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ArmChairRanger

C&P for Loss of use both feet

Question

Hello all, Great site and I have learned a lot for reading. Thank you all.

Any thoughts on deciphering my C&P exam? I am 100% P&T. I am already service connected 50% for b/l flat foot & 40% CRPS but had additional operations last year that further worsened my issues. To get around now I use a VA prescribed wheelchair and 3 wheeled electric scooter.

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this

document:

[X] In-person examination

Evidence Review

Evidence reviewed (check all that apply): [X] Not requested

1. Diagnosis

a. List the claimed condition(s) that pertain to this DBQ:

FEET

b. Select diagnoses associated with the claimed condition(s): [X] Flat foot (pes planus)

ICD code: 00000000000

Side affected: Both

Date of diagnosis: Right: HISTORICAL

Date of diagnosis: Left: HISTORICAL

[X] Plantar fasciitis

ICD Code: 00000000

Side affected: Both

Date of diagnosis: Right HISTORICAL

Date of diagnosis: Left HISTORICAL

[X] Arthritic conditions

[X] Arthritis, degenerative

ICD Code: 0000000000

Side affected: Both

Date of diagnosis: Right HISTORICAL

Date of diagnosis: Left HISTORICAL

c. Comments (if any):

No response provided

d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A

2. Medical history

a. Describe the history (including onset and course) of the Veteran's

foot

condition (brief summary):

veteran was seen and treated for arch pain on multiple occasions in service with many different diagnoses. he received steroid injections into arches and several occasions. after service veteran continued with foot

pain and saw several doctors. This progressed to large painful nodules in his arches. the tumors were so large and invasive that he required excision of the overlying skin as well. skin grafts from anterior thighs to cover the defects. he uses custom shoes and inserts with minimal relief. Uses cane as well. walks on lateral side of his feet. can not place foot flat on floor without increased pain. First surgery and second on left foot was 2005. later 2005 on right foot. op reports and photos were reviewed by me. If veteran walks on sole of feet he gets a tearing type pain in his arches. no stairs or ladders. limited walking. has bench at work to elevate his feet. pain requires narcotic pain meds, muscle relaxers and gabapentin for nerve pain and burning in soles. pin and needle sensation both feet worse at night. painful to wear shoes even with insoles. minimal standing

or walking. feet wake him at night. veteran does have mild pes planus, Not associated with current condition. Since the surgeries he has had recurrence of the tumors in both feet. Lederhosen disease to the

bilateral feet, as well as complex regional pain syndrome, presents to clinic today for re-evaluation of

his foot fibromas. Has significant pain to his feet when walking. Noted to have had 3 debridements to the left foot and 1 to the right, as well as skin grafting bilaterally. Has had 4 previous orthotics, which do not provide relief. Has been to pain management and plastics clinic.

Bilateral feet

- Multiple fibromas to the feet bilaterally, with tender nodules

- Skin graft of the feet noted bilaterally

MRI DATED 4/28/17 INDICATED HE CURRENTLY HAS FIBROUS TUMORS BILATERALLY. HE HAS GROSELY ABNORMAL GAIT DUE TO PAIN.

b. Does the Veteran report pain of the foot being evaluated on this DBQ? [X] Yes [ ] No

If yes, document the Veteran's description of pain in his or her words:

SEE ABOVE

c. Does the Veteran report that flare-ups impact the function of the foot? [ ] Yes [X] No

d. Does the Veteran report having any functional loss or functional impairment of the foot being evaluated on this DBQ (regardless of repetitive use)?

[X] Yes [ ] No

If yes, document the Veteran's description of functional loss or functional impairment in his or her own words:

SEE HISTORY.

