What Is The VA Disability Rating for Peripheral Neuropathy?

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. 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 detail what peripheral neuropathy is, its relation to Agent Orange, Diabetes, and how the VA rates 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
• pain
• muscle weakness and atrophy
• diminished deep tendon reflexes
• 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.

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:
  • Exposure to toxins such as Agent Orange,
  • Volatile organic compounds (such as those in the water at Camp Lejeune), and
  • Alcohol abuse.

Causes of Peripheral Neuropathy

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:
  • Diabetes
  • Alcoholism
  • 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.

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.

Peripheral Neuropathy Secondary to Diabetes

Peripheral neuropathy often appears secondary to diabetes. 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.

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.

Before focusing on peripheral neuropathy, we’re going to break down the most common types of diabetes complications. If a veteran has established that their diabetes is a service-connected disability, they may be experiencing several secondary conditions as well. 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 Retinopathy

Diabetic retinopathy may be the most common microvascular complication of diabetes.  According to the Mayo Clinic, diabetic retinopathy affects the eyes.  It is caused by damage to the retinal blood vessels of the “light-sensitive tissue at the back of the eye” or retina.  In patients with type 2 diabetes, retinopathy may begin to develop as early as 7 years before the diagnosis of diabetes.  However, anyone who has type 1 or type 2 diabetes can develop this condition.  At early onset, diabetic retinopathy manifests by mild vision problems.  Eventually, it can cause blindness.

Diabetic Neuropathy

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

Most often, the damage of diabetic neuropathy involves the hands, legs and feet. This is called peripheral neuropathy, or nerve damage that occurs outside of the spinal cord and brain. Initial symptoms of this medical condition include tingling or burning sensation, or a deep aching pain. Eventually, the area becomes numb, which can lead to muscle atrophy, difficulty with coordination, and increased pain and sensitivity. In severe cases, neuropathy can lead to complete paralysis of the limb.

Because of this, a person may not notice when they stop on something sharp when the condition affects the lower extremities, or not know that they have a blister or small cut, or have touched something that is too cold or too hot. So, a small lesion can lead to a more significant medical issue. This, coupled with a macrovascular complication of peripheral arterial disease, a condition that restricts the flow of blood to the extremities, can cause person with diabetic neuropathy to develop ulcers in the feet or hands that do not heal easily.  Diabetic ulcers can become infected and develop into gangrenous ulcers that lead to amputation.

VA Disability Ratings 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.

For example, nerve damage can involve the peroneal nerve, sciatic nerve, or femoral nerve.  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 under diagnostic code 8521 under 38 CFR § 4.124a, the schedule of ratings for neurological conditions and convulsive disorders.

This ratings schedule 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

Then, the veteran may be entitled to the maximum rating of 40% for that category for each extremity that is affected.  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 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.

Peripheral Neuropathy as a Presumptive Condition

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.

Common Problems for Veterans with Peripheral Neuropathy

Common problems we see are that the condition is often misdiagnosed or undiagnosed.  There are a number of different reasons this happens, but often veterans fail to report the symptoms because they are intermittent or because the veteran assumes that the problems are the result of aging.  A more unfortunate reason that veterans fail to get a diagnosis is that they do not want to be seen as chronic complainers and therefore fail to go to the doctor when they need to.

Misdiagnosis of the condition often happens as a result of failure on the part of medical professionals, both VA and non-VA, to take the time to listen to the veteran’s complaints.  At times, providers will fail to order the proper tests for determining whether or not the veteran has neuropathy.  Other times, they fail to consider comorbid conditions.  Whether the condition has not been diagnosed or has been misdiagnosed, the end result is the same.  A veteran is not being granted the benefits that he or she deserves.

Often when rating disabilities, the VA will mistakenly overlook peripheral neuropathy, especially when it is secondary to a condition that is already service connected.  Medical literature estimates that up to 50 percent of individuals suffering from diabetes also suffer from peripheral neuropathy.  Even with an established relationship between the two conditions, it is not uncommon for a veteran to attend a compensation and pension examination for their diabetes, and the examiner to fail to evaluate the veteran for neuropathy.

Please remember that if a condition is related to service, even as a secondary condition, you should be compensated.

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 specialize in veterans disability and social security disability law, helping clients and their family members obtain the compensation in which they’re entitled to.

Our attorneys are available to support veterans through their VA disability claims and appeals, evaluating your entitlement to VA benefits. Claimants can contact us today for a free case evaluation.