Are you a military veteran with thumb or wrist problems? Have you received a diagnosis of de Quervain’s Tenosynovitis? Did this result from injuries suffered during your military service?
This article will discuss the diagnosis, causes, and symptoms of De Quervain’s tenosynovitis disability. Continue reading to learn about filing for VA disability compensation. You will also see how the VA determines ratings and reasons to appeal.
In this article about veterans with this wrist injury:
- What Is de Quervain’s Tenosynovitis?
- Symptoms of De Quervain’s Tenosynovitis
- Exercises for de Quervain’s Tenosynovitis
- de Quervain’s Tenosynovitis and Carpal Tunnel Are Different
- Impact on Daily Life
- De Quervain’s Tenosynovitis Workers Comp
- Rating VA Disabilities Explained
- Diagnostic Coding of Disabilities
- Example of How the VA Rates Disabilities for Hands
- Similar Conditions
- VA Disability Application Process
- How to Prove That an Injury Is Service Related
- Reasons to Appeal Your VA Rating
- Options for Filing an Appeal
- Do You Need Help Filing a VA Disability Claim?
What Is de Quervain’s Tenosynovitis?
Tendons attach muscles to bones. These rope-like structures pull on the bone when the muscles contract creating movement. Tendons lie inside “tunnels”.
There are two tendons that generate normal function in the wrist and lower thumb. These tendons slide through the tunnels when gripping, clenching, wringing, pinching, or grasping.
With de Quervain’s Tenosynovitis, the tunnel between the thumb and wrist narrows. This can result from the thickening of the tunnel or increased soft tissue around the tunnel. The person experiences pain with thumb movements such as forceful grasping or twisting.
The primary cause of de Quervain’s Tenosynovitis is repetitive use of the hands and wrists. Repeating the same motion over time irritates the lining of these tunnels. This causes them to swell and narrow impairing the tendon motion.
This condition can also result from a wrist or tendon injury. Scar tissue builds up causing the restricted tendon movement. Inflammatory conditions, such as rheumatoid arthritis, can contribute to these problems.
If this problem isn’t treated, the symptoms can increase. The result may be a decrease or total loss of function in the hand and wrist.
Symptoms of De Quervain’s Tenosynovitis
Patients may experience a gradual or rapid onset of pain on the thumb side of their wrist. This pain may travel up the forearm and increases when using the hand and thumb. Individuals may also have swelling or even develop a fluid-filled sac (cyst) in this area.
The pain can be dull or sharp. The person may also feel a “snapping” or “catching” feeling when they move their thumb. Thumb and wrist movement can become limited.
One diagnostic measure, Finkelstein’s test, detects de Quervain’s type of tenosynovitis. The patient touches the affected thumb to the palm of the same hand.
They’re asked to make a fist over the thumb and bend the wrist toward the little finger.
If this maneuver causes pain, the working diagnosis is de Quervain’s Tenosynovitis.
Another condition called, Dupuytren’s contracture is sometimes confused with de Quervain’s Tenosynovitis. Yet, they are different conditions.
With Dupuytren’s contractures, firm cords, bumps, or pits form on the palm. These deformities pull the fingers into the palm. This does not cause problems with the outer thumb and wrist.
Exercises for de Quervain’s Tenosynovitis
Healthcare practitioners may suggest exercises to relieve the pain associated with this condition. The following describes several common exercises.
For thumb lifts, start with your hand resting, palm up, on a flat surface. Raise your thumb to form a “C” shape and hold for 6 seconds. Repeat this stretch 8 to 12 times.
For the passive thumb MP flexion exercise hold your hand in front of you as if you are about to shake someone’s hand. Using your other hand, bend your thumb down until it touches your palm. and hold for 15 to 30 seconds and repeat 2 to 4 times.
The Finkelstein stretch begins in the handshake position again. This time, you actively move your thumb to your palm without help. With your thumb into your palm, use your other hand to gently push your thumb and wrist toward the floor.
When you feel the stretch in the outside part of your thumb, hold for 15 to 30 seconds. Then repeat this movement 2 to 4 times.
