Primary lateral Sclerosis is a Motor Neuron Disorder (Disease) which is a diagnostic journey. There is an unexplainable number of Veterans being diagnosed with this MND over the general population. Most Prime Care VA doctors (interns) miss the early signs of this disorder. They will run you through the entire VA pharmacy before referring you to the Neuro Clinic. I was lucky, my wife was seeing a good Ortho doctor about 4 years ago who noticed I was limping and kind of jokingly asked, "And why are you limping?"
I told him, "I don't know... it seems like my left leg is getting weak for some reason." He told me, "make an appointment to see me." I did. Up to this point I was writing off my weak leg to old age or arthritis. On his exam he noticed something wasn't right to explain the weakness. My foot reflexes (Babinski Toe) were abnormal and my hand reflexes (Hoffmans test) indicated a possible MND. He referred me to a good Neurologist. The weakness has spread to the other leg, my torso and my arms now. My weakness does not involve pain. My pulmonary doctor has diagnosed my breathing difficulties as neuromuscular related. I have lost 35+ pounds within the past 5 months and I am not on a diet. The VA repeatedly asked me if I am a smoker...NO. Repeatedly asked if I drank alcohol...NO. And, the usual VA presumption... depression.

I wrote all that to say this, if you are experiencing unexplainable weakness in a leg or arm, both of either, difficulty swallowing, cramps (legs, feet, arms, palms of your hands), loss of muscle mass and breathing difficulty from weak chest muscles... make an appointment with a good Neurologist.

PS. The VA believed mine was coming from a disc in my back. (That could explain the weakness in my legs but could not explain the atrophy of my two forearms and both leg calves.) It's worth paying for a private (civilian) Neurologist rather than letting the VA try and run you through their long term plan of a cure through the VA pharmacy. Anxiety and Depression meds are their preferred first approach. Too often a waste of time. Many neurologists believe there is a possible link between PLS/ALS and dioxin exposure.

I probably shouldn't have been so down on the VA Medical. The VA Med is a good thing with dedicated people. It is very fortunate that we Veterans have that benefit available to us. I know they have a protocol to follow but in some areas I believe (my opinion), if at all possible... seek an outside opinion/diagnosis too.