C&p Exams All Done

[ssgtob1]

Hi all,

I am new here and have a quick question about my C&P exams. I have many, and can copy and paste them all here if need be, but they all state: Does the Veteran's wrist condition impact his or her ability to work? [] Yes [x ] No

Does that mean that I wont be rated for any of these conditions?

[NavyWife]

Not necessarily.

What matters is did the doc make a statement similar to, "the veterans wrist condition is at least as likely as not related to military service".

The second thing to look at is what boxes were checked off regarding the degree of disability. Then compare those to the rating schedule for your condition.

[Navy04]

As NavyWife stated bud, you will have to post the Exam Reports on here, for us to give you a reasonable idea. Good luck and keep us posted

[ssgtob1]

Ok here goes:

1. Diagnosis

------------

a. Does the Veteran now have or has he/she ever been diagnosed with a mental

disorder(s)?

[X] Yes[ ] No

ICD code: 300.

If the Veteran currently has one or more mental disorders that conform to

DSM-5 criteria, provide all diagnoses:

Mental Disorder Diagnosis #1: Unspecified anxiety disorder

ICD code: 300.

b. Medical diagnoses relevant to the understanding or management of the

Mental Health Disorder (to include TBI): none

2. Differentiation of symptoms

------------------------------

a. Does the Veteran have more than one mental disorder diagnosed?

[ ] Yes[X] No

c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?

[ ] Yes[X] No[ ] Not shown in records reviewed

3. Occupational and social impairment

-------------------------------------

a. Which of the following best summarizes the Veteran's level of

occupational

and social impairment with regards to all mental diagnoses? (Check only

one)

[X] Occupational and social impairment due to mild or transient symptoms

which decrease work efficiency and ability to perform occupational

tasks only during periods of significant stress, or; symptoms

controlled by medication

b. For the indicated level of occupational and social impairment, is it

possible to differentiate what portion of the occupational and social

impairment indicated above is caused by each mental disorder?

[ ] Yes[ ] No[X] No other mental disorder has been diagnosed

c. If a diagnosis of TBI exists, is it possible to differentiate what

portion

of the occupational and social impairment indicated above is caused by

the

TBI?

[ ] Yes[ ] No[X] No diagnosis of TBI

SECTION II:

-----------

Clinical Findings:

------------------

1. Evidence review

------------------

a. Medical record review:

Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed?

[X] Yes[ ] No

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

[ ] Yes[X] No

If no, check all records reviewed:

[X] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[X] Department of Defense Form 214 Separation Documents

[ ] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

b. Was pertinent information from collateral sources reviewed?

[ ] Yes[X] No

3. Symptoms

-----------

For VA rating purposes, check all symptoms that actively apply to the

Veteran's diagnoses:

[X] Anxiety

[X] Chronic sleep impairment

Behavioral observations:

The veteran was seen for 45 minutes. His VBMS file was reviewed prior

to the interview. The limits of confidentiality were explained to him

and he agreed to participate in the C&P evaluation. He was alert,

fully

oriented and cooperative. He was well groomed. Mood was good, affect

was euthymic. Speech and thought content were within normal limits.

Thought processes were logical and goal-directed. No evidence or

report

of delusions or hallucinations. Memory and attention appeared grossly

intact. Insight and judgment were fair. The veteran denied current

suicidal or homicidal ideation.

4. Other symptoms

-----------------

Does the Veteran have any other symptoms attributable to mental disorders

that are not listed above?

[X] Yes[ ] No

If yes, describe:

mild irritability

5. Competency

-------------

Is the Veteran capable of managing his or her financial affairs?

[X] Yes[ ] No

6. Remarks (including any testing results), if any:

---------------------------------------------------

claimed condition: Anxiety

diagnosis: unspecified anxiety disorder

rationale: meets DSM-5 criteria

prognosis: good, symptoms are mild

[ssgtob1]

1. Medical history

------------------

Does the Veteran report recurrent tinnitus: Yes

Date and circumstances of onset of tinnitus: Veteran reports constant

bilateral tinnitus, left greater than right, described as a "ringing"

sound, onset in 2008 during deployment to Iraq.

2. Etiology of tinnitus

-----------------------

At least as likely as not (50% probability or greater) caused by or a result

of military noise exposure.

Rationale: Review of available service treatment records revealed the

notation "Subjective tinnitus" on a "Chronic Problems" list dated 5/21/13.

With service treatment records documentation showing diagnosis of tinnitus

during military service, it is this examiner's opinion that the veteran's

reported tinnitus is at least as likely as not related to his military

service.

3. Functional impact of tinnitus

--------------------------------

Does the Veteran's tinnitus impact ordinary conditions of daily life,

including ability to work: No

4. Remarks, if any, pertaining to tinnitus:

-------------------------------------------

CLAIMED CONDITION: TINNITUS

DIAGNOSIS: TINNITUS

RATIONALE: SERVICE TREATMENT RECORDS AND VETERAN'S REPORT AT THIS

C&P

EXAM

PROGNOSIS: GOOD

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the Veteran's

application.

[ssgtob1]

1. Diagnosis

------------

Does the Veteran now have or has he/she ever been diagnosed with a headache

condition?

