How does the VA rate Diabetic Peripheral Neuropathy?

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 are also eligible to receive 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 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.

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.

Another microvascular complication caused by nerve damage is diabetic neuropathy.  This is another 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.  Most often, the damage of diabetic neuropathy involves the hands, legs and feet.  Initial symptoms include tingling or burning sensation, or a deep aching pain.  Because of this, a person may not notice when they stop on something sharp, or not know that they have a blister or small cut, or have touched something that is too cold or too hot.  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 evaluates diabetic peripheral neuropathy 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.  It then 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% rating, the veteran has to show that there is incomplete paralysis at three levels of severity:  severe, moderate or mild.  These terms have not been defined by the VA.  As such, the veteran needs to inform their treating physician of all symptoms associated with the neuropathy so that the physician can render an accurate determination of the severity of the condition.  As my colleague pointed out in her blog regarding peripheral neuropathy, 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.