Carpal Tunnel Secondary to Diabetes: Complete VA Claims Filing Guide

Carpal tunnel syndrome frequently develops as a secondary condition to service-connected diabetes through multiple pathophysiological mechanisms. Diabetes-related neuropathy, inflammation, and vascular changes increase carpal tunnel susceptibility. Many veterans don't realize they can claim carpal tunnel as secondary to their service-connected diabetes rating, potentially increasing overall VA disability compensation. Understanding the diabetes-carpal tunnel connection and documentation strategies is crucial for successful claims.

Understanding Diabetes-Related Carpal Tunnel

The physiological relationship between diabetes and carpal tunnel is well-documented:

Neuropathic Mechanisms:

Diabetes-induced peripheral neuropathy increases nerve vulnerability to compression
Hyperglycemia causes myelin damage, reducing nerve resilience
Nerve compression tolerance decreased in diabetic neuropathy
Faster progression from subclinical to symptomatic carpal tunnel

Inflammatory Mechanisms:

Diabetes increases systemic inflammation
Inflammatory mediators damage tissue around median nerve
Tenosynovitis (inflammation of tendon sheath) from diabetes compresses nerve
Edema around wrist from diabetes increasing compartment pressure

Vascular Mechanisms:

Diabetes impairs microvascular circulation
Reduced blood flow to compressed median nerve worsens ischemia
Impaired healing from vascular insufficiency

Metabolic Effects:

Hyperglycemia causes glycation of nerve and tendon proteins
Altered fluid dynamics in wrist compartment
Reduced nerve conduction capacity

The VA recognizes carpal tunnel as secondary to diabetes when:

Diabetes is service-connected with assigned rating
Medical evidence shows diabetes-related factors causing carpal tunnel
Physician provides nexus opinion connecting diabetes to carpal tunnel

Rating Impact of Secondary Carpal Tunnel

Adding secondary carpal tunnel to diabetes increases overall disability:

Example Calculations:

40% diabetes + 20% carpal tunnel (secondary) = 52% combined
30% diabetes + 20% carpal tunnel (secondary) = 44% combined
20% diabetes + 10% carpal tunnel (secondary) = 28% combined

Secondary carpal tunnel typically increases overall rating 5-10%, resulting in $100-$300 additional monthly compensation.

Evidence Requirements for Secondary Carpal Tunnel

Primary Service Connection

Verify:

Diabetes is service-connected with assigned rating
Have diabetes Rating Decision
Have glucose control documentation

Carpal Tunnel Evidence

Diagnostic Confirmation:

Physician diagnosis of carpal tunnel syndrome documented
Electromyography (EMG) and nerve conduction studies (NCS) confirming median nerve compression
Physical examination findings (Phalen's test, Tinel's sign positive)
Imaging (ultrasound, MRI) if performed showing nerve compression or swelling

Diabetes-Carpal Tunnel Connection:

Medical records documenting carpal tunnel development coinciding with diabetes
Physician notes noting diabetes as contributing factor
Documentation of diabetes-related neuropathy severity
Glucose control records showing relationship to symptoms
Specialist notes linking diabetes effects to carpal tunnel

Treatment Documentation:

Conservative treatment attempts (splinting, physical therapy)
Steroid injection records if performed
Surgical records if carpal tunnel release performed
Occupational therapy records
Medication records for nerve pain (gabapentin, pregabalin)

Functional Impact:

Hand/wrist weakness or functional loss documented
Occupational limitations from carpal tunnel
ADL (activities of daily living) impact
Sleep disruption from symptoms

Diabetes Severity Documentation:

HbA1c levels showing glucose control
Duration of diabetes
Diabetic complication documentation (neuropathy, nephropathy, retinopathy)
Medication list for diabetes control

Lay Evidence

Personal Statement:

Timeline: "Carpal tunnel developed after my diabetes diagnosis" or "Worsened significantly after diabetes"
Symptom relationship: "My hand numbness and weakness from diabetes increased my carpal tunnel symptoms"
Functional: "Diabetes-related nerve damage combined with carpal tunnel prevents hand function"
Work impact: "Hand weakness from both conditions limits my occupational abilities"
Progression: "As my diabetes control worsened, carpal tunnel symptoms increased"

Supporting Statements:

Neurologist acknowledging diabetes contributing to carpal tunnel
Endocrinologist noting diabetes-related neuropathy effects
Occupational therapist documenting diabetes-neuropathy effects on carpal tunnel
Employer noting hand function limitations

Critical Nexus Letter

The nexus letter must explain how diabetes causes or significantly worsens carpal tunnel.

