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]

I agree with you 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

this lady needs to be reported!  you really should consider it b/c that is an outrage to us Veterans.  She sounds like she doesn't care about the Veteran (you) and I wonder too, like Vync said, how many Veterans have gone without justice because of her actions!

[Vync]

7 minutes ago, Navy4life said:

I agree with you Vync - 

this lady needs to be reported!  you really should consider it b/c that is an outrage to us Veterans.  She sounds like she doesn't care about the Veteran (you) and I wonder too, like Vync said, how many Veterans have gone without justice because of her actions!

Navy,
You're right! Many of them just consider it a job and by the time anyone finds out, they would have either retired or been promoted to a higher ranking job in a different department.

Corrective training in the military helped encourage change that sunk in for most cases. Everyone remembers that from the military, but the VA does not make employees drop and give them 20.

I don't know how they do it at the VA, but can imagine their corrective training conversation going like this:

Boss: "Hey, 36 months ago you incorrectly told a veteran they needed more than six STR's before it warranted a C&P exam."
Rater: "Um, ok..."

[Andyman73]

Should I email him now, or wait until I get the denial letter? 

[Navy4life]

17 minutes ago, Andyman73 said:

Should I email him now, or wait until I get the denial letter? 

Unfortunately you are going to have to wait for the denial IMO.  Because right now you just don't know what decision is.  If the denial comes through, I would then immediately file a complaint along with a NOD asking for a reconsideration.

[Vync]

1 hour ago, Andyman73 said:

Should I email him now, or wait until I get the denial letter? 

I know the official way is to wait for the denial letter. However, what have you got to lose? I would send the email. You might not hear back until next week at the earliest or the week after, but that still would be better than having to wait and respond again, which could take months. In DC, it is late on a Friday and they are seriously snowed under right now... Doubt anyone is left working at VA HQ today.

[Andyman73]

I don't expect to hear back from him till Wednesday, just to give him time to dig out of the snow and then look at my case.  Thanks both of you!

I will report back to this space the results of my email to Mr. Mcdonald.

Semper Fi.

Andyman