Durable Medical Equipment Coverage

In a prior posting I told you about being denied orthopedic shoes and it was suggested that I purchase sneakers or tennis shoes, so I wrote a letter requesting a Standard Appeal, which is 30 days. I sent the letter on 9/15/09, they wrote me a letter on 9/22/09 stating they will review my appeal and on 9/24/09 they sent me a letter stating they had reviewed my extensive and eloquent letter and that I was approved for the financial assistance to obtain therapeutic shoes. I am putting the letter in my blog in the hope that others will be able to use my format to receive Durable Medical Equipment. Please borrow ideas from this letter as needed.

"Topics in this standard appeal letter:
1) Medical history in lay language
2) Current medical history
3) Why I need to wear therapeutic shoes

Dear Durable Medical Committee Members:

My medical history in lay language: I have poor circulation in my lower limbs: my legs and feet. I have deformities of both my left and right feet and have had feet deformities since birth. I was born in 1950 with Arthrogryposis Multiplex Congenita. At birth my legs were cross legged like an Indian sits and folded over my stomach, my feet were by my ears. I entered A.I. duPont Institute, Wilmington, Delaware at age 6 weeks (10/2/50) for my first stay at "the hospital," the last date I was at A.I. was on 4/7/64, four months before my 14th birthday. (Please see enclosed list of operations from A.I. Institute dated 1/24/75.)

When I began attending John G. Leach School for Crippled Children in 1954 my parents requested special permission for me to wear long pants under my dress because my legs were always cold. I continue to have poor circulation in my legs and feet at age 59. I prefer to wear pants for warmth; at night I use an electric blanket, even in the summer, because my cold legs and feet ache at night and make it difficult to sleep. I take a three-hour nap during the afternoon to make up for not sleeping well at night.

My feet are deformed in the bones and joints and also visually deformed from both my birth defect and from the process of living. I have both arthritis and osteoporosis in my feet from the operations and from wearing out my feet over the years.

I have Arthrogryposis in every bone and joint from my hips to my toes. I was born with rocking horse clubfeet on feet that also have Arthrogryposis in every bone and joint. I have big scars on my hips, holes in my knees where I had pins inserted, and scars on the back of my ankles and on the top of my feet from operations. The last of many operations on my feet knees and hips occurred when I was 13 years old; please see operation list. From 1950 to 1964 patients did not enter this hospital during the medical procedure and then go home; sometimes we were in the hospital for one year or longer. Most of my childhood was spent dealing with operations, recovery from the operations, and re-socializing to the world outside the hospital.

I learned to walk on wooden underarm crutches at age three (Please see attached picture of me at age fur on crutches with braces on my feet.) Currently I have walked with crutches for 56 years. I purchased my current pair of crutches from Award Prosthetics in Burnaby, Canada while I was working, more than four years ago. They have anatomic hand grips, one for the right and one for the left hand, and tornado crutch tips that absorb the shock of each step. (Please see two pictures of me standing as an adult on purple crutches; in one picture I have my third service dog, Aven from Canine Companions for Independence, with me.)

For the last six years, since I fell and ripped my rotator cuff and had both wrists repaired for carpal tunnel syndrome, I have used a manual wheelchair in my house and on longer outside ventures.

Current medical history: I have never been able to tie shoes because I do not have hip sockets (instead I have a small bit of bone and some grizzle holding my leg bones to my hip, but I have no ball and socket); therefore I cannot bend very well. I also cannot sit up from lying on my back unless I hold onto something in order to roll over. Because I cannot bend over I have had three service dogs from CCI in Santa, Rosa since 1983. On thing my service dog does is pick up things I drop including my keys, a crutch, her leash, dishtowels, and other items.

Both my feet have been fused in a 90-degree position since I was 13 years old. If there is flexion in my feet it is because the operations I had when I was 13 have begun to wear out, not because I can naturally move my feet. I also cannot wiggle my toes. My body leans forward at my hips, I cannot straighten up, which means I need shoes that are flat for my safety, so I do not fall over on my face. My knees are also bent. This is part of the reason I am 4'6" tall, along with the fact that bones from from the joints, and all my hip, knee, and feet joints are deformed.

