Foot injuries, other — VA Diagnostic Code 5284

Moderate, moderately severe, and severe

The schedule prints those three words and does not define them. Our reading stops there. 38 CFR § 4.6 (Evaluation of evidence) requires every element of the evidence to be studied so that decisions will be equitable and just. 38 CFR § 4.7 (Higher of two evaluations) assigns the higher rating when the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. An examiner’s adjective is evidence. The code does not say the adjective is the rating.

Pain, weakness, and weight-bearing

38 CFR § 4.40 (Functional loss) says weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 CFR § 4.45 (The joints), paragraph (f), lists “Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations.” 38 CFR § 4.59 (Painful motion) says: “It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.” Those sections do not define “moderate” or “severe” under DC 5284.

Actual loss of use of the foot

The note assigns 40 percent “with actual loss of use of the foot.” 38 CFR § 4.63 (Loss of use of hand or foot) says loss of use, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination uses the actual remaining function, whether the acts of balance and propulsion could be accomplished equally well by an amputation stump with prosthesis. That is the regulation’s comparison. Paragraphs (a) and (b) of § 4.63 name additional findings that will be taken as loss of use, including complete paralysis of the external popliteal nerve with footdrop and the organic changes that paragraph lists.

A built-up number such as 5299-5284

38 CFR § 4.27 (Use of diagnostic code numbers) builds an unlisted condition from the two digits for the body part or system plus “99,” and adds the analogous code after a hyphen when the rating is based on a residual condition. 38 CFR § 4.20 (Analogous ratings) permits a rating under a closely related disease or injury when the functions affected, the anatomical localization, and the symptomatology are closely analogous. “Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings.”

Foot codes the schedule prints by name

How does VA rate a foot injury under DC 5284?

38 CFR § 4.71a rates “Foot injuries, other” under Diagnostic Code 5284 at 10 percent for moderate, 20 percent for moderately severe, and 30 percent for severe. A note assigns 40 percent with actual loss of use of the foot. The schedule does not define the severity words. The rater weighs the evidence, including the functional-loss factors in §§ 4.40 and 4.45, and § 4.7 assigns the higher evaluation when the picture more nearly approximates it. Otherwise the lower rating is assigned. Education only.

What counts as loss of use of a foot?

Under 38 CFR § 4.63, loss of use of a foot, for special monthly compensation, exists when no effective function remains other than what an amputation stump with a suitable prosthesis would serve equally well. The comparison for the foot is balance and propulsion. The DC 5284 note uses “actual loss of use of the foot” for the 40 percent schedular evaluation. Education only.

How does VA rate other foot injuries under DC 5284?

38 CFR § 4.71a rates “Foot injuries, other” at 30 percent for severe, 20 percent for moderately severe, and 10 percent for moderate. The note says: “With actual loss of use of the foot, rate 40 percent.” There is no 0 percent line, so § 4.31 assigns 0 percent when the compensable requirements are not met. The schedule does not define the three severity words.

What is the difference between moderate, moderately severe, and severe?

The regulation does not say. It prints the three words. Section 4.6 requires a full reading of the evidence. Section 4.7 assigns the higher evaluation when the picture more nearly approximates it, and otherwise the lower one. Sections 4.40, 4.45, and 4.59 address functional loss, pain on use, and painful motion. They do not supply a definition the foot code omitted. This page invents no measurement that equals 10, 20, or 30 percent.

What does actual loss of use of the foot mean?

The DC 5284 note assigns 40 percent with actual loss of use of the foot. Section 4.63, for special monthly compensation, holds loss of use to exist when no effective function remains other than what an amputation stump below the knee with a suitable prosthesis would serve equally well. For the foot, the comparison is balance and propulsion. The 40 percent note is the schedular line. Section 3.350 is a separate review.

Can both feet be rated, and does the bilateral factor apply?

Section 4.26(a) treats the foot as part of the lower extremity for the bilateral factor. The factor applies when there is a compensable disability in each of two paired extremities. DC 5284 does not say the code is assigned once per foot. Whether two evaluations are in the record is a question for the decision and an accredited representative. This page does not state a per-foot rule.

Why might VA use another foot code instead of DC 5284?

The foot schedule names plantar fasciitis (DC 5269), acquired flatfoot (DC 5276), weak foot (DC 5277), claw foot (DC 5278), metatarsalgia (DC 5279), hallux valgus (DC 5280), hallux rigidus (DC 5281), hammer toe (DC 5282), and tarsal or metatarsal malunion or nonunion (DC 5283). DC 5284 is the “other” line. Section 4.20 requires a close analogy and says conjectural analogies will be avoided.