Hello. I’m looking for advice and any assistance on next steps, if any. Also, sorry for long read and any other issues - first time posting...
TL;DR: Denied ankle secondary to SC Spondylolisthesis due to no link. Thinking of filing supplemental to say ankle secondary to SC Peripheral Neurological Nerve Involvement, Left Sciatic Nerve.
I filed a claim for left ankle instability secondary to my service-connected spondylolisthesis. It was denied due to VA medical opinion not finding a link, attached screenshot. They did, however, increase my back rating, which I’m grateful for. I’d like to add that the increase was not in my claim – the VA added it on their own. I am planning on filing a supplemental claim and stating that I think my ankle is secondary to my service-connected left sciatic nerve disability.
At C&P, the examiner didn’t specifically ask me how the ankle happened, and I unfortunately didn’t divulge. She mainly asked me how the ankle instability was affecting my life. Origin story of the ankle was that I slipped down the stairs on one of the days my back and nerve pain were flared up, and I twisted and sprained my ankle. It was very swollen so I iced it, and it was painful and tender for a while. I thought I’d let it heal on its own. Well, it didn’t heal properly and my ankle repeatedly gives out and twists, even when I’m walking on flat surfaces or just even from getting up from the couch. I re-injure my ankle probably once a month, and I’ve learned to just walk it out. But it’s at the point now that all at once, my back pain would be incapacitating, the nerve pain shoot down my leg and it causes my ankle to throb and I can’t fall sleep.
About a year after the injury, I was finally over it and I asked for imaging of my ankle and was only given an X-ray, which showed nothing because it’s not a bone issue. Then I saw my VA PCP where she observed my ankle was swollen, tender and bruised. She referred me to PM&R who referred me to physical therapy. I had minor improvements with physical therapy, so PM&R referred me to a podiatrist, who honestly was no help. He looked at my arches, diagnosed me with “acquired pes planus” and said that was why I kept spraining it, not asking how I even sprained it in the first place and just overall didn’t fully hear me out. He prescribed me insoles, which has not helped. I don’t even think I have flat feet, but I digress.
As mentioned, I’m thinking of filing a supplemental. As “new” evidence, I plan on writing a personal statement explaining the above, and that I think my ankle is secondary to both my back and nerve (or maybe just nerve?). I asked for additional imaging, so hopefully I get an MRI or something. I also found peer-reviewed articles and medical literature that discuss how spondylolisthesis and sciatic nerve involvement could aggravate the ankle. I read in one of the posts here that that might be helpful to include. I tried to find past VA cases but all of them were the opposite of my issue (nerve or back issue secondary to ankle vs mine being ankle secondary to back and nerve), so not sure if I should include it.
As “relevant” evidence, I plan to submit ankle PT records and CT imaging from 2024 of my back that shows disc slippage and disc bulge, and nerve being pinched and narrowed as a result. It was submitted as part of the initial claim. Should I still submit it as “relevant” evidence?
Am I making any sense or am I reaching? Did I mess up, like should I have claimed ankle pain or something else? I’m wondering if the nexus is really all I’m missing or is there more? I also don't know how to get a nexus outside of C&P exam...I don't want to pay and I get all my care at the VA. Is there a chance or should I just leave it alone? I don’t know nor really care if it will even move the needle for me in terms of increasing my rating, but I want the ankle to be service connected if in the future things get worse.
Thank you!
