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Peripheral Neuropathy - Va Rating Schedule


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11 replies to this topic

#1 donews

 
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Posted 06 February 2008 - 01:32 PM

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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#2 rentalguy1

 
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Posted 06 February 2008 - 08:14 PM

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

#3 donews

 
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Posted 06 February 2008 - 09:37 PM

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.

#4 entropent

 
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Posted 07 February 2008 - 03:39 AM

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.

#5 callover007

 
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Posted 07 February 2008 - 07:47 AM

Donewsome,

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

#6 bbknor

 
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Posted 24 February 2009 - 09:28 PM

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.

#7 Maurice

 
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Posted 24 February 2009 - 11:42 PM

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.

#8 carlie

 
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Posted 25 February 2009 - 06:56 AM

[quote name='bbknor' date='Feb 24 2009, 10:28 PM' post='132422']
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

#9 carlie

 
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Posted 25 February 2009 - 06:58 AM

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

#10 Capt.Contaminate

 
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Posted 25 February 2009 - 09:57 PM

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

#11 Abada

 
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Posted 15 December 2010 - 09:35 AM

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





#12 carlie

 
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Posted 15 December 2010 - 11:32 AM

Abada,
Please repost your information as a new topic.
I am closing this old topic.




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