ASU_0331

So while I was attending college on my Post 9/11 GI Bill I worked in the student veteran center and later on at a county veterans services center. Colleges/Universities are absolutely notorious about certifying veteran educational benefits, meaning that they take forever to do it. I saw this at the community college level up into the university level where veterans would be looking at eviction, repossession, and food shortages due to the ineptness of certifying officials. Firstly, you need to hammer the student veterans center constantly. Start emailing the college administration, CC'ing your representatives from the city, state, and federal level. When I was vice-president of the student veteran association on campus, we had to make fools out of the admin, shame them in the press, and show their asses to every politician we could to force the change needed to gets veterans certified and their benefits flowing.

Update on my C&P exam for bilateral degenerative arthritis of great toe, bilateral IT Band Syndrome, bilateral Osgood Schlatter, and bilateral heel spurs. Examiner acknowledged everything except the Osgood Schlatter disease, because apparently despite the PA at the VA medical center specifically telling me I had Osgood Schlatter disease to my face, she did not write it down in her report. So I basically have had the same issue with my knees, documented since 2017 in both visits and imaging, but not a single doctor has made a diagnosis of what is actually wrong with my knees. The tibial tuberosity is there, on imaging the tendon is showing inflammation and the bumps are clearly visible on my knees below the patella and tender to the examiner's. And they have been there since 2017, but no diagnosis. There is only a note in an imaging report in 2020 to check patient history for Osgood Schlatter's disease (which there is no history). I so by her own explanation of items, I am expecting ratings on 3 items and a denial on the one missing a diagnosis due to doctors over 5 years choosing not to annotate a diagnosis in my records.

QTC did the work-up on my pes planus and it was done extremely well. Granted the provider was wearing bulky as hell orthopedics so she knew exactly what she was seeing when I took off my shoes/socks, saw my feet, and started typing like mad. Personally, I think I am going to fill out the DBQ and hand it over "innocently" so my statements are entered as I say them and not only through annotation by the provider.

So got an email from QTC to expect a call from them to schedule some C&P appointments for a host of lower extremity issues. I logged into the website and lo and behold, they already have me scheduled for two days next week, 08/24-08/25. On the website under my "account" there was a DBQ form that was for all the items on this claim. Do I fill this out prior to my appointment or is this supposed to just be a primer that will be filled out by the provider as they ask me questions? It seems that if I go ahead and take the initiative to fill it out in my own words, I will be able to convey everything I am dealing with, how long, and how it has all manifested from my service-connected disabilities.

Crazy fast update; C&P for all lower extremity issues scheduled for 08/24 and 08/25. Nothing scheduled for the anxiety/depression claim despite being combined. Not sure if it is prove the pain exists and is service connected for the lower extremity issues before diving into the anxiety/depression issue. When I filed, specifically pointed out that the anxiety/depression were linked to my already rated 90% disabilities, not the new ones I am claiming.

Just an update since original post; I went ahead and submitted a claim for anxiety and depression secondary to my existing disabilities and chronic pain. Mainly to preserve date, but also since I am in the middle of treatment, the records will be available. They just combined that claim with my other claim for a host of lower extremity issues that are secondary to my 50% rating of pes planus with plantar fasciitis AND I just received notice that QTC will be contacting me to schedule C&P exams shortly. One of the fastest responses on submission of a fully developed claim that I have ever seen.

The problem I have experienced with this is that they consider the foot pain associated with the plantar fasciitis and the foot pain associated with pes planus as pyramiding symptoms or whatever the hell they call it. During my C&P exam for pes planus, the examiner was astonished at the condition of my feet. She was dropping all the keywords in her notes for 50% rating on pes planus alone. and then spent the rest of time telling me all about how bad her feet were due to pes planus. I think the issue at hand for me was that my VA doctor had just recently diagnosed me with bilateral plantar fasciitis before my C&P so it was in my medical records. So despite only filing a claim for pes planus, they did a combined rating and included plantar fasciitis in the 50% rating. I appealed once already, pointing out that since 2017, my treatment had been for pes planus and pes planus alone and that not one doctor had diagnosed me with plantar fasciitis in that time. So logically, that would mean that pes planus was the primary condition that then caused the secondary condition (plantar fasciitis) and therefore it should have its own separate rating. The denial letter basically pointed out the pyramiding symptoms argument, despite the rating for plantar fasciitis being having been released as its own rating. My main issue is that the two types of pain are very, very different. The flat foot for me is a bone-aching, deep throbbing pain all the time whereas the plantar fasciitis pain is more akin to getting a knife stabbed into the soft tissue of the foot. Yes, they are both foot pain, but on completely different spectrums.