It’s important to avoid repetitive motion activities. This can cause additional tendon and “tunnel” irritation. This can delay improvement in your symptoms.
de Quervain’s Tenosynovitis and Carpal Tunnel Are Different
Carpal Tunnel Syndrome is different from de Quervain’s Tenosynovitis. Carpal Tunnel describes a compression of nerves that causes pain throughout the hand.
Symptoms include numbness and weakness. This causes problems holding items or making a fist.
Impact on Daily Life
Think about how many times a day you pick something up. A pen, coffee cup, toothbrush, clothes, or a fork. Can you open a door, tie your shoes, pull up a zipper, or fasten a button without using your thumb?
This type of tenosynovitis impacts all aspects of daily life. It often occurs in the dominant hand since that’s the one you used to perform the repetitive task.
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De Quervain’s Tenosynovitis Workers Comp
Poor workplace practices often contribute to repetitive strain injuries. Workers’ comp liability and compensation consider the employee’s injury severity. The US workers comp laws also look for employer actions to prevent these injuries. While we work mainly with veteran’s disability law, you can call us for free and see if your condition is a veteran’s disability or a workman’s comp claim.
Rating VA Disabilities Explained
For military veterans, the VA disability process determines your disability rating. This impacts your VA disability benefit. An important part of this process involves determining if the injury is service-related.
Your VA disability rating also reflects the severity of your condition. For example, if there’s no daily impact found, you will receive a rating of 0%. If the veteran can’t work or care for themselves, they will receive a 100% disability rating.
The VA rounds the ratings to the nearest 10. For example, 40%, 50%, and so on. If you have more than one condition, the disability rating is then added together. Yet, you can not exceed 100% disabled because no one is more than 100% able.
Click here to use our Disability Calculator to estimate your VA rating.
Diagnostic Coding of Disabilities
Many hand disabilities fall under the 38 C.F.R. code § 4.124a. This schedule of ratings includes neurologic conditions related to the hand. It includes the complete or partial loss of the ability to use one or more extremities.
Specific conditions have a diagnostic code assigned. The diagnostic code used for de Quervain’s Tenosynovitis is 5024. This describes the swelling of tissues around a tendon.
The diagnostic code 8515 describes conditions affecting the median nerve resulting in paralysis. This is the code used for conditions such as severe carpal tunnel.
When considering neurologic impairment, it’s rated from mild to total paralysis. Hand problems that affect the dominant hand receive higher ratings. If the person is ambidextrous, the injured hand or arm is always considered as the dominant side.
Each finger receives its own rating in conditions that affect more than one finger. The total rating is then combined with ratings for limitations of the hand, wrist, and forearm. The total may not exceed 70% for the dominant hand and 60% for the non-dominant hand.
Hand and wrist disabilities receive ratings ranging from slight to severe muscle damage. For conditions like de Quervain’s Tenosynovitis, the motion limitation determines the rating.
Here one of our VA disability lawyers talks about one of the most important parts of a winning veteran’s disability claim: the nexus letter.
Example of How the VA Rates Disabilities for Hands
The process begins by determining the severity of a disability. Moderate paralysis of the dominant hand rates as 30% and 20% for the non-dominant. The hand nerve rating is 20% for a diagnostic code 8514.
Next, they look for elbow motion limitations. A code is then assigned to described the nerve-related disability.
In this example, the elbow can’t bend further than 55° so it’s given the code 5206. If this is the dominant arm, this receives a rating of 40%.
The non-dominant arm rates as 30%. Since the 30% motion limitation is greater than the 20% nerve disability, the rating is 30%.
The final code for this example is 8514-5206. The first four digits describe the condition. The second four digits define the limitations.
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VA disability ratings vary depending on functional ability. The following examples describe several ratings addressing hand, wrist, and forearm conditions.
Tendonitis in Elbow
When the elbow can only bend 45°, the dominant arm rates as 50% and the non-dominant as 40%. If the bend limit is 55°, the rating is 40% on the dominant and 30% on the non-dominate side.
A 70° bend limit rates as 30% on the dominant and 20% on the non-dominant. Last, a bending limit of 90° receives a rating of 20% for either extremity.
