Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. Sec. 4.124a Schedule of ratings--neurological conditions and convulsive disorders. [With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves]
Organic Diseases of the Central Nervous System------------------------------------------------------------------------
Rating------------------------------------------------------------------------8000 Encephalitis, epidemic, chronic:
As active febrile disease..................................... 100
Rate residuals, minimum....................................... 10
Brain, new growth of:8002 Malignant.................................................. 100
Note: The rating in code 8002 will be continued for 2 years
following cessation of surgical, chemotherapeutic or other
treatment modality. At this point, if the residuals have
stabilized, the rating will be made on neurological residuals
according to symptomatology.
Minimum rating................................................ 308003 Benign, minimum............................................ 60
Rate residuals, minimum....................................... 108004 Paralysis agitans:
Minimum rating................................................ 308005 Bulbar palsy............................................... 1008007 Brain, vessels, embolism of.8008 Brain, vessels, thrombosis of.8009 Brain, vessels, hemorrhage from:
Rate the vascular conditions under Codes 8007 through 8009, 100
for 6 months.................................................
Rate residuals, thereafter, minimum........................... 108010 Myelitis:
Minimum rating................................................ 108011 Poliomyelitis, anterior:
As active febrile disease..................................... 100
Rate residuals, minimum....................................... 108012 Hematomyelia:
For 6 months.................................................. 100
Rate residuals, minimum....................................... 108013 Syphilis, cerebrospinal.8014 Syphilis, meningovascular.8015 Tabes dorsalis.
Note: Rate upon the severity of convulsions, paralysis, visual
impairment or psychotic involvement, etc.8017 Amyotrophic lateral sclerosis 100
Note: Consider the need for special monthly compensation.8018 Multiple sclerosis:
Minimum rating................................................ 308019 Meningitis, cerebrospinal, epidemic:
As active febrile disease..................................... 100
Rate residuals, minimum....................................... 108020 Brain, abscess of:
As active disease............................................. 100
Rate residuals, minimum....................................... 10
Spinal cord, new growths of:..................................8021 Malignant.................................................. 100
Note: The rating in code 8021 will be continued for 2 years
following cessation of surgical, chemotherapeutic or other
treatment modality. At this point, if the residuals have
stabilized, the rating will be made on neurological residuals
according to symptomatology.
Minimum rating................................................ 308022 Benign, minimum rating..................................... 60
Rate residuals, minimum....................................... 108023 Progressive muscular atrophy:
Minimum rating................................................ 308024 Syringomyelia:
Minimum rating................................................ 308025 Myasthenia gravis:
Minimum rating................................................ 30
Note: It is required for the minimum ratings for residuals
under diagnostic codes 8000-8025, that there be ascertainable
residuals. Determinations as to the presence of residuals not
capable of objective verification, i.e., headaches,
dizziness, fatigability, must be approached on the basis of
the diagnosis recorded; subjective residuals will be accepted
when consistent with the disease and not more likely
attributable to other disease or no disease. It is of
exceptional importance that when ratings in excess of the
prescribed minimum ratings are assigned, the diagnostic codes
utilized as bases of evaluation be cited, in addition to the
codes identifying the diagnoses.8045 Residuals of traumatic brain injury (TBI):
There are three main areas of dysfunction that may result
from TBI and have profound effects on functioning:
cognitive (which is common in varying degrees after TBI),
emotional/behavioral, and physical. Each of these areas of
dysfunction may require evaluation.........................
Cognitive impairment is defined as decreased memory,
concentration, attention, and executive functions of the
brain. Executive functions are goal setting, speed of
information processing, planning, organizing, prioritizing,
self-monitoring, problem solving, judgment, decision
making, spontaneity, and flexibility in changing actions
when they are not productive. Not all of these brain
functions may be affected in a given individual with
cognitive impairment, and some functions may be affected
more severely than others. In a given individual, symptoms
may fluctuate in severity from day to day. Evaluate
cognitive impairment under the table titled ``Evaluation of
Cognitive Impairment and Other Residuals of TBI Not
Otherwise Classified.''....................................
Subjective symptoms may be the only residual of TBI or may
be associated with cognitive impairment or other areas of
dysfunction. Evaluate subjective symptoms that are
residuals of TBI, whether or not they are part of cognitive
impairment, under the subjective symptoms facet in the
table titled ``Evaluation of Cognitive Impairment and Other
Residuals of TBI Not Otherwise Classified.'' However,
separately evaluate any residual with a distinct diagnosis
that may be evaluated under another diagnostic code, such
as migraine headache or Meniere's disease, even if that
diagnosis is based on subjective symptoms, rather than
under the ``Evaluation of Cognitive Impairment and Other
Residuals of TBI Not Otherwise Classified'' table..........