Already asking about that in another thread Pac. Thanks for the advice.

So finally bit the bullet and started working with local VA mental health clinic. To be honest, it is a complete and total pain in the ass dealing with a system where face to face communication for me would be ideal in evaluation, but because the VA is still all about COVID masking and social distancing, everything takes place over a damn phone or video conference. In my opinion, complete and total shit show. But anyway, anxiety regarding keeping my wife and daughter safe and being able to keep them safe/provide for them with my multiple health issues got to the point that it was hurting my relationship with them and my work. I am always running scenarios, just like when running an convoy security/escort security, except now the focus is always my wife and daughter. So I went in started the process of seeing what they could for me. After all the intake sessions, they suggested prescription based treatment, but I have no desire to go down that road at this time and instead asked for referral to non-drug treatment. The question is regarding a couple of scales they talked about with me after questioning; specifically the PHQ-9 Depression Scale and the GAD-7 Score. I scored 18/20 respectively on those two scales. Other than highly suggesting getting on drugs for treatment, they really didn't indicate what these meant. Anyone able to help me understand this and if any of this is applicable to a claim that I should file? Also, does filing a MH claim with the VA get released as information for "extacurricular" activities? I am an avid hunter with a bull elk hunt in November for example and don't want to be relegated to becoming an archery hunter only.

So I am 60% on CAD, 50% bilateral pes planus w/plantar fasciitis, 20% DM II, and 10% tinnitus. My CAD will never get better. In fact it has only progressed since my heart attack in 2005. DM II has plateaued with medication, but again, never going away. Barring dsurgery to "release" the plantar tendon, there is nothing to do there except keep suffering with the crap insoles they continue to fit me with. The DM II basically screws me out of corticolsteroid shots as it messes pretty bad with my blood sugar. Currently have claims in for newly diagnoses Osgood Schlatters for both knees, degenerative arthritis of great toes, IT Band Syndrome of both legs, and calcaneal spurs of both feet (all secondary to the service connected bilateral pes planus). If awarded at minimum on these remaining, I will be at 100%. The questions arises is if it is possible to get P&T for any of the issues in combination or on their own even if not at a full 100% individually? I am guessing getting permanent would be a no brainer, but it is the total that seems to be the hurdle.

So decision letter came in today and things are looking pretty damn good from my point of view. Gonna abridge non relevant parts to save time From my decision letter; “We have assigned a 50 percent evaluation for your bilateral pes planus based on: Marked pronation (L/R) Symptoms NOT improved by orthopedic shoe or appliance (L/R) Additional symptom(s) include: Characteristic callosities (L/R) Indication of swelling on use (L/R) Objective evidence of marked deformity (L/R) Pain on manipulation of feet (L/R) Pain on manipulation of feet, accentuated (L/R) Pain on use of feet (L/R) Pain on use of feet, accentuated (L/R) Weight-bearing line over or medial to great toe (L/R) This is the highest scheduler evaluation allowed under the law for flatfoot, acquired. (38 CFR 4.57, 38 CFR 4.71a)” Not a single thing mentioned regarding my plantar fasciitis diagnosis or current steroid injection treatment. Now the pain on use/manipulation/accentuated may be viewed as possible pyramiding for both conditions, but there are additional symptoms/manifestations of plantar fasciitis that are not covered under the 5276 for pes planus, but are covered under the 5269 plantar fasciitis rating. Right now my strategy going forward will be to file for compensation on my current intent to file for issues secondary to the now service-connected pes planus. This includes plantar fasciitis, arthritis of big toes and both knees, ITB syndrome, and patellar tendinosis. If they deny the plantar fasciitis, but grant the others, I can appeal at that time while still getting a percentage bump and additional bilateral factor bump.

Was contacted by the VA today to make an appointment for some ultrasounds as well on my lower extremities. Guess this is going to be a full work-up on my legs due to my current CAD rating of 60%.

So just got a provider message from my cardiologist that he wants to get some ankle brachial pressure index readings done on me for the next 3-4 weeks. Anyone know what this entails? Am I going to be wearing a monitor or something at work? Also, I am already rated at 60% with CAD secondary to DMII. Does atherosclerotic vascular disease affecting the lower extremities have its own rating schedule despite already being rated for CAD at 60%?

