Peripheral neuropathy is a common condition that impacts veterans. It is the result of damage to the nerves located outside of the brain and spinal cord. Symptoms can include extreme sensitivity to touch, tingling sensations, weakness, loss of balance, muscle cramps or weakness, numbness, and stabbing or burning pain. In severe cases, it can limit the use of the impacted limb. As the limb is used less and less, the muscles can atrophy, further limiting the ability to move. In the most severe cases, peripheral neuropathy can result in the complete loss of use of the limb.
“Peripheral neuropathy” is a catch-all term for any damage to the nerves outside of the brain and spinal cord. The VA will assign a rating based on the nerve that is impacted. Damage to the external popliteal nerve (in the leg) is rated as follows:
Meanwhile, damage to the sciatic nerve (in the leg) is rated as follows:
For the upper extremities, the VA rates the right arm and the left arm differently based on which side is dominant. If a veteran is right-handed, their right arm is the “major” arm, and the left arm is the “minor” arm. For example, the median nerve (in the arm) is rated as follows:
The rating schedule provides little clarity on what constitutes “mild,” “moderate,” “moderately severe,” or “severe” incomplete paralysis. If a veteran’s nerve damage is “wholly sensory,” that is to say, it does not cause paralysis or loss of use but does cause symptoms such as pain and numbness, the maximum severity a veteran can receive is “moderate.”
There can be significant differences in the rating a veteran is entitled to based on the nerve that is impacted. It is important to ensure that the VA evaluates a veteran’s nerve damage based on the correct nerve, and can mean the difference between an 80 percent evaluation based on complete paralysis and a 40 percent evaluation for complete paralysis.
Veterans often have nerve damage to both upper and/or both lower extremities, for example nerve damage in both legs. It is important to ensure that the VA provides separate ratings for each limb, rather than rating them together. Similarly, one limb may be worse than the other, and it is important to have the VA rate them separately and individually.
Agent Orange is a herbicide and defoliant used in Vietnam, Thailand, and along the Demilitarized Zone (DMZ) in Korea. It was used as a tactical herbicide to clear leaves and vegetation for military operations. Agent Orange has numerous harmful chemicals, including high levels of dioxin. These chemicals have been documented to cause significant damage to those exposed to them.
Establishing entitlement to a presumption of exposure to Agent Orange is an important step in pursuing service connection. If a presumption applies, the veteran does not have to prove they were exposed to Agent Orange. Veterans are presumed to have been exposed to Agent Orange if they served from 1962 to 1975 in Vietnam, aboard a military vessel in the inland waterways of Vietnam, on a vessel within 12 nautical miles of the demarcation line of the waters of Vietnam and Cambodia, or was on regular perimeter duty on the fenced-in perimeters of U.S. installations in Thailand.
Veterans are also presumed to have been exposed to Agent Orange if they served on or near the Korean DMZ from September 1, 1967 to August 31, 1971, if they served on active duty in a regular Air Force unit location where a C-123 aircraft with traces of Agent Orange was assigned and had repeated contact with this aircraft, if they were involved in transporting, storing, or other uses of Agent Orange during military service, or if they were a Reservist to certain flight, ground, or medical crews.
Several medical conditions are presumed to be related to Agent Orange. If one of these presumptions apply, the veteran does not need to submit evidence to prove that their condition was caused by Agent Orange. Several cancers including bladder cancer, chronic B-cell leukemia, Hodgkin’s disease, multiple myeloma, Non-Hodgkin’s lymphoma, prostate cancer, respiratory cancers, and some soft tissue sarcomas are presumed to be caused by Agent Orange. Non-cancerous medical conditions presumed to be related to Agent Orange exposure include AL amyloidosis, chloracne, diabetes mellitus type 2, hypothyroidism, ischemic heart disease, parkinsonism, Parkinson’s disease, porphyria cutanea tarda. It is important to note that even if a presumption does not apply, a veteran can still prove exposure to Agent Orange or that a condition is related to Agent Orange exposure with evidence.
Peripheral Neuropathy, like the conditions described above, is presumed to be related to Agent Orange. However, the presumption is limited to neuropathy that was at least 10 percent disabling within one year of herbicide exposure. As described above, 10 percent evaluations are generally provided for mild incomplete paralysis. Therefore, to be entitled to a presumption of service connection, a veteran must show that they had symptoms of mild nerve damage, such as tingling in the extremities, numbness, and/or some pain within one year of herbicide exposure. The best evidence is medical records showing a diagnosis or reports of those symptoms in service or shortly after service, however few veterans report such mild symptoms while in service. Competent lay statements describing these symptoms beginning during service or near service can be used to support entitlement to the presumption.
If a veteran’s peripheral neuropathy began more than a year after their exposure to Agent Orange, the veteran is not entitled to the presumption. However, a veteran can still receive service connection with the proper evidence. Medical research does support that Agent Orange can cause delayed onset peripheral neuropathy. It is important for a veteran to provide sufficient medical research to convince a VA examiner, or to provide a positive nexus statement from a private doctor, to connect their neuropathy to their Agent Orange exposure.
If a veteran’s neuropathy began more than a year after their exposure to Agent Orange, it can be difficult to prove service connection. However, there are other avenues of service connection that may be available. Diabetes mellitus type II is presumed to be caused by Agent Orange exposure. Notably, diabetes does not have the same requirement that it begin within one year of exposure to herbicides that peripheral neuropathy has. Therefore, even if a veteran’s diabetes begins several years after service and exposure, it is still presumed to be related to Agent Orange. Peripheral neuropathy is a common secondary condition to diabetes. Diabetes over time damages the nerves in the arms and legs and can lead to neuropathy. If a veteran has neuropathy and diabetes, a medical opinion should be requested to connect the two.
Similarly, Parkinson’s disease and parkinsonism are conditions that are presumed to be related to Agent Orange exposure. Similar to diabetes, there is not a time limit on when these symptoms must develop to be entitled to the presumption. Therefore, if a veteran’s Parkinson’s or parkinsonism develops after exposure to Agent Orange, it will be presumed to be related. Parkinson’s and parkinsonism can impact the peripheral nerves, and may entitle a veteran to separate compensable ratings for extremity neuropathy. Medical opinions should be requested to evaluate the impact of a veteran’s Parkinson’s disease or parkinsonism on the peripheral nerves.
Berry Law is America’s Veterans law firm, and your fire support team to fight the VA. If you applied for VA compensation for Parkinson’s and were denied or under-evaluated, we can help you appeal. With a team full of Veterans, we have the experience you need to get your claim approved. Contact Berry Law today to schedule a free case evaluation with a member of our team.
Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter.