C&P Exam for Peripheral Neuropathy: What to Expect and How to Prepare!

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In this article, Brian Reese the VA Claims Insider explains everything you need to know to prepare for a VA C&P exam for peripheral neuropathy.

If you’ve filed a VA disability claim for peripheral neuropathy, there’s a high probability you’ll be scheduled for a Compensation and Pension (C&P) exam by a private company contracted by the VA.

We’ll cover what to expect and how to prepare along with the questions you can expect during the exam.

Peripheral neuropathy is a very common among military veterans; in fact, peripheral neuropathy is the #46 most common VA disability claim.

Pro Tip: VA ratings for peripheral neuropathy range from 10 percent to 80 percent, with breaks at 20 percent, 40 percent, and 60 percent. The highest scheduler rating for peripheral neuropathy with complete paralysis is 80 percent.

What to Expect at a C&P Exam for Peripheral Neuropathy

A C&P exam for peripheral neuropathy is designed to assess whether (#1) you have some form of neuropathy diagnosed, and if so, (#2) the severity of your symptoms in terms of frequency, severity, and duration along with any negative impacts to your work, life, and social functioning.

Here’s what you can expect during a VA C&P exam for peripheral neuropathy:

• Review of Medical History: The C&P examiner should start by reviewing your medical records, including any previous diagnoses, medical history, treatments, and evaluations related to spinal and nerve issues, including peripheral neuropathy. The examiner has access to the medical records and documents you submitted to the VA, so you don’t need to bring records with you to the exam. However, it’s certainly acceptable to do so if you think it will help you remember important things.

• History and Onset: The examiner should ask about your military service history and any prior diagnoses of neuropathy. Peripheral neuropathy in veterans can arise from diverse risk factors. Exposure to toxins like Agent Orange, physical trauma, infections, and diabetes, particularly with a family history, all heighten vulnerability. Alcohol abuse, autoimmune disorders, and genetic predispositions also contribute. Age-related nerve function decline, coupled with environmental hazards and lifestyle factors such as smoking, further increase risk. Awareness of these factors is crucial for early detection and effective management, preserving veterans’ well-being.

• Discussion of Symptoms: The examiner should ask you about your symptoms of peripheral neuropathy, including when you first noticed them and how often you experience them. Common symptoms of peripheral neuropathy in veterans include numbness, tingling, and pain, especially in the hands and feet. Weakness, coordination problems, and muscle cramps are also prevalent. Veterans may experience heightened sensitivity to touch and changes in reflexes. Foot problems like ulcers and infections are common due to decreased sensation. Autonomic symptoms such as changes in blood pressure and digestion may occur. Sleep disturbances are also reported. Remember, your final VA rating for peripheral neuropathy depends upon the Frequency (how often), Severity (how bad), and Duration (how long) of symptoms and how those symptoms negatively affect your work, life, and social functioning.

• Negative Impacts on Work, Life, and Social Functioning: Peripheral neuropathy in veterans can severely disrupt work, life, and social functioning. At work, symptoms like numbness, pain, and weakness impede job performance and may lead to loss of employment. Outside of work, daily activities and hobbies become challenging due to mobility limitations and chronic pain, affecting independence and mental well-being. Socially, neuropathy hampers participation in gatherings and events, leading to feelings of isolation and strained relationships. Overall, neuropathy profoundly impacts veterans’ quality of life, necessitating tailored support and management strategies.

• Physical Examination: The C&P examiner will conduct a physical exam of the neck, back, and spine to check for signs and symptoms of peripheral neuropathy. A thorough examination should focus on muscle strength, reflexes, sensation, and coordination. The examiner will also check for signs of pain, discomfort, difficult sitting, standing, and walking, as well as limitation of range of motion. To ensure accurate measurements, the range of motion should be measured with a goniometer.

• Completion of Disability Benefits Questionnaire (DBQ) for Peripheral Nerve Conditions: The examiner will document their findings on the DBQ for Peripheral Neuropathy, which is then submitted to the VA Rater for further processing. Eventually, the VA Rater will either approve, deny, or defer your claim for neuropathy.

List of Questions You Might Get Asked at a Peripheral Neuropathy C&P Exam

Here’s a comprehensive list of questions from 13 sections of the DBQ for Peripheral Nerve Conditions that veterans can expect to be asked during a C&P exam for peripheral neuropathy:

SECTION I – DIAGNOSIS

Diagnosis Related to Peripheral Nerve Conditions/Neuropathy:

• What is the diagnoses related to peripheral nerve conditions or neuropathy?
• What is the ICD code and dates of diagnoses?

SECTION II – MEDICAL HISTORY

Medical History of the Veteran’s Peripheral Nerve Condition:

• Describe the history, onset, and course of the veteran’s peripheral nerve condition.

SECTION III – SYMPTOMS

Symptoms Attributable to Peripheral Nerve Conditions:

• Does the veteran have any symptoms attributable to peripheral nerve conditions?
• If yes, describe the location and severity of: Constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness.

SECTION IV – MUSCLE STRENGTH TESTING

Muscle Strength Testing:

• The areas to test include elbow flexion and extension, wrist flexion and extension, grip strength, and pinch strength between the thumb and index finger for both right and left sides. Also test muscle strength for knee extension, ankle plantar flexion, and ankle dorsiflexion, also for both the right and left sides. Each muscle group’s strength is rated on a scale from 0/5, indicating no muscle movement, to 5/5, which represents normal strength.

