Flat Feet C&P Exam

[Wise Guy]

I have a C&P Exam on Wednesday and I'm afraid I'll get denied. Flat feet was denied before along with Plantar Fasciitis because it's not service connected. I went back to my physician outside the VA and he typed my nexus as follows:

"Bilateral flatfoot acquired possibly during time in military. When not congenital as a cause, pes planus (flatfoot) is caused due to ill fitting shoe-gear without subtalar range of motion support, which could have been a result to time in service, 51% probability.Patient presents today with bilateral heel pain, worse right foot. Patient states that the pain is 2 out of 10. Patient denies any injury. Patient states he is having pain to the plantar aspect of his right heel that has been going on for several months. Patient denies being diabetic. Patient states he received custom orthotics as a week ago and has notes slight improvement. Patient denies taking any anti-inflammatories. Patient states that he has noticed his achilles feeling tight during athletic activity. *****Physical exam: Decreased ankle dorsiflexion noted bilateral. Mild tenderness to palpation to the plantar medial aspect of the right calcaneus. No pain with lateral compression of bilateral calcaneus. No pain along posterior tibial tendon bilateral. Increased pronation to patient's mis and rear foot bilateral. (The X-rays show as normal)"

It got denied due to not being service connected, so I went back and got the below nexus typed and signed. 

"After reviewing ******** service record at my medical opinion is his pronounced bilateral pes planus or flat feet are connected to his time in service with the Marine Corps. Plus, his flat feet are due to high impact physical activity for military training such as marching drills, drills at Corporals Course, Sergeant course, Intermediate Administration Specialist Course, and the wearing of combat boots. These have caused strain on his posterior tibial tendon resulting in painful flat feet. The diagnosis of pronounced bilateral flat feet is severe with fitted soles. He still has symptoms with a pain level ranging to 8 out of 10. Recall treatment options have been discussed but will be deferred at this time."

 

This is good but I don't know if it will connect come to think about it. From my recollection, I only went to medical once for plantar fasciitis and it's not shown as chronic. My flat feet was marked as normal upon entry of the Marine Corps and wasn't marked at all for my final physical. There's no check in any of the boxes indicating if my feet were normal or not. The ball was lazily dropped. I did just get a service connection for my hip injury. Should I go back to this doctor again and have him add a sentence that says, "Also, it is more likely than not that his pronounced bilateral flat feet worsened following the injury to his right hip with compensating for the pain"?

 

Or does the VA Compensation even contact the doctor to check to see if they generated it or edited it? I have 1 full day to figure this out ands submit to add to my claim for Wednesday.

[GBArmy]

Wise Guy This is my opinion, and I am not a doctor. I think that it is kinda weak. You never know if your evidence is good enough going into an exam, or how open minded your examiner will be. But you have been denied for the disability before, and that is a hard hill to climb because the will be looking at the previous decision. He said your foot condition "possibly" caused by your service. Didn't say to what degree of certainty, such as "more likely than not." He needed to be definite. Your idea to get a modified statement is better (it is more likely than not that his pronounced bilateral flat feet worsened following the injury to his right hip with compensating for the pain",) but it is changing your position I believe from direct to secondary. IMHO your doc has to now talk to the rationale that your now s-c hip condition causes your foot pain. Needs to refer to medical evidence, like journals or known published documents. Is your doc Board certified? If so, make sure you have his pedigree included. How long have you been out? If you change your direction to secondary to hip, then it isn't important. If not, showing continuous medical treatment would be a factor. If you are claiming direct service connection, showing med records, etc. in the service is critical. If you go with secondary, not a factor. Strengthen your nexus for secondary IMHO.

[Miken2c74]

When applying for disability compensation there are three elements that must be present, 1 in most a cases  current diagnosis of a "disability" 2 an injury or disease in the military of the disability, 3 a Nexus (at least as likely as not). You should request your C-File so you can see what the VA sees. You can also fill in some the blanks in your records with lay statements (self, friends, family, and old battle buddies). You have to paint a picture of your disability "chronologically". Take your time. @GBArmy has gave me a lot of info also.

Edited August 4, 2020 by Miken2c74 (see edit history)

[Berta]

"Patient states he received custom orthotics as a week ago and has notes slight improvement."

I get custom orthotics from my podiatrist- some still take plasters casts but he uses a new method, and it takes a few weeks for them to be made.

Was the medical opinion prepared by a podiatrist?

If not, would your podiatrist be willing to  make a nexus statement?

 

 

 

Edited August 4, 2020 by Berta (see edit history)

[deedub75]

The fact that a new exam has been ordered is a good sign in my opinion. They need to see your current level of disability and fill out a new DBQ. They will also weigh this new evidence from your nexus letter against your previous denial and the new medical opinion that be written in your upcoming exam. Was this nexus written by an orthopedic surgeon or a podiatrist?  Either one would be good. I’m sure your upcoming exam will be conducted by a nurse practitioner and your nexus letter if written by an orthopedic surgeon or podiatrist should carry more weight.