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VetDeniedSince1980s

Your Opinion Please Read!!!

Question

For anyone who cares to Review and comment. Especially you Ms. Berta!!!

First document is SMR indicating my dad injured his left foot with a fracture to his 2nd metatarsal in 1969. 

Second document is an X-ray result from CP exam in 2005. Please note old nonunion fracture to RIGHT foot 5th metatarsal along with all other issues to RIGHT foot and leg. And no findings or issues whatsoever to left leg or foot. 

If you were the one conducting this exam just by reviewing both these documents what would your opinion be??? Please comment and Thank You All!!!!

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Edited by VetDeniedSince1980s

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I moved your post to VA claims research because I think it will get more views there. 

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Based on the info in the two documents, I believe service connection will not be granted.    The most recent report indicates fracture to 5th metatarsal of right foot and the 1969 report reflects a contusion(bruise) and fracture to 2nd metatarsal of the left foot.   It is not only a question of right foot versus left foot but 5th metatarsal versus 2nd metatarsal.  This gives the VA even more ammo to deny the claim since the reports also differ on which bone was fractured. 

In my opinion,  this claim will continue to be denied without an IMO and the IMO will have to show a strong nexus between your father's current medical condition and his military service and be supported by reasonable medical rationale.  Due to the amount of time that has passed and the differences in the two reports, I think it would be difficult for an orthopedic specialist to provide a credible IMO.   I hope I am wrong.

GP

 

 

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The thing that is missing is the nexus.  A nexus statment, which may or may not be elsewhere in your records will be something close to "the Veterans (current disability diagnosis) is at least as likely as not due to a foot fracture in 1969 during military service".  

Absent a nexus, I agree that it wont fly.  Im not qualifed to differentiate between the 2d and 5th metatarsals, that is a significant discrepency and would also need some sort of resolution. 

I recommend:

1.  Review your records, and look for a nexus statement.  It need not be that doc, it can be another doc who examined you.  If you find that elusive nexus, then keep appealing and allege a "colvin" violation.  (Colvin violation means the decision maker has substituted his own unsubstantiated (medical) opinion for that of a qualified medical professional.   Or, the decision maker went "against" the favorable medical opinion and did not give a reason or bases as to why he found this examiners opinion to be unpersuasive.)

2.  If you find a nexus, keep appealing until you win.  

3.  If the nexus is missing, then try to see if it has been unincluded in your cfile for whatever reason.  If its just "gone" then resbmit the nexus and you can reopen due to N and M evidence via 38 cfr 3.156.  

4.  If there is no nexus anywhere, then an IME/IMO will be necessary for service connection UNLESS you can get the nexus statement from a VA medical professional.  

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My impression is useless.  I'm no radiologist and cant tell heads from tails about what the situation is without all of the fact in front of me.  That being said, was the 1st report done by a VA Radiology department?  If so, you might want to take the x rays to a non va radiologist/orthopedic specialist and get it read again. 

I had my back re-read like that and it opened up a whole new story that got my back service connected. 

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unfortunately the foot has a lot of low ratings

 

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 
Bilateral50
Unilateral30
Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities: 
Bilateral30
Unilateral20
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 unilateral10
Mild; symptoms relieved by built-up shoe or arch support0
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 rating10
5278   Claw foot (pes cavus), acquired: 
Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity: 
Bilateral50
Unilateral30
All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads: 
Bilateral30
Unilateral20
Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads: 
Bilateral10
Unilateral10
Slight0
5279   Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral10
5280   Hallux valgus, unilateral: 
Operated with resection of metatarsal head10
Severe, if equivalent to amputation of great toe10
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 foot10
Single toes0
5283   Tarsal, or metatarsal bones, malunion of, or nonunion of: 
Severe30
Moderately severe20
Moderate10
Note: With actual loss of use of the foot, rate 40 percent. 
5284   Foot injuries, other: 
Severe30
Moderately severe20
Moderate10
Note: With actual loss of use of the foot, rate 40 percent. 

......Buck

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§4.70   Inadequate examinations.

If the report of examination is inadequate as a basis for the required consideration of service connection and evaluation, the rating agency may request a supplementary report from the examiner giving further details as to the limitations of the disabled person's ordinary activity imposed by the disease, injury, or residual condition, the prognosis for return to, or continuance of, useful work. When the best interests of the service will be advanced by personal conference with the examiner, such conference may be arranged through channels.

 

I agree with georgiapapa and the other members  He needs to get a IMO (INDEPENDENT MEDICAL OPINION)

I think a trip to a private Foot Dr (specialist ) would be very beneficial  and have Doc to read these exams and then exam your Dad and give his opinion as to the left& right leg/foot  and state in his opinion this is at least as likely as not due to his prior military service on what he finds.

And take the military medical records that you have and high lite the parts that this Specialist needs to read   let him know he don't need to read all the report but the main parts about what they said about your Dad leg/foot Back then,  so he can state he read his past military records about his LEFT &  RIGHT LEG &FOOT.

The VA will take the private foot specialist impression over a VA Regular MD.

 

I wish your Dad the Best and he gets a good decision soon!

Hang In There!

 

......................Buck

 

jmo

 

...................Buck

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