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Metatarsal Arthritis


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11 replies to this topic

#1 oldvet

 
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Posted 17 August 2008 - 01:02 PM

How is VA supposed to rate this? As arthritic joints or a foot injury? I have been cited as having a "foot injury" under 5284. and therefore rated as a 0 because it does not meet the moderate condition. If the Xray shows arthritis of the metatarsal joints shouldn't that be rated as such?
Thanks,
oldvet

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#2 rentalguy1

 
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Posted 17 August 2008 - 01:15 PM

I can think of three different dx codes that they could legitimately rate this condition under. The codes are 5003 (Arthritis, degenerative), 5017 (Gout), and 5020 (Synovitis). 5003 and 5020 use the same rating criteria. 5017 uses a different rating criteria that would be more advantageous to you, but doubtful that you could get the VA to rate it under this code as "analagous," since you have a actual diagnosis that matches a ratable diagnostic code. The rating criteria is:

5003 Arthritis, degenerative (hypertrophic or osteoarthritis):




Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:


With X-ray evidence of involvement of 2 or more major joints

or 2 or more minor joint groups, with occasional incapacitating

exacerbations 20


With X-ray evidence of involvement of 2 or more major joints


or 2 or more minor joint groups 10

Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.



Note(2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic code 5013 to 5024, inclusive.

For the other two codes:

The diseases under diagnostic codes 5013 through 5024 Will be rated on limita­tion of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002.

5002 Rating criteria:



5002 Arthritis rheumatoid (atrophic) as an active process




With constitutional manifestations associated with

active joint involvement, totally incapacitating 100

Less than criteria for 100% but with weight loss and anemia

productive of severe impairment of health or severely

incapacitating exacerbations occurring 4 or more times a year

or a lesser number over prolonged periods 60


Symptom combinations productive of definite impairment of

health objectively supported by examination findings or
incapacitating exacerbations occurring 3 or more times a year 40


One or two exacerbations a year in a well-established diagnosis 20



For chronic residuals:




For residuals such as limitation of motion or ankylosis, favorable or unfavor­able, rate under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the codes a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.


Note: The ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis. Assign the higher evaluation.




#3 oldvet

 
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Posted 17 August 2008 - 04:04 PM

Why would VA give me a zero percentage and say that I was rated under 5284 Foot injuries, other?

The examiner showed traumatic arthritis of the first metatarsophalangeal joint. The code on the worksheet shows 5299-5284. Am I missing something ?

Thanks,
oldvet

#4 rentalguy1

 
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Posted 17 August 2008 - 04:53 PM

Yeah...they played with the codes. You need to file a NOD and tell them to change the code to 5002 with at least a 10% rating. Tell them that this is a erroneous code, as the diagnosis has it's own code in 38 CFR 4.71a, and does not need to use a analogous code. Also tell them that 38 CFR 4.13 allows for chaging of erroneous codes.

#5 JB3AFSP2

 
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Posted 17 August 2008 - 05:17 PM

rentalguy1,

I believe that I need to go a similar route with my case except I'll use diagostic code 5003 due to traumatic injury. Is there a way that I can request and get a copy of my examiner's report? X-rays were taken of my hand and I'm interested in seeing whether or not any arthritis was noted. I have a suspicion that since I didn't specifically request compensation due to arthritis, even though I complained of pain, they may have ignored it and simply based their rating on what I put on the claim form...left hand fracture.

#6 oldvet

 
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Posted 17 August 2008 - 06:09 PM

Yeah...they played with the codes. You need to file a NOD and tell them to change the code to 5002 with at least a 10% rating. Tell them that this is a erroneous code, as the diagnosis has it's own code in 38 CFR 4.71a, and does not need to use a analogous code. Also tell them that 38 CFR 4.13 allows for chaging of erroneous codes.



Thanks rentaguy1 ! Appreciate the help!
oldvet

#7 oldvet

 
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Posted 17 August 2008 - 06:20 PM

Yeah...they played with the codes. You need to file a NOD and tell them to change the code to 5002 with at least a 10% rating. Tell them that this is a erroneous code, as the diagnosis has it's own code in 38 CFR 4.71a, and does not need to use a analogous code. Also tell them that 38 CFR 4.13 allows for chaging of erroneous codes.



One more question though Does the fact that only the 1st metatarsal joint has arthritis change anything? The code says two or more joints.
oldvet

#8 rentalguy1

 
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Posted 17 August 2008 - 06:30 PM

Now that I go back and look at it, that kind of makes sense. They were bound by law to acknowledge the injury, and it didn't line up with the criteria for 5002, so they put it under a analogous code. I don't think there is any way to argue it so that the code could be changed to 5017. Therefore, they may have done you a favor in this instance. I say that becuase this particular code allows for a increase to 10% fairly easily. I think all you would need to prove a claim for increase is that the foot is bothering you quite a bit.

Do you happen to have plantar fascitis along with the arthritis? If not, watch out, because it is most likely in your future. It's absolutely no fun. If you have it, or end up with it, be sure to file for that condition secondary to your already sc'd foot arthritis.

#9 oldvet

 
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Posted 17 August 2008 - 09:02 PM

Now that I go back and look at it, that kind of makes sense. They were bound by law to acknowledge the injury, and it didn't line up with the criteria for 5002, so they put it under a analogous code. I don't think there is any way to argue it so that the code could be changed to 5017. Therefore, they may have done you a favor in this instance. I say that becuase this particular code allows for a increase to 10% fairly easily. I think all you would need to prove a claim for increase is that the foot is bothering you quite a bit.

Do you happen to have plantar fascitis along with the arthritis? If not, watch out, because it is most likely in your future. It's absolutely no fun. If you have it, or end up with it, be sure to file for that condition secondary to your already sc'd foot arthritis.


Thanks. No, I don't have it but will keep a watch on things. Thanks again.
oldvet

#10 oldvet

 
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Posted 18 August 2008 - 07:26 PM

Thanks. No, I don't have it but will keep a watch on things. Thanks again.
oldvet



rentalguy1
I think I satnd corrected on my last comment. I have had awful heel pain and an xray taken recently shows "A small plantar and dorsal calcaneal spurs are noted at the left foot." If this is what I think it is i.e. faciitis then how should I handle it? The VA has this report so it is not new evidence, maybe just overlooked.
Thanks,
oldvet

#11 rentalguy1

 
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Posted 18 August 2008 - 07:50 PM

get a appointment with your VA PCP and tell him you think you have PF. If that's what it is, then the pain will extend from your heel to the ball of your foot. It will be hard to flex your toes in either direction or stand on your toes. It also is excruciating to stand up first thing in the morning without physically grabbing your toes and stretching them back first. If these are your symptoms, then you have PF. One your PCP gives you a dx, try to get him to state in your progress notes that it's due to your sc'd foot problem. Once you have that, then file a secondary claim for it. If you need to know what to ask for, search for my "Planning My NOD" thread.

#12 oldvet

 
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Posted 18 August 2008 - 08:50 PM

get a appointment with your VA PCP and tell him you think you have PF. If that's what it is, then the pain will extend from your heel to the ball of your foot. It will be hard to flex your toes in either direction or stand on your toes. It also is excruciating to stand up first thing in the morning without physically grabbing your toes and stretching them back first. If these are your symptoms, then you have PF. One your PCP gives you a dx, try to get him to state in your progress notes that it's due to your sc'd foot problem. Once you have that, then file a secondary claim for it. If you need to know what to ask for, search for my "Planning My NOD" thread.


Thank you very much rentalguy1, I really appreciate you assistance on this.
oldvet




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