Peripheral Neuropathy and VA Disability
According to the Merck Manual, peripheral neuropathy is “dysfunction of one or more peripheral nerves.” In lay terms, neuropathy is commonly referred to as ‘nerve damage’ in the extremities. Many veterans who are service connected for other disabilities also suffer from peripheral neuropathy; however, they have never been formally diagnosed with this condition.
The Merck Manual lists the following symptoms of neuropathy: sensory disturbances, pain, muscle weakness and atrophy, diminished deep tendon reflexes, and vasomotor symptoms. Again, in lay terms the symptoms could simply be numbness and/or tingling, burning pain, lack of sensation, or difficulty distinguishing sharp vs. dull or hot vs. cold in the extremities. It is important to note that the symptoms may be alone or in any combination.
There are different types of peripheral neuropathy. Mononeuropathy is when only a single nerve is affected. Multiple mononeuropathy is when two or more nerves in separate areas are affected. Polyneuropathy is when many nerves are simultaneously affected, bilaterally symmetrical.
Peripheral neuropathy can be caused by many different conditions, such as diabetes mellitus, alcoholism, trauma, immune disorders, chronic renal insufficiency, thyroid disease, toxic exposure, certain kinds of cancer, etc.
This condition is often undiagnosed or misdiagnosed. There are many different reasons for this. Common reasons seen in our practice for veterans being undiagnosed include veterans failing to report symptoms because they are intermittent or veterans assuming that symptoms are the result of aging. A more unfortunate reason is that many veterans do not want to be perceived as chronic complainers; hence, they just do not go to the doctor even when they should. A very common reason for misdiagnosis is failure of the medical professionals, VA and non-VA providers alike, to take the time to properly listen to the veteran’s complaints. Some providers fail to order the necessary tests to determine if their patient has neuropathy, or they fail to consider comorbid conditions. This lack of attention may be due to budget and/or time constraints. Nevertheless, whether neuropathy is undiagnosed or misdiagnosed, the effect is the same in that deserving veterans are missing out on benefits they may be entitled to.
It is essential that veterans seek medical treatment for neuropathy, including undergoing the necessary tests to properly diagnose and rate its severity. Tests that are frequently used for this purpose include neurological examinations during routine visits, electromyography (EMG) tests, nerve conduction velocity (NCV) tests, and biopsies.
When rating disabilities, the VA often overlooks peripheral neuropathy, especially as secondary to an already service connected condition. A common scenario is the link between diabetes mellitus and peripheral neuropathy. It is estimated in the medical literature that up to 50 percent of individuals with diabetes suffer from neuropathy. Despite the known relationship between diabetes and neuropathy, it is very common for a veteran to undergo a compensation and pension examination for diabetes at the VA, however, the examiner does not evaluate the veteran for neuropathy. In turn, the VA fails to give the veteran a disability rating for this condition.
The important point to take away is that if you suffer from peripheral neuropathy or symptoms of neuropathy, you must be properly diagnosed. If your condition is directly related to military service or can be secondarily connected to another service connected condition, you deserve to be compensated.