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VA Rating Guess Cubital Tunnel Syndrome DBQ


Merlynda

Question

Below is my Peripheral Nerve DBQ. Any chance I will be rated 10%?

Basically normal EMG, normal strength, normal everything. 

Except chronic numbness, tingling and night splints. 

T H A N K S !

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

1. Diagnosis
    ------------
Does the Veteran have a peripheral nerve condition or peripheral neuropathy?
    [X] Yes   [ ] No
    
Diagnosis #1:  Bilateral sensory cubital tunnel syndrome (sensory symptoms in ulnar nerve distribution)
ICD code:  G56.20
Date of diagnosis:  2019
       
2. Medical history
    ------------------
a. Describe the history (including onset and course) of the Veteran's peripheral nerve condition (brief summary): 

claimed condition: carpal tunnel syndrome

This 57 year old has tingling and numbness in the forearms, involving 4th and 5th digits, these symptoms started in ~2011 with overuse of computer mouse and typing, began to experience difficulty turning jars,holding the steering wheel, my hands get tingling and I have to shake them out. If I use a scissors or a tool for too long, my hands cramp up, and it really hurts, has difficulty moving mouse at work had EMG/NCS in 2012 - which was normal has soft and hard wrist splints

Symptoms primarily involve the 4th and 5th digits which is ulnar nerve distribution not median nerve distribution (carpal tunnel syndrome)

04 Jun 2012 1532 EDT
            
WALTER REED NATIONAL MILITARY MEDICAL CENTER DEPARTMENT OF NEUROLOGY Bethesda, MD 20889 
(301) 295-4770  Electroneuromyography 
            
Sex: Female
History: 51 y/o female with "years of symptoms" presents to WRNMMC Neurology for EMG/NCS for bilateral hand numbness. Pt reports since 2000 she has noticed intermittent numbness involving bilateral hands (R>L) Unsure distribution of symptoms; however endorses symptoms into the forearm. Endorses night symptoms and
having to "shake" the hands for symptom relief. Wears wrist braces at night and has experienced some improvement of symptoms. Endorses left neck (points to trapezius muscle) pain. Rare shooting pain into shoulder area.

Focused Neuromuscular Examination: Normal bulk and tone 5/5 strength bilateral upper extremities (proximal & distal muscles)DTRs 2+ and symmetric + tinnels and + phalens
         
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: [ ] None   [ ] Mild   [X] Moderate   [ ] Severe
Left upper extremity:  [ ] None   [X] Mild   [ ] Moderate   [ ] Severe

Intermittent pain (usually dull)
Right upper extremity: [ ] None   [ ] Mild   [X] Moderate   [ ] Severe
Left upper extremity:  [ ] None   [X] Mild   [ ] Moderate   [ ] Severe

Paresthesias and/or dysesthesias
Right upper extremity: [ ] None   [ ] Mild   [X] Moderate   [ ] Severe
Left upper extremity:  [ ] None   [X] Mild   [ ] Moderate   [ ] Severe

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

       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+

       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

7. Trophic changes
    ------------------
Does the Veteran have trophic changes (characterized by loss of extremity hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy?
    [ ] 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?
    [X] Yes   [ ] No
    
           Phalen's sign:
             Right: [ ] Positive   [X] Negative
             Left:  [ ] Positive   [X] Negative

           Tinel's sign:
             Right: [ ] Positive   [X] Negative
             Left:  [ ] Positive   [X] Negative
             

10. Nerves Affected: Severity evaluation for upper extremity nerves and radicular groups
    ---------------------------
a. Radial nerve (musculospiral nerve)
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

b. Median nerve
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

c. Ulnar nerve
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

d. Musculocutaneous nerve
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

e. Circumflex nerve
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

f. Long thoracic nerve
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

g. Upper radicular group (5th & 6th cervicals)
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

h. Middle radicular group
Right  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

i. Lower radicular group
Right: [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       
Left:  [X] Normal   [ ] Incomplete paralysis   [ ] Complete paralysis
       

11. Nerves Affected: Severity evaluation for lower extremity nerves and radicular groups
        No response provided.
        
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
       
b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition:
         No response provided.
         
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 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, symptoms and scars
    ---------------------------
a. 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
       
b. Does the Veteran have any scars (surgical or otherwise) related to and conditions or to the treatment of any conditions listed in the Diagnosis
       Section above?
       [ ] Yes   [X] No
       
c. Comments, if any:
         No response provided.
         
