Structure of a Pes Planus claim with secondaries

[ASU_0331]

Trying to file an intent to claim on Ebenefits today, but apparently the application is not working correctly.  In the meantime, I would like to input on structuring the claim for pes planus (flat feet) with secondaries.

Pes planus and pain in my feet are both noted and documented on my final physical from the USMC (0331 heavy machine-gunner).  In 2017, I visited my VA PCP regarding a marked increase in foot, knee, and hip pain and was referred to MRI/x-ray/podiatry where it was the pes planus was confirmed along with a host of other issues including heel spurs (posterior & plantar), tendinitis (knees), Baker's cyst (right knee), ganglion cyst (right knee), tendinitis ( both quadriceps), ITB syndrome (both legs), degenerative joint disease (both big toes), and joint impingement (hips).  My old podiatrist made the comment that everything starts at my feet and that from there is effects everything going up my legs; trying to avoid pain in feet by changing how I walk basically effects the toes, the knees, the tendons, and my hips.  He ordered a set of custom inserts and sent me on my way.

Since then I have worn out the inserts, still having to walk the same way and my shoes still show the same wear pattern to avoid pain, to no relief.  Visited a new PCP this week and was referred to physical therapy for all the tendon/impingement issues and new podiatry for the flat feet.  Going to document all with what I hope will include new MRI/x-rays of knees and feet to have double confirmation of issues.  But I question how this should all be constructed.  I have a great VSO that is always extremely helpful, but he is just swamped so would like to present to him as close to a completed package as possible.  I am thinking this;

 

Pes Planus/Plantar Fasciitis

• L Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome)
• R Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome)
• L Toe Pain (arthritis)
• R Toe Pain (arthritis)
• L Hip Impingement
• R Hip Impingement

The posterior/plantar bone spurs will probably just be coded under the pes planus coding since it seems like they always are done that way.  All the tendon issues surrounding the knees will just be coded all under the knee pain, the toes as arthritis, and the impingement on their own issues.  Not sure what or even if the cysts will be rated or what they would fall under.  What are thoughts about this from everyone?   

Edited October 2, 2018 by ASU_0331

[doc25]

On 10/2/2018 at 2:26 PM, ASU_0331 said:

Trying to file an intent to claim on Ebenefits today, but apparently the application is not working correctly.  In the meantime, I would like to input on structuring the claim for pes planus (flat feet) with secondaries.

Pes planus and pain in my feet are both noted and documented on my final physical from the USMC (0331 heavy machine-gunner).  In 2017, I visited my VA PCP regarding a marked increase in foot, knee, and hip pain and was referred to MRI/x-ray/podiatry where it was the pes planus was confirmed along with a host of other issues including heel spurs (posterior & plantar), tendinitis (knees), Baker's cyst (right knee), ganglion cyst (right knee), tendinitis ( both quadriceps), ITB syndrome (both legs), degenerative joint disease (both big toes), and joint impingement (hips).  My old podiatrist made the comment that everything starts at my feet and that from there is effects everything going up my legs; trying to avoid pain in feet by changing how I walk basically effects the toes, the knees, the tendons, and my hips.  He ordered a set of custom inserts and sent me on my way.

Since then I have worn out the inserts, still having to walk the same way and my shoes still show the same wear pattern to avoid pain, to no relief.  Visited a new PCP this week and was referred to physical therapy for all the tendon/impingement issues and new podiatry for the flat feet.  Going to document all with what I hope will include new MRI/x-rays of knees and feet to have double confirmation of issues.  But I question how this should all be constructed.  I have a great VSO that is always extremely helpful, but he is just swamped so would like to present to him as close to a completed package as possible.  I am thinking this;

 

Pes Planus/Plantar Fasciitis

• L Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome)
• R Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome)
• L Toe Pain (arthritis)
• R Toe Pain (arthritis)
• L Hip Impingement
• R Hip Impingement

The posterior/plantar bone spurs will probably just be coded under the pes planus coding since it seems like they always are done that way.  All the tendon issues surrounding the knees will just be coded all under the knee pain, the toes as arthritis, and the impingement on their own issues.  Not sure what or even if the cysts will be rated or what they would fall under.  What are thoughts about this from everyone?   

Sounds like this is an after-service claim/claims.