SECTION V – REFLEX EXAM

Deep Tendon Reflexes (DTRs):

• Assess and rate the reflexes for biceps, triceps, brachioradialis, knee, and ankle.

SECTION VI – SENSORY EXAM

Sensation Testing for Light Touch:

• Indicate sensation for areas like the shoulder, forearm, hands, thigh, leg, and foot.

SECTION VII – TROPHIC CHANGES

Trophic Changes Due to Peripheral Neuropathy:

• Does the veteran have trophic changes such as loss of hair or smooth, shiny skin attributable to peripheral neuropathy?

SECTION VIII – GAIT

Gait Analysis:

• Is the veteran’s gait normal?
• If no, describe the abnormal gait and its etiology.

SECTION IX – SPECIAL TESTS FOR MEDIAN NERVE

Special Tests for Median Nerve Evaluation:

• Were special tests indicated and performed for median nerve evaluation? (e.g., Phalen’s and Tinel’s signs).

SECTION X – NERVES AFFECTED

Severity Evaluation for Upper and Lower Extremity Nerves:

• Indicate if nerves like radial, median, ulnar, sciatic, etc., are affected and the severity of the condition.

SECTION XI – ASSISTIVE DEVICES

Use of Assistive Devices:

• Does the veteran use any assistive devices for locomotion?
• Specify the devices and their frequency of use.

SECTION XII – FUNCTIONAL IMPACT

Impact of Peripheral Nerve Condition on Work:

• Does the veteran’s peripheral nerve condition impact their ability to work?

SECTION XIII – REMARKS AND ADDITIONAL INFORMATION

Additional Comments:

• Provide any additional comments or observations that might help in assessing the veteran’s condition.

Examples of Work, Life, and Functional Impacts of Peripheral Neuropathy

Work Impacts

• Decreased Productivity: Peripheral neuropathy can cause pain, numbness, and tingling sensations that distract individuals from their tasks, potentially leading to decreased productivity and performance at work.

• Increased Absenteeism: The symptoms of peripheral neuropathy may necessitate frequent medical appointments and days off, especially on days when symptoms are particularly severe, thereby increasing absenteeism.

• Limited Job Opportunities: Individuals with severe peripheral neuropathy may find their ability to perform certain types of jobs, particularly those requiring fine motor skills or extended periods of standing or walking, severely limited.

Life Impacts

• Social Withdrawal: The constant discomfort and pain associated with peripheral neuropathy can lead individuals to withdraw from social activities and hobbies, impacting their social life and personal interests.

• Emotional Health: The chronic nature of neuropathy and its effects on daily functioning can lead to emotional distress, including conditions such as depression and anxiety.

• Sleep Disturbances: Pain and tingling sensations during the night can significantly disrupt sleep patterns, leading to poor sleep quality and chronic fatigue, which affects overall health and wellbeing.

Functional Impacts

• Reduced Mobility: Peripheral neuropathy can impair the motor functions of the feet and hands, leading to difficulties in walking or performing movements that require coordination and balance.

• Impaired Sensation: Loss of sensation or abnormal sensations in the hands and feet can reduce the ability to sense touch or temperature, making it challenging to handle objects, gauge temperature changes, or detect injuries.

• Weakness: Muscle weakness due to peripheral nerve damage can result in difficulties with activities that require strength, such as climbing stairs, lifting objects, or standing for extended periods, potentially leading to increased risk of falls and injuries.

How to Prepare for Your VA C&P Exam for Peripheral Neuropathy

Here are some tips to help you prepare for your peripheral neuropathy C&P exam:

• Gather Records and Documents: Collect all relevant medical records, including diagnosis testing and reports, treatment history, medications list, and any correspondence related to your peripheral neuropathy. This documentation will provide essential evidence to support your claim during the examination. Review the documents in detail and feel free to bring hard copies with you to the C&P exam for reference.

• Create a Symptoms Diary: Keep a detailed log of your symptoms, noting the frequency, severity, and duration of episodes and flare-ups. Document any factors that exacerbate or alleviate your symptoms of pain, weakness, numbness, etc. This diary will help you explain the impact of peripheral neuropathy on your work, life, and social functioning during the C&P exam.

• List Functional Impacts: Make a list of specific ways that peripheral neuropathy affects your ability to perform daily tasks and activities. For example, peripheral neuropathy can cause weakness, numbness, and tingling in the legs and feet impair mobility and increase fall risk. Manual dexterity can suffers as well, making precise tasks difficult. Sensation loss heightens injury risk. Prolonged sitting or standing exacerbates discomfort. Balance issues complicate movement. Driving ability may decline. Self-care tasks may require assistance. Physical activity and work performance can be affected. Social interactions may decrease. Sleep disturbances and mental health issues often accompany neuropathic pain.

• Review the DBQ for Peripheral Nerve Conditions: Review the DBQ for Peripheral Nerve Conditions before your exam. Be prepared to describe the onset and progression of your condition and symptoms over time, as well as any treatments you have pursued and their effectiveness (if any).

DBQ for Peripheral Neuropathy [Download]

The VA DBQ for Peripheral Nerve Conditions will be completed electronically by the C&P examiner at your exam.

We’ve made a copy available for review and download below:

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