Automobile Allowance Denied

[Michellee]

Well big yellow envelope came in today. WHERE DO I GO FROM HERE? WHAT MORE EVIDENCE ARE THEY LOOKING FOR? I DON"T UNDERSTAND> OK the reason for decision says that imo dr xxxxxxxx noted that i suffered a cervical spine injury which resulted in left foot drop with one hundred percent loss of use of the leg and cervical radiculopathy with seventy five percent loss of use of the right arm> Then they have medical physical statement filled out by VA doc where he states I have left foot drop. Then they dont mention my DDD and claim there is no evidence that I have loss of use of the left lower extremity. ?????? Then they don't mention the MRI that shows the spinal stenosis or cord injury and they also report that they obtained outpation treatment reports from the VA medical center that showed I just enrolle in the primary care clinic in March 2010. I am confused on that one I have been enrolled since Jan 98. I was medically boarded out from active duty for a Left foot Lisfranc Injury gone bad and from incorrect casting of the left foot. They immediately caught my spinal problems after I reported to the VA as soon as I got home. I fell in a 15 foot hole during the Gulf war. So that is how I sustained all those traumatic injuries. Getting back to letter they noted an error that Physical therapy had said I was able to ambulate 30 feet with use of rolling walker which was an error that I had to take up with PT and they said they would fix they meant 3 feet and not 30 feet and some how regional got the incorrect info and not the correction that PT made. They also note that I have descrepancies with the lenght of my extremeties. I guess one of my legs have become shorter which is a result of the continuos incorrect casting while on active duty which threw my hip out and today I have severe pain in my hip and lumbar. They keep citing that I dont meet the requirement of 38 CFR 3.808. When I do have loss of use my left foot. Also have loss of function of my left leg and have no effective functioning ability to ambulate with it. Maybe I can get my outside neuro doc to explain to them and do a nexus. Do you think that will help. Perhaps its not tied together because I have so many different things going on with my back and my left foot. I can ambulate without a wheelchair if I did I would be dragging it while using a cane and could only do it for about 3 feet. I find things stuck in it and don't even realize it was there, tacks, paperclips, little rocks under my foot sometimes. My left leg is ice cold when my right leg is nice and warm. They don't even mention my MRI that I submitted as evidence. Should I drive down to Regional its about 3 hours away. What should I do now? This is the second refile for this claim. I am getting tired.

[Michellee]

Help please, looking for suggestions and anyone who has been through similar and been successful.

[LarryJ]

I've got a claim in concerning MY left leg (what's left of it) at this time, but I have not received any correspondence from the VA as of yet. Having trouble driving the old Volvo with the clutch, need something to get back and forth to the VAMC, considering I'm down there two or mores times weekly.

[JamesBreckenridge]

Michellee: Wait, you have loss of use of your left foot, and it's service connected, and they DENIED a claim for automobile grant? What EXACTLY did they say in the narrative?

See 38 CFR 3.808

EDIT: Ah, I had to re-read your post. It looks like they're saying you don't have loss of use of your left foot? But what you're describing sounds like loss of use to me. Here's how we define "loss of use":

Per 38 CRR 3.350:

Foot and hand. (i) Loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis; for example:

( a ) Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 31/2inches or more, will constitute loss of use of the hand or foot involved.

( b ) Complete paralysis of the external popliteal nerve (common peroneal) and consequent footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot.

If your foot is about as useful to walking as a prosthetic would be, that's loss of use. You don't have to actually HAVE a prosthetic foot. ANd I've seen opinions that come saying that the vet's foot is WORSE than a prosthetic. Loss of use. If a claim like yours crossed my desk, I'd have to ask for a medical opinion from the VA doc that examined you. "Doc, is the vet's foot drop the equivalent of loss of use, which we define as being when the propulsion and balance functions of the foot could just as well be performed by a prosthetic?" Usually, the response I get back is that yes, it's loss of use.

If you're using a walker and are just dragging it around with you, that's loss of use to me. Do you have a POA or VSO who is fairly chummy with the Rating Board, who can talk to them and ask "Why was this denied?"

You could actually visit your state's Regional Office. You might even be able to meet with the Service Center Manager or possibly even someone from the Director's Office, and SHOW them that you can't move your foot, that you're just dragging it and it does you no good as far as balance or propulsion goes. That can sometimes get something accomplished.

