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Ankle Rating Decision Questions. Lowballed?


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#1 Jayg

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Posted 21 March 2008 - 09:06 AM

I was granted 20% for "marked limited motion of the ankle. This is maximum disability evaluation for an ankle condition without ankylosis or a frozen ankle."

Thanks to others, I've been plowing through the rating schedules. I had before but it's so vast I hadn't known where to look.

Here's my award decision...
"A review of your medical records indicated that you were treated for an inversion sprain of your left ankle in February 1980. Treatment records shoed tht the ankle was short casted for two weeks. Records showed a full normal range of motion with no pain and release to limited duty on February 28, 1980. Your separation examination date May 6, 1981 does not show any residual disability of the left ankle or complaints of any disability of the left ankle at service separation. A review of your VA treatment records from as early as April 2001 does not show any complaints of a disability of your left ankle. VA records from February 2002 show treatment for complaints of a left knee conditon, but there is no record of complaints of a left ankle condition. Lay statements provided [by] David Ott [Col. ret., my then Capt., battery commander] indicated his knowledge of injury and treatment for the left ankle injury. Your recent VA examination on your left ankle showed swelling with no effusion. Mild bony enlargement and deformity was noted. Dorsiflexion was limited to 0 degrees with plantar flexion to 14 degrees. Pain was noted on the range of motion testing with additional limitation of motion due to pain, weakness and fatigue. Based on evidence of severe inversion sprain in active service and continued complaints of pain in the left ankle and the VA examintation showing a marked limitation of motion in the ankle due to pain and weakness, we will grant service connection for your left ankle with a 20 percent disability evaluation. An evaluation of 20 percent is assigned for marked limited motion of the ankle.

This is the maximum disability evaluation for an ankle condition without ankylosis or a frozen ankle.
"

I took this to mean that's all I could get on the ankle but now I'm thinking that may not be true. I looked up "ankylosis" and found this definition... "stiffness or fixation of a joint by disease or surgery" Stiff it is! I haven't had surgery but I do have arthritis- djd.

The rating schedule section;

THE ANKLE
Rating
5270 Ankle, ankylosis of:

In plantar flexion at more than 40, or in dorsiflexion at more
than 10 or with abduction, adduction, inversion or eversion
deformity 40%
In plantar flexion, between 30 and 40, or in dorsiflexion,
between 0 and 10 30
In plantar flexion, less than 30 20

5271 Ankle, limited motion of:*

Marked 20* (my award rating)
Moderate 10

5272 Subastragalar or tarsal joint, ankylosis of:

In poor weight-bearing position 20
In good weight-bearing position 10

5273 Os calcis or astragalus, malunion of:

Marked deformity 20
Moderate deformity 10

5274 Astragalectomy 20


In poor weight-bearing position 20
In good weight-bearing position 10
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Now I don't understand all that. But my ankle will roll out from under me suddenly and w/out warning. Is there more I can claim or appeal on this joint?
There is evidence of complaint in those in between years and they have it too. But I don't think that's any longer an issue here- or is it?

Sorry this is long but I need TDIU and I don't have the reuesite percentage yet. I have to claw at every straw I can find.
Too, my file has been sent to VMAC for a 'medical opinion" but I haven't been able to find out for what yet. The arthritis would be my guess.

You all have been great and I am most appreciative of all the advice given and experience you have shared.
Any further help would be most apprecciated.
Thank you.
J

Edited by Jayg, 21 March 2008 - 08:47 PM.


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#2 Ryan H.

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Posted 21 March 2008 - 09:42 AM

I am going for My C&P next friday. It is supposed to be for my right ankle.

In 2002, during my flight training, I had a "very bad" sprain in my right ankle. Military Doc's told me Ice, elevation, and motrin for 2 weeks would take care of it.

I had my initial C&P in april of 2005 and they granted service connected with 0% compensation.

Since the 2005 C&P my right ankle got so bad that i could hardly walk on it at times. I went to a podiatrist, and an ortho doctor to see what the problem was. They told me that my ankle looked like one that belonged to someone twice my age. They said that i have arthitus and alot of soft tissue damage due to a free floating mass cause by prior trauma. My ortho doc sent me for an MRI which also showed my ATFL tendon is severely attenuated, "Tore." My orto doc recomended 2 surgerys 1 arthoscopic to smooth the arthritus that is currently present and the other to reconstruct my torn ligament.

On the 6th i went through the arthoscopic and it is healing OK. I still have moderate pain and very limited motion in the ankle.....

I guess the moral of the story is The VA had all the evidence when i went through my 1st C&P and they chose to ignore it. Now I have had more problems and They probably will ignore it once again.
This time I even sent them a CD with my full MRI on it.....

Edited by jbasser, 22 March 2008 - 09:05 PM.


#3 Ryan H.

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Posted 21 March 2008 - 09:45 AM

wow i dont know how that happened...... how do you edit post on this site... sorry thats a bit off topic.

#4 LarryJ

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Posted 21 March 2008 - 03:43 PM

No, the question of your disability since your injury in service is no longer an issue, otherwise you wouldn't have received the 20%.

And, yes, according to your limited (non-existing) ROM, you should have been granted 30%.
All you can do, at this point, is to file an NOD and hit them with a doctor's statement that you have NO ROM not only due to your DJD but ALSO due to your PAIN. Matter-of-fact, that is essentially what your VA C&P actually said. Pain MUST be considered along with the limited ROM. I had the same problem, exactly.

ALL you're going to get is 30%, UNLESS you can convince them that your ankle disability has caused your "loss of use of" your ankle/foot.

Documentation, Medical Opinions, etc. etc., you know the drill.

