Dr. Assessment Of Peripheral Neuropathy - Question On Rating

[green]

I had an outside neurologist perform an assessment of my diabetic peripheral neuropathy and would like to know how those of you who have experience in this area see this as being rated. The VA form includes the following information:

Diagnosis - Diabetic Polyneuropathy

History - 15 yrs of stabbing pains in feet, burning in feet, numbness in hands and feet, difficulty with fine finger motor control and gait imbalance.

Does the veteran have any symptoms attributable to diabetic peripheral neuropathy

Constant pain - right upper (mild) left upper (mild), right lower (severe) left lower (severe)

Paresthesias and/or Dysesthesias - right upper (moderate), left upper (moderate), right lower (none), left lower (none)

Numbness - right upper (mild), left upper (mild), right lower (severe), left lower (severe)

Other symptoms - loss of balance

Strength (all normal except grip and pinch rated at 4/5)

Deep Tendon Reflexes (all normal except ankles = absent)

Light monofiliment - shoulder and inner/outer forearm = normal, hand/fingers, knee/thigh = decreased, ankle/lower leg, foot and toes = absent

Position sense - upper = decreased, lower = absent

Vibration sensation - upper = decreased, lower = absent

Cold sensation - upper = decreased, lower = absent

Trophic changes - loss of hair on legs and feet

Although the neurologist noted I have upper and lower extremity diabetic peripheral neuropathy they didn't assign a specific nerve or indication of severity of the paralysis

EMG studies - yes

looked at right upper (said that the assumption would be the left would be the same) form noted as abnormal

looked at both left and right lower and form noted as abnormal

Functional impact on ability to work- neuropathic pain drugs interfere with cognitive function, hand use impairment (typing and use) due to pain and numbness

Thank you for your input, it is much appreciated!

[john999]

Hmmmmm.....PN by definition works from the hands and feet upwards and inwards. I have 10% for my hands and feet. I have pretty bad pain in my feet and just about all the hair on my legs and feet is gone. I used to have real hairy legs and now my legs are bald and look sort of weird. Do you lower legs fee tender to the touch? When I grab my lower legs and squeeze I feel pain and tenderness. It is not normal . I think there are other symptoms with the feet that are important for a higher rating. It is all bad. The more numb they are and the poorer your circulation the more danger you are in of losing a limb to amputation. Also, the higher the numbness goes up the legs and arms the worse. Have you read up on the symptomology of PN and how it progresses? With the pain I have in my feet it goes way beyond 10% to me. That is subjective and a lot of PN symptoms are subjective. If it gets to the point you find it difficult to walk or grip then you should be getting a higher rating because how are you supposed to work if your grip is weak or you are dropping things all the time?

Don't let anyone do anything invasive to your feet because you probably don't heal as well as you used to so there is danger of gangrene setting in from open wounds. I would not ever let anyone but very good podiatrist cut my toenails and I would not let them trim corns or warts or anything where there will be a wound. I got one of those deep shots to kill pain in my foot. I got a staff infection and almost lost my foot. You can look at the VA's way of rating PN and they have specific set of symptoms they look for to rate severity. Just from point that it harms your ability to work and your balance you should get more than 10%, but you have to be pretty bad to get more than ten percent. Is your PN result of service connected DMII or a back injury?

[green]

John, I have a service connected disability for juvenile onset diabetes or diabetes 1. My initial diagnosis was 33 years ago and having lived with the disease for this long I have several issues going on. PN has been noted in my VA records for 15 years but I'm just now filing.

Given the ratings are noted as mild, moderate or severe, I'm wondering what the rating officials will do with the information I provided.

Thanks,

Scott

Edited June 16, 2015 by green

[green]

I'm so confused. I called the neurologist who filled out the form and stated that the VA wanted to know the neural path with issues identified. they revised the form and although they noted significant issues and an abnormal EMG they marked on the VA disability benefits questionnaire that I have upper and lower extremity diabetic peripheral neuropathy they note (under the severity section) (where the form asks for an assessment of paralysis of specific nerves) the nerves as "normal". I'm guessing that the actual nerve is undamaged but the path it takes is degraded due to the disease and the Dr. wasn't comfortable stating it wasn't. I'm not sure what impact this will have on my rating. In submitting the form to the VA for review I plan on including the doctor's notes and the actual EMG document.

The NCS says:

right sural and ulnar sensory responses are abnormal due to unobtainable responses

right median sensory response was abnormal due to prolonged latency and low amplitude

right radial sensory response was abnormal due to reduced amplitude

bilateral peroneal motor responses were abnormal due to low amplitudes and slowed velocity

right tibial motor had borderline normal velocity

right ulnar motor response was abnormal due to slowed velocity

Needle EMG

limited needle exam of selected right upper and lower limb muscles was performed and was abnormal. Increased insertional activity was present in selected right hand m and EDB.

If there are any ex VA raters out there or other knowledgeable folks I would definitely appreciate your perspective.