Was there not a medical opinion as to loss of use requested? If not, ask for one. In the alternative, you could have your family doctor or whoever looks at your orthopedic complaints render a medical opinion. Something along the lines of "I have been treating Michelle since (whenever) and she has (whatever condition of the left leg). It has resulted in complete foot drop, rendering her left foot no more useful than a prosthetic would be in regards to balance and propulsion functions. She has loss of use of her left foot." If I saw a claim come in with that, I'm not even going to bother sending the vet to a VA exam or opinion, I've got what I need already.

And Larry: You need to about be in a wheelchair or similar to get Specially Adapted Housing per 3.809. Special Home Adaptation under 3.808a requires you to be nearly blind or not able to use your hands.

Edited August 4, 2010 by JamesBreckenridge

[LarryJ]

Michellee: Wait, you have loss of use of your left foot, and it's service connected, and they DENIED a claim for automobile grant? What EXACTLY did they say in the narrative?

See 38 CFR 3.808

And Larry: You need to about be in a wheelchair or similar to get Specially Adapted Housing per 3.809. Special Home Adaptation under 3.808a requires you to be nearly blind or not able to use your hands.

No, James, I'm sorry, maybe I didn't make sense with my posting.

I am in the same situation as Michellee vis a vis her loss of use of her left foot and the fact that she has filed trying to get her automobile grant. I have filed to get my automobile grant also, having JUST filed and not heard anything back as of yet. The old Volvo I'm trying to drive has a manual transmission and my left "foot" is at an approximately 45 degree angle from where it should be due to bones in my lower left leg having been broken (along with my ankle and foot having been crushed) and not corrected surgically at that time. Anyway now they cannot come up with a prothesis that will allow me the use of my foot in the fashion G-d intended so, in trying to operate the clutch, sometimes it's okay, sometimes my foot will not stay on the clutch pedal (making for interesting take-offs and landings) and sometimes when I go to use the clutch I simply cannot FIND it with my foot.

Anyway, I was very interested in her posting, seeing as how I am up against the same situation. Heck, I can't even find anyone that knows what you have to provide, proof-wise, to get the grant. They say you must have loss of your foot OR loss of USE of your foot. WHO determines that? I ask my PCP and he blinks like an owl and hunches up his shoulders . I ask the person at the counter at the VBA office in the VAMC where I have MY office, same thing . I ask the lady at the prosthesis office . I'm going to ask the cute little gal at the hearing clinic next, not that she'd have any idea, but I want to see her bat her baby-blues !

[Michellee]

OK I finally got the attachment to work. Here is what the Regional office said. Keep in mind I have only scanned the reason for decision page and taken out personal information like name, SSN and doctor name and VA treating facility. My current S/C ratings are Degenerative Disease Lumbar spine 30%, Traumatic Athritis at 0%, Risiduals of Foot injury (Lis Franc) 20%, Paralysis of sciatic nerve left leg 20%, Paralysis of sciatic nerve right leg 20%, Tendon inflamation 10%, MDD 30%, left hip strain at 10%, and then there is some female conditions that were both rated as 0 % which resulted in my uterus traumatic flipping over and was not like that prior to the fall and they only gave me 0% which I have major problems with to this day. I also have multiple spinal trauma that I have not been rated for that was picked up by 2 different MRI one of them I have attached below. VA acknowledge it after I was awarded TDIU and I didn't bother to get rerated for the spine, cervical, swollen shoulder etc, migraines. I had been complaining since the fall and even when I got home and reported to the VA about about my neck and my back and they kept telling me it was just DDD and athritis. I have been having migraines since 98 and no rating or diagnoses. I suspect all of this is a result of the service connected injury sustained from falling in a 15 foot hole which I was rescued, hospitalized and under treatment for 2 years before being medically discharged for and told to report to the VA when I got home. Some things have become bearable through medications and some have flat out gotten worse. I am losing my right arm and lost my left foot and leg, and they act like its no big deal. I get so tired of fighting, begging, borrowing. I even had PT to annotate incorrectly in my records that I used a walker for 30 feet when they claim they went back and made a correction by adding an addendum to my record saying the therapist was mistaken in his not and I am not capable of going more than 3 feet with a rolling walker and thats dragging my leg. Furthermore, they didn't include the MRI in the list of evidence and they make it sound like my disability is due to pain and numbness. I have spinal cord injury noted on my MRI and stenosis of spinal canal putting pressure on the chord, mine is down to 8.6 and a normal adult female is suppose to be between 12-14 so I was told by neuro that I am seeing now outside the VA. I have straightening of the normal cervical curvature (military neck), right neural foramen spondylosis, bulging disk at the C5-C6, reduce height C5-C6 and ALL DISK SPACES ARE REDUCED IN SIGNAL. So maybe something is not talking to my left leg or foot. You think???????? I am so fustrated and my anxiety is off the scale right now. I also have osteophytes are seen on the left of the C4-C5 this was on the xray and not the recent MRI. The VA doc kept refering to all of this as neck pain. WTF. I finally went and made an appointment with a real neuro doc outside the VA that we are using my husband's Tricare for and paying additional fees out of pocket. I need to know whats really going on and why, and what the real diagnoses are in addition to all this. James what do you think about all of this??? Larry your guess is as good as mine???? Good luck. Keep my posted on how you make out, though. It will be interesting. Sorry I wrote so much, I am just really pissed right now.