Evaluate emotional/behavioral dysfunction under Sec. 4.130
(Schedule of ratings--mental disorders) when there is a
diagnosis of a mental disorder. When there is no diagnosis
of a mental disorder, evaluate emotional/behavioral
symptoms under the criteria in the table titled
``Evaluation of Cognitive Impairment and Other Residuals of
TBI Not Otherwise Classified.''............................
Evaluate physical (including neurological) dysfunction based
on the following list, under an appropriate diagnostic
code: Motor and sensory dysfunction, including pain, of the
extremities and face; visual impairment; hearing loss and
tinnitus; loss of sense of smell and taste; seizures; gait,
coordination, and balance problems; speech and other
communication difficulties, including aphasia and related
disorders, and dysarthria; neurogenic bladder; neurogenic
bowel; cranial nerve dysfunctions; autonomic nerve
dysfunctions; and endocrine dysfunctions...................
The preceding list of types of physical dysfunction does not
encompass all possible residuals of TBI. For residuals not
listed here that are reported on an examination, evaluate
under the most appropriate diagnostic code. Evaluate each
condition separately, as long as the same signs and
symptoms are not used to support more than one evaluation,
and combine under Sec. 4.25 the evaluations for each
separately rated condition. The evaluation assigned based
on the ``Evaluation of Cognitive Impairment and Other
Residuals of TBI Not Otherwise Classified'' table will be
considered the evaluation for a single condition for
purposes of combining with other disability evaluations....
Consider the need for special monthly compensation for such
problems as loss of use of an extremity, certain sensory
impairments, erectile dysfunction, the need for aid and
attendance (including for protection from hazards or
dangers incident to the daily environment due to cognitive
impairment), being housebound, etc.........................------------------------------------------------------------------------
Evaluation of Cognitive Impairment and Subjective Symptoms------------------------------------------------------------------------The table titled ``Evaluation of Cognitive Impairment and Other
Residuals of TBI Not Otherwise Classified'' contains 10
important facets of TBI related to cognitive impairment and
subjective symptoms. It provides criteria for levels of
impairment for each facet, as appropriate, ranging from 0 to 3,
and a 5th level, the highest level of impairment, labeled
``total.'' However, not every facet has every level of
severity. The Consciousness facet, for example, does not
provide for an impairment level other than ``total,'' since any
level of impaired consciousness would be totally disabling.
Assign a 100-percent evaluation if ``total'' is the level of
evaluation for one or more facets. If no facet is evaluated as
``total,'' assign the overall percentage evaluation based on
the level of the highest facet as follows: 0 = 0 percent; 1 =
10 percent; 2 = 40 percent; and 3 = 70 percent. For example,
assign a 70 percent evaluation if 3 is the highest level of
evaluation for any facet.......................................
Note (1): There may be an overlap of manifestations of
conditions evaluated under the table titled ``Evaluation Of
Cognitive Impairment And Other Residuals Of TBI Not
Otherwise Classified'' with manifestations of a comorbid
mental or neurologic or other physical disorder that can be
separately evaluated under another diagnostic code. In such
cases, do not assign more than one evaluation based on the
same manifestations. If the manifestations of two or more
conditions cannot be clearly separated, assign a single
evaluation under whichever set of diagnostic criteria
allows the better assessment of overall impaired
functioning due to both conditions. However, if the
manifestations are clearly separable, assign a separate
evaluation for each condition..............................
Note (2): Symptoms listed as examples at certain evaluation
levels in the table are only examples and are not symptoms
that must be present in order to assign a particular
evaluation.................................................
Note (3): ``Instrumental activities of daily living'' refers
to activities other than self-care that are needed for
independent living, such as meal preparation, doing
housework and other chores, shopping, traveling, doing
laundry, being responsible for one's own medications, and
using a telephone. These activities are distinguished from
``Activities of daily living,'' which refers to basic self-
care and includes bathing or showering, dressing, eating,
getting in or out of bed or a chair, and using the toilet..
Note (4): The terms ``mild,'' ``moderate,'' and ``severe''
TBI, which may appear in medical records, refer to a
classification of TBI made at, or close to, the time of
injury rather than to the current level of functioning.
This classification does not affect the rating assigned
under diagnostic code 8045.................................
