Bradykinesia is nearly universal among Parkinson’s patients. In fact, along with rigidity and resting tremor, bradykinesia is one of the cardinal motor symptoms of Parkinson’s disease.
However, bradykinesia can have other causes besides Parkinson’s. As a result, the VA separately rates bradykinesia whether or not a veteran has filed, or lacks a diagnosis for, a Parkinson’s VA disability claim.
To be clear, the VA usually rates bradykinesia as a symptom of Parkinson’s. However, if bradykinesia resulted from medication, traumatic brain injury (TBI), or other service-connected issues besides Parkinson’s, the VA will rate it independently and the veteran will receive bradykinesia VA disability benefits.
In this article about Bradykinesia and VA disability:
- How the VA Rates Bradykinesia With and Without Parkinson’s VA Disability Claims
- Examples of Bradykinesia VA Disability Ratings
- How Does a Parkinson’s VA Disability Claim Affect a Claim for Bradykinesia?
- Service Connecting Bradykinesia With and Without a Parkinson’s VA Disability Claim
- You Do Not Need a Parkinson’s VA Disability Claim for Bradykinesia
How the VA Rates Bradykinesia With and Without Parkinson’s VA Disability Claims
The VA regulations do not include a ratings table for bradykinesia. In fact, the way the VA rates bradykinesia is not tied to its causes but its effects.
Bradykinesia is a brain disorder. Studies differ on the exact mechanism within the brain that causes the condition. However, there’s agreement that the part of the brain called the basal ganglia sends weak or miscoded signals that cause an involuntary slowing of your movement.
Rather than rating bradykinesia based on its neurological cause, it is rated based on the regions of the body affected by the slowed movement. Specifically, the VA rates bradykinesia as a form of paralysis instead of a brain disorder. This means veterans seeking VA disability benefits for bradykinesia will need medical records that not only confirm the existence of bradykinesia but also specify the affected areas and the severity at each location.
The benefit of this approach is that veterans who file a VA disability claim for bradykinesia will receive a rating for each of its manifestations. For example, a veteran who experiences bradykinesia in their right arm and left leg will receive two residual ratings that will be aggregated via VA math. Similarly, a veteran with bradykinesia in the face and both legs will receive three VA disability ratings.
Furthermore, it is crucial for your doctor to document every manifestation of bradykinesia because each one helps your final VA disability rating. The VA provides VA form 21-0960c for your physician to identify Parkinson’s disease symptoms. This form includes a field to indicate extremities affected by bradykinesia. Your physician will also need to note down other affected areas, such as the face, mouth, or jaw.
Location of the Bradykinesia
Bradykinesia can manifest anywhere. The most noticeable locations are your arms and legs, making it difficult to lift objects or walk without shuffling. The disorder can also affect your fingers (causing difficulties buttoning your shirt or combing your hair) jaw (causing you to chew slowly), and face (causing a loss or dulling of facial expressions). In some patients, bradykinesia can even affect the mouth and neck, leading to speaking difficulties.
For example, bradykinesia that manifests as an impairment of balance may be rated using the rating table for paralysis of the eleventh cranial nerve under Diagnostic Code 8211 of the VA’s regulations. Similarly, bradykinesia in an upper extremity may be rated using the rating table for paralysis of the musculospiral nerve or median nerve under Diagnostic Code 8514 or 8515. On the other hand, a lower extremity may be rated using the rating table for paralysis of the sciatic nerve or external popliteal nerve under Diagnostic Code 8520 or 8521.
Fortunately, you do not need to wade into the VA’s diagnostic codes to know which nerve paralysis most closely approximates your case of bradykinesia. You just need your physician to identify where the bradykinesia occurs (upper arm, lower leg, face, hip, shoulder, etc.).
Severity of the Bradykinesia
At each affected location, the VA assigns disability ratings based on the severity of the bradykinesia. Unfortunately, the VA’s ratings tables can be difficult to interpret objectively.
For example, the VA rating table for arm paralysis that is used to rate bradykinesia assigns a rating of 20%, 40%, 70%, or 90% based on whether the bradykinesia is “mild,” “moderate,” “severe,” or “complete,” respectively.
Complete bradykinesia would mean loss of all, or substantially all, voluntary control over the region. This rating will be unlikely in all but the most serious cases. However, different claims adjudicators may interpret the difference between mild, moderate, and severe differently. This could result in the same manifestation being rated differently depending on which adjudicator reviews your claim.
The VA refers to this rating process as “evaluation by comparison.” Under the VA’s regulations, the claim adjudicator is supposed to consider many factors in deciding the severity of a veteran’s bradykinesia. These factors include:
- The site and character of the bradykinesia.
- The relative impairment in motor function caused by the bradykinesia.
- Whether bradykinesia has caused atrophy.
- Sensory loss caused by bradykinesia.
- Whether the bradykinesia has resulted in complete or partial loss of use of the extremity.
- Speech impediments caused by bradykinesia.
- The impact of bradykinesia on the veteran’s gait.
- Whether the veteran’s bradykinesia is accompanied by tremors.
Examples of Bradykinesia VA Disability Ratings
The VA’s approach to bradykinesia varies widely depending on the case. This is a good thing because it allows the VA to tailor its rating for your case of bradykinesia. For example, in one reported case, a veteran who experienced bradykinesia in his upper extremities was entitled to a 20% disability rating for his non-dominant arm and 30% for his dominant arm. These residual ratings will be aggregated using VA math to produce an overall VA disability rating of 40%.
