Rating for Restless Legs Syndrome

[DevilDog12]

I am currently rated 0% for Restless Legs Syndrome SC'd for Exposures during Gulf War.  I filed an NOD, because C&P doctor stated it was mild in his report.  However, I am on a very heavy dose of Ropinirole to treat it, because of it being so severe.  The dose is high enough to treat Parkinsons Disease.  My family doctor and VA primary care provider prescribed me this dose of medication.  My question is, has anyone won a claim or appeal for this illness and low rating?  And what did you get rated?

[DevilDog12]

Definitely will....

[DevilDog12]

Here it is.......some of it is correct, some is bull.  He listed symptoms as mild, but also says my daily life, work performance, and sleep are affected, and I am on a dose of Ropinirole high enough to tranquilize a horse. 

Central Nervous System and Neuromuscular Diseases

(except Traumatic Brain Injury, Amyotrophic Lateral Sclerosis,

Parkinson's Disease, Multiple Sclerosis, Headaches, TMJ

Conditions, Epilepsy, Narcolepsy, Peripheral Neuropathy, Sleep

Apnea, Cranial Nerve Disorders, Fibromyalgia, and

Chronic Fatigue Syndrome)

Disability Benefits Questionnaire

Name of patient/Veteran:

Indicate method used to obtain medical information to complete this

document:

[X] In-person examination

Evidence review

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

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

CONFIDENTIAL Page 34 of 57

[ ] Yes[X] No

If no, check all records reviewed:

[X] Military service treatment records

[X] Other:

The claims file in VBMS was reviewed by the examiner. The

veteran's

electronic folder in VBMS was reviewed by the examiner.

1. Diagnosis

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

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

nervous system (CNS) condition?

[X] Yes [ ] No

[X] Other central nervous condition

Other diagnosis #1: Willis Ekbom Disease

ICD code: 333.99

Date of diagnosis: 1998

2. Medical history

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

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

central

nervous conditions (brief summary):

Gradual onset of insomnia around 1998, eventually attributed to restless

leg syndrome (Willis Ekbom Disease) with gradual worsening over

subsequent

years. Willis Ekbom Disease now affects legs even while awake.

b. Does the Veteran's central nervous system condition require

continuous

medication for control?

[X] Yes [ ] No

If yes, list medications used for central nervous system conditions:

Ropinerol

c. Does the Veteran have an infectious condition?

[ ] Yes [X] No

If yes, is it active?

[ ] Yes [ ] No

d. Dominant hand

CONFIDENTIAL Page 35 of 57

[X] Right [ ] Left [ ] Ambidextrous

3. Conditions, signs and symptoms

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

a. Does the Veteran have any muscle weakness in the upper and/or lower

extremities?

[ ] Yes [X] No

b. Does the Veteran have any pharynx and/or larynx and/or swallowing

conditions?

[ ] Yes [X] No

c. Does the Veteran have any respiratory conditions (such as rigidity of the

diaphragm, chest wall or laryngeal muscles)?

[ ] Yes [X] No

d. Does the Veteran have sleep disturbances?

[X] Yes [ ] No

If yes, check all that apply:

[X] Insomnia

[X] Hypersomnolence and/or daytime "sleep attacks"

[X] Persistent daytime hypersomnolence

e. Does the Veteran have any bowel functional impairment?

[ ] Yes [X] No

f. Does the Veteran have voiding dysfunction causing urine leakage?

[ ] Yes [X] No

g. Does the Veteran have voiding dysfunction causing signs and/or symptoms

of

urinary frequency?

[ ] Yes [X] No

h. Does the Veteran have voiding dysfunction causing findings, signs and/or

symptoms of obstructed voiding?

[ ] Yes [X] No

i. Does the Veteran have voiding dysfunction requiring the use of an

appliance?

[ ] Yes [X] No

j. Does the Veteran have a history of recurrent symptomatic urinary tract

infections?

[ ] Yes [X] No

k. Does the Veteran (if male) have erectile dysfunction?

