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      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
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    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

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    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ 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  • 0

Peripheral Neuropathy - Va Rating Schedule

Question

Posted

Does anyone know the proper rating or diag code for this?

Anyone else here have Peripheral Neuropathy? What rating code did they give you?

Donewsome

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11 answers to this question

Posted

I'm assuming it is due to IVDS, so it would be 5243-(dx code for whatever nerve is affected)

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Posted

Thank you both for your replies.

The reason I was searching for more input is I think they have me rated wrong or atleast under the wrong code.

The gave me SC for Peripheral Neuropathy as secondary to my DMII.

They said it was not in the Rating Schedule so they rated it with the next closest disease.

They are rating me for Paralysis of the Sciatica Nerve. The have me rated at 10% and basically unless I become unable to walk at all I can't get an increase past 10% for each leg. Because the qualifications to get increased in Paralysis of the Sciatica Nerve mostly have nothing to do with my actual condition, therefore I can't show medical evidence of an increase.

I really think they have me under the wrong catagory and just need to find some alternative to suggest to them.

I take Neurontin (Gabapentin) also. I take 6 x 300 mg each day for a total 1800 mg each day.

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Posted

The reason I was searching for more input is I think they have me rated wrong or atleast under the wrong code.

The gave me SC for Peripheral Neuropathy as secondary to my DMII.

They said it was not in the Rating Schedule so they rated it with the next closest disease.

They are rating me for Paralysis of the Sciatica Nerve. The have me rated at 10% and basically unless I become unable to walk at all I can't get an increase past 10% for each leg. Because the qualifications to get increased in Paralysis of the Sciatica Nerve mostly have nothing to do with my actual condition, therefore I can't show medical evidence of an increase.

I really think they have me under the wrong catagory and just need to find some alternative to suggest to them.

There is no specific diagnostic code for peripheral neuropathy, and the common practice is to rate it in analogy to paralysis of the affected nerve. Most raters will analogize it to paralysis of the common peroneal nerve, but your rater used the sciatic nerve. It doesn't mean that you cannot get a higher evaluation, it depends entirely upon the rater. Some will go up to 20 percent, and even more, but there must be significant objective evidence of disease. Symptoms such as complete loss of protective sensation in a stocking distribution (documented on objective examination), recurrent ulceration, stuff like that are indicators that a higher evaluation would be warranted. Also, if electrodiagnostic studies were to show moderate or severe peripheral neuropathy, you would have an excellent case for a higher rating.

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Posted

Donewsome,

I also have periphial neuropathy due to DMII. My codes are 8521 for lower-8515 for upper.

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Posted

I will be appylying for periphial neuropathy of the ulnar nerve and common peroneal nerve. Where and how sould I start? Should I have a private doctor do an exam? Hope to hear from someone. I need advice.

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Posted

I have peripheral Neuropathy in my neck,shoulders,fingers,feet and toes. Go see your Dr,not the VA Doctors. I'm checking on seeing a specialist that deal with PN. Good luck with your claim.

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Posted

I will be appylying for periphial neuropathy of the ulnar nerve and common peroneal nerve. Where and how sould I start? Should I have a private doctor do an exam? Hope to hear from someone. I need advice.

bbknor,

Please start a new thread as you have questions that are different from the

Topic on this thread.

Thanks,

carlie

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Posted

donews,

Sorry I can't answer your question.

I just wanted to say, it's good to see you post

and know you are still above ground with us.

We've missed you.

carlie

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Posted

Hello Donews. I too have Pn of all extremities hands and feet though I am waiting to be SC. At present I do not have diabetes but it is from a chemical exposure (Multis). I believe that the code will only go to a maz of 60 percent but you can get 10 perdcent per extremeity if I remember the Code. This pertaining to the EMG and Nerve conductivity of which I have had 3 from the VA and 1 from and outside Neurologist.Yes I still am waiting to get my appeal in to fight the sc part. Also other diseases that are secondary can come from it. Dioxin , AO is the Culprit and exposure must be proved. It is important to know that a battle is brewing with Congress to make a law that covers all vets with PN no matter where you served . If you have the disese then you were exposed PRESUMPTIVE . All veterans need to be calling there Cong and Senators and let them know the law has to be specific. You may be able to get a 30 percent rating on each limp too if they have not changed it from last yr. I wish you well brother and hopefully I will not be too far behind you in getting sc and your award. God Bless, C,C, Never Give Up

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Posted

There is no specific diagnostic code for peripheral neuropathy, and the common practice is to rate it in analogy to paralysis of the affected nerve. Most raters will analogize it to paralysis of the common peroneal nerve, but your rater used the sciatic nerve. It doesn't mean that you cannot get a higher evaluation, it depends entirely upon the rater. Some will go up to 20 percent, and even more, but there must be significant objective evidence of disease. Symptoms such as complete loss of protective sensation in a stocking distribution (documented on objective examination), recurrent ulceration, stuff like that are indicators that a higher evaluation would be warranted. Also, if electrodiagnostic studies were to show moderate or severe peripheral neuropathy, you would have an excellent case for a higher rating.

