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Advice For My Upcoming Peb


johnnyhayhurst

Question

I was diagnosed with a left ankle trimalleolar fracture in JAN of 09 this happened in Florida Ii followed up with ortho the did a CT scan showed that i had a malunion of the left medial malleolus i was two months out of the first surgery and they had to rebrake my ankle in order to do a complete revision. After the next surgery a my ankle became infected a couple weeks later I went in for a surgical debridement and possible removal of the plate i was in the hospital for 2 weeks with a wound vac on my leg they had to go back in and clean it up one more time before i was discharged and they took out the syndesmosis screw and the entire lateral plate. After that on the 30 december he decided to take out the rest of the hardware after he diagnosed me with osteoarthritis. The next time i saw him he told me that I would not improve and consulted me for a Medboard i have left ankle pain, weakness stiffness, instability, locking, lack of endurance and effusion im unable to run cant walk without being in pain. Now I went to pick up my packet today after the DCCS signed it and all they have for a diagnosis is osteoarthritis. The problem i have with this is I have skin adhesion down to the bone on the inside of my left ankle that is about 3 inches long and my range of motion is 10 deg dorsiflextion and 30 deg plantar flexion. So i did some research and im not sure if i got it right but the osteoarthritis stated by my doc the code would be 30% for In plantar flexion, between 30º and 40º, or in dorsiflexion, between 0º and 10º 30 is that correct?

THE CHARACTERISTICS IN RED APPLY TO ME

I also found this about skin deformities but im not sure if it applies to me

A veteran who VA rated under diagnostic codes 7800, 7801, 7802, 7803, 7804, or 7805 before October 23, 2008 can request review under diagnostic codes 7800, 7801, 7802, 7804, and 7805, irrespective of whether the veteran’s disability has increased since the last review. VA will review that veteran’s disability rating to determine whether the veteran may be entitled to a higher disability rating under diagnostic codes 7800, 7801, 7802, 7804, and 7805. A request for review pursuant to this rulemaking will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008.

Rating

With visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or, with four or five characteristics of disfigurement....50

With visible or palpable tissue loss and either gross distortion orasymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips) with two or three characteristics of disfigurement.................................................. 30

With one characteristic of disfigurement..................................................................... 10

Note (1): The 8 characteristics of disfigurement, for purposes of evaluation under §4.118, are:

Scar 5 or more inches (13 or more cm.) in length.

Scar at least one-quarter inch (0.6 cm.) wide at widest part.

Surface contour of scar elevated or depressed on palpation.

Scar adherent to underlying tissue.

Skin hypo-or hyper-pigmented in an area exceeding six square

inches (39 sq. cm.).

Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in

an area exceeding six square inches (39 sq. cm.).

Underlying soft tissue missing in an area exceeding six square

inches (39 sq. cm.).

Skin indurated and inflexible in an area exceeding six square

inches (39 sq. cm.).

Note (2): Rate tissue loss of the auricle under DC 6207 (loss of auricle) and anatomical loss of the eye under DC 6061 (anatomical loss of both eyes) or DC 6063 (anatomical loss of one eye), as appropriate.

Note (3): Take into consideration unretouched color photographs when evaluating under these criteria.

Note (4): Separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply § 4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code.

Note (5): The characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.

I also thought that i might be able to get this through the va

© For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement

(ii) History and complaint. Service department record or other evidence of in-service treatment for the wound. Record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in paragraph © of this section, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles.

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I think this could be problematic for you:

"all they have for a diagnosis is osteoarthritis"

You should receive a rating for the osteoarthritis under the chronic presumptive regulations as long as this claim is filed within one year after service, If you raise this arthritic issue.

I think this could be problematic for you:

"all they have for a diagnosis is osteoarthritis"

“Certain chronic diseases, including arthritis, will be

presumed to have been incurred in or aggravated by service if

they manifest to a degree of 10 percent within one year after

separation from service, even if there is no evidence of such

disease during service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R.

§§ 3.307, 3.309(a). If a chronic disease is noted during

service (or within the applicable presumptive period under 38

C.F.R. § 3.307), subsequent manifestations of the same

disease at any later date, however remote, will be service

connected, unless clearly attributable to intercurrent

causes. However, where a condition is noted during service

(or within the applicable presumptive period) but is not

chronic, service connection may be granted only where there

is evidence of continuity of symptomatology after separation

from service.

