Neuropathy or peripheral neuropathy, is a common disorder that affects around 20 million people in the United States. It is a type of nerve damage that involves the peripheral nervous system, causing a number of symptoms in the extremities (arms, feet and hands).  These symptoms can range from mild to severe.

Peripheral Neuropathy is a medical condition characterized by peripheral nerves dysfunction due to damage. The peripheral nerves are those which are responsible for sending the signals from the central nervous system (brain and spinal cord) to the rest of the body. When these nerves are damaged, the CNS signals to the extremities (legs, arms, hands, feet) are interrupted, misinterpreted or completely broken, leading to a number of symptoms and signs that could vary based on the type of nerve affected.

Symptoms of neuropathy include:

• Tingling, numbness, burning, crawling sensation and/or pain in the feet and/or hands – symptoms unrelated to use
• Loss of sensation and feeling
• Muscle weakness and coordination problems
• Other body system symptoms.

Here are some examples of how neuropathy can impact your functional abilities:

• If the sensory nerves in the hand are affected, the signal from your brain that tells your hand that they are touching something hot may not tell your brain to move your hand immediately!
• If the motor nerves of your leg are affected, your leg muscles will not receive the proper moving signal from your brain, leading to mobility issues.

Peripheral nerves also affect all the other organs in the body.  These types of nerves are called autonomic nerves, which send signals to organs such as the heart, digestive system and endocrine system.  If the nerve damage from neuropathy progressed to these nerves, these organs will also be impacted.

There are various ways that Peripheral Neuropathy is classified:

• Number of nerves involved: one single nerve (mononeuropathy), or multiple nerves in the body (polyneuropathy)
• The type/function of nerves affected  (sensory, motor, autonomic).
• Based on the histological findings of the size of the nerve fibers damaged; small fiber neuropathy and large fiber neuropathy
• Based on the findings of the electrophysiological test; demyelinating (meaning the sheath of the nerves are damaged) and axonal (the main fiber of the nerve inside the sheath) or mixed variety.

In most cases Peripheral Neuropathy is “secondary” (caused by), an underlying other medical condition, injury, deficiency, toxin, or medication.  Sometimes, doctors cannot find a clear cause for the neuropathy, a condition called Idiopathic Peripheral Neuropathy.

Some of the most common causes of Peripheral Neuropathy include:

1. Diabetes

Nearly 50% of diabetic individuals in the US have some level of peripheral neuropathy. Chronic high levels of blood glucose can cause blood vessels and nerve damage. This is the case in both type 1 and type 2 diabetes. However, the onset of symptoms sometimes varies between the two types. In the case of type 1 diabetes, neuropathy symptoms could take many years to appear. Peripheral neuropathy symptoms in those with type 2 could start happening in a much shorter period after blood sugar has been out of control.  In some cases, people are not actually aware of their type 2 diabetes mellitus condition until they visit their doctor with symptoms of peripheral neuropathy.

2.  Injury or Trauma

This is the most common cause for mononeuropathy, such as nerve injuries due to accidents, surgeries/ medical procedures, or overuse injuries such as carpel tunnel syndrome.

3. Autoimmune neurologic disorders

Conditions like chronic inflammatory demyelinating polyneuropathy and Guillain-Barré syndrome are examples of disease where the body’s abnormal autoimmunity may attack nerve cells and cause neuropathy.

4.  Autoimmune systemic diseases

Conditions such as rheumatoid arthritis and lupus.

5.  Benign tumors or cancers pressing against the nerves, or in some cancer cases the immune system reacts to the cancer by also attacking the nerves causing a widespread nerve degeneration in the body.

6.  Radiation and chemotherapy

Chemotherapy-induced peripheral neuropathy (CIPN) is caused by cytotoxic chemotherapies, and can lead to motor and sensory impairments in the extremities. Although it is not caused by all types of chemo, It may occur in up to 90% of patients during chemotherapy, and can persist in a proportion of survivors in the long term. Radiation can also cause the same issues, however not necessary during therapy and can start months to years after.

7.  Exposure to certain toxins such as lead, mercury, arsenic and thallium.

8.  Excessive alcohol drinking

9. Infections such as Lyme disease, HIV and leprosy

10.  Nutritional issues

Examples includes vitamin B1, B3, or B12 deficiency, excess vitamin B6, or Gluten-sensitivity neuropathy (celiac disease).

11.  Hereditary disorders such as hereditary sensory neuropathy and Charcot-Marie-Tooth disease.

12. Liver and kidney disorders

These can lead to accumulation of toxins in the body causing nerve damage.

