Upcoming C&P for loss of use of arms due to ALS — how do I address incorrect arm/shoulder strength testing?

You must proactively address the conflicting medical evidence by clearly articulating to the examiner that manual muscle testing (MMT) is an invalid measure of functional loss for your progressive, neurological disease, and you should insist on a complete, functional assessment. For ALS, the rating is governed by **38 CFR 4.124a, Diagnostic Code 8017**, which mandates evaluation under the criteria for **paralysis of the peripheral nerves**; the loss of use determination for Special Monthly Compensation (SMC) is a functional one, not solely based on strength grades. The precedent in *DeLuca v. Brown* establishes that rating must consider additional functional limitations like pain, weakness, and fatigue during repetitive use, which a static MMT cannot capture. Cite the clear contradiction in your file: one examiner's findings of 0/5 and 1/5 (complete to severe paralysis) versus another's 3/5 (moderate weakness), and state that the latter is inconsistent with the diagnosed progression of ALS. Your actionable next steps are: 1) At the exam's outset, respectfully provide the examiner with a copy of the first, more severe C&P report and your ALS diagnosis, 2) Verbally explain that MMT scores like "3/5" do not reflect your actual daily functional incapacity (e.g., inability to feed, dress, or toilet yourself), and 3) Request that the examiner document your *functional* loss and note the progressive nature of ALS, as required by **38 CFR 3.350(a)(2)** for loss of use. Follow up by submitting a formal statement on VA Form 21-4138 detailing the exam's shortcomings if the report remains inaccurate.

*This information is for educational purposes based on VA policy and case law and is not a substitute for professional legal or medical advice.*