Veterans Benefits Network-C&P Exam for Bilateral Foot Problems (2024)

Today I went in for a CP exam for bilateral foot conditions. I was seen by a V.A. nurse practioner. She listened to my story of my foot problems and I informed her of being admitted to Tampa VA Chronic Pain Management Team for care.

After my story she asked where I was stationed and when did I initially get foot treatment in service. I gave her the dates and told her about boot inserts and how they really didn't help me. she also asked if I was able to purchase OTC insoles. I answered and she simply shook her head. After looking at my SMR's she said my records were very hard to read and that I was diagnosed with pes planus and plantar fasciitis in 1992. My earlier records from 1988 she said couldn't be read.

She also told me that my all of my toes are deformed with "hammertoes".

Will plantar fascitiis, pes planus, and "hammertoes" be rated bilaterally or individually since both of my feet are affected?

Pes Planus and Plantar Fascitiis will be a single rating as the latter is rated analogous to the former. As for the rating of it, it will depend. I believe you can be rated each side if there is differing severity, or rated a single bilateral rating for both.

As far as the hammer toes:

Code5282: When the toes are permanently bent, they are calledhammer toes.Often hammer toes are the result of claw foot. In these cases, hammer toes cannot be rated separately. Rate the entire condition under claw foot. If all the toes are hammer toes, but the foot is not a claw foot, then it is rated 10%. Single hammer toes are rated 0%.

seniorchief000 wrote:I was rated for Planter Fascitiis 30%, was and still am confused as its just a single rating. Doesnt say bilateral which is strange because it effects both feet. Anyone been rated one rating for both feet?

Look at the schedule of ratings. My guess is that you have a single bi-lateral rating. That is the most common for both feet being impacted as separate severity isn't that usual.

Guldolphin wrote:Pes Planus and Plantar Fascitiis will be a single rating as the latter is rated analogous to the former. As for the rating of it, it will depend. I believe you can be rated each side if there is differing severity, or rated a single bilateral rating for both.

As far as the hammer toes:

Code5282: When the toes are permanently bent, they are calledhammer toes.Often hammer toes are the result of claw foot. In these cases, hammer toes cannot be rated separately. Rate the entire condition under claw foot. If all the toes are hammer toes, but the foot is not a claw foot, then it is rated 10%. Single hammer toes are rated 0%.

So, if I'm understanding you correctly, I could be rated for plantar fascitiis and claw foot deformity since ALL of my toes are hammer toes.

Claw foot - 10%
Plantar Fascitiis - ?

Thanks for the reply. Waiting on ebennies now.

seniorchief000 wrote:So if its a single rating for both feet as mine was with the 30%. It would not be considered bi-lateral when I go to put the percentages into the calculator. So just count it as a single 30%?

yes and no.....

If you have other ratings impacting your limbs you would include it.

OK.. I looked in MyHealthyVet and found CP Exam DBQ for my foot exam. Can someone tell me if this verbiage means granted or denied?

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ]
a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness.
c. Rationale: EAS: 20 Feb 1986 RAS: 13 July 1993
STR dtd 23 March 1992 C/o fallen arches Dx Plantar Fasciitis P: arch supports.
The Veteran complained of foot pain and fallen arches in 1992 while in service. He was prescribed arch supports. His entrance exam showed normal
CONFIDENTIAL Page 22 of 69
feet. He still has bilateral foot pain and xrays show pes planus. Therefore it is at least as likely as not the Veteran's claimed flate feet were caused by or incurred during service.

Guldolphin wrote:Keep in mind a favorable C&P exam does not mean you will be awarded. I have had 2 denials taken to the BVA that had favorable C&Ps and still denied.

How does a positive CP exam warrant a denial? Doesn't that make confidence in the system useless?

Two months and counting. Still no word on foot issues. However, I have had 2 more CP exams in the meantime. One for a bum shoulder I claimed as secondary to a fall when I broke my back. And the second CP exam was for PTSD.

Question: If I am approved for PTSD on this second CP exam will the effective date go back to my initial claim date?

levelheaded4ever wrote:because there must be evidence of an in service event and solely lay statements from the Veteran without corroborating evidence does not meet the standard.

Actually, the CAVC has ruled multiple times that lay evidence alone is sufficient to establish an in-service event.