Essential Nexus Components

Clear Secondary Connection "The veteran's carpal tunnel syndrome is at least as likely as not secondary to, or aggravated by, his/her service-connected diabetes."

Diabetes-Carpal Tunnel Mechanism Explain specific mechanisms:

Diabetes-related neuropathy increasing nerve vulnerability to compression
Inflammatory cascade from hyperglycemia affecting nerve and tendon
Vascular insufficiency reducing compressed nerve blood flow
Tenosynovitis from diabetes inflammation compressing nerve
Glycation-induced protein damage reducing nerve resilience
Poor healing capacity from diabetes preventing spontaneous nerve recovery

Medical Evidence Review Reference diabetes severity (glucose control, HbA1c), neuropathy presence, and carpal tunnel diagnosis.

Timeline of Development Show diabetes diagnosis → neuropathy development → carpal tunnel onset or worsening.

Functional Impact Connection Explain how combined conditions create greater disability than carpal tunnel alone.

Quality Nexus Providers

VA Endocrinologists: With neurologist collaboration (free)
VA Neurologists: With diabetes knowledge (free)
Private Neurologists: Familiar with diabetes neuropathy ($400-$800)
Occupational Medicine Specialists: Understanding diabetes effects
Hand Surgeons: Experienced with diabetes-related carpal tunnel

C&P Exam Preparation

The VA may schedule C&P exams for secondary carpal tunnel claims.

Exam Strategy

Emphasize Diabetes-Carpal Tunnel Connection When discussing carpal tunnel:

Note it developed or worsened after diabetes diagnosis
Explain diabetes neuropathy worsening compression symptoms
Describe glucose control relationship to symptoms
Mention diabetes complications affecting nerve health

Specific Functional Examples

"My diabetes-related nerve damage made my hands more sensitive to carpal tunnel compression"
"When my blood sugar is poorly controlled, both my diabetic numbness and carpal tunnel pain increase"
"My diabetes neuropathy means my hands can't tolerate compression as well"
"The nerve damage from diabetes combined with carpal tunnel makes my hands nearly useless"

Hand Function Demonstration During exam, demonstrate:

Grip weakness or dysfunction
Numbness in thumb, index, middle, ring fingers
Atrophy of thenar muscles if present
Limitations with fine motor tasks

Real Secondary Carpal Tunnel Claims

Case 1: Diabetes with Neuropathy-Related Carpal Tunnel

A veteran with 30% diabetes rating filed secondary carpal tunnel.

Evidence:

Diabetes Rating Decision (30%)
EMG/NCS: Median nerve compression confirming carpal tunnel
Diabetic neuropathy documentation: Bilateral lower extremity neuropathy
Carpal tunnel onset: 2 years after diabetes diagnosis
Neurologist note: "Carpal tunnel secondary to diabetes-related peripheral neuropathy increasing compression vulnerability"
Occupational therapy: Functional limitations from combined neuropathy and carpal tunnel
Hand weakness: Grip strength reduced from nerve damage
Splinting attempted; minimal improvement
Nexus letter: "CTS secondary to diabetes-related neuropathic and inflammatory changes"

Result: 20% carpal tunnel (secondary). Combined: 44% (from 30%). Additional monthly compensation: $145. Effective date: Diabetes effective date (back pay).

Case 2: Progressive Carpal Tunnel with Worsening Diabetes

A veteran with 20% diabetes filed secondary carpal tunnel after progressive symptoms.

Documentation:

Diabetes service connection
Glucose control records: HbA1c progressively increasing (worsening)
Carpal tunnel development timing: Coinciding with diabetes control decline
EMG/NCS: Median nerve compression documented
Physician note: "Carpal tunnel severity correlates with glucose control"
Medical records: As diabetes worsened, carpal tunnel symptoms increased
Neuropathy severity: Significant diabetic neuropathy present

Result: 10% carpal tunnel. Combined: 28% (from 20%). Monthly increase: $75.

Case 3: Post-Surgical Carpal Tunnel from Diabetes

A veteran with 40% diabetes required carpal tunnel release.