15. Diagnostic testing
    ----------------------
a. Have EMG studies been performed?
       [X] Yes   [ ] No
       
Extremities tested:
[X] Left upper extremity
Results:[X] Normal [ ] Abnormal 
Date:  2012
               
b. Are there any other significant diagnostic test findings and/or results?
       [X] Yes   [ ] No

If yes, provide type of test or procedure, date and results (brief summary):

          Note Text
           
1. Carpal tunnel syndrome
Procedure(s):  -EMG Limited Study x 1
-NCS Right Median Nerve Motor Function x 1
-NCS Right Ulnar Nerve Motor Function x 1
-NCS Right Ulnar Nerve Sensory Function (Orthodromic) x 1
-NCS Right Radial Nerve Sensory Function x 1
-NCS Right Median Nerve Sensory Function (Orthodromic) x 2
            
Sex: Female
History: 51 y/o female with "years of symptoms" presents to WRNMMC Neurology for EMG/NCS for bilateral hand numbness. Pt reports since 2000 she has noticed intermittent numbness involving bilateral hands (R>L) Unsure distribution of symptoms; however endorses symptoms into the forearm. Endorses night symptoms and having to "shake" the hands for symptom relief. Wears wrist braces at night and has experienced some improvement of symptoms. Endorses left neck (points to trapezius muscle) pain. Rare shooting pain into shoulder area.
Focused Neuromuscular Examination:
Normal bulk and tone
5/5 strength bilateral upper extremities (proximal & distal muscles)DTRs 2+ and symmetric
+ tinnels and + phalens
             
Sensory NCS
             
Nerve / Sites Distance Segments Peak Lat NP Amp cm ms µV
R MEDIAN - VS ULNAR PALMAR
Median 8 Median - Wrist 1.95 139.9
Ulnar 8 Ulnar - Wrist 2.00 34.0
R MEDIAN - VS RADIAL
Median 10 Median - Dig I 2.75 46.5
Radial 10 Radial - Dig I 2.60 15.3

Motor NCS - MEDIAN APB
             
Nerve / Sites Rec. Site Lat Amp Rel Amp Segments Dist. Vel. Area ms mV % cm m/s mVms
R MEDIAN - APB
Wrist APB 3.35 9.1 100 Wrist - APB 7 39.9
Elbow APB 6.95 9.3 103 Elbow - Wrist 21.5 59.7 41.6
               
Motor NCS - ULNAR ADM
             
Nerve / Sites Rec. Site Lat Amp Rel Amp Segments Dist. Vel. Area ms mV % cm m/s mVms
R ULNAR - ADM
Wrist ADM 3.45 11.5 100 Wrist - ADM 7 40.6
B.Elbow ADM 6.80 10.7 92.9 B.Elbow - Wrist 19.5 58.2 36.3
A.Elbow ADM 8.05 10.9 94.4 A.Elbow - B.Elbow 7 56.0 34.9
               
Needle EMG
             
EMG Summary 
Table  Insertional 
Spontaneous MUAP Recruitment
                
Activity 
PSW Fib Fasc Other Amp Dur. PPP Effort Pattern 
R. APB N None None None None N N N N N

L. CERV PSPINAL N None None None None NA NA NA NA NA
             
SUMMARY OF FINDINGS:
1. Right median palmar mixed/sensory nerve study was normal
2. Right median vs radial sensory nerve study was normal
3. Right median motor nerve study was normal.
4. Right ulnar motor nerve study was normal.
5. An EMG of the right upper extremity and left cervical paraspinal muscles was performed using a disposable monopolar needle. Muscles tested were normal.  ELECTRODIAGNOSTIC INTERPRETATION:
This is a normal nerve conduction study. No electrodiagnostic evidence of carpal tunnel syndrome, ulnar neuropathy or cervical radiculopathy. 
           
          
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:
has difficulty moving mouse at work, slows me down
          
17. Remarks, if any:
    --------------------
No remarks provided.
        

 
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6 answers to this question

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As you pointed out most of its "normal".  They did indicate it slowed you down.  My guess is LESS than 20 percent, and most likely 0 percent.  Based entirely on what this says, I would say you would be lucky to get 10 percent.  A more likely senario is that you get zero percent or denied.  

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Unfortunately according to this DBQ 0%

Not knowing all about this claim or your prior claims  if your S.C. For any other condition /Injury?

I would say service connected @ 0%

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How did you service connect cubital tunnel syndrome? I have the same condition (numbness, splints to keep my arms straight at night, etc).

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Not really sure. Complaints in my medical record since 2005. Also, claim was a BDD. I was still on active duty. Got decision letter 14 days after release from Service. 

 

 

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