[ ] Yes [X] No

4. Neurologic exam

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

CONFIDENTIAL Page 36 of 57

a. Speech

[X] Normal [ ] Abnormal

b. Gait

[X] Normal [ ] Abnormal, describe:

c. Strength

Rate strength according to the following scale:

0/5 No muscle movement

1/5 Visible muscle movement, but no joint movement

2/5 No movement against gravity

3/5 No movement against resistance

4/5 Less than normal strength

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

d. Deep tendon reflexes (DTRs)

Rate reflexes according to the following scale:

CONFIDENTIAL Page 37 of 57

0 Absent

1+ Decreased

2+ Normal

3+ Increased without clonus

4+ Increased with clonus

Biceps:

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

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

Triceps:

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

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

Brachioradialis:

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

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

Knee:

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

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

Ankle:

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

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

e. Does the Veteran have muscle atrophy attributable to a CNS condition?

[ ] Yes [X] No

f. Summary of muscle weakness in the upper and/or lower extremities

attributable to a CNS condition (check all that apply):

Right upper extremity muscle weakness:

[X] None

Left upper extremity muscle weakness:

[X] None

Right lower extremity muscle weakness:

[X] None

Left lower extremity muscle weakness:

[X] None

NOTE: If the Veteran has more than one medical condition contributing to

the muscle weakness, identify the condition(s) and describe each

condition's contribution to the muscle weakness:

N/A

5. Tumors and neoplasms

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

CONFIDENTIAL Page 38 of 57

a. Does the Veteran have a benign or malignant neoplasm or metastases

related

to any of the diagnoses in the Diagnosis section?

[ ] Yes [X] No

d. Does the Veteran currently have any residual conditions or complications

due to the neoplasm (including metastases) or its treatment, other than

those already documented in the report above?

[ ] Yes [X] No

e. If there are additional benign or malignant neoplasms or metastases

related to any of the diagnoses in the Diagnosis section, describe using

the above format:

N/A

6. 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 related to any conditions

listed in the Diagnosis section above?

[ ] Yes [X] No

7. Mental health manifestations due to CNS condition or its treatment

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

a. Does the Veteran have depression, cognitive impairment or dementia, or

any

other mental health conditions attributable to a CNS disease and/or its

treatment?

[ ] Yes [X] No

8. Differentiation of Symptoms or Neurologic Effects

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

Are you able to differentiate what portion of the symptomatology or

neurologic effects above are caused by each diagnosis?

[X] Yes [ ] No

If yes, list which symptoms or neurologic effects are attributable to

each

diagnosis, where possible:

Insomnia attributed to RLS; daytime hypersomnolence and daytime sleep

attacks attributed to ropinerol, taken for RLS treatment.

CONFIDENTIAL Page 39 of 57

9. Assistive devices

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

a. Does the Veteran use any assistive device(s) as a normal mode of

locomotion, although occasional locomotion by other methods may be

possible?

[ ] Yes [X] No

10. Remaining effective function of the extremities

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

Due to a CNS condition, 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

11. Diagnostic testing

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

a. Have imaging studies been performed?

[ ] Yes [X] No

b. Have PFTs been performed?

[ ] Yes [X] No

c. If PFTs have been performed, is the flow-volume loop compatible with

upper

airway obstruction?

[ ] Yes [ ] No

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

[ ] Yes [X] No

12. Functional impact

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

Do the Veteran's central nervous system disorders impact his or her

ability

to work?

[X] Yes [ ] No

If yes, describe impact of each of the Veteran's central nervous system

disorder condition(s), providing one or more examples:

Residual daytime hypersomnolence affects all activities; and veteran must

avoid or exercise caution when engaging in activities where sudden

unexpected onset of sleep could cause harm to self or others.

CONFIDENTIAL Page 40 of 57

13. Remarks, if any:

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

The Veteran's disability pattern of insomnia appears to be: (3) a

diagnosable chronic multisymptom illness with a partially explained

etiology.

It is "at least as likely as not" that the veteran's

disability pattern

of insomnia and diagnosed disease of Willis Ekbom Disease is related to

a

specific exposure event experienced by the Veteran during service in

Southwest Asia.

The rationale for this opinion is that the veteran has had persistent

and

recurrent insomnia symptoms and underlying symptoms of Willis Ekbom

Disease from the time of their initial development soon after the

veteran's deployment to the Persian Gulf while the veteran was in

the

military until the present time; with the current insomnia and Willis

Ekbom Disease symptoms occurring in similar locations, and appearing to

be of similar natures, as the insomnia the veteran developed while he

was

in the military; with the current insomnia and Willis Ekbom Disease

symptoms with similar precipitating, exacerbating, and relieving factors

as the insomnia the veteran developed while in the military.