So I am getting juggled a bit between VSO since my awesome last one retired so would appreciate the proper route to take. I was just rated at at 50% Pes Planus with Plantar Fasciitis under 5276. This was a supplemental claim for only pes planus that was filed on 02/01/21 with a decision made on 03/12/21. After speaking with a VSO, who read me the decision letter and raters notes, he said there is no doubt the 50% for pronounced pes planus was justified, but was not sure why they arbitrarily added plantar fasciitis to the decision. I mentioned to the VSO that effective 02/04/21, a diagnostic code of 5269 - Plantar Fasciitis was added to the schedule of ratings - musculoskeletal system and if it was possible that they combined them under diagnostic code 5676, because that was how it was always done before and the rater did not read or know about the new diagnostic code. He said that could be the reason. Just to note, I was diagnosed at the VA with bilateral pes planus in 2017 and given insoles. I was again seen by the VA for foot pain and bilateral pes planus was again affirmed in 2018 with a different set of insoles. This last January I again went in with foot pain where pes planus was again affirmed, had another set of insoles cast, and was diagnosed for the first time with bilateral plantar fasciitis and given steroid injections in each foot. Ultimately I am looking to get the plantar fasciitis rated separately from the pes planus under the new diagnostic code of 5269, which due to the severity and being bilateral would be at 30%. In fact, my VSO had already submitted an intent to file for bilateral plantar fasciitis, arthritis of both great toes, patellar tendinosis of both knees, arthritis of both knees, and ITB syndrome as being secondary to the pes planus once it was service-connected. The history of my pes planus dates back to my final physical and I have been receiving treatment for it since 2017 in the form of insoles when it was originally diagnosed with the VA. It was only this last year that I was diagnosed with plantar fasciitis as a result of the pes planus. So what route do I take on this supplemental claim? I feel like a High level Review won't allow me to submit the VA medical records showing that I have been treated unsuccessfully for pes planus since 2017. Is that something I can bring up in the phone conversation with the reviewer to get the plantar fasciitis rated separately under 5269? I am not submitting any new evidence so to speak, but literally VA medical records that were already in the system for years. The other question is, does the new diagnostic rating for plantar fasciitis even apply to me? I filed on 02/01/21 and the new rating schedule went into effect on 02/04/21. I want to fight this decision because I am already rated at 70% with CAD, DMII, and Tinnitus. Getting the plantar fasciitis rated separately would be the difference between an 86% rating rounding up to 90% and 92% rounding down to 90%. This does not include the issues secondary to the pes planus like the arthritis and tendinosis that are under my current intent to file.

So I had forgotten about something I had read while researching Pes Planus and Plantar Fasciitis. In February, 2021, the VA specifically created a new rating code for Plantar Fasciitis, 5269 which when bilateral and you get no relief from both non-surgical and surgical treatment is 30%. I am thinking that since my supplemental claim for pes planus went in on 02/01 with a decision made on 03/12, they used the old rating system and lumped it all under the 5276 rating at 50%. Under the new rating, I should be get a 50% rating under 5276 and more than likely a 30% rating under 5269. This would also trigger a bilateral factor since it would be two compensable disabilities on both legs. Going to end up appealing to make sure the ratings are correctly done under the correct codes. Seems like my ratings hit an overlap.

Thanks all. I am going to see how they end up coding it when the BBE comes in and I will drop the info here just for search engine's sake.

So I am currently at 20% DMII with 60% CAD secondary to the DMII. I have recently been working on my pes planus claim and associated pain with plantar fasciitis. This includes a ton of general pain in my legs from calf muscles into knees and thighs. I have always attributed this pain to my pes planus altering my gait. However with all the x-rays I have had for my pes planus claim and other items, something has been popping out to me. On my latest knee x-rays this is included; "There are atherosclerotic vascular calcifications." On the x-rays of my hips there are these two notes in the report, "Extensive calcified atherosclerotic vascular disease for age." and "Advanced calcified atherosclerotic vascular disease for age." So looking for more info on this being a new secondary to the DMII or is it secondary to the CAD which is secondary to the DMII. I wasn't even sure where it falls under on the ratings tables either. Appreciate the help.

