C & P Exam - Rater Asked For Another DBQ

[gs106]

Background:  I had a C & P exam on 5 Dec 2015 for several disabilities.  The examiner didn't mention cervical radiculopathy during the exam but in his notes he stated that the numbness in the upper extremity was caused by carpal tunnel syndrome and not cervical radiculopathy.  Cervical radiculopathy had been diagnosed twice...once while I was on active duty and once after. Are the second examiners findings as shown below likely to help my claim?

  Excerpts from the DBQ:

The examiner stated that the right upper extremity is CTS; however, we have

the private EMG showing moderate CTS on the right with ulnar neuropathy and

C7 radiculopathy. Please review the evidence listed above (noting that you

are not restricted to just the evidence above) and state whether or not the

Veteran has a diagnosis of right upper extremity radiculopathy secondary to

his cervical spine, or right ulnar neuropathy directly related to military

service.

Second examiners findings:

VBMS reviewed.

As noted, veteran appears to have cervical radiculopathy, ulnar neuropathy,

and CTS. As each of these abnormalities are in anatomically different

locations, they are not mutually exclusive. He has STR noting bilateral

cervical radiculopathy in 2000 as well as an '03 dx of ulnar neuropathy

and positive exam findings for CTS. It would appear more likely than not that

veteran has neuropathies involving all three anatomical locations based on

exam and NCS findings and is at least as likely as not that they fit the

timeframe to connect to service.

[pwrslm]

Examiner qualifications are a high point here.  Was the guy a neurologist?  If not, I cant see him/her prevailing in a challenge on this. 

Is the Cervical radiculopathy active?  The Ulnar neuropathy has to have a cause, its the largest nerve in the arm, comes from C6/7 area in the cervical spine.  The Ulnar issue and the Cervical radiculopathy can and probably is the same diagnosis.  They have to do an NCG/EMG test to figure this issue out, or they cannot determine that the carpal tunnel is valid and not related to the previous diagnosis.  If the EMG shows that there is no longer any radiculopathy from the cervical spine, they will prevail...

 

Get an independent medical opinion from a non VA neurologist if you can.  Detail it as much as he will and let him see all of your military and VA treatment records, as well as the opinion from the C&P exam.  See what they do for ya.

Edited December 20, 2015 by pwrslm

[Vync]

You got both "more likely than" (75%) and "as likely as not" (50%) in there, which usually is good, but pwrslm is right that the weight of a neuro doc specialist exceeds that of a general practitioner. Also, keep in mind that all EMG's are not created equal. In my case, confirming cervical radiculopathy while laying down it was negative, but while sitting up it was positive. Gravity is a very real factor, even though some doctors don't want to admit it.

Be aware of the acronyms. These are all different types of nerve impingement (where something is pressing up on your nerves). CTS can mean either "carpal tunnel syndrome" (which is in your hands/wrists) or "cubital tunnel syndrome" (which is in the elbow and is also known as "ulnar neuropathy"). Cervical radiculopathy occurs in your neck, but can cause problems in arms, hands, head, or other places.

As info, I had multiple nerve decompression surgery via a private surgeon to correct carpal and ulnar tunnel syndrome. They made a total of six incisions in my hand, forearm, and around the elbow. I also had similar surgeries on each leg around the knee, ankle and foot. It helped, but didn't completely go away. Thought I would share this with you in the event that yours starts to drive you so crazy that you consider surgery.

[Navy04]

Hard to say, but in my case I had the VA C&P Doc state a few Diagnoses that were missed in original claim, therefore RO would either send me to another C&P for the new condition, or Have a Licensed Doc in that Specialty fill out a DBQ on their own, and send to the RO for rating purposes. Good luck and keep us posted. God Bless