OK I finally got the attachment to work. Here is what the Regional office said. Keep in mind I have only scanned the reason for decision page and taken out personal information like name, SSN and doctor name and VA treating facility. My current S/C ratings are Degenerative Disease Lumbar spine 30%, Traumatic Athritis at 0%, Risiduals of Foot injury (Lis Franc) 20%, Paralysis of sciatic nerve left leg 20%, Paralysis of sciatic nerve right leg 20%, Tendon inflamation 10%, MDD 30%, left hip strain at 10%, and then there is some female conditions that were both rated as 0 % which resulted in my uterus traumatic flipping over and was not like that prior to the fall and they only gave me 0% which I have major problems with to this day. I also have multiple spinal trauma that I have not been rated for that was picked up by 2 different MRI one of them I have attached below. VA acknowledge it after I was awarded TDIU and I didn't bother to get rerated for the spine, cervical, swollen shoulder etc, migraines. I had been complaining since the fall and even when I got home and reported to the VA about about my neck and my back and they kept telling me it was just DDD and athritis. I have been having migraines since 98 and no rating or diagnoses. I suspect all of this is a result of the service connected injury sustained from falling in a 15 foot hole which I was rescued, hospitalized and under treatment for 2 years before being medically discharged for and told to report to the VA when I got home. Some things have become bearable through medications and some have flat out gotten worse. I am losing my right arm and lost my left foot and leg, and they act like its no big deal. I get so tired of fighting, begging, borrowing. I even had PT to annotate incorrectly in my records that I used a walker for 30 feet when they claim they went back and made a correction by adding an addendum to my record saying the therapist was mistaken in his not and I am not capable of going more than 3 feet with a rolling walker and thats dragging my leg. Furthermore, they didn't include the MRI in the list of evidence and they make it sound like my disability is due to pain and numbness. I have spinal cord injury noted on my MRI and stenosis of spinal canal putting pressure on the chord, mine is down to 8.6 and a normal adult female is suppose to be between 12-14 so I was told by neuro that I am seeing now outside the VA. I have straightening of the normal cervical curvature (military neck), right neural foramen spondylosis, bulging disk at the C5-C6, reduce height C5-C6 and ALL DISK SPACES ARE REDUCED IN SIGNAL. So maybe something is not talking to my left leg or foot. You think???????? I am so fustrated and my anxiety is off the scale right now. I also have osteophytes are seen on the left of the C4-C5 this was on the xray and not the recent MRI. The VA doc kept refering to all of this as neck pain. WTF. I finally went and made an appointment with a real neuro doc outside the VA that we are using my husband's Tricare for and paying additional fees out of pocket. I need to know whats really going on and why, and what the real diagnoses are in addition to all this. James what do you think about all of this??? Larry your guess is as good as mine???? Good luck. Keep my posted on how you make out, though. It will be interesting. Sorry I wrote so much, I am just really pissed right now.

[JamesBreckenridge]

It doesn't appear to me that the VA examiner was asked the question if there was loss of use of the foot. I would need a copy of the C&P exam and the 2507 exam request to be sure, but that's how it looks. I'm guessing that what happened was that somebody was either lazy or poorly trained or having a bad day, and instead of asking the correct question, they just checked the box that results in an standard examination to evaluate the leg, and no opinion was even requested.

What aggravates me is that you HAVE an opinion by a private doctor that says there is loss of use! And the VA examiner may not have said in so many words that there was loss of use, but he sure as heck didn't say there WASN'T!

Do you have a POA?

The fastest way to get this fixed is to turn right around and ask for a reconsideration, that you feel that either your private doctor's opinion was ignored, or that the VA doctor was not asked whether there was loss of use according to the VA definition. Before you do THAT though, request the 2507 exam request and a copy of the C&P examination to see what the VA doctor was actually asked and what his actual reply was.

Also, if you're going to a private doctor anyway, print out the definition I gave you for "loss of use" and ask for a medical opinion as to whether your condition meets the criteria, and include that with your request for reconsideration.