Hello all, So got home from being away for five days and discover that a decision was made on my supplemental claim for pes planus. I am waiting on the BBE, but currently E-Benefits currently has the following; bilateral pes planus with plantar fasciitis 50% My supplemental claim was for bilateral pes planus, which after my QTC exam I was certain I would be rated at the pronounced bilateral rating of 50% due to my conversation with the examiner and her comments as she examined my feet. I currently have an intent to file which was going to cover issues secondary to my bilateral pes planus once the pes planus was service-connected, which would have been arthritis in both big toes, plantar fasciitis, arthritis in both knees, ITB Syndrome, and patellar tendinosis. Am I being shortchanged by them combining the pes planus with plantar fasciitis as E-Benefits currently has it listed? My initial pes planus diagnosis dates back to 2017 and my bilateral plantar fasciitis diagnosis was just made at the beginning of this year which to me makes it secondary to the bilateral pes planus and thus deserving of its own rating. And while I know you don't get a bilateral factor added when you get a flat bilateral rating for pes planus, I was certain you get the bilateral rating when you are rated for both bilateral pes planus AND bilateral plantar fasciitis. Just seems fishy to me that they added the "with plantar fasciitis" to what appears to be the rating for pronounced bilateral flat feet at 50%.

Ham, Is there a bilateral rating in the case of two compensable disabilities that are labeled such as the "pronounced bilateral flat feet"? For example, pronounced bilateral flat feet is at 50% and 30% for both feet affected by plantar fasciitis. Would a combined rating get the bilateral factor applied?

Hamslice, I think you are getting hamstrung (pun completely intended) by the wording of the rating criteria, which is why you are not getting a bilateral factor; 10% – Veterans can receive the 10 percent rating for plantar fasciitis affecting one or both feet that is responsive to treatment. Verbiage in that details a flat 10% if one or both feet are affected. At second highest rating; 30% – Veterans can receive the 30 percent rating for plantar fasciitis affecting both feet and is not responsive to treatment. I think you would then be getting a bilateral factor included. If what you said was true of pes planus, a veteran with 30% on the left and 20% on the right with bilateral factor would be getting the same as the highest rated criteria for pes planus; 30 + 20 = 44 + 4.4 bilateral =48.4 =>50% total rating.

Getting mixed messages on this now. Hahahaha, which is just how the VA likes it! Broken, where is that calculator located. Very nice one rather than the one that I use.

So if I understand you correctly, pronounced bilateral pes planus is 50%. This would mean the left foot is 50% and the right foot is 50%. Bilateral factor of 10% makes this 55% with a push to 60%?

Can someone explain to me the bilateral factor, specifically when it comes to such issues as pes planus and plantar fasciitis? If you have pronounced bilateral pes planus, they give you 50%. Does a bilateral factor apply or is it already included into the 50% award? The same question with the new rating criteria for plantar fasciitis; when it affects both feet and not responsive to treatment, they give you 30%. So if I understand it correctly, you can have bilateral pes planus and get just a straight 50%, no bilateral factor added. The same if you have bilateral plantar fasciitis. The only time you would then get a bilateral factor is if you have BOTH bilateral pes planus and bilateral plantar fasciitis. Then it would go in order of severity, in this case 50% for the pes planus + 30% for plantar fasciitis = VA math + 10% bilateral factor = Total disability rating? Thanks for replies all.

Just an update; Had a C&P exam with QTC on Tuesday (02/16). Was pretty surprised that I got called up for one so quickly after my VSO submitted the supplemental claim. The exam was with a FPN and she was very nice and pleasant to deal with. She dived into my records pretty hard and was able to pull up something that I didn't even remember from 1995 where I was seen for foot pain and issued inserts for my boots. She then linked it to final physical exam where pes planus was noted as well as continued complaints of foot pain, especially during cold weather in 1998 and then again when I got out in 2003. Then she dived into the most current visits I have had with the VA starting in 2017 or so and then end up with the actual physical exam. She performed a pretty quick exam and seemed to hit all the key points and entered them in her notes and computer. One thing to note, she had very obvious feet/knee/hip issues and during her exam she continually pointed out how she had to deal with the exact same issues she was seeing on me. She even went so far as to reach into her purse and show me the cold treatment roll-on she uses for her flare-ups to get her through the day. I know that QTC gets a bad rap sometimes, as well as FPN, but between my QTC exam for CAD and this one for feet, they have treated me pretty well. Just waiting to see what was determined now.

I remember other QTC exams being uploaded to Blue Button, but cannot remember where they are located in the reports. Does anyone have any info on where they are located within the medical record available on Blue Button?