After my last feet operations, when I was 13, I was able to wear Stride Right sneakers, and some more attractive shoes, for many years. In 2000 I became aware of pain in my feet while walking and I saw Dr. Brent Wendel at the Puget Sound Foot and Ankle Center in Seattle. He prescribed AFO's and therapeutic shoes. I found that the rocker bottoms he prescribed were to dangerous with my swing through gate (I kept falling down after getting rocker shoes), but therapeutic shoes with flat bottoms worked with the AFO's. I have never needed to purchase new AFO's. (Please see the medical records sent from Dr. Wendel.)

I have been wearing the same black Crary Custom Shoes in Oregon (seen in pictures of me as an adult) for two years; they are beginning to wear out. When I purchased my current shoes I received assistance from Kaiser through Employment Medical Insurance and I paid the co-pay. The reasons why I need to wear therapeutic shoes, when there are so many attractive alternatives in tennis and sneakers are many:
-My braces are large because my feet are deformed so I need a wider size shoe; my current shoes, which I purchased from Crary two years ago are Performance Walkers with Velcro; they are size 7-2 wide.
-I need Velcro straps because I cannot bend over to tie shoes.
-More Velcro must be added to new shoes to make the straps long enough to reach over the AFO's and fasten to the shoe.
-I need the stability of the therapeutic shoe.
-I need shoes that are all ready flat footed, or I would need to go to a specialty prosthetic shoe shop that can grind down the heel. *(However, the specialty prosthetic shoe shops will not add longer straps or grind down heels unless the shoes are purchased from their shops.)
*(In the past I was pressured into and convinced to purchase shoes form Hanger Shoes in Longview, WA and from When The Shoe Fits in Vancouver, WA. I was unable to wear the shoes I purchased from these two shops because the heels were too high.)

I am requesting financial assistance from Durable Medical Equipment Benefits to purchase new therapeutic shoes because the therapeutic shoes I purchased from Crary are now two years old, and because I am now living on Social Security Disability Income (SSDI).
1) My request for therapeutic shoes is not just about my feet, it is a whole body medical issue.
2) I am unable to tie shoes, so my shoes must have Velcro straps that reach across my AFO's.
3) I have tried tennis shoes and sneakers, including New Balance Shoes, in the past with the AFO's, and they have always had a higher heel (I am severely flat-footed) that thrusts me forward, and if they they have Velcro straps they needed to be lengthened to fit over the AFO's.
4) Stride Right, flat sneakers, are too small for the AFO's.
5) I am severely flat-footed and I need flat-soled shoes.
6) The therapeutic shoes provide more structure and support than softer non-therapeutic shoes would provide.
7) Like every other American woman, I wish I could wear attractive, fancy, different colored and fun shoes but I cannot.
8) I cannot afford to pay for the same safe and supportive therapeutic shoes that were previously paid for by Kaiser Medical Insurance when I was working.
9) If I could work I would be working.

I am hoping that after reading this request you will decide that I meet the requirements for the Durable Medical Equipment of Therapeutic Shoes. Before you make a decision to deny my request for Therapeutic Shoes as Durable Medical Equipment I would

1) appreciate the opportunity to come to your meeting have you inspect my feet in person for deformity and poor circulation;
2) If you do not want to personally inspect my feet for deformity and poor circulation, I would like to be referred to a Medical Podiatrist, recommended by the Durable Medical Committee for a second opinion.

Thank you for your attention to the Durable Medical Equipment Benefit of Therapeutic Shoes for my safety and stability.

(No attachments are included in this blog.) I hope this letter is helpful to someone or many. Put in all the facts, use words like safety and stability, make note of what you would do if you were able, like buying pretty shoes, and send me an e-mail if you need more assistance. Blessings, Iris