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    • How to get your questions answered.

      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.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • 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

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • 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/ http://www.hadit.com/forums/index.php?/topic/40963-va-fl-10-34/ http://www.hadit.com/forums/index.php?/topic/40964-va-fl-10-32/ http://www.hadit.com/forums/index.php?/topic/40966-va-fl-10-30/ http://www.hadit.com/forums/index.php?/topic/40967-va-fl-10-26/ http://www.hadit.com/forums/index.php?/topic/40968-va-fl-10-25/ http://www.hadit.com/forums/index.php?/topic/40819-va-fl-10-24e1/ http://www.hadit.com/forums/index.php?/topic/40818-va-fl-10-24/ http://www.hadit.com/forums/index.php?/topic/40817-va-fl-10-22/ http://www.hadit.com/forums/index.php?/topic/40814-va-fl-10-04/ http://www.hadit.com/forums/index.php?/topic/40969-va-fl-10-03/ http://www.hadit.com/forums/index.php?/topic/40812-va-fl-10-02/ http://www.hadit.com/forums/index.php?/topic/40808-va-fl-09-52/ http://www.hadit.com/forums/index.php?/topic/40806-va-fl-09-50/ http://www.hadit.com/forums/index.php?/topic/40970-va-fl-09-41/ http://www.hadit.com/forums/index.php?/topic/40971-va-fl-09-38/ http://www.hadit.com/forums/index.php?/topic/40804-va-fl-09-33/ http://www.hadit.com/forums/index.php?/topic/40972-va-fl-09-28/ http://www.hadit.com/forums/index.php?/topic/40671-va-fl-09-27/ http://www.hadit.com/forums/index.php?/topic/40973-va-fl-09-26/ http://www.hadit.com/forums/index.php?/topic/40803-va-fl-09-25/ http://www.hadit.com/forums/index.php?/topic/40802-va-fl-09-21e2/ http://www.hadit.com/forums/index.php?/topic/40801-va-fl-09-21/ http://www.hadit.com/forums/index.php?/topic/40799-va-fl-09-20/ http://www.hadit.com/forums/index.php?/topic/40798-va-fl-09-17/ http://www.hadit.com/forums/index.php?/topic/40974-va-fl-09-15/ http://www.hadit.com/forums/index.php?/topic/40975-va-fl-09-13/ http://www.hadit.com/forums/index.php?/topic/40797-va-fl-09-10e1/ http://www.hadit.com/forums/index.php?/topic/40796-va-fl-09-10/ http://www.hadit.com/forums/index.php?/topic/40795-va-fl-09-09/ http://www.hadit.com/forums/index.php?/topic/40976-va-fl-09-08/ http://www.hadit.com/forums/index.php?/topic/40794-va-fl-09-07/ http://www.hadit.com/forums/index.php?/topic/40793-va-fl-09-06/ http://www.hadit.com/forums/index.php?/topic/40977-va-fl-09-05/ http://www.hadit.com/forums/index.php?/topic/40731-va-fl-08-41/ http://www.hadit.com/forums/index.php?/topic/40730-va-fl-08-38/ http://www.hadit.com/forums/index.php?/topic/40729-va-fl-08-36/ http://www.hadit.com/forums/index.php?/topic/40728-va-fl-08-34/ http://www.hadit.com/forums/index.php?/topic/40726-va-fl-08-33/ http://www.hadit.com/forums/index.php?/topic/40725-va-fl-08-31/ http://www.hadit.com/forums/index.php?/topic/40978-va-fl-08-29/ http://www.hadit.com/forums/index.php?/topic/40724-va-fl-08-26/ http://www.hadit.com/forums/index.php?/topic/40723-va-fl-08-23/ http://www.hadit.com/forums/index.php?/topic/40722-va-fl-08-20/ http://www.hadit.com/forums/index.php?/topic/40979-va-fl-08-15/ http://www.hadit.com/forums/index.php?/topic/40721-va-fl-08-12/ 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Gulf War Exam C&p: Peripheral Nerves Conditions