Have your new VA podiatrist fill out the Foot DBQ https://www.vba.va.gov/pubs/forms/VBA-21-0960M-6-ARE.pdf

Your VA PCP  needs to fill out the Knee and Hip DBQs:

Knee- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-9-ARE.pdf

Hip- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-8-ARE.pdf

Usually DBQs will suffice to back up all your documentation, BUT; yes there's a BUT, the VA Ratings Schedulers love it when a DBQ doesn't accompany your documentation. Even if it is noted and documented IN-SERVICE from your service medical record(SMR);any and all claims are subject to a denial for almost any B.S. reason.

You will also need for your podiatrist and PCP to enter into their notes a nexus of opinion for each  condition stating  1 of 3 key phrases for service-connection.

1. "Due to" military service (100% probability)

2. "More likely than not" due to military service(greater than 50% probability)

3. "At least as likely as not" due to military service( equal to or greater than 50% probability)

They must provide a clear and concise RATIONALE as well.

[VA has quack C&P examiners that aren't always specialists in the conditions a veteran is claiming. You get your podiatrist and PCP to say your conditions ARE service-connected in the format above. You give your claim much needed weight should the C&P examiner try to give you an unfavorable exam. If one dr. says your condition is service connected and the other says is not? That is a tie and the tie always goes to the veteran.]

I noticed you're not having ankle and lower back problems. You will eventually. There's a DBQ for those two, as well. And you will need Nexus of opinions for any condition that occurs later on. Why? Because the VA must have competent medical evidence to substantiate each claim.

If you have All DBQs and the Nexus of opinions, you will give your claim a boost in getting each condition granted sooner rather than later. It's not a guarantee you'll be granted the first time. But, you'll give that claim a fighting chance.

Keep in mind that IF you receive a denial for any condition. Do not give up on it! You will need to dissect the VA reasoning, then get to work on filing a Notice of Disagreement in rebuttal of whatever B.S. reasoning they give. You may need to provide additional evidence or something was overlooked. We veterans have more power over the VA than we are led to believe.

Don't forget to claim Tinnitus and Bilateral Hearing Loss.

Best wishes on your claims. We're here to answer any of your questions.

[ASU_0331]

On 10/3/2018 at 8:37 PM, doc25 said:

Sounds like this is an after-service claim/claims.

Have your new VA podiatrist fill out the Foot DBQ https://www.vba.va.gov/pubs/forms/VBA-21-0960M-6-ARE.pdf

Your VA PCP  needs to fill out the Knee and Hip DBQs:

Knee- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-9-ARE.pdf

Hip- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-8-ARE.pdf

Usually DBQs will suffice to back up all your documentation, BUT; yes there's a BUT, the VA Ratings Schedulers love it when a DBQ doesn't accompany your documentation. Even if it is noted and documented IN-SERVICE from your service medical record(SMR);any and all claims are subject to a denial for almost any B.S. reason.

You will also need for your podiatrist and PCP to enter into their notes a nexus of opinion for each  condition stating  1 of 3 key phrases for service-connection.

1. "Due to" military service (100% probability)

2. "More likely than not" due to military service(greater than 50% probability)

3. "At least as likely as not" due to military service( equal to or greater than 50% probability)

They must provide a clear and concise RATIONALE as well.

[VA has quack C&P examiners that aren't always specialists in the conditions a veteran is claiming. You get your podiatrist and PCP to say your conditions ARE service-connected in the format above. You give your claim much needed weight should the C&P examiner try to give you an unfavorable exam. If one dr. says your condition is service connected and the other says is not? That is a tie and the tie always goes to the veteran.]

I noticed you're not having ankle and lower back problems. You will eventually. There's a DBQ for those two, as well. And you will need Nexus of opinions for any condition that occurs later on. Why? Because the VA must have competent medical evidence to substantiate each claim.

If you have All DBQs and the Nexus of opinions, you will give your claim a boost in getting each condition granted sooner rather than later. It's not a guarantee you'll be granted the first time. But, you'll give that claim a fighting chance.

Keep in mind that IF you receive a denial for any condition. Do not give up on it! You will need to dissect the VA reasoning, then get to work on filing a Notice of Disagreement in rebuttal of whatever B.S. reasoning they give. You may need to provide additional evidence or something was overlooked. We veterans have more power over the VA than we are led to believe.

Don't forget to claim Tinnitus and Bilateral Hearing Loss.

Best wishes on your claims. We're here to answer any of your questions.

Thanks for the great advice.