38 C.F.R. § 3.303(b). “

BUT- that wont cover the actual residuals you have from the ankle problem.

Are you saying the MED board results do not mention the ankle problems at all?

The scar certainly appears to be ratable as well. If they dont mention the surguvcal problems, then it might be hard to get both the ankle and the scar rated.

Is any of this info in the Med Board packet and in your SMRs?:

"consulted me for a Medboard i have left ankle pain, weakness stiffness, instability, locking, lack of endurance and effusion im unable to run cant walk without being in pain."

Are you still in the Med Board or transition process? Have you been given any info as to getting a VSO and having them help to prepare your SC VA claim?

Did you attend already or is it still coming up- the specific briefings as to the VA claims process?

I feel you need a Vet rep or VSO now to advise you on this.

Is there some way you can challenge the Med Board report or have it corrected while your are still inservice?

I am a civilian-I hope others chime in here.

The osteoarthritis diagnosis should lay the foundation for that rating with few if no problems.Bt this appears to me to be secondary to the main ankle disability.The ankle problem could severely impact on your ability to work as a civilian, at some point in time-so this has to be carefully assessed for service connection.

(Gee sounds like they sure messed up in treating it)

If you got that code and percentage from 38 CFR Schedule of Ratings, I would say that info would be correct if it matches your disability and if the ankle problem is fully accounted for.

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I have question for everyone here-

I understand how the diagnpositc criteria might work here BUT- isnt the ankle problem here -ratable as separate from any secondary osteoarthritis?

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I think this could be problematic for you:

"all they have for a diagnosis is osteoarthritis"

You should receive a rating for the osteoarthritis under the chronic presumptive regulations as long as this claim is filed within one year after service, If you raise this arthritic issue.

I think this could be problematic for you:

"all they have for a diagnosis is osteoarthritis"

"Certain chronic diseases, including arthritis, will be

presumed to have been incurred in or aggravated by service if

they manifest to a degree of 10 percent within one year after

separation from service, even if there is no evidence of such

disease during service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R.

§§ 3.307, 3.309(a). If a chronic disease is noted during

service (or within the applicable presumptive period under 38

C.F.R. § 3.307), subsequent manifestations of the same

disease at any later date, however remote, will be service

connected, unless clearly attributable to intercurrent

causes. However, where a condition is noted during service

(or within the applicable presumptive period) but is not

chronic, service connection may be granted only where there

is evidence of continuity of symptomatology after separation

from service.

38 C.F.R. § 3.303(b). "

BUT- that wont cover the actual residuals you have from the ankle problem.

Are you saying the MED board results do not mention the ankle problems at all?

The scar certainly appears to be ratable as well. If they dont mention the surguvcal problems, then it might be hard to get both the ankle and the scar rated.

Is any of this info in the Med Board packet and in your SMRs?:

"consulted me for a Medboard i have left ankle pain, weakness stiffness, instability, locking, lack of endurance and effusion im unable to run cant walk without being in pain."

Are you still in the Med Board or transition process? Have you been given any info as to getting a VSO and having them help to prepare your SC VA claim?

Did you attend already or is it still coming up- the specific briefings as to the VA claims process?

I feel you need a Vet rep or VSO now to advise you on this.

Is there some way you can challenge the Med Board report or have it corrected while your are still inservice?

I am a civilian-I hope others chime in here.

The osteoarthritis diagnosis should lay the foundation for that rating with few if no problems.Bt this appears to me to be secondary to the main ankle disability.The ankle problem could severely impact on your ability to work as a civilian, at some point in time-so this has to be carefully assessed for service connection.

(Gee sounds like they sure messed up in treating it)

If you got that code and percentage from 38 CFR Schedule of Ratings, I would say that info would be correct if it matches your disability and if the ankle problem is fully accounted for.

yes i am still in the medboard process i recieved my packet back with the signatured from the dccs the other day i can still refuse to sign it and appeal. he does have in the medical history discription that i consulted me for a Medboard i have left ankle pain, weakness stiffness, instability, locking, lack of endurance and effusion im unable to run cant walk without being in pain."

i will talk to the VA tomorrow thanks for the reply it really helped

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