[X] Yes [ ] No

[X] Migraine including migraine variants

ICD code: 346.10 Date of diagnosis: July 2006

2. Medical History

------------------

a. Describe the history (including onset and course) of the Veteran's

headache conditions (brief summary):

Pt states onset of headaches after head injury in 2005. Headaches

described as (no aura) left frontal throbbing associated with nausea

(rare emesis) with photophobia. Frequency is once per wk and last all

day without treatment. MOtrin helps moderately. Pt states he can work

through headaches but be prefers to lie down. Review of C-file notes

7/17/06 evaluation after hit head on jet flap with laceration to top of

head (4cm requiring sutures) with complaint of headache but no

dizziness/nausea/emesis. States no loss of consciousness occurred and

pt fully oriented with nonfocal exam. Diagnosis was open wound to

scalp

and headache. Pt seen for suture removals on 7/24/06 and again on

8/26/06 still complaining of headache related to above event.

b. Does the Veteran's treatment plan include taking medication for the

diagnosed condition?

[X] Yes [ ] No

If yes, describe treatment (list only those medications used for the

diagnosed condition):

prn motrin

3. Symptoms

-----------

a. Does the Veteran experience headache pain?

[X] Yes [ ] No

[X] Pulsating or throbbing head pain

[X] Pain localized to one side of the head

[X] Pain worsens with physical activity

b. Does the Veteran experience non-headache symptoms associated with

headaches? (including symptoms associated with an aura prior to headache

pain)

[X] Yes [ ] No

[X] Nausea

[X] Vomiting

[X] Sensitivity to light

c. Indicate duration of typical head pain

[X] Less than 1 day

d. Indicate location of typical head pain

[X] Left side of head

4. Prostrating attacks of headache pain

---------------------------------------

a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating

attacks of migraine / non-migraine headache pain?

[X] Yes [ ] No

If yes, indicate frequency, on average, of prostrating attacks over the

last several months:

[X] Once every month

b. Does the Veteran have very prostrating and prolonged attacks of

migraines/non-migraine pain productive of severe economic inadaptability?

[ ] Yes [X] No

5. Other pertinent physical findings, complications, conditions, signs

and/or

symptoms

-----------------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above?

[ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs and/or symptoms related to any

conditions

listed in the Diagnosis section above?

[X] Yes [ ] No

If yes, describe (brief summary):

A/OX3, MMSE 30/30, speech nl

Fundi sharp discs (no OS disc pallor)

Cranial nerves 2-12 grossly intact except OS esophoria, Visual fields

full, Pupils equal/round/reactive to light; no relative afferent

pupillary defect

Motor nl with nl tone

Sensory normal PP throughout except decreased PP over left lateral 1/2

great toe and between lateral 1/2 of 2nd toe and medial 1/2 3rd toe

Coord nl finger to nose/heel to shin bilaterally

Gait nl with nl romberg/tandem

Deep tendon reflexes trace - 1+ symmetric with bilat flexor plantar

responses

+ tinels bilat wrist and left elbow; + phalens bilat

7. Functional impact

--------------------

Does the Veteran's headache condition impact his or her ability to work?

[ ] Yes [X] No

8. Remarks, if any:

-------------------

Claimed Condition: Headache syndrome

Onset: 2006

Diagnosis: migraine without aura

Rationale: history/exam/C-file review

Prognosis: unknown

[ssgtob1]

1. Diagnosis

------------

Does the Veteran have a peripheral nerve condition or peripheral neuropathy?

[X] Yes [ ] No

Diagnosis #1: bilateral carpal tunnel syndrome (mild)

ICD code: 354.0

Date of diagnosis: Aug 2014

Diagnosis #2: left toes digital neuropathy (mild)

ICD code: 955.6

Date of diagnosis: Aug 2014

2. Medical history

------------------

a. Describe the history (including onset and course) of the Veteran's

peripheral nerve condition (brief summary):

Pt states claim of lower extremity bilateral numbness refers to left

>

right entire toes on left and right great toe paresthesias constant

since 2006. Pt states no aggravating features and never seeked medical

attention for this specifically. Pt also states in hands equally in

both palmar surfaces involving all fingers which is episodic but daily

since 2009. Pt states typing can trigger symptoms and resolves within

minutes of stop typing. Pt states never treated with splints and no

EMG

for these conditions.

b. Dominant hand

[ ] Right [X] Left [ ] Ambidextrous

3. Symptoms

-----------

a. Does the Veteran have any symptoms attributable to any peripheral nerve

conditions?

[X] Yes [ ] No

Constant pain (may be excruciating at times)

Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Intermittent pain (usually dull)

Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Paresthesias and/or dysesthesias

Right upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe

Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe

Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe

Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe

Numbness

Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe

4. Muscle strength testing

--------------------------

a. Rate strength according to the following scale:

0/5 No muscle movement

1/5 Palpable or visible muscle contraction, but no joint movement

2/5 Active movement with gravity eliminated

3/5 Active movement against gravity

4/5 Active movement against some resistance

5/5 Normal strength

Elbow flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Elbow extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Grip:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Pinch (thumb to index finger):

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Knee extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Ankle plantar flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Ankle dorsiflexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

b. Does the Veteran have muscle atrophy?