3. Flatfoot (pes planus)

------------------------

a. Does the Veteran have pain on use of the feet? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

If yes, is the pain accentuated on use? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

b. Does the Veteran have pain on manipulation of the feet? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

If yes, is the pain accentuated on manipulation? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both c. Is there indication of swelling on use? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

d. Does the Veteran have characteristic callouses? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

e. Effects of use of arch supports, built-up shoes or orthotics:

Tried But Remains Symptomatic

Device Side Not Relieved:

[X] Orthotics [ ] Right [ ] Left [X] Both

f. Does the Veteran have extreme tenderness of plantar surfaces on one or both

feet? [X] Yes [ ] No

If yes, indicate side affected: [ ] Right [ ] Left [X] Both

Is the tenderness improved by orthopedic shoes or appliances? RIGHT - [ ] Yes [X] No [ ] N/A

LEFT - [ ] Yes [X] No [ ] N/A

g. Does the Veteran have decreased longitudinal arch height of one or both feet

on weight-bearing? [ ] Yes [X] No

h. Is there objective evidence of marked deformity of one or both feet

(pronation, abduction etc.)? [ ] Yes [X] No

i. Is there marked pronation of one or both feet? [ ] Yes [X] No

j. For one or both feet, does the weight-bearing line fall over or medial to the great toe? [ ] Yes [X] No

k. Is there a lower extremity deformity other than pes planus, causing alteration of the weight-bearing line? [ ] Yes [X] No

l. Does the Veteran have "inward" bowing of the Achilles tendon

(i.e., hindfoot

valgus, with lateral deviation of the heel) of one or both feet?

[ ] Yes [X] No

m. Does the Veteran have marked inward displacement and severe spasm of the

Achilles t

endon (rigid hindfoot) on manipulation of one or both feet?

[ ] Yes [X] No

n. Comments: No comments provided

11. Surgical procedures

a. Has the Veteran had foot surgery (arthroscopic or open)?

[X] Yes [ ] No

If yes, indicate side affected, type of procedure and date of surgery: [X] Right foot procedure: SEE HISTORY

Date of surgery:

[X] Left foot procedure: SEE HISTORY Date of surgery:

b. Does the Veteran have any residual signs or symptoms due to arthroscopic or other foot surgery?

[X] Yes [ ] No

If yes, describe residuals: SEE HISTORY

12. Pain

RIGHT FOOT:

Is there pain on physical exam? [X] Yes [ ] No

If yes, (there is pain on physical exam), does the pain contribute to functional loss?

[X] Yes [ ] No

(Further description of limitations requested in Section XIII below.)

LEFT FOOT:

Is there pain on physical exam? [X] Yes [ ] No

If yes, (there is pain on physical exam), does the pain contribute to functional loss?

[X] Yes [ ] No

(Further description of limitations requested in Section XIII below.)

13. Functional loss and limitation of motion

a. Contributing factors of disability (check all that apply and indicate side

affected):

[X] Weakened movement (due to muscle injury, disease or injury of peripheral

nerves, divided or lengthened tendons, etc.) Side affected: [ ] Right [ ] Left [X] Both

[X] Excess fatigability

Side affected: [ ] Right [ ] Left [X] Both

[X] Incoordination, impaired ability to execute skilled movements smoothly

Side affected: [ ] Right [ ] Left [X] Both

[X] Pain on movement

Side affected: [ ] Right [ ] Left [X] Both

[X] Pain on weight-bearing

Side affected: [ ] Right [ ] Left [X] Both

[X] Pain on non weight-bearing

Side affected: [ ] Right [ ] Left [X] Both

[X] Swelling

Side affected: [ ] Right [ ] Left [X] Both

[X] Instability of station

Side affected: [ ] Right [ ] Left [X] Both

 [X] Disturbance of locomotion

Side affected: [ ] Right [ ] Left [X] Both

[X] Interference with standing

Side affected: [ ] Right [ ] Left [X] Both

[X] Lack of endurance

Side affected: [ ] Right [ ] Left [X] Both

Contributing factors of disability associated with limitation of motion:

b. Is there pain, weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeatedly over a period of time?

RIGHT FOOT: [ ] Yes [X] No

LEFT FOOT: [ ] Yes [X] No

c. Is there any other functional loss during flare-ups or when the foot is used

repeatedly over a period of time?

RIGHT FOOT: [ ] Yes [X] No

LEFT FOOT: [ ] Yes [X] No

14. Other pertinent physical findings, complications, conditions, signs, symptoms and scars

a. Does the Veteran have any other pertinent physical findings, complications,

conditions, signs or symptoms related to any conditions listed in the

Diagnosis section above?

[X] Yes [ ] No

If yes, describe (brief summary): SEE HISTORY

b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above?