Question

Posted · Report post

This was part of my Gulf War Exam, and it doesn't look like it should be rated from the GW. But, the wrist injury received while I was in the Marines does have nerve issues. Would they continue the rating on it's own, or would I have to re-file again on a claim not under Gulf War? I'm currently rated for the wrist, but nothing to do with the nerve issues.
Peripheral Nerves Conditions
(not including Diabetic Sensory-Motor Peripheral Neuropathy)
Disability Benefits Questionnaire
Name of patient/Veteran: XXXX
Indicate method used to obtain medical information to complete this
document:
[ ] Review of available records (without in-person or video telehealth
examination) using the Acceptable Clinical Evidence (ACE) process
because
the existing medical evidence provided sufficient information on which
to
prepare the DBQ and such an examination will likely provide no
additional
relevant evidence.
[ ] Review of available records in conjunction with a telephone interview
with the Veteran (without in-person or telehealth examination) using the
ACE process because the existing medical evidence supplemented with a
telephone interview provided sufficient information on which to prepare
the DBQ and such an examination would likely provide no additional
relevant evidence.
[ ] Examination via approved video telehealth
[X] In-person examination
Evidence review
---------------
Was the Veteran's VA claims file reviewed?
[X] Yes [ ] No
If yes, list any records that were reviewed but were not included in the
Veteran's VA claims file:
CPRS
If no, check all records reviewed:
[ ] Military service treatment records
[ ] Military service personnel records
[ ] Military enlistment examination
[ ] Military separation examination
[ ] Military post-deployment questionnaire
[ ] Department of Defense Form 214 Separation Documents
[ ] Veterans Health Administration medical records (VA treatment
records)
[ ] Civilian medical records
[ ] Interviews with collateral witnesses (family and others who have
known the Veteran before and after military service)
[ ] No records were reviewed
[ ] Other:
1. Diagnosis
------------
Does the Veteran have a peripheral nerve condition or peripheral neuropathy?
[X] Yes [ ] No
Diagnosis #1: lt ulnar neuropathy
ICD code: (354.2)
Date of diagnosis: 9/6/13
2. Medical history
------------------
a. Describe the history (including onset and course) of the Veteran's
peripheral nerve condition (brief summary):
He stated that he developed tingling in the left arm for a long time
started while on active duty his left wrist was injured while on active
duty no history of neck pain or surgery; no history of elbow injury or
surgery. He takes Neurontin; he has mild weakness of the left hand with
no history of diabetes mellitus. He has mild wasting of his left hand.
b. Dominant hand
[X] Right [ ] Left [ ] Ambidextrous
3. Symptoms
-----------
a. Does the Veteran have any symptoms attributable to any peripheral nerve
conditions?
[X] Yes [ ] No
Constant pain (may be excruciating at times)
Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Intermittent pain (usually dull)
Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Paresthesias and/or dysesthesias
Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe
Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Numbness
Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe
Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe
4. Muscle strength testing
--------------------------
a. Rate strength according to the following scale:
0/5 No muscle movement
1/5 Palpable or visible muscle contraction, but no joint movement
2/5 Active movement with gravity eliminated
3/5 Active movement against gravity
4/5 Active movement against some resistance
5/5 Normal strength
Elbow flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Elbow extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Wrist flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Wrist extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Grip:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Pinch (thumb to index finger):
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Knee extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Ankle plantar flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Ankle dorsiflexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
b. Does the Veteran have muscle atrophy?
[X] Yes [ ] No
If muscle atrophy is present, indicate location:
lt 1st dorsal interossei
Normal side: not measured cm. Atrophied side: not measured
cm.
5. Reflex exam
--------------
Rate deep tendon reflexes (DTRs) according to the following scale:
0 Absent
1+ Hypoactive
2+ Normal
3+ Hyperactive without clonus
4+ Hyperactive with clonus
Biceps:
Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Triceps:
Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Brachioradialis:
Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Knee:
Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Ankle:
Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+
6. Sensory exam
---------------
Indicate results for sensation testing for light touch:
Shoulder area (C5):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Inner/outer forearm (C6/T1):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Hand/fingers (C6-8):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Upper anterior thigh (L2):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Thigh/knee (L3/4):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Lower leg/ankle (L4/L5/S1):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Foot/toes (L5):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
7. Trophic changes
------------------
Does the Veteran have trophic changes (characterized by loss of extremity
hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy?
[ ] Yes [X] No
8. Gait
-------
Is the Veteran's gait normal?
[X] Yes [ ] No
9. Special tests for median nerve
---------------------------------
Were special tests indicated and performed for median nerve evaluation?
[ ] Yes [X] No
10. Nerves Affected: Severity evaluation for upper extremity nerves and
radicular groups
-----------------------------------------------------------------------