[ ] Yes [X] No

5. Reflex exam

--------------

Rate deep tendon reflexes (DTRs) according to the following scale:

0 Absent

1+ Hypoactive

2+ Normal

3+ Hyperactive without clonus

4+ Hyperactive with clonus

Biceps:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Triceps:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Brachioradialis:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Knee:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Ankle:

Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+

6. Sensory exam

---------------

Indicate results for sensation testing for light touch:

Shoulder area (C5):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Inner/outer forearm (C6/T1):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Hand/fingers (C6-8):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Upper anterior thigh (L2):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Thigh/knee (L3/4):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Lower leg/ankle (L4/L5/S1):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Foot/toes (L5):

Right: [X] Normal [ ] Decreased [ ] Absent

Left: [ ] Normal [X] Decreased [ ] Absent

7. Trophic changes

------------------

Does the Veteran have trophic changes (characterized by loss of extremity

hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy?

[ ] Yes [X] No

8. Gait

-------

Is the Veteran's gait normal?

[X] Yes [ ] No

9. Special tests for median nerve

---------------------------------

Were special tests indicated and performed for median nerve evaluation?

[X] Yes [ ] No

Phalen's sign:

Right: [X] Positive [ ] Negative

Left: [X] Positive [ ] Negative

Tinel's sign:

Right: [X] Positive [ ] Negative

Left: [X] Positive [ ] Negative

10. Nerves Affected: Severity evaluation for upper extremity nerves and

radicular groups

-----------------------------------------------------------------------

a. Radial nerve (musculospiral nerve)

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

b. Median nerve

Right: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis

If Incomplete paralysis is checked, indicate severity:

[X] Mild [ ] Moderate [ ] Severe

Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis

If Incomplete paralysis is checked, indicate severity:

[X] Mild [ ] Moderate [ ] Severe

c. Ulnar nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

d. Musculocutaneous nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

e. Circumflex nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

f. Long thoracic nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

g. Upper radicular group (5th & 6th cervicals)

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

h. Middle radicular group

Right [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

i. Lower radicular group

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

11. Nerves Affected: Severity evaluation for lower extremity nerves

-------------------------------------------------------------------

a. Sciatic nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

b. External popliteal (common peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

c. Musculocutaneous (superficial peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

d. Anterior tibial (deep peroneal) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

e. Internal popliteal (tibial) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

f. Posterior tibial nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

g. Anterior crural (femoral) nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

h. Internal saphenous nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

i. Obturator nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

j. External cutaneous nerve of the thigh

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

k. Ilio-inguinal nerve

Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis

12. Assistive devices

---------------------

a. Does the Veteran use any assistive devices as a normal mode of

locomotion,

although occasional locomotion by other methods may be possible?

[ ] Yes [X] No

13. Remaining effective function of the extremities

---------------------------------------------------

Due to peripheral nerve conditions, is there functional impairment of an

extremity such that no effective function remains other than that which

would

be equally well served by an amputation with prosthesis? (Functions of the

upper extremity include grasping, manipulation, etc., while functions for

the

lower extremity include balance and propulsion, etc.)

[ ] Yes, functioning is so diminished that amputation with prosthesis would

equally serve the Veteran.

[X] No

14. Other pertinent physical findings, complications, conditions, signs

and/or symptoms

-----------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above?

[ ] Yes [X] No

b. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms?

[X] Yes [ ] No

If yes, describe (brief summary):

A/OX3, MMSE 30/30, speech nl

Fundi sharp discs (no OS disc pallor)

Cranial nerves 2-12 grossly intact except OS esophoria, Visual

fields full, Pupils equal/round/reactive to light; no relative

afferent pupillary defect

Motor nl with nl tone

Sensory normal PP throughout except decreased PP over left lateral

1/2 great toe and between lateral 1/2 of 2nd toe and medial 1/2 3rd

toe

Coord nl finger to nose/heel to shin bilaterally

Gait nl with nl romberg/tandem

Deep tendon reflexes trace - 1+ symmetric with bilat flexor plantar

responses

+ tinels bilat wrist and left elbow; + phalens bilat

15. Diagnostic testing

----------------------

a. Have EMG studies been performed?

[ ] Yes [X] No

b. Are there any other significant diagnostic test findings and/or results?

[ ] Yes [X] No

16. Functional impact

---------------------

Does the Veteran's peripheral nerve condition and/or peripheral neuropathy

impact his or her ability to work?

[ ] Yes [X] No

17. Remarks, if any:

--------------------

Claimed Condition: lower extremity bilateral numbness

Onset: 2006

Diagnosis: left toes digital neuropathy (mild)

Rationale: history/exam/C-file review. Note: a right lower extremity

neuropathy was not identified to explain Veteran's claimed complaints.

No diagnosis is established.

Prognosis: unknown

Claimed Condition: bilateral hand paresthesias (new claim)

Onset: 2009

Diagnosis: bilateral carpal tunnel syndrome (mild)

Rationale: history/exam

Prognosis: unknown