Comments Submitted to the VA on the Changes to the Ratings for the Neurological System

The following are the comments we submitted on your behalf to the VA in regards to the proposed changes to the ratings of the Neurological System, including the Central Nervous System, the Cranial Nerves, and the Peripheral Nerves. 

After the VA publishes their proposed changes, they always allow a period for comments. Thank you for submitting your comments to us so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system fairer for all veterans. 

Here are the comments we submitted for the Neurological System:

We at www.MilitaryDisabilityMadeEasy.com would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings of the Neurological Conditions and Convulsive Disorders.

Comment #1. 

The proposed movement disorder rating system is an excellent change that has the potential to make ratings more accurate and consistent. 

There are a few things, however, that need additional consideration to ensure this outcome.

The proposed rating system has Hoehn-Yahr stages 4 and 5 both rating 100%. However, stage 4 and stage 5 present significantly different disabilities, with a person at stage 4 still able to stand and walk independently, while they are wheelchair or bedridden without assistance at stage 5.

The proposed ratings jump from 30% to 100%, leaving room for stage 4 to instead be rated at the 60% level, which is consistent with the ratings used throughout the neurological system. 

If a 100% rating for stage 4 was intended, please provide more complete instruction to clarify this rating choice and how to deal with conditions that fall between a 30% and 100% disability. 

Also, the use of “unilateral” and “bilateral” to define the different stages presents complications that may result in ratings that do not correctly cover the disability present. 

For example, Stage 1 specifies a unilateral disease but not the severity of the disease. Many neurological movement disorders have the capacity to affect only a single side of the body, but can present a very severe disability. For example, if the disorder resulted in unilateral paralysis, then a rating under this system would unjustly rate only 0%. To avoid inaccurate ratings, further clarification on the disability present and not just unilateral vs bilateral would be beneficial. 

Finally, a note specifically instructs that in order for a rating under the Functional Limitations system, the symptoms all must be verified by a physician and attributed to the movement disorder, but disregards this need for a rating based on the Hoehn-Yahr Scale. In order to assure that the Hoehn-Yahr Scale is appropriately applied, we believe this should also be done only by a qualified physician. Please adjust this note to instruct the need for proper medical opinion when applying either rating system. 

Comment #2. 

Paramyoclonus multiplex is a condition that can affect multiple parts of the body, including but not limited to, the face. Since it is currently rated analogously with a convulsive tic, the ratings will no longer appropriately apply with the proposed changes to code 8103, making it only for facial tics. Please specify a new analogous rating option for this condition to ensure that it is correctly rated following the changes. A rating under one of the new codes for movement disorders seems to be a more appropriate choice.  

Comment #3.

In 4.123 (4), the instruction for rating mixed nerves states that only a rating for motor neuropathy should be given when both motor and sensory neuropathy are present in the same nerve/code. This works when the ratings for sensory neuropathy are equal to or lower than the lowest rating for motor neuropathy, but in some codes, like 8520, complete sensory neuropathy is rate 20%, while grade 4 motor neuropathy is rated only 10%. While unusual, it is theoretically possible for complete sensory neuropathy to be present with only grade 4 motor neuropathy. Restricting the ability to rate the mixed neuropathy on the higher sensory rating will limit fair ratings based on the true resulting disability of the condition.

Thank you for considering these comments.