1.  Sensory symptoms (feeling): These could be either negative or positive. Negative sensory symptoms include feelings of numbness or deadness, loss of balance, especially with the eyes closed, and painless injuries due to loss of sensation. Positive symptoms may include pain, tingling, burning, prickling sensation, aching, tightness, electric shock–like feelings, or hypersensitivity to touch.
2. Motor symptoms (those that are related to movement): Motor symptoms can include proximal weakness (in the parts closer to the torso), distal weakness (in the parts that are further away from the torso such as feet) or more focal weakness. Symptoms of proximal limb weakness can include:
   • difficulty get up from a seated or supine position (lying on the back with the face pointing upward) at work
   • struggling to climb up and down stairs
   • falling while walking or carrying something due to the knees giving way
   • difficulty in raising the arms above the shoulders, such as grabbing something from a high shelf.

Distal motor symptoms in your upper extremities may include impaired fine hand coordination.  Such symptoms can leave you struggling to type or you find it difficult to perform certain tasks such as turning the keys to lock a door, or opening jars.  Distal motor symptoms in your lower extremities can be experienced as foot slapping, toe scuffing or frequent tripping.

Other motor symptoms may include muscle shrinking, painful cramps, and uncontrolled twitching.

3.   Autonomic symptoms: Autonomic neuropathy may involve one or multiple systems including the gastrointestinal,  cardiovascular, and urinary system.  It may also affect the body sweat glands.  If you have autonomic neuropathy, you may experience the following:

• • ataxia (coordination issues in movement and speech)
  • gait instability
  • Coming close to fainting or fainting.

Furthermore, autonomic neuropathies have symptoms that correlate to the anatomic site of nerve damage as follows:

• gastrointestinal symptoms (such as abdominal pain, malabsorption, inability to swallow, fecal incontinence)

• • cardiovascular symptoms (fast or irregular heartbeat, fainting or feeling like fainting when standing)
  • bladder issues (feeling incomplete bladder emptying, or having poor urine stream)
  • impotence
  • sudomotor problems (heavy sweating and heat intolerance).

You don’t have to experience all these symptoms to get a diagnosis or qualify for disability, in fact, the majority of people may have only one or few of these symptoms. What matters the most is how severe these symptoms are and how much they affect your quality of life and your abilities to perform your daily tasks. For example, you may only suffer from burning sensation or pain with no impairment of the motor or autonomic functions in any limb, however, your pain could be severe enough that is considered debilitating.

Neuropathic pain occurs in about 1 in every 10 adults over age 30.   Peripheral neuropathy can be chronic and severe, affecting the individual’s physical, psychosocial and economic wellbeing and significantly impacting their employment and quality of life. It is often also resistant to treatment and many people who suffer from moderate or severe neuropathic pain are significantly disabled.

Mental Health issues:

Depression and anxiety are some of the most prominent complications of peripheral neuropathy. A research study has found that moderate to severe symptom levels of anxiety and depression were found in 28% to 35% of those with painful diabetic neuropathy.

Other studies have also reported that pain, numbness, unsteadiness and reduced mobility and quality of life are significantly associated with developing depression and anxiety among those with peripheral neuropathy.  Depression and anxiety can add to your limitations in selfcare, socialization, the ability perform your routine daily tasks.  Neuropathy sufferers with depression and anxiety should priroitize mental health treatment, even though they may have had no mental health issues prior to the onset of their neuropathy.

Addressing and treating these complications should be one of the main priorities in the management of any mental health care problems such as depression and anxiety.  Untreated mental health issues could further worsen your ability to selfcare, socialize, perform your familial duties or work tasks.

Physical complications:

Due to peripheral nerve damage, there is numerous physical complications that are common among people with neuropathy particularly in those with diabetic neuropathy including:

• Increased risk for foot injury.

Neuropathy suffers often fail to notice foot injuries due to numbness and lack of sensation.  Foot ulceration and infections may result from failure to secure timely medical treatment.  In worst cases, toe, foot or leg amputations may result.

• Increased risk for falls.

Falling is typically the result of numbness, imbalance, pain or altered proprioception (the ability to sense and feel where you feet are on walking)

Cognitive issues:

In more recent years, researchers have found that peripheral neuropathy can have a significant impact on the individual’s cognitive functions such as attention, memory, language, executive and motor functions. Many studies have found significant decrease in cognitive functions in patients with peripheral neuropathy when compared to control groups. It was also reported that the severity of peripheral neuropathy correlates with diminshed cognitive performance. This also includes reduction in gait velocity and inability to multitask while walking, which can lead to an increased risk of falls.

Diagnosing peripheral neuropathy is complex, and often requires a series of tests to confirm.  Diagnosing peripheral neuropathy can sometimes be challenging for physicians,  particularly in those who were not previously diagnosed with a common condition that could lead to peripheral neuropathy, such as diabetes. This necessitates thoroughly investigating all the possible causes to be able to identify exactly what other medical issues that had potentially lead to developing peripheral neuropathy, and treat it as soon as possible.

