The Disability Benefits Questionnaire (DBQ) was created to help speed the processing of Veterans’ disability compensation and pension claims. These forms are being used at the Compensation & Pension (C&P) examinations for evaluating disability compensation and pension claims. However, DBQs can also be completed by the Veterans’ private physician or treating VA physician and submitted to the VA to streamline the disability rating process.
The DBQs forms use check boxes and standardized language to allow for a quick and easy input into the Evaluation Builder (EB). The EB is a rules-based calculator first implemented to improve both the quality and efficiency of decisions. However, the EB was meant to produce a recommendation for the rating, not the final rating itself. In fact, the rater is required to assess all evidence of record, along with the DBQ, to arrive at the proper evaluation. We are finding, however, that the raters are still not adequately evaluating the evidence as a whole and some Veterans are receiving improper ratings on the decisions. This mistake can take months or even years to appeal in order to arrive at a proper rating and effective date.
Where I’ve seen this happen more frequently is in the evaluation of neuropathy. Neuropathy is seen with a number of different underlying medical conditions and can affect the sensory, motor, and autonomic nerves depending on severity and length of the disease involved. The condition may involve a single nerve (mononeuropathy) or involve several nerves (polyneuropathy).
In a recent case that I reviewed, the VA had granted a mild impairment for the veteran’s peripheral neuropathy based on a DBQ completed at a C&P examination where the examiner marked the check boxes for mild nerve involvement of the common peroneal nerve. However, the rater apparently did not take into consideration the Veteran’s treating neurologist objective findings under consideration to determine the final evaluation. In the Veteran’s treating records involving multiple office examinations, the neurologist had indicated that there was objective evidence of worsening reflexes and increased pain symptomatology involving his bilateral extremities as a result of the neuropathy. As a result of this worsening, the rater should have deduced that the Veteran’s peripheral neuropathy of each lower extremity resulted in disability tantamount to moderate incomplete paralysis of the common peroneal nerve.
Why does VA get this rating wrong so often? I see this same mistake over and over again. One reason is the fact that neuropathy has many causes, and any number of the three nerve types can be affected at any one time. Isolating the effects of the damage and interpreting the physician’s findings of each takes some time and patience. And, for the raters who are likely under scrutiny to process these cases quickly, it is a freedom they cannot afford. But the Veterans are the ones paying for it.
The second reason is the DBQ itself. The Peripheral Nerves Condition Disability Benefits Questionnaire guides the physician to provide an assessment of the extent of either incomplete or complete paralysis of the upper and lower extremities in boxes 10 and 11 in the form. In some cases, the examiner’s clinical assessment of the extent of impairment in box 10 or 11 may be inconsistent with the objective findings concerning the peripheral nerve disability that are documented in other boxes of the DBQ, or even worse, inconsistent with the evidentiary record as a whole.
For example, the DBQ may show in boxes 10 and 11 that the Veteran’s peripheral nerve disability is consistent with mild incomplete paralysis; however, if either the DBQ or any other objective evidence of record shows muscle weakness, atrophy, and diminished reflexes, a higher rating is warranted because of the additional effects of the neuropathy. It is also important to remember that if the Veteran’s treating physician has indicated in the record that the impairment rises to a mild-moderate level and has demonstrated objective findings that support this conclusion, the VA is required to give the higher rating of moderate for the impairment.
Ultimately, it is the responsibility of the rating specialist, not the examining medical professional to determine, through the rating schedule, and in the light of the whole recorded history, the effect of a disability on the average impairment in earning and assign a proper disability evaluation.
The VA general rules in determining the level of incomplete paralysis of the peripheral nerves are as follows:
- Mild – subjective symptoms or diminished sensation
- Moderate – absence of sensation confirmed by objective findings
- Severe – more than sensory findings are demonstrated, such as atrophy, weakness, diminished reflexes, etc…
To complicate matters, the rating specialist has to also evaluate the level of incomplete paralysis in regards to rating peripheral nerve disabilities that are manifested by neuritis or neuralgia of the peripheral nerve. Neuritis is characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating. Neuralgia is characterized usually by a dull and intermittent pain.
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