Approximately half the time of one year to file my NOD for decision of 10% for paralysis of the sciatic nerve has passed. I’ve been trying to figure the best course of action to address this matter. Research, research, research . . . and consequently how I came across this post within this forum.

I filed for paralysis of the sciatic nerve secondary to L3-L4 and L5-S1 DDD of the Lumbar Spine. The C&P examiner has this primary listed as the following:

Impression:

Discogenic disease L3/L4 with joint space narrowing sclerosis and osteophyte formation. : mild anterior wedging of L1.

Addendum:

No pain on range of motion o flare ups on any of the above joints except as sated above. All above joints have no additional limitations by pain, fatigue, weakness or lack of endurance.

(This last is an out and out lie: I had an ACDF on my neck only months before this and have a claim for cervical DDD on account of it because of military records reflecting the initial injury and I can’t turn my neck as I should, and have problems to the 100% contrary of what he states and none of this includes what I told them, with my wife there, about my left leg and back.)

The examiner goes on to say that it is part of what happened to me in the Army, etc, etc. In the exam it was noted that I have no tendon reflex in my left knee. The doctor had to help me get on the examining table. There are other things not noted in the report that can be substantiated but this will serve my purpose here. Also I’m leaving things out not important now, i.e., tears at T12, L1, etc, etc---there are many more notations in this regard prior to the end of the report.

While at the C&P exam I was adamant about the peripheral radiculopathy down my left lower back to include my entire left leg, lack of strength in the left leg, inability to sit or stand for long periods, inability to stand or walk more than a few minutes---few being less than ten. Other issues were covered as well.

The examiner weighed over 300 LBS, never got off of his little stool when he measured my motion radius and when I could bend no further forward he grabbed by belt and told me to keep going when I could not. He then supported my weight as I leaned forward using my ankles not bending at the waste. If I had not had my wife with me I would not have known, to this day, that he was actually measuring me with a device. I now know that this is an incorrect way to apply the measurement but it is my word against his. I’ve since filed a NOD in regard to this primary claim.

I was later awarded 20% for a primary with regard to the above condition with no notation or award given to anything else. IT was my VSO who told me that I would have to claim a secondary condition to get compensation for the additional conditions. After talking to a doctor about the correct definition of words I’d have to use in my claim, the doctor wrote a letter stating:

To whom it may concern:

After a review of Mr. Abda’s medical history it is my opinion that it is at least as likely as not that the paralysis of his sciatic never is due to complications of his lumbar disc disease as evidenced by previous scans. (He refers to recent MRI scans within my files) He has absent tendon reflexes on his left knee and pronounced peripheral neuropathy.

During the time of my first claim I was being treated by a doctor who proscribed a power wheelchair for me via Medicare. I have been disabled because of these injuries since September of 2005 and only knew I was an eligible candidate for VA compensation just before the October 10 exam date. My condition is referred to by neurologists as the “glacier disease” because of its slow and steady progression. That last notation was five years ago. My condition has worsened considerably since then documented by VA emergency room visits and other private practice doctors. So, part of my NOD was accompanied by this new information including my claim of improper measurements and not reflecting the true nature of my injury and lack of mobility.

So, when I made my secondary claim, also was included the new documentation of the wheelchair, neurologist’s notes of lower left extremities being weaker than the right at 3-4 to 5/5 on the right. There is one private and one VA Compensation M.D. that reports no knee reflex. All doctors have reported the lessening of strength on the left and no reflex.

However, I got this double talk from the C&P exam for the first and primary claim:

“ . . . 5/5 motor strength lower extremities, although left is less than the right. His right knee has 2+ deep tendon reflexes, left is absent.”

Correct me if I’m wrong on this, but, either you have 5/5 in lower extremities or you don’t. If I have less in my left than in my right then I don’t have 5/5 in my left. Am I incorrect in this interpretation?

Accordingly, two private M.D.’s not only report lack of knee reflex but that my left lower motor extremities are at L-3-4 and R-5 out of 5. I have to lift my leg with my hands and arms to do certain activities and was documented at my last Primary Care Doctor visit at the VA Hospital where it was noted, again, just here a week ago that my lower left extremities are a 3-4 out of 5. I’ve been in the wheelchair since May of 2010.

Now, to further my confusion, when I got m award for my primary claim, this is what the VA stated in its Reasons for Decision:

“You had normal sensation and 5/5 motor strength in you lower extremities. “

Keep in mind that two private doctors, one and M.D. and the other a well respected Neurologist, report otherwise in regard to lower left extremities.