#5 Jayg

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Posted 21 March 2008 - 08:30 PM

No, the question of your disability since your injury in service is no longer an issue, otherwise you wouldn't have received the 20%.

And, yes, according to your limited (non-existing) ROM, you should have been granted 30%.
All you can do, at this point, is to file an NOD and hit them with a doctor's statement that you have NO ROM not only due to your DJD but ALSO due to your PAIN. Matter-of-fact, that is essentially what your VA C&P actually said. Pain MUST be considered along with the limited ROM. I had the same problem, exactly.

ALL you're going to get is 30%, UNLESS you can convince them that your ankle disability has caused your "loss of use of" your ankle/foot.

Documentation, Medical Opinions, etc. etc., you know the drill.

Specifically, my C&P on that ankle says
2+ swelling w/out effusion(?jg)
Objective evidence of pain with guarding and grimacing. Pain is present @ 0 degrees and increases throughout range of motion testing. Pain does not end.
(brother and how! JG) There are additional limitations of range of motion or joint function secondary to pain, fatigue, weakness or lack of endurance following repetitve use. The major functional impairment is pain."
ROM
Active - dorsiflexion 0 - 0, plantar flexion 0 - 14
Passive - dorsiflexion 0 - 0, plantar flexion 0 - 20
with repetitive ROM dorsiflexion 0 - 0, plantar flexion 0 - 14

She goes on to murder me... I mean state, "no tendon damage, no bone joint or nerve damage. No muscle herniation, no loss of muscle function. No joint is affected."

This examiner took two personal calls arguing on the phone with her (I presume) husband. Hooo did I catch it. I royally disagree with her closing analysis and that ROM testing is really wide open to debate from what I saw.
She made the statement "gait steady" on one page and "he attempts but is unable to rise on his heels and toes for gait testing." on another. :angry:
There are plenty of notes in my records saying "gait weak transferring." <_<

This was back in 2006. Frankly, I'd welcome another C&P exam.

I just provided the additional information to better help suggestion.

Am I appealing for rating under 5270 instead of 5271 from which they rated me? Is pain a seperate rating factor?
I have an NOD in but hadn't addressed the ankle thinking it was at max as suggested. I'm going to nod this one asap but I want to know 'text and verse,' if I may, on which my disagreement will be based.

The doctor's statement is tough. I've been unemployed since 2004, on food stamps, just keeping the lights on and the price of everything going up. I have to get as far as I can w/out, or at least before, paying doctors bills. :blink:

I'll take the 30%! That would make me 50% instead of 40%. (I presume it would replace, not add to the current 20%) I'm clawing my way up this bloody ladder. And so far I have been granted nothing for pain or other secondary conditions.
Thanks again!

#6 donews

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Posted 21 March 2008 - 10:08 PM

Jayq,

If you are asking what does "2+ swelling w/out effusion(?jg)" mean;

They are saying that you have swelling without abnormal buildup of joint fluid.

Hope that helps some.

#7 Jayg

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Posted 21 March 2008 - 11:44 PM

Jayq,

If you are asking what does "2+ swelling w/out effusion(?jg)" mean;

They are saying that you have swelling without abnormal buildup of joint fluid.

Hope that helps some.

That does explain that. Thanks. My ankle, both now actually, are mainly both hard swollen, deformed, rather than puffy though they can and do get that way.

What I'm trying to find out here is if there are specific codes I can refer to to seek and increase my evaluation. I've read the read but s'truth, do not entirely comprehend it. I know it was suggested I could go for 30%. Does that include the pain or is that a second factor?

I am just a bit overawed here and not just exactly sure which way to bounce. As I noted elsewhere, things seem to be moving now and I want to strike while that's so.

#8 JR Reihs

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Posted 22 March 2008 - 09:55 AM

Jayg,

I would file a claim for arthritis secondary to the ankle, this could possibly get you a additional 10% rather quickly while you are filing a NOD on the origional award.

#9 john999

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Posted 22 March 2008 - 12:17 PM

I would go to the psychiatrist and claim that the pain and disability from your leg is depressing you and making it impossible to work. Meanwhile, find a shrink who will do an IMO to evaluate your emotional condition. Most disabled people in pain are depressed. This could add some points to your rating.

#10 Jayg

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Posted 22 March 2008 - 08:24 PM

I would go to the psychiatrist and claim that the pain and disability from your leg is depressing you and making it impossible to work. Meanwhile, find a shrink who will do an IMO to evaluate your emotional condition. Most disabled people in pain are depressed. This could add some points to your rating.

Of course I'm depressed. I'd be crazy if I wasn't in this mess! But those psyche drugs and counselors scare the bejabbers out of me and I will avoid them as long as I can. That's a weapon of last resort.

#11 luvHIM

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Posted 22 March 2008 - 10:24 PM

Are you on pain meds for your ankle(s)?

Also, I would agree with the suggestion to file for the arthritis as secondary to the current disability condition. Injuries can and usually do promote the advancement of arthritis, especially DJD (which I have also been diagnosed with). Best regards.

#12 Jayg

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Posted 23 March 2008 - 08:37 AM

Are you on pain meds for your ankle(s)?

Also, I would agree with the suggestion to file for the arthritis as secondary to the current disability condition. Injuries can and usually do promote the advancement of arthritis, especially DJD (which I have also been diagnosed with). Best regards.

Pain meds? Oh yeaa. <_< The arthritis isn't restricted to the ankle. VA calls it "severe debilitating arthritis."
I take methadone for pain and Mirapex for neuropathy daily, and for "as needed" Tramadol, Baclofen (for lower back), and Naproxen 500mg.

I will definitely file for the pain as suggested. Thanks!

Edited by Jayg, 23 March 2008 - 10:00 AM.





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