Carpal Tunnel, How Does Va Rate?

[bh1981]

Hello fellow Vets,

I had a nerve conduction test done with my neurologist and asked if he felt my carpal tunnel was related to military service with which he replied, "yes, definitively and absolutely". I obviously requested him to fill out a DBQ and am currently standing by for it. However, I have read numerous citations for this and cannot come up with a conclusive answer. How in the world does the VA rate carpal tunnel!? I read a few citations that stated the VA does not use terminology such as mild, moderate, or severe to characterize carpal tunnel so how do they rate it? Also, my private neurologist stated that I have moderate to severe carpal tunnel in my right hand and moderate in my left hand. I have attached a PDF of the electric nerve scan and physician impressions for your view. If rated, does anyone have any idea what that rating might be? Also, I have read some stuff about bilateral factors. Would a bilateral factor be applicable with carpal tunnel?Thanks, as always.

EDIT: For some reason I could not upload the PDF. Here is what was written by my doc;

EMG & NCV Findings:

Evaluation of the Left Median Motor nerve showed prolonged distal onset latency (4.7ms) and reduced amplitude (5.8mV). The Right Median Motor nerve showed prolonged distal onset latency (4.9 ms), reduced amplitude (3.3 MV), and decreased conduction velocity (Elbow-Wrist, 30 m/s). The Left Median Anti Sensory nerve showed prolonged distal peak latency (4.0 ms), reduced amplitude (13.5 uV), and decreased conduction velocity (Wrist-2nd Digit, 39 m/s). The Right Median Anti Sensory nerve showed no response (Wrist). All remaining nerves (as indicated in the following tables) were within normal limits.

All examined muscles (as indicated in the following table) showed no evidence of electrical instability.

Impression:

Bilateral median neuropathies at or distal to the wrists, i.e. carpal tunnel syndrome which appear to be in moderate to severe in the right hand and moderate in the left hand.

Edited April 16, 2015 by bh1981

[stinger]

In my experience, carpal tunnel is fixable. I had it. No residuals.

[toddt]

Here is what I found:

C.F.R. §4.124a—Schedule of ratings–neurological conditions and convulsive disorders

4.124a-1The median nerve

8515 Paralysis of:

Complete; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the

muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion

of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx

of thumb, defective opposition and abduction of the thumb at right angles to palm; flexion of wrist weakened; pain with trophic

disturbances

Complete: 70 60

Incomplete:

Severe 50 40

Moderate 30 20

Mild 10 10

The first number being for bilateral.

[bh1981]

Here is what I found:

C.F.R. §4.124a—Schedule of ratings–neurological conditions and convulsive disorders

4.124a-1The median nerve

8515 Paralysis of:

Complete; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the

muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion

of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx

of thumb, defective opposition and abduction of the thumb at right angles to palm; flexion of wrist weakened; pain with trophic

disturbances

Complete: 70 60

Incomplete:

Severe 50 40

Moderate 30 20

Mild 10 10

The first number being for bilateral.

So, if rated for moderate, my dominant hand would be 30% and non-dominant would be 20% correct? Using VA math that comes to about 48% with a bilateral factor, rounding up to 50%. Would that be correct?

[bh1981]

In my experience, carpal tunnel is fixable. I had it. No residuals.

I'm glad yours was fixed. Surgery for me, at this point of time, is out of the question. I cannot afford to have any downtime due to recovery.

[Julie1975]

So, if rated for moderate, my dominant hand would be 30% and non-dominant would be 20% correct? Using VA math that comes to about 48% with a bilateral factor, rounding up to 50%. Would that be correct?

I believe that is correct. If it helps I've copied/pasted the VA's explanation for my 10% each *left and right* CTS (median nerve). The verbiage is the same for my right (dominant hand) but instead of "a higher evaluation of 20", it says "30". There is a bilateral calculator out there somewhere that will do the math for you.

"We have assigned a 10 percent evaluation for your carpal tunnel syndrome, left hand/wrist

based on: . mild incomplete paralysis of the minor extremity

A higher evaluation of 20 percent is not warranted unless the evidence shows nerve damage

is moderate.

You claimed this as: carpal tunnel syndrome hand and arm. Although the examiner reported

moderate symptoms, your wholly sensory symptoms are more suggestive of a mild severity

level for VA ratine purposes."

[bh1981]

I believe that is correct. If it helps I've copied/pasted the VA's explanation for my 10% each *left and right* CTS (median nerve). The verbiage is the same for my right (dominant hand) but instead of "a higher evaluation of 20", it says "30". There is a bilateral calculator out there somewhere that will do the math for you.

"We have assigned a 10 percent evaluation for your carpal tunnel syndrome, left hand/wrist

based on: . mild incomplete paralysis of the minor extremity

A higher evaluation of 20 percent is not warranted unless the evidence shows nerve damage

is moderate.

You claimed this as: carpal tunnel syndrome hand and arm. Although the examiner reported

moderate symptoms, your wholly sensory symptoms are more suggestive of a mild severity

level for VA ratine purposes."

Thanks for sharing Julie! The last paragraph in your assessment is what my confusion is over. "The examiner reported moderate symptoms...but your sensory symptoms are more suggestive of a mild severity rating." How do they determine the severity rating as being mild if the rating examiner determined you had moderate symptoms!? I guess I'll throw my fully developed claim at them and see what happens. Thanks again for sharing!