Jump to content


  • hate-ads-subscribe-now.jpg

  • Ad
  • Ad
  • 14 Questions about VA Disability Compensation Benefits Claims


    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

  • Ad
  • 0

Questions About My Peripheral Neuropathy C & P Exam Report


I apologize for the long post but I felt all of the info was needed in order to get the best input from fellow hadit forum members.

Yesterday I received a copy of my recent C & P exam report for my claims for AO Multiple Myeloma and PN secondary to Multiple Myeloma. I have no complaints with the part of the C & P exam findings on my Multiple Myeloma which mirror those of my private oncologists. The C & P examiner also concluded "The claimed condition (peripheral neuropathy of lower extremities) is at least as likely as not proximately due to or the result of the Veteran's service connected condition (multiple myeloma). This statement is in agreement with my neurologist's IMO conclusion so I have no problem with this part of the report. My problem with the report deals with the responses in the section concerning severity of the peripheral neuropathy.

Keep in mind that my entire C & P exam was performed by a nurse practitioner and lasted a total of about 15 minutes. The examiner did not perform any exams or tests in regards to my multiple myeloma. I had made copies of my oncologist reports and lab reports and brought them to the C & P exam for the examiner. She took the copies and it appears she used the reports to fill in the responses for her C & P report. She asked how my multiple myeloma was first diagnosed and I told her it was discovered by my neurologist who performed blood tests when I went to him about problems with neuropathy and the neurologist referred me to an oncologist after one of my blood tests indicated myeloma protein in my blood. In regards to my peripheral neuropathy, the only test she performed was when she broke what appeared to be a large Q tip in half, had me close my eyes while she touched my legs with the ends of the broken Q tip. As she would touch my leg, she would ask if I knew whether she was touching me with the dull end or the sharp end. No other tests were performed and no other questions were asked. I also provided her with a copies of the EMG and nerve studies on my lower extremities and my upper extremities from my private doctor. She also kept these and cited them in her C & P report.

In her report the examiner indicated that I had moderate intermittent pain in both of my lower extremities, moderate paresthesias and/or dysesthesias in both of my lower extremities, and moderate numbness in both of my lower extremities. She also indicated that I had mild intermittent pain in both of my upper extremities, mild paresthesias and/or dysesthesias in both of my upper extremities, and mild numbness in both of my upper extremities. NOTE: I did not file a claim for peripheral neuropathy in my upper extremities and the examiner never checked my upper extremities.

In the part of C & P report regarding the affected nerves and severity of condition, the following instructions are given to the examiner by the VA: "For VA purposes, the term incomplete paralysis indicates a degree of lost or impaired function substantially less than the description of complete paralysis that is given with each nerve." The instructions further state "If the nerve is completely paralyzed, check the box for complete paralysis." "If the nerve is not completely paralyzed, check the box for incomplete paralysis and indicate severity." "For VA purposes, when nerve impairment is wholly sensory, the evaluation should be mild, or at most moderate."

Each nerve is listed on the C & P report just like on the DBQs and the following choices are given: ( )normal, ( )incomplete paralysis, ( ) complete paralysis. Under each nerve section, the report's instructions states "if incomplete paralysis is checked, indicate severity." The following choices are given to indicate severity: ( )mild, ( )moderate, ( )severe.

Despite her findings that I had pain, paresthesias and numbness in my extremitites, on every nerve listed she checked the normal blocks rather than incomplete paralysis and she did not check any blocks showing severity. NOTE: Keep in mind again, she never performed any tests to check the functioning of my lower extremities or asked me about the functioning.

The EMG & NCV reports I provided to the VA examiner were reports prepared and signed by the private doctor who performed the tests. This doctor specializes in performing electrodiagnostic studies for diagnosing nerve root disorders as well as various peripheral nerve disorders. This doctor's findings were also referred to by my private neurologist in his IMO letter to the VA. The private doctor performing the EMG & NCV tests stated: "This is an abnormal study." "There is evidence of severe, axonal and demyelinating tibial neuropathy in both lower extremities affecting the motor component." "There is evidence of prolonged H-reflex response in both lower extremities." Evaluation of the left tibial nerve motor nerve showed reduced amplitude (1.0mV). The right tibial motor nerve showed prolonged distal onset latency (7.5 ms) and reduced amplitude (2.2mV)." "H-reflex studies indicate that the left tibial H-reflex has prolonged latency (37.34 ms)." "The right tibial H-reflex has prolonged latency (37.50 ms)."

My private neurologist stated in his IMO letter, "I have diagnosed the patient with symmetrical distal polyneuropathy in his lower extremities that is primarily sensory." "He has slight proprioception problems and a positive romberg which is effecting his gait." He also stated in his IMO letter that my peripheral neuropathy in my lower extremities was more than likely secondary to my multiple myeloma disease.

I feel that by checking the box "normal" rather than "incomplete paralysis", I will be rated at 0%. I believe the examiner should have checked incomplete paralysis because my feet and lower legs are totally numb and I have lost some motor function in them. I have difficulty walking on uneven or rough terrain because I have a tendancy to stumble or trip. I recently had multiple ant bites on one of my feet because I did not know my foot was in an ant bed.

Please give me your thoughts and suggestions concerning the C & P exam report and possible ratings. Also, let me know if you think the VA might possibly service connect peripheral neuropathy in my upper extremities based on the VA examiner's report of my upper extremities.


