Peripheral neuropathy is a common condition that can make daily tasks more challenging. This condition often appears due to another condition, such as diabetes. Former military service members who are living with peripheral neuropathy may be eligible for VA disability benefits. In this post, we’re going over the VA rating for peripheral neuropathy.
What Is Peripheral Neuropathy?
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.
Symptoms of Neuropathy
The Merck Manual lists the following symptoms of neuropathy:
- sensory disturbances
- muscle weakness and atrophy
- diminished deep tendon reflexes
- vasomotor symptoms.
Does VA consider peripheral neuropathy a disability?
While the VA does not have an exact diagnostic code for peripheral neuropathy, they do rate the condition based on the nerves affected by your specific neuropathy. Below we will detail how the VA rates peripheral neuropathy and some common causes frequently seen from military service and veterans.
What is the VA Disability Rating for Peripheral Neuropathy?
The VA doesn’t have a diagnostic code for peripheral neuropathy, so the VA rates the condition based on the nerve(s) involved. Typically speaking, the maximum VA rating for peripheral neuropathy is 40%, but you may be entitled to more if your symptoms are severe and includes several of your limbs affected.
To receive service connected benefits for peripheral neuropathy, you must show that your symptoms meet the VA rating criteria for certain nerve damage. For example, nerve damage can involve the peroneal nerve, sciatic nerve, or femoral nerve.
How is peripheral neuropathy rated?
The common peroneal nerve is derived from the lumbar and sacral spine regions as a part of the sciatic nerve. The VA may rate this nerve damage and pain under diagnostic code 8521 under 38 CFR § 4.124a, the schedule of ratings for neurological conditions and convulsive disorders.
The VA rating schedule for nerve damage branches off down the extremities into the foot. If the common peroneal nerve is damaged and the veteran has:
- foot drop and,
- slight droop of first phalanges (See diagram) of all toes, and,
- not able to raise the foot from the ankle, and,
- lost some movement of the toes, and,
- decreased feeling over the top of the foot and toes
What is the maximum VA rating for peripheral neuropathy?
Then, the veteran may be entitled to the maximum VA rating of 40% for that category for each extremity that is affected with peripheral neuropathy. If the damage is not as complete for a 40 percent rating, the veteran has to show that there is incomplete paralysis at three levels of severity:
- severe (30%)
- moderate (20%)
- mild (10%)
Keep in mind that these terms have not been defined by the VA. As such, the veteran needs to inform their treating physician of all symptoms and impairments associated with the peripheral neuropathy so that the physician can render an accurate determination of the severity of the condition.
As mentioned above, the most import thing is for the veteran to be properly diagnosed for any condition associated with diabetes mellitus in order to receive the compensation they deserve.
Types of Neuropathy: Mononeuropathy and Polyneuropathy
Neuropathies are typically classified according to the problems caused or the root of the damage. This is where we get the terms of mononeuropathy and polyneuropathy.
- Mononeuropathy is damage to a single peripheral nerve. Physical injury or trauma is the most common cause. Mononeuropathy can also be caused by prolonged pressure on the nerve, extended sedentary periods or continuous repetitive motions. Carpal tunnel is a common type of mononeuropathy caused by overuse strain on the nerve that passes through an individual’s wrist. The damage can cause numbness, tingling, pain, and unusual sensations in the first three fingers on the thumb side of a person’s hand.
- Polyneuropathy is damage to multiple peripheral nerves throughout the body. It makes up the greatest number of peripheral neuropathy cases. Polyneuropathy has a wide variety of causes which include:
Common Causes of Peripheral Neuropathy in Veterans
The causes of peripheral neuropathy can be divided into three distinct categories: Acquired, hereditary, and Idiopathic neuropathies.
- Acquired neuropathies are caused by environmental factors (and are what a veteran would attempt to get service connected). Environmental factors which could cause neuropathy are toxins, trauma, illness, and infection. Know causes included:
- Poor nutrition or vitamin deficiency
- Certain cancers (or their related chemotherapy treatment)
- Overly aggressive immune system damage
- Certain medications
- Kidney or thyroid disease
- Infections such as Lyme disease, shingles, or AIDS
- Hereditary neuropathies are less common. As the name indicates, these neuropathies are passed from parent to child. The most common is the Charcot-Marie-Tooth disease.
