial release- failed Date of surgery: 2000 b. Does the Veteran have any residual signs or symptoms due to arthroscopic or other foot surgery? [ J Yes [XJ No 12. Pain RIGHT FOOT: Is there pain on physical exam? [XJ Yes [ J No If yes, (there is pain on physical exam), does the pain contribute to functional Loss? [XJ Yes [ J No (Further description of Limitations requested in Section XIII below.) LEFT FOOT: Is there pain on physical exam? [XJ Yes [ J No If yes, (there is pain on physical exam), does the pain contribute to functional Loss? [X] Yes [ J No (Further description of Limitations requested in Section XIII below.) 13. Functional Loss and Limitation of motion a. Contributing factors of disability (check all that apply and indicate side affected): [X] Excess fatigability Side affected: [ ] Right [ J Left [X] Both [X] Pain on movement Side affected: [ J Right [ J Left [X] Both [X] Pain on weight-bearing Side affected: [ J Right [ J Left [X] Both [X] Pain on non weight-bearing Side affected: [ ] Right [ J Left [X] Both [X] Disturbance of Locomotion Side affected: [ J Right [ J Left [XJ Both [X] Interference with standing Side affected: [ J Right [ J Left [X] Both Contributing factors of disability associated with Limitation of motion: b. Is there pain, weakness, fatigability, or incoordination that significantly Limits functional ability during flare-ups or when the foot is used repeatedly over a period of time? RIGHT FOOT: [X] Yes [ J No If yes, (there is a functional Loss due to pain, during flare-ups and/or when the joint is used repeatedly over a period of time) please describe the functional Loss: Foot pain with standing, walking, steps, or Ladders Lead to veteran being transferred to a desk job for 80% of his duties with the Corps of Engineers. LEFT FOOT: [X] Yes [ J No If yes, (there is a functional Loss due to pain, during flare-ups andfor when the joint is used repeatedly over a period of time) please describe the functional Loss: Foot pain with standing, walking, steps, or Ladders Lead to veteran being transferred to a desk job for 80% of his duties with the Corps of Engineers. c. Is there any other functional Loss during flare-ups or when the foot is used repeatedly over a period of time? RIGHT FOOT: [ J Yes [X] No LEFT FOOT: [ ] Yes [X] No 14. Other pertinent physical findings, complications, conditions, signs, symptoms and scars a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions Listed in the Diagnosis section above? [XJ Yes [ J No If yes, describe (brief summary): Very early hallux valgus and DJD of 1st metatarsal head is now noted. b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions Listed in the Diagnosis section above? [XJ Yes [ J No If yes, are any of these scars painful or unstable; have a total area equal to or greater than 39 square em (6 square inches); or are Located on the head, face or neck? (An "unstable scar" is one where, for any reason, there is frequent Loss of covering of the skin over the scar.) [ J Yes [X] No If no, provide Location and measurements of scar in centimeters. Location: Plantar right foot Measurements: Length 7cm X width 0.2cm c. Comments: No comments provided 15. Assistive devices a. Does the Veteran use any assistive device as a normal mode of Locomotion, although occasional Locomotion by other methods may be possible? [XJ Yes [ J No If yes, identify assistive devices used (check all that apply and indicate frequency): Assistive Device: [XJ Cane(s) [X] Other: Orthotics Frequency of use: [X] Occasional [ J Occasional [ J Regular [ J Regular Progress Notes [ J Constant [XJ Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: Cane is used when traveling or on requirements to walk more than usual. 16. Remaining effective function of the extremities Due to the Veteran's foot condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the Lower extremity include balance and propulsion, etc.) [ J Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 17. Diagnostic testing a. Have imaging studies of the foot been performed and are the results available? [X] Yes [ J No If yes, is degenerative or traumatic arthritis documented? [XJ Yes [ J No If yes, indicate foot: [ J Right [ J Left [X] Both b. Are there any other significant diagnostic test findings or results? [ J Yes [X] No c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed condition: No response provided 18. Functional impact Regardless of the Veteran's current employment status, do the condition(s) Listed in the Diagnosis section impact his or her ability to perform any type of occupational task (such as standing, walking, Lifting, sitting, etc.)? [XJ Yes [ J No If yes, describe the functional impact of each condition, providing one or more examples: Walking more than 1/2 mile or standing over 10-15 minutes had such an effect, he was transferred to a desk job for 80% of his duties to accomondate him. 19. Remarks, if any: Very early callus is noted on medial great toes, compatible with early bunion as noted on x-rays. A slight achilles bowing of 7 degrees on right and 5 degrees on Left also was noted at todays examination. Clinically these are very minimal findings today.