Evidence:

Diabetes service connection
Pre-operative EMG: Severe median nerve compression
Surgical records: Carpal tunnel release performed
Post-operative: Partial symptom improvement but persistent dysfunction
Surgeon note: "Carpal tunnel severity worsened by diabetes-related tissue changes"
Continued symptoms: 40% recovery despite surgery due to diabetes effects
Endocrinologist: "Diabetes-related inflammation and neuropathy limit surgical recovery"
Functional: Hand weakness persists from combined diabetes and surgical sequelae

Result: 20% carpal tunnel. Combined: 52% (from 40%). Monthly increase: $125.

Common Mistakes to Avoid

Mistake 1: No Primary Diabetes Rating

Cannot file secondary carpal tunnel without service-connected diabetes.

Solution: Ensure diabetes is already rated.

Mistake 2: No EMG/NCS Testing

Filing without objective nerve testing documentation.

Solution: Obtain EMG/NCS confirming median nerve compression.

Mistake 3: No Clear Diabetes-Carpal Tunnel Connection

Simply having both conditions insufficient without nexus.

Solution: Get neurologist to explicitly document diabetes role in carpal tunnel.

Mistake 4: Missing Neuropathy Documentation

Not documenting diabetes-related neuropathy severity.

Solution: Ensure medical records clearly document diabetic neuropathy.

Mistake 5: No Glucose Control Timeline

Not showing correlation between diabetes control and carpal tunnel symptoms.

Solution: Provide HbA1c records and glucose logs showing relationship to symptoms.

Step-by-Step Filing

Step 1: Verify Diabetes Rating

Confirm service-connected diabetes with rating
Have diabetes Rating Decision
Gather glucose control documentation

Step 2: Obtain Carpal Tunnel Diagnosis

Schedule neurology evaluation
Request EMG/NCS testing
Ensure carpal tunnel confirmed with objective testing

Step 3: Gather Documentation

Diabetes treatment records showing glucose control
Neuropathy documentation (lower extremity findings support diabetes severity)
Neurology records and EMG/NCS results
Treatment records (splinting, therapy, possible surgery)
Any occupational therapy records

Step 4: Write Detailed Personal Statement

Describe diabetes → carpal tunnel timeline
Explain neuropathy effects on hand compression tolerance
Describe glucose control relationship to symptoms
Detail hand/wrist functional limitations
Note occupational impact from hand weakness

Step 5: Obtain Nexus Letter

Request from VA neurologist (free)
Or obtain from private neurologist
Ensure diabetes-related mechanisms explanation

Step 6: File Form 21-0995

Reference primary diabetes condition and rating
Identify carpal tunnel as secondary
Attach EMG/NCS, nexus letter, personal statement

Step 7: Submit to VA

Online: VA.gov (fastest)
Mail: VA Regional Office
In-person: Local VA office with VSO

Step 8: Attend C&P Exam (if scheduled)

Demonstrate hand weakness and numbness
Explain diabetes-neuropathy-carpal tunnel relationship
Describe functional limitations

Step 9: Await Decision

VA responds 60-120 days
Rating Decision shows combined percentage
First payment reflects new rating

Timeline and Back Pay

Effective Date: Secondary conditions effective from diabetes effective date

Back Pay Potential: Significant if approved retroactively from diabetes effective date

Appeal Strategies if Denied

Option 1: Objective Testing

Submit EMG/NCS studies if not previously provided.

Option 2: Stronger Nexus

Obtain detailed nexus from experienced neurologist addressing diabetes mechanisms.

Option 3: Higher-Level Review

Request senior reviewer examination.

Option 4: Board Appeal

For weak denials, request Board hearing.

Frequently Asked Questions

Q: Can carpal tunnel be secondary if it's bilateral? A: Yes, bilateral carpal tunnel from diabetes is approvable.

Q: Does my diabetes rating change if I add secondary carpal tunnel? A: No, diabetes rating unchanged; combined overall increases.

Q: How much increase from secondary carpal tunnel? A: Typically 5-10% increase depending on severity.

Q: What if carpal tunnel existed before diabetes diagnosis? A: Still viable if diabetes significantly worsened symptoms through neuropathy or inflammation.

Q: Can carpal tunnel be secondary to both occupational exposure AND diabetes? A: Potentially, but claim as secondary to primary cause (usually diabetes if service-connected).