Secondly, the decision rating for my secondary claim was granted at 10% for “radiculopathy” not paralysis of the sciatic nerve as I had claimed. They did not call me back in for another C&P exam but, instead, went back and amended the previous and original exam stating:

“Service connection for lumbar radiculopathy, left lower extremity (claimed as paralysis of the sciatic nerve, absence of the tendon reflexes of the left knew, and peripheral neuropathy) as secondary to the service-connected disability of lumbar degenerative disk (sic)(previously claimed as back condition).”

Service treatment records do not show treatment of, complaints of, or a diagnosis of radiculopathy, left lower extremity during your active duty military service. However, service connection has been granted because radiculopathy is a known complication of lumbar degenerative disk (sic) disease.

*sic* (Note: disk should be disc)

Then, more double talk as follows (this within the same decision letter)

. . . A 10 percent evaluation has been granted form October 22, 2009 because the evidence shows incomplete paralysis below the knee, which is mild. A higher evaluation of 20 percent is not warranted because the evidence fails to show incomplete paralysis below the knee, which is moderate.

I use the term “double talk” because the criteria for the above reference (paralysis of the sciatc nerve) are as follows:

From the CFRs

8520: Paralysis of Sciatic Nerve

Complete. . . (Skipped)

. . . Incomplete:

Severe, with marked muscular atrophy….60

Moderately severe…………………..…………….40

Moderate ………………………….….…….………..20

Mild……………………………………….……..…….…10

I don’t have to have any of the criteria that were cited to get more than 10%. But they make it sound like I do. It’s double talk.

Per my VSO, he said I had to have a doctor declare my condition more than Mild to obtain a higher disability rating. He said that I could not reason this issue out in correspondence or by logic in writing because my word would not count. It has to be a M.D. or higher to argue the point.

I’ve tried to understand how they can take a symptom of a diagnosis, remember, it is not up for grabs in interpretation because I have an M.D. and a Neurologist state that I have it (paralysis of the sciatic nerve) and that the radiculopathy is actually a symptom of the paralysis, not that the radiculopathy is a symptom of my Lumbar DDD, which it is, but the Paralysis is there, is a secondary of the primary claim and that the paralysis is a result of my DDD which has, within it, radiculopathy. There too is the fact that my left is weaker by even the VA Primary M.D. I see at the VA hospital.

The actual report from the C&P examiner that was amended states the following in regard to how they (the VA) handled my secondary claim:

“Examination results:

This is a review only. C-file reviewed. Mr. Abda is not seen for this evaluation. However, I did see Mr. Abda for C&P examination for his lumbar spine back on 3/9/10. At that time, he reported back pain with bilateral lower extremity radiculopathy, left worse than right. At that time, I found that it was as least as likely as not that his current lumbar degenerative disc disease is a continuation of progression of that seen on the x-ray of 1/11/79 while in the service. Question to me today is if his current cervical radiculopathy and peripheral neuropathy are related to his service connected lumbar degenerative disc disease. I have reviewed the documentation, including the note from XXX medical center and I am not clear what the cervical comes from. However, clearly his lower extremity radiculopathy is, in fact, related to his lumbar spine disability which as I find in March is as likely as not related to his time in service. Again, I do not see any indication of cervical radiculopathy at this time, but I believe I have answered the question anyway.”

And that is it: This is all they used to make the decision. Please note that I think that they put TWO questions to the doctor at this point. I have service records for severe injuries to my head and shoulders and was unconscious for over two hours while in the Army. I had just previously made a secondary claim for Paralysis of the Sciatic Nerve and I think both got to his desk at that same time. But it all remains a lot of double talk and give absolutely no indication of the severity of my condition, or, the lack of for that matter in regard to my paralysis.

I’m not well educated. I didn’t quite finish the 10th grade and I got my GED while the first year of my enlistment in the Army as a promise and stipulation I made to my parents that I would do so in agreement so that I could enlist at the age of 16, go through delayed entry program and actually start active service at age 17. (ROTC played a big role in this setup and it was over 30 years ago so no Q and A on this one, it just is and not part of the process here.) I’m now 50 and I just started with the VA last year. I’m sorry if I don’t communicate will or take a long time in trying to get my point across. I’m just not good at it but I would be very humbled if someone could post to me about this situation. I need help and I don’t know what to do about the pickle I’m in.

I’ve been on SSD for over 5 years and I can do less and less every day. My wife is my care taker. I have more claims in for other areas such as emotional this and that and the other. This is all by a mental health care professional and not in my own words so I wait to see what the VA will do with all this stuff.

But time is running out on my time to file a NOD for my secondary claim decision and it is super hard to find a doctor that will get involved in litigation issues that are not solely for my health.

I don’t know what to do.

Please help.

A

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Posted

Abada,

Please repost your information as a new topic.

I am closing this old topic.

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