Evidence Checklist: Amyotrophic Lateral Sclerosis (ALS)

EMG documenting widespread denervation (El Escorial criteria)Critical

Needle EMG showing active denervation (fibrillation potentials, positive sharp waves) and chronic reinnervation in at least three body regions (bulbar, cervical, thoracic, lumbosacral), meeting El Escorial or Awaji criteria for ALS.

Neurologist evaluation with UMN and LMN sign documentationCritical

A neurologist's evaluation documenting combined upper motor neuron (spasticity, hyperreflexia, Babinski) and lower motor neuron (atrophy, fasciculations, weakness) signs consistent with ALS.

Pulmonary function tests and swallow study

PFTs documenting respiratory muscle weakness (reduced FVC) and a modified barium swallow or FEES study documenting dysphagia severity.

ALSFRS-R (ALS Functional Rating Scale) documentation

The ALSFRS-R score documents functional decline across speech, swallowing, limb function, and respiratory domains. Useful for establishing level of impairment for rating purposes.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Motor Neuron DiseaseCritical

VA standardized form for motor neuron diseases capturing neurological deficits and functional status.

Documentation of qualifying military service (ALS is presumptive for all veterans)Critical

ALS is a VA-presumptive condition for all veterans with honorable service. Documentation of military service is sufficient to establish service connection without a nexus opinion.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.