Share this post

Link to post
Share on other sites

4 answers to this question

Recommended Posts

GeorgiaPapa, PN is a hard to judge, but when I went into my first C&P" it was a Joke" , but they gave me 20% both legs. Then I to a Neurologist for EMG and nerve study and sent that directly to VA with a letter from the Doctor of my condition. The Neurologist doctor test upper and lower body. The VA follew up with another C&P test and this test was basic a test like yours. The person had no clue on what they were doing, but they did notice my left leg was smaller and and shorter. VA came back with 60% left side and 40% right called Paraylsis of the Sciatic nerve or PN, with 10% for both hands. I think making sure that my Neruologist report got to VA direct was that got the job done.

You need to go back and NOT give up. I live in pain all the time, so I feel your pain. It sound like with your walking condition is the same as mind, dragging your feet, tripping, I trip twice last week and me and concrete don't work!

I'm pretty sure that PN can only secondary to another condition and not primary YET. It should be primary because I had this the PN along time before my DMII.

Share this post

Link to post
Share on other sites


appeal. i have the same thing. peripheral neuropathy.. no feeling at all in my feet.

Share this post

Link to post
Share on other sites

deanbrt & SP4RVN1971,

I will wait and see how I am actually rated for PN before I have further contact with the VARO. I just can not understand how the C & P examiner could show that all my nerves are normal yet state that I have moderate intermittent pain, moderate paresesthias, and moderate numbness in my lower extremities. This is not logical. Hopefully the person doing the rating will have enough sense to understand this also.

The statements from my two private doctors should also put to rest any notions that my nerves are normal, especially the statement contained in the EMG & NCV test report where the doctor stated "There is evidence of severe, axonal and demyelinating tibial neuropathy in both lower extremities affecting the motor component." Based on this statement and other info in the report and the IMO letter from my neurologist, I believe I am entitled to 20% for each lower extremity based on the criteria in the VA disability ratings schedule.

Any additional thoughts or suggestions would certainly be appreciated.


Share this post

Link to post
Share on other sites

I don't believe she checked normal. The dirty little secret about VA's EMR (Electronic Medical Record)is that it will provide default responses. I imagine your NP did her thing, filled out what she wanted to be bothered with and closed the record. Anything she didn't put an entry into shows up with the default value which is "normal".

You would think, with an EMR, and a computer generated exam sheet, that any intelligent organization would require an entry in each field. The VA apparently is quite comfortable with default answers representing medical facts. Why doesn't it say NE or No Entry or NULL?

I have actually had more complete physical exams conducted by NP's than some of the VA's "doctors"! Clearly there are some exams that should never be assigned to an NP.

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Our picks

    • e-Benefits Status Messages 

      Claims Process – Your claim can go from any step to back a step depending on the specifics of the claim, so you may go from Pending Decision Approval back to Review of Evidence. Ebenefits status is helpful but not definitive. Continue Reading
      • 0 replies
    • I was rated at 10% for tinnitus last year by the VA. I went to my private doctor yesterday and I described to him the problems that I have been having with my sense of balance. Any sudden movement of my head or movement while sitting in my desk chair causes me to lose my balance and become nauseous. Also when seeing TV if there are certain scenes,such as movement across or up and down the screen my balance is affected. The doctor said that what is causing the problem is Meniere's Disease. Does any know if this could be secondary to tinnitus and if it would be rated separately from the tinnitus? If I am already rated at 10% for tinnitus and I could filed for Meniere's does any one know what it might be rated at? Thanks for your help. 68mustang
      • 15 replies
    • Feb 2018 on HadIt.com Veteran to Veteran. Sharing top posts and a few statistics with you.
      • 0 replies
    • I have a 30% hearing loss and 10% Tinnitus rating since 5/17.  I have Meniere's Syndrome which was diagnosed by a VA facility in 2010 yet I never thought to include this in my quest for a rating.  Meniere's is very debilitating for me, but I have not made any noise about it because I could lose my license to drive.  I am thinking of applying for additional compensation as I am unable to work at any meaningful employment as I cannot communicate effectively because of my hearing and comprehension difficulties.  I don't know whether to file for a TDUI, or just ask for additional compensation.  My county Veterans service contact who helped me get my current rating has been totally useless on this when I asked her for help.  Does anyone know which forms I should use?  There are so many different directions to proceed on this that I am confused.  Any help would be appreciated.  Vietnam Vet 64-67. 
    • If you are new to hadit and have DIC questions it would help us tremendously if you can answer the following questions right away in your first post.

      What was the Primary Cause of Death (# 1) as listed on your spouse’s death certificate?

      What,if anything, was listed as a contributing cause under # 2?

      Was an autopsy done and if so do you have a complete copy of it?

       It can be obtained through the Medical Examiner’s office in your locale.

      What was the deceased veteran service connected for in his/her lifetime?

      Did they have a claim pending at death and if so what for?

      If they died from anything on the Agent Orange Presumptive list ( available here under a search) when did they serve and where? If outside of Vietnam, what was their MOS and also if they served onboard a ship in the South Pacific what ship were they on and when? Also did they have any major  physical  contact with C 123s during the Vietnam War?

      And how soon after their death was the DIC form filed…if filed within one year of death, the date of death will be the EED for DIC and also satisfy the accrued regulation criteria.
        • Like
      • 14 replies