a. Radial nerve (musculospiral nerve)
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
b. Median nerve
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
c. Ulnar nerve
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis
If Incomplete paralysis is checked, indicate severity:
[ ] Mild [X] Moderate [ ] Severe
d. Musculocutaneous nerve
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
e. Circumflex nerve
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
f. Long thoracic nerve
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
g. Upper radicular group (5th & 6th cervicals)
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
h. Middle radicular group
Right [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
i. Lower radicular group
Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis
11. Nerves Affected: Severity evaluation for lower extremity nerves
-------------------------------------------------------------------
Not applicable
12. Assistive devices
---------------------
a. Does the Veteran use any assistive devices as a normal mode of
locomotion,
although occasional locomotion by other methods may be possible?
[ ] Yes [X] No
b. If the Veteran uses any assistive devices, specify the condition and
identify the assistive device used for each condition:
No response provided.
13. Remaining effective function of the extremities
---------------------------------------------------
Due to peripheral nerve conditions, is there functional impairment of an
extremity such that no effective function remains other than that which
would
be equally well served by an amputation with prosthesis? (Functions of the
upper extremity include grasping, manipulation, etc., while functions for
the
lower extremity include balance and propulsion, etc.)
[ ] Yes, functioning is so diminished that amputation with prosthesis would
equally serve the Veteran.
[X] No
14. Other pertinent physical findings, complications, conditions, signs
and/or symptoms
-----------------------------------------------------------------------
a. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
section above?
[ ] Yes [X] No
b. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms?
[ ] Yes [X] No
15. Diagnostic testing
----------------------
a. Have EMG studies been performed?
[X] Yes [ ] No
Extremities tested:
[X] Left upper extremity
Results: [ ] Normal [X] Abnormal
Date: 1/15/13
b. Are there any other significant diagnostic test findings and/or results?
[X] Yes [ ] No
If yes, provide type of test or procedure, date and results (brief
summary):
Findings:
The left median sensory nerve conduction study (NCS) showed normal
peak
latency and amplitude.
The left ulnar sensory NCS showed normal peak latency and amplitude.
The left median motor NCS showed normal distal latency, amplitudes,
and conduction velocity.
The left ulnar motor NCS was ABNORMAL and showed normal distal
latency,
normal
amplitudes, and DIMINISHED conduction velocities across the ELBOW.
The right ulnar motor NCS showed normal distal latency, amplitudes,
and conduction velocities.
The left median-to-ulnar comparison mixed nerve study showed no
significant
difference in latencies.
Electromyography (EMG) of selected muscles representing the ulnar
innervations showed normal insertional activity, no spontaneous
activity, and
normal voluntary MUAP's.
IMPRESSION:
1) Abnormal study.
2) Electrophysiological evidence of LEFT ulnar neuropathy across the
elbow
consistent with a focal demyelinating process. No evidence of axonal
loss.
3) NO electrophysiological evidence of a left median neuropathy at the
wrist.
PLAN:
1) Prosthetics consult to issue a LEFT elbow brace to the patient
2) Advised patient to protect the elbows with gel pads or towels
anytime they
are on a hard surface and to limit sleeping with hands overhead
3) Please consider obtaining a LEFT elbow xray given hx of remote
injury
4) Can consider hand surgery consult in the future for possible
surgical
interventions if above conservative measures fail.
5) Thank you the consult.
/es/ AMAR G PATEL
PM&R PGY 3
Signed: 04/18/2013 14:21
16. Functional impact
---------------------
Does the Veteran's peripheral nerve condition and/or peripheral neuropathy
impact his or her ability to work?
[X] Yes [ ] No
If yes, describe impact of each of the Veteran's peripheral nerve and/or
peripheral neuropathy condition(s), providing one or more examples:
Left ulnar neuropathy condition will limit repetitive moderately
strenuous physical activity with his left hand.
17. Remarks, if any:
--------------------
the veterans ulnar neuropathy is a disease with a clear and specific
etiology and diagnosis.
Medical opinion-it is less likely is not, less than 50% probability,
that
the above condition is related to any specific exposure event
experienced
by the veteran during service in Southeast Asia;
rationale-current medical literature review does not correlate ulnar
neuropathy with Gulf War exposure.

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1 answer to this question

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This was also added in the commentary:

2. Restatement of requested opinion
-----------------------------------
a. Insert requested opinion from general remarks:
ALSO,
The Veteran is claiming service connection for low back pain and left
wrist pain. Please review the medical opinion requests below regarding
these two issues:
MED OPINION #1:
A. Requested DBQ: Peripheral Nerves
" Claimed conditions: nerve damage left wrist
" Claimed nexus: secondary or related to the in-service left wrist
fracture
" Opinion requested: Is there a diagnosis of nerve damage in the
left wrist? If yes, is it at least as likely as not related to the
left
wrist fracture in service?
B. Available pertinent evidence:
" Military Service: Marines from March 14, 1990 to June 28, 1994
" Service Treatment Records (STRs): These records show the left
wrist fracture
" Private Treatment Records: none
" VA Treatment Records: the Atlanta VAMC treatment records
(available for your review in CPRS) show that the Veteran has
complained
of pain in the left wrist. There are images available for your review
as
well.

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