Firstly, what is peripheral neuropathy?
The name tells you quite a bit about the condition: Peripheral: Beyond your central nervous system (brain and spinal cord), Nero: Nerve related, -Pathy: Disease.
You likely went into your doctor’s office because you were having burning, tingling, or even stabbing pain in your foot. Peripheral neuropathy is caused by damage to your peripheral nerves and can result in weakness, numbness, and pain in your hands and feet. It can also affect other parts of your body and cause pain during activities that would otherwise be painless. While many veterans suffer from peripheral neuropathy, those same veterans have never formally been diagnosed with the condition.
The Merck Manual lists the following symptoms of neuropathy: sensory disturbances, muscle weakness and atrophy, diminished deep tendon reflexes, and vasomotor symptoms. Put in layman terms, that area numbness or tingling, burning pain, lack of sensation or difficulty in distinguishing between sharp and dull, or hot and cold, in the extremities. These symptoms can present alone or in any of various combinations.
So, what causes 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:
- 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.
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:
One of the most common types of chronic polyneuropathy is diabetic neuropathy. Neuropathy will be more severe in those individuals who have poorly controlled blood sugar levels. As with mononeuropathy, common symptoms include numbness, tingling, and loss of sensation in an individual’s arms and legs. (If you are service connected for diabetes, you need to see if you also have a rating for you diabetic neuropathy secondary to that condition.) Sometimes, nerves related to organ function can also be affected. This type of nerve damage can cause diarrhea, constipation, and/or loss of bowel or bladder control, and in some cases sexual dysfunction. Some of these may entitle you to special monthly compensation (or SMC).
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. Part two of this article will discuss how to get that secondary condition service connected and get you the compensation you deserve.
Thank you for your service.