Peripheral Neuropathy Bilateral And Drop Foot

[Guest jangrin]

If anyone knows, please respond,

If a veteran has bilateral PN, drop foot, loss of hair, skin changes in lower limbs what CFR rating code is used? Is it the function? Drop Foot? or the Peripheral nerves?

Also is the special "K" award for drop foot (loss of use) for one foot or does it have to be bilateral?

Thanks for your imput.

Jangrin

[Berta]

Jangrin- others are the experts here in these types of disabilities- however this recent BVA case shows how they rate peripheral neuropathy:

http://www.va.gov/vetapp06/files3/0616103.txt

This case might help more as it goes over the diagnostic codes well-and considers the foot drop is included with an 80% rating due to complete paralysis:

http://www.va.gov/vetapp06/files1/0600786.txt

"Under that Diagnostic Code, 10, 20, and 40 percent ratings

are warranted for mild, moderate, and moderately severe

incomplete paralysis of the sciatic nerve. A 60 percent

rating is warranted for severe incomplete paralysis, with

marked muscular atrophy, and an 80 percent rating is

warranted where there is complete paralysis; the foot dangles

and drops, no active movement possible of muscles below the

knee, flexion of knee weakened or (very rarely) lost.

38 C.F.R. § 4.124a (2005)."

[Guest terrysturgis]

Berta, Great post. The only I see different from my case to the posted decisions is that my examiner granted me a higher rating for PN based on range of motion. 40% on three of my limbs. Yes it hurts to move.

Thanks again. Terry Sturgis

[sixthscents]

Loss of use...

§4.63 Loss of use of hand or foot.

Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function of the hand or foot, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance and propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis.

(a) Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of 2 major joints of an extremity, or shortening of the lower extremity of 3-1/2 inches (8.9 cms.) or more, will be taken as loss of use of the hand or foot involved.

(B) Complete paralysis of the external popliteal nerve (common peroneal) and consequent, footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot

4.71 a Muskoskeletal system

5104 Anatomical loss of one hand and loss of use of one foot 100%

5105 Anatomical loss of one foot and loss of use of one hand 100%

5106 Anatomical loss of both hands 100%

5107 Anatomical loss of both feet 100%

5108 Anatomical loss of one hand and one foot 100%

5109 Loss of use of both hands 100%

5110 Loss of use of both feet 100%

5111 Loss of use of one hand and one foot 100%

Under cfr 38 OF COURSE.. THESE ARE COMBINED RATINGS, LOSS OF USE OF ONE LIMB IS 50%...

This is my specialty area... since I am rated at 100% for this alone... any help needed give me a yell.

remember, while the anteriior tibialis nerve, and the common peroneal nerve rating apply... they only do so until loss of use of the foot is established. At that point each limb is rated at 50%...

while this would seem to go against the pyramiding formula it does not, since a new rating solely under loss of use is established... in short you aint being rated for the nerves any more but the functional loss.

[john999]

6sents

If you have PN what do you get for pain. I got 10% for each limb, but that does not really compensate me for the pain which makes many things impossible to do. I am always hurting somewhere. I don't believe the VA ever considered pain just the ROM and things like that.

[sixthscents]

To my knowlege VA does not compensate pain per se: they compensate periods of debilitating effect, or periods of incapacitation etc. Really the question first to ask, and if I may know is from where does your pain stem from. Now it can simply be peripheral neuropaty unknown etiology, compensated due to AO.. but otherwise I suspect that there is some root injury that occured which causes the Neuropathy, and radiculapathy (shooting pain, or pain which radiates down a limb)

Lets discuss that a bit to make sure we are all clear... Not you John I know you are but for the others...

NEUROPATHY is the term which is generally associated with the symptoms associated with the ability to move, feel, and streangth of a limb. So symptoms which are related to neuropathy are weakness, tingeling, inability to flex, loss of deep tendon reflexes, loss of sensation or feeling etc. - this includes autonomous reflexes.. like knee jerk

RADICULAPATHY is associated with pain which radiates outward from a source normally down a limb, and pain responses.

It is quite common to have both Neuropathy and Radiculapathy... though it would seem contraditory. You can easily lose feeling in the skin of a limb, but have shooting pain along the nerve path.

So the VA does not rate pain, simply because there is no objective way to measure it. Pain is extreamly subjective and what may incapacitate me or you, may not another.... so they actually go by periods of incapacitation in many instances. This can be proven by work records, showing sick days, ER visits due to pain, or a pain journal.. etc. So, again the VA does not give a rating based solely on pain, they do consider it when rating the combined injury.

For example the VA specifically rates IVDS on neuropathy symptoms, but takes into account the periods of incapacitation, and determine the rating based heavily upon the frequency and duration of the incapacitating episodes. So, while pain is not solely rateable, it is a major factor - if conclusively proven - in the development of a claim.

Again, what is the cause of the PN if I may ask, and then I can give you what the VA uses as its basis for calculating pain into the equation. It differs rather erratically from injury to injury.

[Vike17]

Pain in and of itself is not compensable by VA. The affects of the pain from residulas of an injry is. Most, but not all, musculoskeletal disabilities are rated by range of motion. When a C&P exam is done, the examiner is suppose to measure the active and passive ranges of motion. Then the examiner is suppose to take a second measurement for what is known as being for the Deluca Criteria. The Deluca criteria is the range of motion that takes into account, among other things, pain. Weakness of Movement, Lack of endurance, and effects of episodic exacerbations (flare-ups) on functional ability are also the other conditions taken into account according to the Deluca criteria. When the examiner is taking the second measurement, they are suppose to comment on these condition as it relates to the joint in question and if they additionally limit the range of motion of that joint. Then the examiner will state at what degree of movement these condition additionally limit the joint. In the end the rating reflects the additional limitation due to the condition listed under the Deluca Criteria.

For more information see, Deluca -v- Brown. 6 Vet. App. 321, 324 (1993).

Vike 17