This includes:

Medical history: your doctor will enquire about your symptoms, their severity, how long you have had them, what triggers them or makes them worse and whether specific measures make them better. You will also be asked about your smoking and alcohol habits, family history of neurologic disorders, your work, exposure to certain toxins or infectious diseases.

Physical exam: your doctor will examine you to try to find any physical signs of any other conditions that could cause peripheral neuropathy.  They will also conduct a simple neurological exam to have a basic evaluation of the state of your sensory and motor functions, before requiring more specialized imaging tests.

Blood tests: such as blood glucose levels, complete blood count, liver and kidney functions, vitamin B12 levels, immunoproteins levels.

Genetic testing to exclude inherited neuropathy disorders.

Imaging tests, including Muscle and nerve ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans.

 Other tests that are specific to the nerves, either to evaluate the damage in the nerve structure such as a nerve biopsy, or to test for the nerve function such as electromyography (EMG) or nerve conduction velocity.

Tests for autonomic nerve damage such as QSART test which measures your ability to sweat in different parts of your body.

Addressing the underlying cause is a key in the treatment plan of peripheral neuropathy.  When the cause is treated or corrected, improvement of the neuropathy symptoms will be observed as the nerves will have a chance to heal and regenerate.

Medication is the primary mode to manage the sensory symptoms of neuropathy

• Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can help relieve mild symptoms.   Topical treatment such as anesthetics or heating creams containing Capsaicin can also be effective in relieving some of peripheral neuropathy symptoms.
• If over-the-counter medications are inadequate, prescription medications for neuropathy may include:
  • Antidepressants such as Nortriptyline
  • Anticonvulsants  such as Carbamazepine

Narcotic painkillers are typically a last resort due to dependency concerns and the fact that  many neurologist have found narcotic pain medications to be ineffective with neuropathy pain. 

Additionally, medications can be used to manage autonomic symptoms, for example, blood pressure medications to help manage orthostatic hypotension.

Non/surgical treatments include physiotherapy to help improve muscle weakness or nerve compression issues. Mechanical aids such as splints and braces could also be beneficial in treating some of the motor symptoms. Other complementary therapies such as acupuncture, massage and psychotherapy can assist in helping individuals cope with chronic sensory symptoms.

Transcutaneous electrical nerve stimulation (TENS) is a non-surgical procedure that is used in the treatment of pain in various conditions. It involves attaching electrodes to the skin at the site of pain and administering gentle electric current at varying frequencies.

Surgery is not a typical treatment modality for neuropathy.  It can help in cases of mononeuropathy a neuropathy that is a result of injury, entrapment or compression.  Such surgery seeks to release a nerve that may be entraped, such as in the condition carpal tunnel syndrome or the situation where a tumor is compressing a nerve.  Polyneuropathies with more widespread nerve damage as in the case of diabetic neuropathy or chemotherapy induced neuropathy, cannot be treated by surgical intervention.

Lifestyle changes may be important to accompany any of the previous treatments.  A healthy lifestyle can have play a crucial rule in treating some underlying neuropathy causes, strengthening of the immune system and allowing your body to heal. This includes smoking sensation,  limiting or eliminating alcohol consumption, exercising, keeping a healthy weight and eating well-balanced diet. If you have diabetes, it is important to strictly control your blood glucose levels.

OK, so we have spent a lot of time discussing the medical condition. Let’s get to the bottom line: can you get disability benefits for neuropathy?  Yes, you can! As discussed earlier, in many cases, this condition could be debilitating and significantly impact your ability to perform your work duties. All claims for social security disability insurance benefits require insured status and a duration of at least 12 months.  See our website for exact details.

Social security rules and regulations in determining disability for neuropathy in Texas are the same as in all other states.  Social security follows a sequence of questions referred to as the 5-step sequential evaluation.   This analysis includes consideration of whether the neuropathy meets or equals a listing.  In another blog article I have discussed the listings in detail.  Failure to meeting the listing found at 11.14 (and found in the so-called “Bluebook”) does not mean the neuropathy based disability case will be denied.  Rather it means the disability decision-maker must move on with the case analysis.

The criterion under listing for neuropathy represents a very severe case that the medical community agrees would qualify for social security disability benefits.  But neuropathy of “listing level” is not required to secure social security disability benefits.  Rather, the listing represents a “shortcut” to a favorable.   Here’s how to meet the listing for neuropathy found at Section 11.14:

There are two paths to meeting the listing for neuropathy:

Failure to meet the conditions for the neuropathy listing simply means that the social security decision maker or administrative law judge must move to the next step in the 5-step Sequential Evaluation Process. The decision maker will consider if you could either return to your past work or do any work that exists in sufficient numbers in the national economy despite your neuropathy.

A  key part of this decision is a determination of your Residual Functional Capacity (RFC) .  RFC in social security disability law language is simply what work related abilities you still retain despite your neuropathy.