****************************************************************************

Peripheral Nerves Conditions

(not including Diabetic Sensory-Motor Peripheral Neuropathy)

Disability Benefits Questionnaire

Name of patient/Veteran: Jason E Bainbridge

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

CONFIDENTIAL Page 41 of 57

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

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

Was the Veteran's VA claims file reviewed?

[ ] Yes [X] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

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

[ ] 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

[X] Other:

The claims file in VBMS was reviewed by the examiner. The

veteran's

electronic folder in VBMS was reviewed by the examiner.

1. Diagnosis

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

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

[X] Yes [ ] No

Diagnosis #1: Willis Ekbom Disease

ICD code: 333.99

Date of diagnosis: 1998

2. Medical history

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

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

peripheral nerve condition (brief summary):

Gradual onset of restless leg syndrom (Willis Ekbom Disease) around

1998, with gradual worsening over subsequent years. Willis Ekbom

Disease

now affects legs even while awake.

CONFIDENTIAL Page 42 of 57

b. Dominant hand

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

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

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

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

Paresthesias and/or dysesthesias

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

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

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

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

Numbness

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

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

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

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

CONFIDENTIAL Page 43 of 57

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 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

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

Triceps:

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

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

CONFIDENTIAL Page 44 of 57

Brachioradialis:

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

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

Knee:

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

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

Ankle:

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

Left: [ ] 0 [ ] 1+ [X] 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: [X] Normal [ ] Decreased [ ] Absent

Other sensory findings, if any:

N/A

7. Trophic changes

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

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

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

CONFIDENTIAL Page 45 of 57

[ ] 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?

[ ] Yes [X] No

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

radicular groups

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

a. Radial nerve (musculospiral 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

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: [ ] 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

d. Musculocutaneous 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

CONFIDENTIAL Page 46 of 57

If Incomplete paralysis is checked, indicate severity:

[X] Mild [ ] Moderate [ ] Severe

e. Circumflex 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

f. Long thoracic 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

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

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

h. Middle radicular group

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

i. Lower radicular group

CONFIDENTIAL Page 47 of 57

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

11. Nerves Affected: Severity evaluation for lower extremity nerves

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

a. Sciatic nerve

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

If Incomplete paralysis is checked, indicate severity:

[X] Mild

[ ] Moderate

[ ] Moderately Severe

[ ] Severe, with marked muscular atrophy

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

If Incomplete paralysis is checked, indicate severity:

[X] Mild

[ ] Moderate

[ ] Moderately Severe

[ ] Severe, with marked muscular atrophy

b. External popliteal (common peroneal) 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. Musculocutaneous (superficial peroneal) 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

CONFIDENTIAL Page 48 of 57

d. Anterior tibial (deep peroneal) 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

e. Internal popliteal (tibial) 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

f. Posterior tibial 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

g. Anterior crural (femoral) 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

h. Internal saphenous 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

CONFIDENTIAL Page 49 of 57

If Incomplete paralysis is checked, indicate severity:

[X] Mild [ ] Moderate [ ] Severe

i. Obturator 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

j. External cutaneous nerve of the thigh

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

k. Ilio-inguinal 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

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

CONFIDENTIAL Page 50 of 57

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?

[ ] Yes [X] No

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?

[X] Yes [ ] No

If yes, describe impact of each of the Veteran's peripheral nerve

and/or

peripheral neuropathy condition(s), providing one or more examples:

Residual daytime hypersomnolence affects all activities; and veteran

must avoid or exercise caution when engaging in activities where

sudden

unexpected onset of sleep could cause harm to self or others.

17. Remarks, if any:

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

The Veteran's disability pattern of restless leg syndrom appears to

be:

(3) a diagnosable chronic multisymptom illness with a partially

explained

CONFIDENTIAL Page 51 of 57

etiology.

It is "at least as likely as not" that the veteran's

disability pattern

of restless leg syndrom and diagnosed disease of Willis Ekbom Disease is

related to a specific exposure event experienced by the Veteran during

service in Southwest Asia.

The rationale for this opinion is that the veteran has had persistent

and

recurrent symptoms of Willis Ekbom Disease from the time of their

initial

development soon after the veteran's deployment to the Persian Gulf

while

the veteran was in the military until the present time; with the current

Willis Ekbom Disease symptoms occurring in similar locations, and

appearing to be of similar natures, as the restless leg syndrome the

veteran developed while he was in the military; with the current

insomnia

and Willis Ekbom Disease symptoms with similar precipitating,

exacerbating, and relieving factors as the restless leg syndrome the

veteran developed while in the military.