Conclusion

Carpal tunnel secondary to diabetes is a defensible claim with EMG/NCS confirmation and a quality nexus letter explaining diabetes mechanisms. File Form 21-0995 with comprehensive neurological documentation.

With evidence of the diabetes-carpal tunnel connection, most veterans successfully establish secondary carpal tunnel ratings and increased overall compensation.

Carpal Tunnel Secondary to Diabetes: Complete VA Claims Filing Guide

Understanding Diabetes-Related Carpal Tunnel

The physiological relationship between diabetes and carpal tunnel is well-documented:

Neuropathic Mechanisms:

Diabetes-induced peripheral neuropathy increases nerve vulnerability to compression
Hyperglycemia causes myelin damage, reducing nerve resilience
Nerve compression tolerance decreased in diabetic neuropathy
Faster progression from subclinical to symptomatic carpal tunnel

Inflammatory Mechanisms:

Diabetes increases systemic inflammation
Inflammatory mediators damage tissue around median nerve
Tenosynovitis (inflammation of tendon sheath) from diabetes compresses nerve
Edema around wrist from diabetes increasing compartment pressure

Vascular Mechanisms:

Diabetes impairs microvascular circulation
Reduced blood flow to compressed median nerve worsens ischemia
Impaired healing from vascular insufficiency

Metabolic Effects:

Hyperglycemia causes glycation of nerve and tendon proteins
Altered fluid dynamics in wrist compartment
Reduced nerve conduction capacity

The VA recognizes carpal tunnel as secondary to diabetes when:

Diabetes is service-connected with assigned rating
Medical evidence shows diabetes-related factors causing carpal tunnel
Physician provides nexus opinion connecting diabetes to carpal tunnel

Rating Impact of Secondary Carpal Tunnel

Adding secondary carpal tunnel to diabetes increases overall disability:

Example Calculations:

40% diabetes + 20% carpal tunnel (secondary) = 52% combined
30% diabetes + 20% carpal tunnel (secondary) = 44% combined
20% diabetes + 10% carpal tunnel (secondary) = 28% combined

Secondary carpal tunnel typically increases overall rating 5-10%, resulting in $100-$300 additional monthly compensation.

Evidence Requirements for Secondary Carpal Tunnel

Primary Service Connection

Verify:

Diabetes is service-connected with assigned rating
Have diabetes Rating Decision
Have glucose control documentation

Carpal Tunnel Evidence

Diagnostic Confirmation:

Physician diagnosis of carpal tunnel syndrome documented
Electromyography (EMG) and nerve conduction studies (NCS) confirming median nerve compression
Physical examination findings (Phalen's test, Tinel's sign positive)
Imaging (ultrasound, MRI) if performed showing nerve compression or swelling

Diabetes-Carpal Tunnel Connection:

Medical records documenting carpal tunnel development coinciding with diabetes
Physician notes noting diabetes as contributing factor
Documentation of diabetes-related neuropathy severity
Glucose control records showing relationship to symptoms
Specialist notes linking diabetes effects to carpal tunnel

Treatment Documentation:

Conservative treatment attempts (splinting, physical therapy)
Steroid injection records if performed
Surgical records if carpal tunnel release performed
Occupational therapy records
Medication records for nerve pain (gabapentin, pregabalin)

Functional Impact:

Hand/wrist weakness or functional loss documented
Occupational limitations from carpal tunnel
ADL (activities of daily living) impact
Sleep disruption from symptoms

Diabetes Severity Documentation:

HbA1c levels showing glucose control
Duration of diabetes
Diabetic complication documentation (neuropathy, nephropathy, retinopathy)
Medication list for diabetes control

Lay Evidence

Personal Statement:

Timeline: "Carpal tunnel developed after my diabetes diagnosis" or "Worsened significantly after diabetes"
Symptom relationship: "My hand numbness and weakness from diabetes increased my carpal tunnel symptoms"
Functional: "Diabetes-related nerve damage combined with carpal tunnel prevents hand function"
Work impact: "Hand weakness from both conditions limits my occupational abilities"
Progression: "As my diabetes control worsened, carpal tunnel symptoms increased"

Supporting Statements:

Neurologist acknowledging diabetes contributing to carpal tunnel
Endocrinologist noting diabetes-related neuropathy effects
Occupational therapist documenting diabetes-neuropathy effects on carpal tunnel
Employer noting hand function limitations

Critical Nexus Letter

The nexus letter must explain how diabetes causes or significantly worsens carpal tunnel.