Social security decision-makers often determine RFC in terms of broad job classifications like “sedentary” work, or “light” work.   Sedentary work is performed primarily in a seated position, whereas light work requires standing and walking for most of the work day.

So by way of example, an administrative law judge might determine that you cannot stand and walk for most of the day because of the weakness and pain in your legs and feet.  He would therefore find you did not retain an RFC for light work.  But if he found your neuropathy did not prevent you from sitting for most of a normal work day, he would find you have a “sedentary” RFC.

Once your RFC has been determined the SSA decisionmaker must ask this question:

• Given your RFC,  could you go back  to any of the work you did in the last 15 years, AND
• Is there any other work you could perform with this RFC.

For persons over 50 years of age, the emphasis is on the first question.  The social security administration recognizes that it is more difficult to adjust to new work when we are older than 50.  See my detailed webpage about social security disability benefits over 50.

The key to winning a social security disability case for neuropathy is to establish work-related functional limitations that preclude work.

Here are some typical winning neuropathy case situations:

• Your neuropathy keeps you from being able to stand and walk for most of the workday – in other words, your RFC is sedentary.  If your prior work had a “light” RFC, you would not be capable of returning to it.  If you are over 5o years of age, and acquired no skills you could use in “sedentary” work, you would be approved for disability.  See our over-50 disability approval calculator for more details.
• Even if you have had a sit-down desk-job you can win disability benefits for neuropathy if your RFC precludes prolonged sitting, or the fine motor skills necessary to use a computer on a sustained basis.

You do not have to have a social security disability attorney or representative to win disability benefits for neuropathy.  But an experienced social security disability lawyer near you greatly increases your chances of victory, and eases your burden during a trying and long process.  Some key points about Social Security Disability lawyers:

• They receive a fee only if they win for you and you receive back benefits
• Most will take your case at any stage, including from the very outset (initial application)

Some keys to winning your disability case are:

• Complete the SSA forms completely and accurately.  This includes:
  • Your work history on form SSA-3369.
  • Complete description of how your neuropathy affects your daily life and any ability to perform work-related tasks via form SSA- 3373.
•  Statements from former bosses, collogues or family are not necessary.
• Thorough and current medical treatment records including all your diagnostic tests. It is important for your records to show any history of hospitalization that could be related to your neuropathy.
• Your medical records needs to reflect the symptoms and problems you are having.  The medical records need to include details of your diagnosis such as your physical and/or mental limitations.  Your medical record should show the severity of your condition and your problems with work-related abilities such as:
  • moving your extremities
  • seeing near as well  as far
  • maintaining balance while walking or standing, and problems on changing your position from seating to standing
  •  attention, concentration or memory.
• While it is important to review your medical records, your role is not to “police” your doctor’s record keeping.  Typically problems with medical records not supporting the disability claim center on the fact that disability claimants fail to tell their doctors just how much they are suffering.   Social security will compare your statements about your limitations to what they see reflected in the medical notes. Medical records indicating you “are doing fine” visit after visit will hurt your neuropathy-based disability claim.
• A written statement by your neurologist can be helpful, and you can find plenty of “Medical Source Statement” templates on the internet to present to a doctor.  Disability claimants often ask their doctor “for a letter” on their disability.  Both practices on the part of disability claimants is, in my opinion, problematic for the following reasons:
  • Doctors become doctors because they want to heal people, not support disability claims.  Presenting a doctor with a form or requesting a support letter without a true meaningful conversation with the physician frequently is offensive to the doctor.  I have written a detailed blog on how you should approach your physician.  It involves a conversation, not just dropping a form off at the front desk.
  • if undirected, doctors will provide conclusory letters, with statements like “my patient is completely and totally disabled”.  Such letters are not persuasive to the social security administration.
  • Securing a strong and persuasive neurologist statement is a vital part of a social security disability attorney’s job.  If you have an attorney, you should not seek written doctor statements without involving your lawyer, who more than likely will prefer to handle this themselves.    In fact, you should take the initiative to secure doctor statements to support your disability case only if you are committed to handling your disability case without the help of a lawyer.  This is because any experienced disability lawyer you hire in the future may find the doctor’s statement you secured to be inadequate, and your neurologist will be frustrated when the lawyer requests yet more paperwork in your case.
  • Your neurologist’s opinion about your functional limitations (RFC), which is several questions that your licensed physician would ask you to determine the impact of the disease on reducing your physical and cognitive abilities. The more restrictive your RFC, the more likely you are to qualify for the disability.
  • Your prognosis, and whether there is a route for you to make a full recovery.

The most crucial thing that would help you qualify for social disability benefits is to provide evidence that demonstrates the severity of your condition and its impact on your daily life and your ability function normally whether to be able to get to work and/or to perform your work duties. The more documents you provide and the more detailed your neurologists is about diagnosis and reduced abilities, the greater your chance is to qualify.