Condition references
Radiculopathy concerns spinal nerve roots. The Peripheral Nerves questionnaire documents nerve symptoms and affected nerves. The back and neck questionnaires also have dedicated radiculopathy sections for their spinal region.
Which questionnaire applies depends on the condition and examination requested. These references do not mean everyone must submit all three forms, and they do not choose a nerve rating code or percentage.
Public Disability Benefits Questionnaire
The Peripheral Nerves questionnaire records symptoms, strength, reflexes, sensation and affected upper- and lower-extremity nerves, including upper-extremity radicular groups. It is relevant to documenting nerve impairment; it excludes diabetic sensory-motor peripheral neuropathy, which has its own questionnaire.
On the original questionnaire: SECTION I - DIAGNOSIS; SECTION III - SYMPTOMS; SECTIONS X–XI - NERVES AFFECTED · pp1–3,6–10.
Public Disability Benefits Questionnaire
The Back (Thoracolumbar Spine) questionnaire has a dedicated radiculopathy section for lower-extremity symptoms and lumbar/sacral nerve-root findings in the spinal examination.
On the original questionnaire: SECTION VIII - RADICULOPATHY · pp9–10.
Public Disability Benefits Questionnaire
The Neck (Cervical Spine) questionnaire has a dedicated radiculopathy section for upper-extremity symptoms and cervical radicular groups in the spinal examination.
On the original questionnaire: SECTION VII - RADICULOPATHY · p9.