Essential Nexus Components

Clear Secondary Connection "The veteran's carpal tunnel syndrome is at least as likely as not secondary to, or aggravated by, his/her service-connected diabetes."

Diabetes-Carpal Tunnel Mechanism Explain specific mechanisms:

Diabetes-related neuropathy increasing nerve vulnerability to compression
Inflammatory cascade from hyperglycemia affecting nerve and tendon
Vascular insufficiency reducing compressed nerve blood flow
Tenosynovitis from diabetes inflammation compressing nerve
Glycation-induced protein damage reducing nerve resilience
Poor healing capacity from diabetes preventing spontaneous nerve recovery

Medical Evidence Review Reference diabetes severity (glucose control, HbA1c), neuropathy presence, and carpal tunnel diagnosis.

Timeline of Development Show diabetes diagnosis → neuropathy development → carpal tunnel onset or worsening.

Functional Impact Connection Explain how combined conditions create greater disability than carpal tunnel alone.

Quality Nexus Providers

VA Endocrinologists: With neurologist collaboration (free)
VA Neurologists: With diabetes knowledge (free)
Private Neurologists: Familiar with diabetes neuropathy ($400-$800)
Occupational Medicine Specialists: Understanding diabetes effects
Hand Surgeons: Experienced with diabetes-related carpal tunnel

C&P Exam Preparation

The VA may schedule C&P exams for secondary carpal tunnel claims.

Exam Strategy

Emphasize Diabetes-Carpal Tunnel Connection When discussing carpal tunnel:

Note it developed or worsened after diabetes diagnosis
Explain diabetes neuropathy worsening compression symptoms
Describe glucose control relationship to symptoms
Mention diabetes complications affecting nerve health

Specific Functional Examples

"My diabetes-related nerve damage made my hands more sensitive to carpal tunnel compression"
"When my blood sugar is poorly controlled, both my diabetic numbness and carpal tunnel pain increase"
"My diabetes neuropathy means my hands can't tolerate compression as well"
"The nerve damage from diabetes combined with carpal tunnel makes my hands nearly useless"

Hand Function Demonstration During exam, demonstrate:

Grip weakness or dysfunction
Numbness in thumb, index, middle, ring fingers
Atrophy of thenar muscles if present
Limitations with fine motor tasks

Real Secondary Carpal Tunnel Claims

Case 1: Diabetes with Neuropathy-Related Carpal Tunnel

A veteran with 30% diabetes rating filed secondary carpal tunnel.

Evidence:

Diabetes Rating Decision (30%)
EMG/NCS: Median nerve compression confirming carpal tunnel
Diabetic neuropathy documentation: Bilateral lower extremity neuropathy
Carpal tunnel onset: 2 years after diabetes diagnosis
Neurologist note: "Carpal tunnel secondary to diabetes-related peripheral neuropathy increasing compression vulnerability"
Occupational therapy: Functional limitations from combined neuropathy and carpal tunnel
Hand weakness: Grip strength reduced from nerve damage
Splinting attempted; minimal improvement
Nexus letter: "CTS secondary to diabetes-related neuropathic and inflammatory changes"

Result: 20% carpal tunnel (secondary). Combined: 44% (from 30%). Additional monthly compensation: $145. Effective date: Diabetes effective date (back pay).

Case 2: Progressive Carpal Tunnel with Worsening Diabetes

A veteran with 20% diabetes filed secondary carpal tunnel after progressive symptoms.

Documentation:

Diabetes service connection
Glucose control records: HbA1c progressively increasing (worsening)
Carpal tunnel development timing: Coinciding with diabetes control decline
EMG/NCS: Median nerve compression documented
Physician note: "Carpal tunnel severity correlates with glucose control"
Medical records: As diabetes worsened, carpal tunnel symptoms increased
Neuropathy severity: Significant diabetic neuropathy present

Result: 10% carpal tunnel. Combined: 28% (from 20%). Monthly increase: $75.

Case 3: Post-Surgical Carpal Tunnel from Diabetes

A veteran with 40% diabetes required carpal tunnel release.