****************************************************************************

Medical Opinion

Disability Benefits Questionnaire

Name of patient/Veteran: Jason E Bainbridge

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

CONFIDENTIAL Page 52 of 57

Evidence review

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

Was the Veteran's VA claims file reviewed? No

If no, check all records reviewed:

[X] Military service treatment records

[X] Other:

The claims file in VBMS was reviewed by the examiner. The

veteran's

electronic folder in VBMS was reviewed by the examiner.

MEDICAL OPINION SUMMARY

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

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: If, after examining the Veteran and

reviewing the claims file, you determine that the Veteran's disability

pattern is either (3) a diagnosable chronic multi-symptom illness with a

partially explained etiology, or (4) a disease with a clear and specific

etiology and diagnosis, then please provide a medical opinion, with

supporting rational, as to whether it is "at least as likely as

not" that the

disability pattern or diagnosed disease is related to a specific exposure

event experienced by the Veteran during service in Southwest Asia.

b. Indicate type of exam for which opinion has been requested: GM-Gulf

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE

CONNECTION ]

b. The condition claimed was less likely than not (less than 50%

probability) incurred in or caused by the claimed in-service injury, event

or

illness.

c. Rationale: The Veteran's disability pattern of headaches appears to

be:

(3) a diagnosable chronic multisymptom illness with a partially explained

etiology.

It is not "at least as likely as not" that the veteran's

disability pattern

of headaches and diagnosed disease of migraine headaches, with recurrent

sinusitis, is related to a specific exposure event experienced by the

Veteran

during service in Southwest Asia.

The rationale for this opinion is that the veteran's migraine headaches

and

CONFIDENTIAL Page 53 of 57

underlying recurrent sinusitis, have been attributed to being the residuals

of the veteran's wisdom tooth extraction, as the veteran's wisdom

teeth

impacted into his maxillary sinuses.

TYPE OF MEDICAL OPINION PROVIDED: [ OPINION REGARDING CONFLICTING MEDICAL

EVIDENCE ]

I have reviewed the conflicting medical evidence and am providing the

following opinion: N/A

*************************************************************************

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: If, after examining the Veteran and

reviewing the claims file, you determine that the Veteran's disability

pattern is either (3) a diagnosable chronic multi-symptom illness with a

partially explained etiology, or (4) a disease with a clear and specific

etiology and diagnosis, then please provide a medical opinion, with

supporting rational, as to whether it is "at least as likely as

not" that the

disability pattern or diagnosed disease is related to a specific exposure

event experienced by the Veteran during service in Southwest Asia.

b. Indicate type of exam for which opinion has been requested: GM-Gulf

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE

CONNECTION ]

a. The condition claimed was at least as likely as not (50% or greater

probability) incurred in or caused by the claimed in-service injury, event

or

illness.

c. Rationale: The Veteran's disability pattern of insomnia appears to

be: (3)

a diagnosable chronic multisymptom illness with a partially explained

etiology.

It is "at least as likely as not" that the veteran's

disability pattern of

insomnia and diagnosed disease of Willis Ekbom Disease is related to a

specific exposure event experienced by the Veteran during service in

Southwest Asia.

The rationale for this opinion is that the veteran has had persistent and

recurrent insomnia symptoms and underlying symptoms of Willis Ekbom Disease

from the time of their initial development soon after the veteran's

deployment to the Persian Gulf while the veteran was in the military until

CONFIDENTIAL Page 54 of 57

the present time; with the current insomnia and Willis Ekbom Disease

symptoms

occurring in similar locations, and appearing to be of similar natures, as

the insomnia the veteran developed while he was in the military; with the

current insomnia and Willis Ekbom Disease symptoms with similar

precipitating, exacerbating, and relieving factors as the insomnia the

veteran developed while in the military.

TYPE OF MEDICAL OPINION PROVIDED: [ OPINION REGARDING CONFLICTING MEDICAL

EVIDENCE ]

I have reviewed the conflicting medical evidence and am providing the

following opinion: N/A

*************************************************************************

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: If, after examining the Veteran and

reviewing the claims file, you determine that the Veteran's disability

pattern is either (3) a diagnosable chronic multi-symptom illness with a

partially explained etiology, or (4) a disease with a clear and specific

etiology and diagnosis, then please provide a medical opinion, with

supporting rational, as to whether it is "at least as likely as

not" that the

disability pattern or diagnosed disease is related to a specific exposure

event experienced by the Veteran during service in Southwest Asia.

b. Indicate type of exam for which opinion has been requested: GM-Gulf

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE

CONNECTION ]

a. The condition claimed was at least as likely as not (50% or greater

probability) incurred in or caused by the claimed in-service injury, event

or

illness.

c. Rationale: The Veteran's disability pattern of restless leg syndrom

appears to be: (3) a diagnosable chronic multisymptom illness with a

partially explained etiology.