Note (5): A veteran whose residuals of TBI are rated under a
version of Sec. 4.124a, diagnostic code 8045, in effect
before October 23, 2008 may request review under diagnostic
code 8045, irrespective of whether his or her disability
has worsened since the last review. VA will review that
veteran's disability rating to determine whether the
veteran may be entitled to a higher disability rating under
diagnostic code 8045. A request for review pursuant to this
note will be treated as a claim for an increased rating for
purposes of determining the effective date of an increased
rating awarded as a result of such review; however, in no
case will the award be effective before October 23, 2008.
For the purposes of determining the effective date of an
increased rating awarded as a result of such review, VA
will apply 38 CFR 3.114, if applicable.....................8046 Cerebral arteriosclerosis:
Purely neurological disabilities, such as hemiplegia, cranial
nerve paralysis, etc., due to cerebral arteriosclerosis will
be rated under the diagnostic codes dealing with such
specific disabilities, with citation of a hyphenated
diagnostic code (e.g., 8046-8207).
Purely subjective complaints such as headache, dizziness,
tinnitus, insomnia and irritability, recognized as
symptomatic of a properly diagnosed cerebral
arteriosclerosis, will be rated 10 percent and no more under
diagnostic code 9305. This 10 percent rating will not be
combined with any other rating for a disability due to
cerebral or generalized arteriosclerosis. Ratings in excess
of 10 percent for cerebral arteriosclerosis under diagnostic
code 9305 are not assignable in the absence of a diagnosis of
multi-infarct dementia with cerebral arteriosclerosis.
Note: The ratings under code 8046 apply only when the
diagnosis of cerebral arteriosclerosis is substantiated by
the entire clinical picture and not solely on findings of
retinal arteriosclerosis.------------------------------------------------------------------------
Evaluation of Cognitive Impairment and Other Residuals of TBI Not
Otherwise Classified------------------------------------------------------------------------
Facets of cognitive impairment andother residuals of TBI not otherwise Level of Criteria
classified impairment------------------------------------------------------------------------Memory, attention, concentration, 0 No complaints of
executive functions. impairment of memory,
attention,
concentration, or
executive functions.
1 A complaint of mild
loss of memory (such
as having difficulty
following a
conversation,
recalling recent
conversations,
remembering names of
new acquaintances, or
finding words, or
often misplacing
items), attention,
concentration, or
executive functions,
but without objective
evidence on testing.
2 Objective evidence on
testing of mild
impairment of memory,
attention,
concentration, or
executive functions
resulting in mild
functional
impairment.
3 Objective evidence on
testing of moderate
impairment of memory,
attention,
concentration, or
executive functions
resulting in moderate
functional
impairment.
Total Objective evidence on
testing of severe
impairment of memory,
attention,
concentration, or
executive functions
resulting in severe
functional
impairment.Judgment............................ 0 Normal.
1 Mildly impaired
judgment. For complex
or unfamiliar
decisions,
occasionally unable
to identify,
understand, and weigh
the alternatives,
understand the
consequences of
choices, and make a
reasonable decision.
2 Moderately impaired
judgment. For complex
or unfamiliar
decisions, usually
unable to identify,
understand, and weigh
the alternatives,
understand the
consequences of
choices, and make a
reasonable decision,
although has little
difficulty with
simple decisions.
3 Moderately severely
impaired judgment.
For even routine and
familiar decisions,
occasionally unable
to identify,
understand, and weigh
the alternatives,
understand the
consequences of
choices, and make a
reasonable decision.
Total Severely impaired
judgment. For even
routine and familiar
decisions, usually
unable to identify,
understand, and weigh
the alternatives,
understand the
consequences of
choices, and make a
reasonable decision.
For example, unable
to determine
appropriate clothing
for current weather
conditions or judge
when to avoid
dangerous situations
or activities.Social interaction.................. 0 Social interaction is
routinely
appropriate.
1 Social interaction is
occasionally
inappropriate.
2 Social interaction is
frequently
inappropriate.
3 Social interaction is
inappropriate most or
all of the time.Orientation......................... 0 Always oriented to
person, time, place,
and situation.
1 Occasionally
disoriented to one of
the four aspects
(person, time, place,
situation) of
orientation.
2 Occasionally
disoriented to two of
the four aspects
(person, time, place,
situation) of
orientation or often
disoriented to one
aspect of
orientation.
3 Often disoriented to
two or more of the
four aspects (person,
time, place,
situation) of
orientation.
Total Consistently
disoriented to two or
more of the four
aspects (person,
time, place,
situation) of
orientation.