Evidence:

Diabetes service connection
Pre-operative EMG: Severe median nerve compression
Surgical records: Carpal tunnel release performed
Post-operative: Partial symptom improvement but persistent dysfunction
Surgeon note: "Carpal tunnel severity worsened by diabetes-related tissue changes"
Continued symptoms: 40% recovery despite surgery due to diabetes effects
Endocrinologist: "Diabetes-related inflammation and neuropathy limit surgical recovery"
Functional: Hand weakness persists from combined diabetes and surgical sequelae

Result: 20% carpal tunnel. Combined: 52% (from 40%). Monthly increase: $125.

Common Mistakes to Avoid

Mistake 1: No Primary Diabetes Rating

Cannot file secondary carpal tunnel without service-connected diabetes.

Solution: Ensure diabetes is already rated.

Mistake 2: No EMG/NCS Testing

Filing without objective nerve testing documentation.

Solution: Obtain EMG/NCS confirming median nerve compression.

Mistake 3: No Clear Diabetes-Carpal Tunnel Connection

Simply having both conditions insufficient without nexus.

Solution: Get neurologist to explicitly document diabetes role in carpal tunnel.

Mistake 4: Missing Neuropathy Documentation

Not documenting diabetes-related neuropathy severity.

Solution: Ensure medical records clearly document diabetic neuropathy.

Mistake 5: No Glucose Control Timeline

Not showing correlation between diabetes control and carpal tunnel symptoms.

Solution: Provide HbA1c records and glucose logs showing relationship to symptoms.

Step-by-Step Filing

Step 1: Verify Diabetes Rating

Confirm service-connected diabetes with rating
Have diabetes Rating Decision
Gather glucose control documentation

Step 2: Obtain Carpal Tunnel Diagnosis

Schedule neurology evaluation
Request EMG/NCS testing
Ensure carpal tunnel confirmed with objective testing

Step 3: Gather Documentation

Diabetes treatment records showing glucose control
Neuropathy documentation (lower extremity findings support diabetes severity)
Neurology records and EMG/NCS results
Treatment records (splinting, therapy, possible surgery)
Any occupational therapy records

Step 4: Write Detailed Personal Statement

Describe diabetes → carpal tunnel timeline
Explain neuropathy effects on hand compression tolerance
Describe glucose control relationship to symptoms
Detail hand/wrist functional limitations
Note occupational impact from hand weakness

Step 5: Obtain Nexus Letter

Request from VA neurologist (free)
Or obtain from private neurologist
Ensure diabetes-related mechanisms explanation

Step 6: File Form 21-0995

Reference primary diabetes condition and rating
Identify carpal tunnel as secondary
Attach EMG/NCS, nexus letter, personal statement

Step 7: Submit to VA

Online: VA.gov (fastest)
Mail: VA Regional Office
In-person: Local VA office with VSO

Step 8: Attend C&P Exam (if scheduled)

Demonstrate hand weakness and numbness
Explain diabetes-neuropathy-carpal tunnel relationship
Describe functional limitations

Step 9: Await Decision

VA responds 60-120 days
Rating Decision shows combined percentage
First payment reflects new rating

Timeline and Back Pay

Effective Date: Secondary conditions effective from diabetes effective date

Back Pay Potential: Significant if approved retroactively from diabetes effective date

Appeal Strategies if Denied

Option 1: Objective Testing

Submit EMG/NCS studies if not previously provided.

Option 2: Stronger Nexus

Obtain detailed nexus from experienced neurologist addressing diabetes mechanisms.

Option 3: Higher-Level Review

Request senior reviewer examination.

Option 4: Board Appeal

For weak denials, request Board hearing.

Frequently Asked Questions

Q: Can carpal tunnel be secondary if it's bilateral? A: Yes, bilateral carpal tunnel from diabetes is approvable.

Q: Does my diabetes rating change if I add secondary carpal tunnel? A: No, diabetes rating unchanged; combined overall increases.

Q: How much increase from secondary carpal tunnel? A: Typically 5-10% increase depending on severity.

Q: What if carpal tunnel existed before diabetes diagnosis? A: Still viable if diabetes significantly worsened symptoms through neuropathy or inflammation.

Q: Can carpal tunnel be secondary to both occupational exposure AND diabetes? A: Potentially, but claim as secondary to primary cause (usually diabetes if service-connected).

Conclusion

With evidence of the diabetes-carpal tunnel connection, most veterans successfully establish secondary carpal tunnel ratings and increased overall compensation.