It is "at least as likely as not" that the veteran's

disability pattern of

restless leg syndrom and diagnosed disease of Willis Ekbom Disease is

related

to a specific exposure event experienced by the Veteran during service in

Southwest Asia.

The rationale for this opinion is that the veteran has had persistent and

recurrent symptoms of Willis Ekbom Disease from the time of their initial

development soon after the veteran's deployment to the Persian Gulf

CONFIDENTIAL Page 55 of 57

while the

veteran was in the military until the present time; with the current Willis

Ekbom Disease symptoms occurring in similar locations, and appearing to be

of

similar natures, as the restless leg syndrome the veteran developed while he

was in the military; with the current insomnia and Willis Ekbom Disease

symptoms with similar precipitating, exacerbating, and relieving factors as

the restless leg syndrome the veteran developed while in the military.

TYPE OF MEDICAL OPINION PROVIDED: [ OPINION REGARDING CONFLICTING MEDICAL

EVIDENCE ]

I have reviewed the conflicting medical evidence and am providing the

following opinion: N/A

*************************************************************************

PRIMARY CARE PHYSICIAN

Signed: 09/01/2015 18:43

10/14/2015 ADDENDUM STATUS: COMPLETED

Results of additional labs performed on August 31, 2015 revealed a TSH of 3.4,

with a free T4 of 0.72; a serum Vitamin B-12 level of 359.00; a PSA of 1.14; and

a

negative antinuclear antibody.

[DevilDog12]

And, the Doctor is a Primary Care Physician, not a Neurologist.  Can I request a new C&P?

[Vync]

Hey DevilDog,
The section on page 49 was most likely why they rated your condition as mild.

It might be possible to request a new C&P, but the VA commonly uses regular doctors to perform a wide variety of C&P exams. The opinion of a specialist (neurologist) would definitely outweigh the opinion of a regular doc.

While reading your C&P findings, I wondered if you happened to have any sleep studies performed. If so, I would recommend you look at the findings. If they show moderate or severe RLS, make sure the VA used the results in your rating (they are supposed to list what evidence was used to make the decision) and might be able to overrule the regular doc because they are interpreted by a neurologist. If you have not had a sleep study performed, it might be beneficial to see if the VA can do one for you. They can be pricey if done in a private clinic with private insurance. With the problems indicated in your C&P exam, I am almost wondering if you might need to be on a CPAP, but keep in mind I am not a doctor or expert. It just seems pretty consistent with having horrible sleep patterns.

In addition, I am including this. Based on the information I put in bold below, you might be able to get rated for daytime hypersomnolence as secondary to the RLS. The "attributed" statement might not meet the VA's 50/50 minimum standard, but if it was me, it would definitely indicate that it might be worth exploring. I included the rating criteria further below for sleep issues.

Are you able to differentiate what portion of the symptomatology or
neurologic effects above are caused by each diagnosis?
[X] Yes [ ] No
If yes, list which symptoms or neurologic effects are attributable to
each
diagnosis, where possible:
Insomnia attributed to RLS; daytime hypersomnolence and daytime sleep
attacks attributed to ropinerol, taken for RLS treatment.

Do the Veteran's central nervous system disorders impact his or her
ability
to work?
[X] Yes [ ] No
If yes, describe impact of each of the Veteran's central nervous system
disorder condition(s), providing one or more examples:
Residual daytime hypersomnolence affects all activities; and veteran must
avoid or exercise caution when engaging in activities where sudden
unexpected onset of sleep could cause harm to self or others.

Page 35
[X] Persistent daytime hypersomnolence

 

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#se38.1.4_197

6847   Sleep Apnea Syndromes (Obstructive, Central, Mixed):
Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy	100
Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine	50
Persistent day-time hypersomnolence	30
Asymptomatic but with documented sleep disorder breathing	0

 

[DevilDog12]

Thanks for the info!!

[Fat]

How do they test for restless leg syndrome?