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

[iceturkee]

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

i had it in both of my wrists. had surgery in the left hand. that seemed to cure the right one which was never operated on.

[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."

I found the bilateral calculator as well. For those interested it is http://www.pebforum.com/VA%20_CALC/VA%20_CALC/calc.html

[Julie1975]

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!

You're very welcome! I'm appealing my CTS because that comment also confuses me. When I read my C&P I had a completely different idea of what my ratings would be when compared to 38 C.F.R.

As far as symptoms, during the exam I had positive Phalen's & Tinel's sign (both sides). He confirmed paresthesias/dysethesias in both extremities and a decreased sensation during light touch at that nerve. I also had a nerve test (a few years ago) confirming CTS.

I personally think I'm confused on what "wholly sensory" means. I see that phrase a lot but can't seem to wrap my simple mind around it. Good luck on your FDC! If my NOD is ever resolved, I'll definitely post up the results.

[bh1981]

You're very welcome! I'm appealing my CTS because that comment also confuses me. When I read my C&P I had a completely different idea of what my ratings would be when compared to 38 C.F.R.

As far as symptoms, during the exam I had positive Phalen's & Tinel's sign (both sides). He confirmed paresthesias/dysethesias in both extremities and a decreased sensation during light touch at that nerve. I also had a nerve test (a few years ago) confirming CTS.

I personally think I'm confused on what "wholly sensory" means. I see that phrase a lot but can't seem to wrap my simple mind around it. Good luck on your FDC! If my NOD is ever resolved, I'll definitely post up the results.

Yeah, I got a positive in both Phalen's and Tinel's as well. I've had great luck with fully developed claims in the past. For my TBI screening they sent me to an outside provider and that was a horrendous experience. At least with these FDC's and DBQ's I can select and interview my treating physician and use my private insurance to pay for the assessment. When possible I can and will use my own selected provider for these assessments because I can follow up with them if I have a question pertaining to the DBQ they filled out. With the person I saw over the TBI assessment, because the VA was paying for it, they would not give me the results which I feel is completely erroneous. That's neither here nor there. Hopefully my physician makes it crystal clear that my condition is what it is and will alleviate the VA in making assumptions for "rating purposes". Philly VAROIC seems to be going pretty quick with FDC's as of late and I cannot go through the usual claim process as I am moving out of state next month, back to my adopted "home state" of Florida. So hopefully they won't send me for further C&P evaluations with a FDC. They didn't with my last FDC so we'll see! Good luck to you as well Julie. I hope your NOD works out well for you and you get your fair shake.

[bh1981]

You're very welcome! I'm appealing my CTS because that comment also confuses me. When I read my C&P I had a completely different idea of what my ratings would be when compared to 38 C.F.R.

As far as symptoms, during the exam I had positive Phalen's & Tinel's sign (both sides). He confirmed paresthesias/dysethesias in both extremities and a decreased sensation during light touch at that nerve. I also had a nerve test (a few years ago) confirming CTS.

I personally think I'm confused on what "wholly sensory" means. I see that phrase a lot but can't seem to wrap my simple mind around it. Good luck on your FDC! If my NOD is ever resolved, I'll definitely post up the results.

Also, I forgot to mention that there is a device that has been approved for the FDA in alleviating the symptoms of CTS. I am in no way, shape, or form affiliated with the device or manufacturer so hopefully this post does not get deleted by moderators. But it has helped me at night, when CTS is worse, and I figured I'd share it with you. It is called CTRAC for CTS. It's basically a device that can be used on both hands and the intended purpose is to stretch the ligament that pushes against the median nerve in the wrists. So it acts as a sort of "release therapy" without the surgery. I have been using it for about 3 full weeks now and have noticed a significant difference in my non-dominant hand and a difference in my dominant hand that makes CTS more manageable. It's still there but the tingling and numbing have gone down significantly at night and during the daytime. It might be something to look into for whatever it may be worth.

[Julie1975]

Thanks for the info on CTRAC. I will definitely check it out. I wear braces which helps somewhat and want to avoid surgery for a while (tired of being in and out of hospitals). Thanks again!