Paresthesia of the Skin
Paresthesia describes a tingling, pricking, or “pins and needles” feeling in the skin. This often results from damage to the peripheral nerves in the hands and wrists.
The VA rates this as mild if the symptoms only cause minimal limitations and don’t impact function. It’s ruled moderate if it interferes with the ability to function at full capacity.
Each finger that has limited movement and function is always rated separately. The rating will depend on the severity of the disability.
VA Disability Application Process
There are several steps you must take when filing for VA disability benefits. First, you need to determine if your condition is eligible for compensation.
It’s important to fill out all parts of the application. This will prevent delays down the road.
You’ll need to collect documents describing your disability. This includes VA and private sector medical records related to your claim. These records describe the severity and progression of your condition.
Include letters from people who know about your disability and its impact on your life. This can include family, friends, clergy, law enforcement, employers, and co-workers.
You must submit your DD214 or other separation documents and service medical records. Schedule a claim exam to document your condition at the time of application. It’s important to note that you only have 365 days from the date you submit the application to complete the claim.
How to Prove That an Injury Is Service Related
The burden is on the veteran to show that the injury is service-related. The following describes the evidence the VA looks for.
You will need to provide a current record from a medical exam. This should provide show how your condition interferes with performing daily tasks.
It must describe the reasons why you can’t engage in meaningful work. This document should connect the disability to a service-related event, injury, or illness.
The 1973 fire at the National Personnel Records Center destroyed many veteran’s records. If this applies to you, submit a “buddy statement”. This must come from someone over the age of 17 with first-hand knowledge of your causative event.
Reasons to Appeal Your VA Rating
Often, a veteran may believe that their VA disability rating is incorrect or too low. It’s not uncommon for the VA to have inaccurate effective dates. This can result in a lower benefit ruling than is due to the veteran.
Veterans may also be missing back pay benefits that they’re not aware of. You have the right to appeal the ruling. This can be done via physical forms or an online portal. Your best bet is to call us and discuss your appeal with your case manager. He or she will know what to do next.
Here, one of our VA disability lawyers talks about what we do when we appeal your case to the Veteran’s Administration.
Options for Filing an Appeal
The Veterans Appeals Modernization Act of 2017 law went into effect on February 19, 2019. This act’s purpose is to streamline the VA appeals process. It also allows alternative approaches to reviewing VA decisions.
It’s often advantageous to hire an attorney who specializes in VA claim appeals from the start. We have the experience to help you correctly file your appeal. Our attorneys understand what information the VA is looking for when deciding to change a ruling.
A Clear and Unmistakable Error (CUE) VA claim says that the rating is incorrect and should be changed. The veteran must prove that the regulations and facts submitted in the C-File were incorrectly applied. This type of claim often proves unsuccessful.
Many experts suggest filing a VA Disability appeal instead of a CUE claim. If you win the appeal, you will receive all previous compensation you’re due in a lump sum. Then your monthly benefit will increase.
Here one of our VA disability lawyers goes over the questions Woods and Woods, The Veteran’s Firm, is often asked about veterans’ disability claims and appeals.
Do You Need Help Filing a VA Disability Claim?
If you have de Quervain’s Tenosynovitis due to a service-related injury, you may qualify for compensation. This article described this condition, the impact on functionality, and how to file a claim.
Woods & Woods, The Veteran’s Firm, specializes in VA disability cases. We assist veterans and their families in obtaining VA benefits. Our expert staff also handles many appeals on behalf of veterans.
You will never receive a bill for phone calls, hourly work, or initial applications. If you don’t get VA disability benefits, you won’t owe us a penny. Contact us today for a free legal consultation.
Theoretically you could, but if you have symptoms of both of those, you may have a more complex disability that will get you a higher rating. Adding up disabilities helps, but because of VA math, it doesn’t add up conditions as fast as you’d think. Let’s take a close look at your case.
Keep a journal, take pictures or videos with your phone, or get an appointment with your family doctor if you have to. The VA knows that many symptoms come and go, and their frequency is a key part of getting a higher VA rating.