Motor activity (with intact motor 0 Motor activity normal.
and sensory system).
1 Motor activity normal
most of the time, but
mildly slowed at
times due to apraxia
(inability to perform
previously learned
motor activities,
despite normal motor
function).
2 Motor activity mildly
decreased or with
moderate slowing due
to apraxia.
3 Motor activity
moderately decreased
due to apraxia.
Total Motor activity
severely decreased
due to apraxia.Visual spatial orientation.......... 0 Normal.
1 Mildly impaired.
Occasionally gets
lost in unfamiliar
surroundings, has
difficulty reading
maps or following
directions. Is able
to use assistive
devices such as GPS
(global positioning
system).
2 Moderately impaired.
Usually gets lost in
unfamiliar
surroundings, has
difficulty reading
maps, following
directions, and
judging distance. Has
difficulty using
assistive devices
such as GPS (global
positioning system).
3 Moderately severely
impaired. Gets lost
even in familiar
surroundings, unable
to use assistive
devices such as GPS
(global positioning
system).
Total Severely impaired. May
be unable to touch or
name own body parts
when asked by the
examiner, identify
the relative position
in space of two
different objects, or
find the way from one
room to another in a
familiar environment.Subjective symptoms................. 0 Subjective symptoms
that do not interfere
with work;
instrumental
activities of daily
living; or work,
family, or other
close relationships.
Examples are: mild or
occasional headaches,
mild anxiety.
1 Three or more
subjective symptoms
that mildly interfere
with work;
instrumental
activities of daily
living; or work,
family, or other
close relationships.
Examples of findings
that might be seen at
this level of
impairment are:
intermittent
dizziness, daily mild
to moderate
headaches, tinnitus,
frequent insomnia,
hypersensitivity to
sound,
hypersensitivity to
light.
2 Three or more
subjective symptoms
that moderately
interfere with work;
instrumental
activities of daily
living; or work,
family, or other
close relationships.
Examples of findings
that might be seen at
this level of
impairment are:
marked fatigability,
blurred or double
vision, headaches
requiring rest
periods during most
days.
Neurobehavioral effects............. 0 One or more
neurobehavioral
effects that do not
interfere with
workplace interaction
or social
interaction. Examples
of neurobehavioral
effects are:
Irritability,
impulsivity,
unpredictability,
lack of motivation,
verbal aggression,
physical aggression,
belligerence, apathy,
lack of empathy,
moodiness, lack of
cooperation,
inflexibility, and
impaired awareness of
disability. Any of
these effects may
range from slight to
severe, although
verbal and physical
aggression are likely
to have a more
serious impact on
workplace interaction
and social
interaction than some
of the other effects.
1 One or more
neurobehavioral
effects that
occasionally
interfere with
workplace
interaction, social
interaction, or both
but do not preclude
them.
2 One or more
neurobehavioral
effects that
frequently interfere
with workplace
interaction, social
interaction, or both
but do not preclude
them.
3 One or more
neurobehavioral
effects that
interfere with or
preclude workplace
interaction, social
interaction, or both
on most days or that
occasionally require
supervision for
safety of self or
others.Communication....................... 0 Able to communicate by
spoken and written
language (expressive
communication), and
to comprehend spoken
and written language.
1 Comprehension or
expression, or both,
of either spoken
language or written
language is only
occasionally
impaired. Can
communicate complex
ideas.
2 Inability to
communicate either by
spoken language,
written language, or
both, more than
occasionally but less
than half of the
time, or to
comprehend spoken
language, written
language, or both,
more than
occasionally but less
than half of the
time. Can generally
communicate complex
ideas.
3 Inability to
communicate either by
spoken language,
written language, or
both, at least half
of the time but not
all of the time, or
to comprehend spoken
language, written
language, or both, at
least half of the
time but not all of
the time. May rely on
gestures or other
alternative modes of
communication. Able
to communicate basic
needs.
Total Complete inability to
communicate either by
spoken language,
written language, or
both, or to
comprehend spoken
language, written
language, or both.
Unable to communicate
basic needs.Consciousness....................... Total Persistently altered
state of
consciousness, such
as vegetative state,
minimally responsive
state, coma.------------------------------------------------------------------------
Miscellaneous Diseases------------------------------------------------------------------------
Rating------------------------------------------------------------------------8100 Migraine:
With very frequent completely prostrating and prolonged 50
attacks productive of severe economic inadaptability.........
With characteristic prostrating attacks occurring on an 30
average once a month over last several months................
