What Is Carpal Tunnel? Key Facts for Veterans

Veterans often develop carpal tunnel syndrome because of military service. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes pressed or squeezed at the wrist. The median nerve runs from the forearm into the palm.

The carpal tunnel is a narrow, rigid passageway comprised of ligaments and bones found at the base of the hand. It houses the tendons that bend the fingers and the median nerve.

What Are the Symptoms of Carpal Tunnel?

Thickening from the lining of irritated tendons or other inflammation narrows the tunnel and compresses the median nerve.

This situation creates the following symptoms:1

• Weakness
• Numbness
• Tingling
• Pain*

*The pain could be local to the hand and wrist, and some may feel it in the forearm and arm.

CTS is a very common and widely known type of entrapment neuropathies, in which one of the body’s peripheral nerves (PNS) is squeezed or pressed.

What Are the Causes of Carpal Tunnel?

Carpal tunnel syndrome occurs due to increased pressure on the tendons and the median nerve in the carpal tunnel. It is important to note CTS is not an injury or issue with the median nerve itself. A combination of factors is attributed to causing the condition:1

• Repetitive use and motions of the wrist and hand, such as typing or vibrating hand tools
• Any movements and activities involving hands lower than the wrists that are repetitive
• Underlying conditions such as obesity, rheumatoid arthritis, diabetes, and hypothyroidism
• Other mechanical problems in the wrist joint
• Acute trauma to the area creating pressure due to increased swelling on the tendons and/or median nerve in the carpal tunnel (i.e., sprain or fracture)
• Pregnancy
• Menopause

How Is Carpal Tunnel Treated? What Are the Treatments for Carpal Tunnel?

Treatment can vary based on symptoms, the condition’s progression (how severe the condition has become), and its etiology (cause).

If the cause is repetitive motions, lifestyle changes would be a viable treatment approach. For example, if the repetitive motion is typing, you may benefit from the use of an ergonomic keyboard or taking more breaks more often.

Stretching or strengthening exercises are effective treatments, such as nerve gliding exercises. This can help the median nerve move better within the carpal tunnel.

If there is sufficient inflammation and aggravation in the area, your doctor may ask you wear a splint so that it can be immobilized for a period. Sometimes, the recommendation is to wear the splint at night while you sleep to address any numbness and tingling sensations. This will rest the median nerve and tendons in the carpal tunnel and decrease pain thereby, helping you sleep better.

Non-steroidal inflammatory drugs (NSAIDs) and other medications that help to decrease inflammation may be ordered by your doctor. If the condition warrants, steroid injections could help. Your doctor may recommend steroid injections if your condition worsens and you feel the need to add this course of treatment if NSAIDs and other medications are not effective enough to treat your case.

If none of the non-invasive techniques help, surgery would become an option. The operation is called carpal tunnel release. It increases the tunnel’s size and eases pressure on the median nerve.

VA Evaluation of Carpal Tunnel

To be eligible for a carpal tunnel VA rating, you must meet three criteria by law:

1. Medical diagnosis of carpal tunnel syndrome in a medical record (service treatment records, VA medical records, or private medical records)
2. An event or occurrence in service that involved the peripheral nerves, etc.
3. Your carpal tunnel syndrome was caused or made worse by your active-duty military service OR by another service-connected disability for secondary service connection (“Nexus” for service connection). This is called the nexus requirement.

If you’re trying to increase your VA rating for carpal tunnel, you need to prove that your symptoms are currently worse and warrant a higher rating by law.

An effective way to increase your VA rating for carpal tunnel is to have objective medical evidence indicating the degradation of your hand movement over time.

The top two items that determine your final VA rating for hand conditions such as CTS are:

1. Limitation of range of motion
2. Pain

The Department of Veteran’s Affairs (VA) evaluates veterans with carpal tunnel syndrome under 38 C.F.R. § 4.124a, Diagnostic Code 8515, which addresses the median nerve.

• 0% rating: No pain or discomfort in the carpal tunnel (major and minor hand), no loss of range of motion (ROM), and no loss of functioning.
• 10% rating: Mild incomplete paralysis of the medial nerve in both the major (dominant) and minor (non-dominant) hand.
• 20% rating: Moderate incomplete paralysis: Rated at 30% for the dominant and 20% for the non-dominant.
• 50% rating: Severe incomplete paralysis: Rated at 50% for the dominant arm and 40% for the non-dominant.
• 70% rating: Complete paralysis: If the hand is stuck bent away from the body at the wrist, the middle and index fingers are stuck in extension more than normal (cannot move either down or side to side), thumb is straight and stuck right up next to the index finger (the hand is completely flat) and the muscles at the base of thumb are atrophied (wasting away), and the palm cannot be turned to face downward, it is rated 70% for the dominant arm and 60% for the non-dominant arm.

If you are a veteran who believes you could be eligible to receive VA benefits for carpal tunnel treatment, contact a veteran’s benefits attorney.

Often, CTS exists in conjunction with other service-connected disabilities. Together, your service-connected disabilities may result in an inability to sustain gainful occupation. So, even if you get service connected for CTS with a low rating, if you have a combined rating of 70% with one rating of at least 40%, along with the inability to sustain gainful employment, you should appeal the assigned rating and assert an implied claim for TDIU.

The veterans benefits attorneys at Gang & Associates can assist you with any appeals, especially in situations where you cannot work. We encourage you to contact us at 888.878.9350 or at info@veteransdisabilityinfo.com for more information.

References:

1. National Institute of Neurological Disorders and Stroke. (2004). Carpal Tunnel Fact Sheet. Retrieved from: www.ninds.nih.gov