See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). In Dalton, the Court found a VA opinion inadequate where the examiner did not comment on the Veteran's report of in-service injury and, instead, relied exclusively on the lack of evidence in the service treatment records (STRs) to provide a negative opinion). See Dalton at 39-40

If the Board finds his or her testimony credible, a claimant does not need competent medical evidence to substantiate his or her claim. See Savage v. Gober,10 Vet. App. 488, 495–96 (1997) (holding that, per 38 C.F.R. section 3.303(b), medical evidence of nexus is not required for benefits if the veteran demonstrates continuity of symptoms between his present disability and service);see also Davidson v. Shinseki,581 F.3d 1313, 1316 (Fed. Cir. 2009). Arneson v. Shinseki, 24 Vet. App. 379, 388 (2011).

("The absence of actual evidence is not substantive 'negative evidence'")). Jones v. Shinseki, 23 Vet. App. 382, 387-88 (2010).

The Board "cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence." Buchanan, 451 F.3d at 1337. Section 3.307(b) does not require both medical and competent lay evidence to establish the existence of a chronic disease, and thus, "competent lay evidence can be sufficient in and of itself" to establish entitlement to a benefit. Buchanan, 451 F.3d at 1335 (citing 38 C.F.R. § 3.307(b) (in claiming chronic disease, "factual basis may be established by medical evidence, competent lay evidence[,] or both.")).

Just checked ebenefits today for all of my claimed issues. Went to preparation for a decision from the review status. and the dates have been changed to 3 months sooner than the initial estimate.

Fingers and toes crossed for positivity...

My point is normalJohn Doerater is not going to stick their neck out to service connecton just a lay statement; national quality would crush us...A DRO maybe, as their quality gives them more leeway on less than clear theories of service connection....and the BVA well they can pretty much service connect whatever they want too because they can.

You will need to wait for the letter from the VA. However it looks positive based on the C&P. As far as the rating:

5276 Flatfoot, acquired:

Pronounced; marked pronation, extreme tenderness of plantar
surfaces of the feet, marked inward displacement and severe spasm
of the tendo achillis on manipulation, not improved by orthopedic
shoes or appliances:
Bilateral........................................................................................................... 50 ,.,,
Unilateral ........................................................................................................ 30
Severe; objective evidence of marked deformity (pronation,
abduction, etc.), pain on manipulation and use accentuated,
indication of swelling on use, characteristic callosities:
Bilateral........................................................................................................... 30
Unilateral......................................................................................................... 20 , ,,
Moderate; weight-bearing line over or medial to great toe, inward
bowing of the tendo achillis, pain on manipulation and use of
the feet, bilateral or unilateral ............................................................................. 10
Mild: symptoms relieved by built-up shoe or arch support........................................ 0

It will depend on the rest of the C&P exam. Simply having inserts does not equate to 30%.

tonygreene113 wrote:Just checked ebennies and found date for estimated completion moved up to 4/17-4/18 and preperation for notification.
No change noted in percentages. Looks like another loser for me.
Supplemental lane here I come.

You will not see any change until the claim moves to closed.

ibeathinker wrote:
Actually, the CAVC has ruled multiple times that lay evidence alone is sufficient to establish an in-service event.

Lay evidence was acceptable as evidence of an in-service event well before the CAVC even existed. I started doing this job in 1976 and it was well accepted back then; however, then as well as now the evidence must be deemed "credible" and whether it is credible or not is a judgment call by the decision maker.

In almost every case, again both then and now, if there is nothing to support the assertion beyond the claimant's statement (which is obviously self serving) then little if any weight is given to the statement. Nothing the CAVC has said changes that.

Cruiser

Well I finally received a decision. Rater gave me favorable decision on three things I was initially denied on from appeal.
This was odd since injury was deemed in-service and no other evidence was added.
The feet wasn't approved compensable at 0%. This is what was weird to me.
But I think i have a good argument for establishing an earlier effective date back to when shoulder injury since it was tied to an already compensated claim.

In human math disabilities totalled 160%, VA math brought it to 90% . But granted 100% p&t so...its all good for now.

tonygreene113 wrote:Well I finally received a decision. Rater gave me favorable decision on three things I was initially denied on from appeal.
This was odd since injury was deemed in-service and no other evidence was added.

There had to be something new otherwise there would be nothing to warrant re-opening the claim.

The feet wasn't approved compensable at 0%. This is what was weird to me.

I don't know what you are trying to say. Did you mean that they granted service connection and assigned a 0 percent evaluation? If so, what is weird about that? I did that many times.

But I think i have a good argument for establishing an earlier effective date back to when shoulder injury since it was tied to an already compensated claim.

What is the argument that you have? I don't see anything in what you said that would be a basis for an earlier effective date so I assume that there is more.

Cruiser