[X] Yes [ ] No

If yes, are any of these scars painful or unstable; have a total area

equal to or greater than 39 square cm (6 square inches); or are located

on the head, face or neck? (An "unstable scar" is one where,

for any

reason, there is frequent loss of covering of the skin over the scar.)

[X] Yes [ ] No

If yes, also complete VA Form 21-0960F-1, Scars/Disfigurement c. Comments: No comments provided

15. Assistive devices

a. Does the Veteran use any assistive devices as a normal mode of locomotion,

although occasional locomotion by other methods may be possible?

[X] Yes [ ] No

If yes, identify assistive devices used (check all that apply and indicate frequency):

Assistive Device: Frequency of use:

 [X] Wheelchair [ ] Occasional [ ] Regular [X] Constant

[X] Walker [ ] Occasional [ ] Regular [X] Constant

[X] Other: SCOOTER [ ] Occasional [ ] Regular [X] Constant

b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition:

FEET

16. Remaining effective function of the extremities

Due to the Veteran's foot condition, is there functional impairment of an

extremity such that no effective function remains other than that which would

be equally well served by an amputation with prosthesis? (Functions of the

upper extremity include grasping, manipulation, etc., while functions for the

lower extremity include balance and propulsion, etc.)

[X] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran.

[ ] No

If yes, indicate extremities for which this applies: [X] Right lower

[X] Left lower

For each checked extremity, describe loss of effective function, identify the condition causing loss of function, and provide specific examples (brief summary):

SEE HISTORY

17. Diagnostic testing

a. Have imaging studies of the foot been performed and are the results

available?

[X] Yes [ ] No

If yes, is degenerative or traumatic arthritis documented? [X] Yes [ ] No

If yes, indicate foot: [ ] Right [ ] Left [X] Both

b. Are there any other significant diagnostic test findings or results? [ ] Yes [X] No

c. If any test results are other than normal, indicate relationship of abnormal

findings to diagnosed condition: No response provided

18. Functional impact

Regardless of the Veteran's current employment status, do the

condition(s)

listed in the Diagnosis section impact his or her ability to perform any type

of occupational task (such as standing, walking, lifting, sitting, etc.)?

[X] Yes [ ] No

If yes, describe the functional impact of each condition, providing one or more examples:

HE IS UNABLE TO WORK

 

thank you!

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It is a favorable C & P exam ,referring to your inservice foot issues, ad should put you into the SMC criteria.

When they awarded ths 100% did they-at that time- consider you for SMC S?

What Diagnostic code did they give you for the bi lateral pes planus?

 

"Any thoughts on deciphering my C&P exam? I am 100% P&T. I am already service connected 50% for b/l flat foot & 40% CRPS but had additional operations last year that further worsened my issues. "

Was that more recent surgery done prior to this C & P exam?

Or did the examiner consider all of the surgeries you have had.

CRPS- do you mean that rating is for Complex regional pain syndrome  ?

( is that carpel tunnel syndrome)??

 

Did you get a C & P exam for this-  VA Form 21-0960F-1,( the scars)?

 

 

Edited by Berta
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Just to add ,I think you are eligible for the SMC L Award- as described in this BVA case:

https://www.va.gov/vetapp10/files5/1040495.txt

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Thanks for the reply Berta, appreciate all that you do!

When they awarded ths 100% did they-at that time- consider you for SMC S?  No

What Diagnostic code did they give you for the bi lateral pes planus? Code 5276 - B/L Pronounced

Was that more recent surgery done prior to this C & P exam? Yes, One surgery on each foot mid 2017 to remove multiple large fibromas

CRPS - http://www.rsdhope.org/what-is-crps1.html is rated as left & right lower extremity complex regional pain syndrome B/L

Did you get a C & P exam for this-  VA Form 21-0960F-1,( the scars)?Yes: Scars are rated as: scars, s/p left plantar fasciectomy, thigh graph, fibromatosis (right and left) From C&P form 21-0960: 3. Scars Functional impact

Does the Veteran's scar(s) (regardless of location) or disfigurement of the head, face, or neck impact his or her ability to work? Yes Impact of the Veteran's scar(s) (regardless of location) or disfigurement of the head, face, or neck, providing one or more examples: VERY LIMITED AMBULATION, CONNOT WORK

 

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