In another case, a veteran who experienced bradykinesia in his left leg was entitled to a 40% disability rating because it was accompanied by stooped posture and stiffness and weakness in the leg. Besides these, the veteran’s left foot would drag, and his gait would freeze while walking.
How Does a Parkinson’s VA Disability Claim Affect a Claim for Bradykinesia?
If you have filed a Parkinson’s VA disability claim with bradykinesia as a symptom, the VA will take a two-step approach to determine your VA disability rating:
- Calculate residuals VA disability rating: Individual ratings for each of your symptoms will be determined and they will be aggregated using VA math. These ratings will include bradykinesia, along with any tremors, weakness, or paralysis experienced in those muscle groups, to determine the severity of the disability. Residuals will also account for any other Parkinson’s symptoms like incontinence, constipation, and speech difficulties.
- Compare to Parkinson’s VA disability rating: The minimum Parkinson’s VA disability rating is 30%.
Your Parkinson’s VA disability rating will be the higher of the two. For example, if your residuals rating is 70%, you will receive a Parkinson’s VA disability rating of 70%. Conversely, if your residuals rating is 20%, your Parkinson’s VA disability rating will be 30%. Your Parkinson’s disease disability benefits will always be at or above the 30% minimum Parkinson’s VA disability rating.
Service Connecting Bradykinesia With and Without a Parkinson’s VA Disability Claim
All VA disability claims must have a service connection. There are a few ways bradykinesia may be connected to your service:
VA Presumptive Disabilities Include Parkinson’s VA Disability for Vietnam Veterans
Some veterans, specifically those exposed to Agent Orange, are not required to establish a service connection to Parkinson’s disease. Moreover, any veteran who served in Vietnam or in the coastal waters of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to Agent Orange unless there is evidence to the contrary.
For most Vietnam veterans, this means that their bradykinesia is automatically presumed to be connected to their service and no evidence of a service connection needs to be presented.
Here one of our VA disability lawyers talks about the Agent Orange Presumptive Conditions List.
Manifested During Service
For some veterans, their bradykinesia manifested during their service. Provided they have military medical records documenting their bradykinesia, these veterans will be able to establish a service connection to their bradykinesia.
Occasionally, military doctors misdiagnose chronic or degenerative conditions. For example, bradykinesia often first manifests as a slowing of repetitive motions like typing. A military doctor could misdiagnose bradykinesia as a repetitive stress injury or muscle fatigue. In this case, you may be able to have the VA or your private doctor establish a service connection by showing that your bradykinesia manifested during your service but was misdiagnosed.
Caused by Service
If your service caused your bradykinesia – or your service caused Parkinson’s, which is characterized by bradykinesia – your bradykinesia is service connected. Additionally, due to the neurological nature of bradykinesia, it could have a few causes connected to your service, including:
- TBI (Traumatic Brain Injury): An injury to the basal ganglia region of your brain can cause bradykinesia because the disorder is connected to the basal ganglia.
- Chemical exposure: Exposure to toxic chemicals, including Agent Orange, could lead to neurological problems like bradykinesia.
Secondary Service-Connected Bradykinesia
The VA allows a veteran with a primary service-connected disability to receive VA disability benefits for all disabilities caused by that primary disability. In the case of bradykinesia, this can provide veterans with another avenue to establish a service connection to their disability.
The nexus between a primary and secondary service-connected disability can take many forms, but the most common is a secondary disability caused by the treatment of a primary disability.
For example, if the medication used to treat a primary service-connected disability causes bradykinesia, it is compensable as a secondary service-connected disability. Bradykinesia is related to dopamine levels. This means any medication that affects dopamine, like antidepressants, can cause bradykinesia. Thus, VA disability benefits may be paid for bradykinesia caused by the treatment of service-connected depression.
One of our VA disability lawyers talks about how important the nexus letter is for your application or VA appeal.
You Do Not Need a Parkinson’s VA Disability Claim for Bradykinesia
A Parkinson’s VA disability claim may smooth the path for Vietnam veterans to compensation for bradykinesia. However, compensation for bradykinesia is not limited to Vietnam veterans. The VA provides disability ratings for bradykinesia regardless of cause, but only if that cause is in some way connected to your service. This connection may be direct, such as TBI suffered during your service, or indirect, such as medication used to treat a service-connected primary disability.
Also, keep in mind that the VA rates bradykinesia for each musculoskeletal system affected by it. Thus, any VA disability claim for bradykinesia should include medical records that document every instance of bradykinesia to maximize your overall VA disability rating. Every little bit helps, and if you aggregate the ratings for bradykinesia manifesting in multiple limbs and the face, you might receive a substantial overall VA disability rating.
Moreover, any symptoms that accompany bradykinesia should be documented as well. The VA rates bradykinesia based on the severity of the impact of your disability on your muscle groups. Bradykinesia alone will, therefore, not be rated as highly as bradykinesia that occurs alongside muscle weakness, muscle atrophy, and tremors.
A VA disability claim for bradykinesia could be an uphill battle if it is not part of a Parkinson’s VA disability claim by a Vietnam veteran. Contact Woods and Woods Disability Lawyers to discuss the documentation you will need to support your bradykinesia VA disability claim regardless of your location or whether you were deployed.
No, not at all. You should work with a lawyer though so that you don’t waste any time. There is no charge to call us and see if your claim has a chance and to get the paperwork started.
Contact our office and we’ll go over your service record, medical records, and current symptoms. We have on-staff doctors and psychiatrists that will help you make the best case for the VA.