Foot Injuries - what is the difference between #5283 & #5284?

[Navy4life]

 

Okay so I was looking up the ratings for the foot and I found two I should eventually fall under for my foot:

Code 5283: A broken bone in the foot, whether it has not healed properly or at all, is rated on how badly it affects the functioning of the foot. If it is just a bit painful, but overall the foot functions okay, then it is rated 10%. Something more serious, possibly causing significant pain, is rated 20%. Something very serious that significantly affects the use of the foot, but the foot can still be used, is rated 30%.

Code 5284: All other foot conditions and injuries are rated based on their severity and on how much the foot can be used. A moderate condition is rated 10%, a moderately severe condition rated 20%, and a severe condition rated 30%. This coding is only used if none of the other codes can satisfactorily describe the symptoms of the condition. For example, if there is a bone condition in the foot, but it isn’t a break, then it most likely will still be rated under code 5283 as a broken bone since it still affects the same kind of things a broken bone would. Similarly if the condition is a disease, then it should be rated under the code for a similar disease. If it doesn’t fit into any of those other options, then it can be rated here under 5284.

So since my right foot has two breaks to the 5th metatarsal bone (image attached) and I had surgery to repair it (image attached) where I had screws and pins to the spiral fracture and bone graft to the transverse fracture, which code suits me the best?  This break to my right foot is a DIRECT result to my L ankle issues (already S/C).

 

[Navy4life]

Andyman;

I had all the proper documentation when I filed in early 2013.  I just hope they finally get it right!  Thanks!

[Andyman73]

Navy4life,

I spoke with the VARO handling my claims, just last week, and she told me that 6 STR entries isn't enough for her to put me in for a C&P exam.  Fortunately for me I have a regular appt with my PCP this coming Monday, so I will be discussing that and other issues, for sure!

[Navy4life]

1 hour ago, Andyman73 said:

Navy4life,

I spoke with the VARO handling my claims, just last week, and she told me that 6 STR entries isn't enough for her to put me in for a C&P exam.  Fortunately for me I have a regular appt with my PCP this coming Monday, so I will be discussing that and other issues, for sure!

Why would the VARO state that?  When did it become a "certain amount" of STR's (I know them as SMR's) become a requirement?  Wow that is totally odd to me...I agree with you, do your thing, be your own best advocate and get what you deserve!

[Vync]

Navy4life,
It sounds like 5283 to me. 5284 seems like the catch all code for when none of the other codes match up.

Andy,
Fight the hell out of that. You can have one STR entry and still file a claim. I would ask them to point out the regulation in the CFR which says there is a magic minimum number. It's like this form of sarcasm -- "We're sorry Mrs.AndyMan. But your husband passed away one day before he got out of the military. If he would have passed away six additional times before he got out, he could have had a C&P". That's the kind of faulty logic we endure.

[Andyman73]

Vync and Navy4life,

First she told me that my one entry for neck pain(from when I fell down the stairs) where they couldn't find a specific injury to DX isn't good enough.  Then she told me that 6 entries between medical and dental for chronic jaw pain, also no DX, isn't good enough.

Here I thought that we don't need a DX, to make the link.  I fell down a flight of cement stairs, with an 80lb sea bag/duffel bag on my back.  Landed knees then chest, legs flopping up behind me.  Both knees bone bruised w/1 fractured knee cap, lower back was compressed, causing low back strain.  Seems to me that the pain in the neck(pun intended) that resulted from same, would certainly warrant a look see. 

I filed a claim for pain in the neck, secondary to my back, this past spring.  No go, but x-ray did show some restructuring/calcification on C-5 and 6.  That would certainly explain why my hands and arms go numb at any given time, and painful neck cramps too.

How do I convince the VARO to change her mind?  Wait until I get the denial letter?  I will be speaking to my PCP, during my Monday apt., about these various issues. 

As for the 7 times passing on, that would leave me with 2 remaining cat lives!  Yay me!

Semper Fi.

Andyman

[Vync]

3 hours ago, Andyman73 said:

Vync and Navy4life,

First she told me that my one entry for neck pain(from when I fell down the stairs) where they couldn't find a specific injury to DX isn't good enough.  Then she told me that 6 entries between medical and dental for chronic jaw pain, also no DX, isn't good enough.

Here I thought that we don't need a DX, to make the link.  I fell down a flight of cement stairs, with an 80lb sea bag/duffel bag on my back.  Landed knees then chest, legs flopping up behind me.  Both knees bone bruised w/1 fractured knee cap, lower back was compressed, causing low back strain.  Seems to me that the pain in the neck(pun intended) that resulted from same, would certainly warrant a look see. 

I filed a claim for pain in the neck, secondary to my back, this past spring.  No go, but x-ray did show some restructuring/calcification on C-5 and 6.  That would certainly explain why my hands and arms go numb at any given time, and painful neck cramps too.

How do I convince the VARO to change her mind?  Wait until I get the denial letter?  I will be speaking to my PCP, during my Monday apt., about these various issues. 

As for the 7 times passing on, that would leave me with 2 remaining cat lives!  Yay me!

Semper Fi.

Andyman

Andyman,
Perhaps good ol' Bob Macdonald might be interested in hearing about this?

How many other veterans were unjustly denied because of this moron?