- Idiopathic neuropathies cause is unknown. Almost one-third of neuropathies are classified this way.
How do you prove peripheral neuropathy to VA?
Tests that are frequently used for proving peripheral neuropathy include neurological examinations during routine visits, electromyography (EMG) tests, nerve conduction velocity (NCV) tests, and biopsies.
Peripheral neuropathy can be tough to prove at first because this condition is often undiagnosed or misdiagnosed and there are many different reasons for this. Those reasons can include veterans failing to report symptoms because they are intermittent; or veterans assuming that symptoms are the result of aging.
A more unfortunate reason that peripheral neuropathy can be hard to diagnose at first 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.
VA benefits for Delayed onset peripheral neuropathy
Another frequent reason we see 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 about nerve pain. Delayed-onset peripheral neuropathy is a subset of neuropathy that develops years after service, making it tough to detect.
Some medical 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.
How To Prove Peripheral Neuropathy Secondary to Diabetes
Peripheral neuropathy often appears secondary to diabetes, particularly in veterans. In 2012, 29.1 million Americans had been diagnosed with diabetes. That number undoubtedly has gone up, because at that time there were 86 million Americans age 20 and older who were pre-diabetic.
Veteran’s receiving service connected compensation for diabetes mellitus through the United States Department of Veterans Affairs are also eligible to receive disability compensation for any and all conditions secondary to diabetes.
The complications and co-morbid conditions associated with diabetes are grouped into two categories: macrovascular and microvascular. Let’s discuss these below!
Macrovascular vs. Microvascular Diseases
- Macrovascular disease is a disease of any large blood vessel in the body, including, the coronary arteries, the aorta, and the large arteries in the brain and in the limbs. Diseases include, but are not limited to, coronary artery disease (CAD), cerebrovascular accident or stroke (CVA), congestive heart failure (CHF), peripheral arterial disease (PAD), hypertension, and myocardial infarction (MI).
- Microvascular is the system of tiny blood vessels, including the capillaries, venules, and arterioles that perfuse the body’s tissues. Microvascular diseases include, but are not limited to, retinopathy, nephropathy, neuropathy, gastroparesis, Alzheimer’s disease, skin conditions, and erectile dysfunction.
By obtaining a diagnosis from a medical professional and presenting medical records to the VA, former service members may be able to receive additional veterans disability benefits through secondary service connection.
Diabetic Neuropathy vs. Peripheral Neuropathy in Veterans
Another microvascular complication caused by nerve damage is diabetic neuropathy. This is another medical condition that develops slowly and may begin years before a person is finally diagnosed with diabetes. About half the people with diabetes develop diabetic neuropathy.
High glucose levels causes chemical changes in nerves, if glucose levels remain high over a long period of time, there is permanent damage to the blood vessels that carry oxygen and nutrients to the nerves, causing neuropathy.
There are several types of diabetic neuropathy:
- Peripheral neuropathy
- Autonomic neuropathy
- Proximal neuropathy
- Focal neuropathy
Autonomic neuropathy affects the automatic nervous system, so people with this condition may experience difficulties with the digestive system, sweat glands, cardiovascular system, and sex organs. Proximal neuropathy affects the hips, buttocks, and thighs, and focal neuropathy affects a specific nerve or nerve group. However, peripheral neuropathy is the most common of these conditions.
Peripheral Neuropathy Presumptive to Agent Orange Exposure
It’s important to note that peripheral neuropathy is one of the medical conditions that the VA has connected to Agent Orange exposure. Medical evidence has shown that herbicides like Agent Orange can damage the nervous system.
If you are a Vietnam veteran, meet the criteria for Agent Orange presumption, and are living with peripheral neuropathy, you will automatically be eligible for VA disability compensation.
Have Questions About Your VA Disability Case?
If the VA has denied your claim for VA disability benefits, or you think you deserve a higher rating than you received, contact the team at Hill & Ponton. We focus on veterans disability and helping clients and their family members obtain the disability compensation they are entitled to.
Our attorneys are available to support veterans through their VA disability claims and appeals, evaluating your entitlement to VA benefits. Call today!
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