No back issues right now, but as far as ankles, I basically roll them a lot to the outside.  It could be attributed to the pes planus because I tend to walk quite a bit on the outside of my feet to avoid foot pain, but weak foot does not get its own rating on its own, it just guarantees that the disability responsible for it gets at minimum 10% per the CFR.

I am already service-connected for DM II at 20% and Tinnitus for 10%.  I have a SMR documented high frequency hearing loss, but two C&P exams have shown that I am just a point or two below the threshold of getting it rated as being disabling. 

Currently have a NOD with DRO review about to close for CAD secondary to the DM II and Hypertension.  C&P exams have been completed via QTC and are in the DRO's hands as we speak and waiting on her rating decision.  Hypertension will be 0% because my medicated diastolic BP reading did not average 100.  I have had 4-5 instances in the past three years where it has gone over 100 with the highest being 120.  But those have been times where I might have been off medication or not exercising as much.  Otherwise, my medicated diastolic has been between 85-95 for the past 3 years.  

It is a toss-up on the CAD because the examiner gave an estimated METS range of 5-7, which per the CFR covers both a 60% reading with the 5 and a 30% rating with the 6-7.  I have not been given the official ejection fraction rate yet, but the technician that conducted the echocardiogram told me that from one angle it was 47% and from another it was 49%.  So that would be two other conditions for a 60% rating on the CAD which would be nice considering the extent of my current blockages and existing stents.     

[doc25]

5 hours ago, ASU_0331 said:

Thanks for the great advice.

No back issues right now, but as far as ankles, I basically roll them a lot to the outside.  It could be attributed to the pes planus because I tend to walk quite a bit on the outside of my feet to avoid foot pain, but weak foot does not get its own rating on its own, it just guarantees that the disability responsible for it gets at minimum 10% per the CFR.

I am already service-connected for DM II at 20% and Tinnitus for 10%.  I have a SMR documented high frequency hearing loss, but two C&P exams have shown that I am just a point or two below the threshold of getting it rated as being disabling. 

Currently have a NOD with DRO review about to close for CAD secondary to the DM II and Hypertension.  C&P exams have been completed via QTC and are in the DRO's hands as we speak and waiting on her rating decision.  Hypertension will be 0% because my medicated diastolic BP reading did not average 100.  I have had 4-5 instances in the past three years where it has gone over 100 with the highest being 120.  But those have been times where I might have been off medication or not exercising as much.  Otherwise, my medicated diastolic has been between 85-95 for the past 3 years.  

It is a toss-up on the CAD because the examiner gave an estimated METS range of 5-7, which per the CFR covers both a 60% reading with the 5 and a 30% rating with the 6-7.  I have not been given the official ejection fraction rate yet, but the technician that conducted the echocardiogram told me that from one angle it was 47% and from another it was 49%.  So that would be two other conditions for a 60% rating on the CAD which would be nice considering the extent of my current blockages and existing stents.     

In some cases, some veterans have been granted Depression secondary to Tinnitus. FYI. Take a read and see how this veteran was able to do Secondary connect Depression to Tinnitus. If your Tinnitus worsens over time, it can cause depression. You can't get an increase for Tinnitus as it's capped at 10%, but depression for that has been rated up to 10%, 30%, 50% from my understanding. That will increase your overall percentage, as well.

https://www.va.gov/vetapp15/Files2/1515376.txt

Here is an article that makes the correlation of Depression secondary to Tinnitus.

https://www.hindawi.com/journals/ijoto/2015/689375/

CAD is one to go after. So don't let it go.

Hearing loss is a hard one, it will get worse later on, just keep building that evidence.

DMII can cause skin problems that can be rated secondary to it. Toenail fungus named Onychomycosis can be caused by DMII. If your DMII gets worse, Sleep Apnea can be caused by DMII,as well and OSA is rated 50% with use of a CPAP.

 

[ASU_0331]

The CAD is a given with nexus established by my VA cardiologist and the C&P examiner agreeing with said nexus and putting that as part of her medical opinion.  It is just up to the DRO now and what side she will come down on with the estimated METS range and/or the ejection fraction rate is below 50%.  If I get the 60% for the CAD, I will be at 70% with the leg/knee/foot issues possibly pushing it up to 100%.  Kinda depends on how they will rate the Plantar Fasciitis.  I have seen cases where it has been coded separately from the pes planus and where it has been coded under the pes planus.

 

Just a waiting on rating game now.