☎ (cell phone 240-506-1556)

From:

Craig N. Bash, M.D. Neuro-Radiologist

www.veteransmedadvisor.com

NPI or UPIN-1225123318- lic #--D43471 4938 Hampden lane, Bethesda, MD 20814

Phone: (301) 767-9525 Fax: (301) 365-2589 E-Mail: drbash@doctor.com

Peripheral Neuropathy vs Radiculopathy

Many patients have claims for neurologic problems such as spine-induced radiculopathy but when they go in for their C and P examinations more often than not a nurse practitioner or physician assistant simply dutifully fill out the peripheral neuropathy DBQ - not knowing the difference between neuropathy and radiculopathy. Thus the patient ends up with the wrong diagnosis of neuropathy vs radiculopathy due to the DBQ error. Additionally, these patients often end up with mild neuropathy disease for a rate of 10% when the correct medical code for their radiculopathy would support a code of maybe 30% (depending of course on the number of radicular components and the severity of each components.) Radiculopathy and its components are defined as follows:

Lumbar Radiculopathy

What is Lumbar Radiculopathy?Lumbar refers to the low back region. Nerve roots exit the back to enter the legs. Nerve roots branch out from the spinal cord and carry messages to and from the brain and the lower extremities and pelvis. If one of these roots is sick or injured in the area where it leaves the spine, it is called a radiculopathy. Symptoms usually arise in people between the ages of 30 and 50 and may follow an injury or occur with no warning. Sciatica is pain that radiates from the back down the back of the leg, and is a common manifestation of lumbar radiculopathy. Other common symptoms are numbness and tingling of the leg or foot, weakness, and muscle spasms. 80% to 90% of patients with sciatica recover without surgery.

To: All veterans

Date: 2015

Topic:

Pheripheral Neuropathy vs Radiculopathy

Independent Veteran Medical Opinion (IMO)Veteran Medical Nexus Opinion (VMNO)for Veteran benefits

Pages: 2

What causes Lumbar Radiculopathy?Many disease states can cause lumbar radiculopathy, but most often it is a structural problem like a herniated disc, bone spur, or mechanical stretching or traumatic event. Discs may be damaged from strenuous activity, a congenital defect, or by injury. When the disc is damaged, material in the disc leaks and squeezes the nerve root. This can cause the numbness, tingling, pain, and weakness.

Alternatively, peripheral neuropathy is defined as follows from the Mayo clinic web site, which states the following:

“ … A number of factors can cause neuropathies, including:

Alcoholism. Poor dietary choices made by alcoholics can lead to vitamin deficiencies.

Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and necrotizing vasculitis.

Diabetes. More than half of people with diabetes develop some type of neuropathy. Exposure to poisons. Toxic substances include heavy metals or chemicals. Medications. Certain medications, especially those used to treat cancer (chemotherapy),

may cause peripheral neuropathy. Infections. These include certain viral or bacterial infections, including Lyme disease,

shingles (varicella-zoster), Epstein-Barr virus, hepatitis C, leprosy, diphtheria and HIV. Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of

neuropathy. Trauma or pressure on the nerve. Traumas, such as motor vehicle accidents, falls or

sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion many times, such as typing.

Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves themselves or they can put pressure on surrounding nerves.

Vitamin deficiencies. B vitamins, including B-1, B-6 and B-12, vitamin E and niacin are crucial to nerve health.

Bone marrow disorders. These include abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (osteosclerotic myeloma), lymphoma and amyloidosis.

Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidis…”

Recommendations:

1. Any patient with neurologic losses should be evaluated an experienced physician who is able to diagnosis the problem.

2. This physician should provide the correct treatments and once the patient is treated this physician will be able to correctly fill out the correct DBQ.

3. Secondary complications of any neurologic disease should be added to any DBQ.4. Please remember that the VA has recently adopted a new policy of NO COMPLETED FORM = NO

BENEFITS thus please use the correct VA forms for all claims or you will loose benefits.5. Some useful forms are:

VA Form 21–526 Veteran’sApplication for Compensation and/or Pension

VA Form 21–0966, Intent to Filea Claim for Compensation and/orPension Benefits, (hereinafter ‘‘VAF 21–0966’’)

VA Forms 21–526EZ, 21–527EZ,and 21–534EZ (hereinafter ‘‘EZ forms’’)

6. These e-sites are useful to compete the forms above online:

eBenefits and The Stakeholder Enterprise Portal

Craig Bash M.D. Associate Professor drbash@doctor.com cell 240-506-1556Independent Veteran Medical Opinion (IMO)Veteran Medical Nexus Opinion (VMNO)based on Veterans medical records for veteran benefits