  3. So I went to the VA yesterday to get access to MyHealtheVet and was asking for my records from my C&P exam, the tech told me they had direction NOT to give Vets the notes unless they were 5 years or older. The beauty was that because the notes were already uploaded to the system "By law I have to give them to you" his words excatly. So I got my notes and I am wondering if anyone could extrapolate if they are helpful in getting an increase? I guess if anyone can help I can send it via email, not sure I can attach or want to cut and paste the entire 7 pages here...PM member
  4. I was on Stop/Loss following 9/11, once they released my AFSC it was outgoing folks in droves. The retirement/seperation briefing was at capacity when I took it and the VFW did a cursory review of med records and told folks what they should file for....well when I had my sitdown they missed 1/2 my issues and had the glassed over look of someone who was overwhlemed. And rightly so considiering how many folks were outproceesing at once. My records from the VFW were actually sent to Arkansas (AR), not Alaska (AK) because well...it happens (alot). So my confidnace in them took a nose dive and I filed for myself (to which I have been fighting the past 10 Years). My exam was also the same way, I was sent to the Hospital and the Dr was unaware he was even giving me a final out, he asked what I was there to see him about because the top of the form was blank (lasted less than 15 min). My hearing test failed the first time because they were giving me an annual and not outP so the numbers were jacked up, I did have hearing loss and slight tinuiitus but all that was missed. I guess this is all coming up because a friend getting ready to seperate just spent 4 hours with a VFW rep going over EVERYTHING! I know it's been awhile, but I feel I wouldn't still be in the fight I am in if it was done correctly. Yes I bear part of this because I did things on my own, not getting help because I thought the service org was a hinderance...I mean who misses 1/2 of the important facts and sends things to another state? Anyway, is there any action that can be done about this? I know there have been review boards after 9/11 due to individuals not getting a fair assesment but my service guy (DAV) dosn't think it's the same thing becuase I wasn't on a review board for service conncted, I was simply getting out. Any advise on what I could do? Or just let it go and press on with my current battle....
  5. I am diagnosed (according to the decision) bilateral plantar fasciitis nearly approximate a "Severe" condition. I have heard Pes Planus and seen it mentioned in my records but it's not written in the decision. I believe at this point I should be the higher evaluation as it is NOT improved with inserts (wearing them for 15+ years) and inward displacement, spasms and pain upon manipulation. My lower back has been a problem and in my records but they state it wasn't "Chronic" and now as years have gone on it has become more severe. They have started to recognize the affect but are not tying it together. The VA have been sending me to a downtown Podiatrist for years, he has put me thru his entire regimen from PT, Heat/icing, stretching, cortisone shots (6 each foot in 12 months) and other pain pills and he has told me all he can think of is exploratory surgery (his words 50/50 and "I wouldn't do it if were me"). I have seen the VA Podiatrist in Seattle and he gave me 6 shots (nerve blocks) over a span of 6 months along with all the regular stuff to no avail and has told me that there is nothing left but surgery (and he also stated he wouldn't do it). I am still seeing my General practitioner (8+ years) from the VA whom is prescribing my Morphine (30Mg a day CR and 15Mg IR for breakthrough pain) and I have been referred by her downtown for Nerve studies (all negative), a MRI (L5-S1 minimum bulging), PT and the rest of the typical regimen. I have seen my regular Doc (non-VA) and he has been sending me to Chiropractic care and PT stating he can no longer think of anything to do, he did send me to a Podiatrist...the same one I am seeing for the VA (small pool of Dr's in Alaska). The original VA Podiatrist is one whom had written a long explanative on the relationship and architecture of the Feet and the back, went into great detail of how they are related and put it in my files. He also told me the VA would probably reject the info during my C&P for some reason or another and he was right. The exam findings stated that they had never read anything (in a medical journal or report) tying the two together, I fought it but my VFW dropped the ball and didn't file in time...so I switched to the DAV and they tell me any evidence already submitted cannot be looked at again. I don't want anyone to create and Bravo Sierra on my behalf, but I know if someone sifted thru my records they would put two and two together to show I am not getting better...and by the VA prescribing all these efforts without any betterment, I am getting worse and it starting to effect more functions of my body. Yes I am working, I've tried to taper off the Morphine because frankly I need my brain, I've quit drinking two years ago because I was drinking away pain and depression. I have gone to anger management and also requested pain management classes and anything to help cope thru the VA (they haven't got back to me yet). I have so much info and I know this entire thread will be full of it...I just need the right people to help!
  6. Hi folks, I need help on how to get increase in my disabilty. Currently the VA has me at 30% for Bi-lateral Plantar Fasciitius, this has been an ongoing fight for me and trying to tie my Low Back issues with PF but I may get to that later. I visited the DAV yesterday and they told me I couldn't really request a increase, my Primary care or Podiatrist must state in my records that I meet the more "Pronounced" criteria as opposed to the now "Severe" and then to request an increase and add that my low back issue is "secondary to or exasberated by" the original issue. How in the world to I ask my physcian to report that condition has worsened and meets the higher criteria? I can barely get them to discuss my blood work much less something that will cause an increase. I have been fighting for far too long and as of now my Poditrist, physical therapist and Dr have all but quit and are (and have been) refilling my script for Morphine every month. Morphine, 30mg a day. A DAY! Anyway I could use some advice on how to make this work........
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