With characteristic prostrating attacks averaging one in 2 10
months over last several months..............................
With less frequent attacks.................................... 08103 Tic, convulsive:
Severe........................................................ 30
Moderate...................................................... 10
Mild.......................................................... 0
Note: Depending upon frequency, severity, muscle groups
involved.8104 Paramyoclonus multiplex (convulsive state, myoclonic type):
Rate as tic; convulsive; severe cases......................... 608105 Chorea, Sydenham's:
Pronounced, progressive grave types........................... 100
Severe........................................................ 80
Moderately severe............................................. 50
Moderate...................................................... 30
Mild.......................................................... 10
Note: Consider rheumatic etiology and complications.8106 Chorea, Huntington's.
Rate as Sydenham's chorea. This, though a familial disease,
has its onset in late adult life, and is considered a ratable
disability.8107 Athetosis, acquired.
Rate as chorea.8108 Narcolepsy.
Rate as for epilepsy, petit mal.------------------------------------------------------------------------
Diseases of the Cranial Nerves------------------------------------------------------------------------
Rating------------------------------------------------------------------------
Disability from lesions of peripheral portions of first,
second, third, fourth, sixth, and eighth nerves will be rated
under the Organs of Special Sense. The ratings for the
cranial nerves are for unilateral involvement; when
bilateral, combine but without the bilateral factor.
Fifth (trigeminal) cranial nerve8205 Paralysis of:
Complete...................................................... 50
Incomplete, severe............................................ 30
Incomplete, moderate.......................................... 10
Note: Dependent upon relative degree of sensory manifestation
or motor loss.8305 Neuritis.8405 Neuralgia.
Note: Tic douloureux may be rated in accordance with severity,
up to complete paralysis.
Seventh (facial) cranial nerve8207 Paralysis of:
Complete.................................................... 30
Incomplete, severe.......................................... 20
Incomplete, moderate........................................ 10
Note: Dependent upon relative loss of innervation of facial
muscles.8307 Neuritis.8407 Neuralgia.
Ninth (glossopharyngeal) cranial nerve........................8209 Paralysis of:
Complete...................................................... 30
Incomplete, severe............................................ 20
Incomplete, moderate.......................................... 10
Note: Dependent upon relative loss of ordinary sensation in
mucous membrane of the pharynx, fauces, and tonsils.8309 Neuritis.8409 Neuralgia.
Tenth (pneumogastric, vagus) cranial nerve....................8210 Paralysis of:
Complete...................................................... 50
Incomplete, severe............................................ 30
Incomplete, moderate.......................................... 10
Note : Dependent upon extent of sensory and motor loss to
organs of voice, respiration, pharynx, stomach and heart.8310 Neuritis.8410 Neuralgia.
Eleventh (spinal accessory, external branch) cranial nerve.8211 Paralysis of:
Complete...................................................... 30
Incomplete, severe............................................ 20
Incomplete, moderate.......................................... 10
Note: Dependent upon loss of motor function of sternomastoid
and trapezius muscles.8311 Neuritis.8411 Neuralgia.
Twelfth (hypoglossal) cranial nerve.8212 Paralysis of:
Complete...................................................... 50
Incomplete, severe............................................ 30
Incomplete, moderate.......................................... 10
Note: Dependent upon loss of motor function of tongue.8312 Neuritis.8412 Neuralgia.------------------------------------------------------------------------
Diseases of the Peripheral Nerves------------------------------------------------------------------------
Rating
Schedule of ratings -----------------
Major Minor------------------------------------------------------------------------The term ``incomplete paralysis,'' with this and other
peripheral nerve injuries, indicates a degree of lost
or impaired function substantially less than the type
picture for complete paralysis given with each nerve,
whether due to varied level of the nerve lesion or to
partial regeneration. When the involvement is wholly
sensory, the rating should be for the mild, or at
most, the moderate degree. The ratings for the
peripheral nerves are for unilateral involvement;
when bilateral, combine with application of the
bilateral factor.
Upper radicular group (fifth and sixth cervicals)
8510 Paralysis of:
Complete; all shoulder and elbow movements lost or 70 60
severely affected, hand and wrist movements not
affected...........................................
Incomplete:
Severe............................................ 50 40
Moderate.......................................... 40 30
Mild.............................................. 20 20
8610 Neuritis.8710 Neuralgia.
Middle radicular group
8511 Paralysis of:
Complete; adduction, abduction and rotation of arm, 70 60
flexion of elbow, and extension of wrist lost or
severely affected..................................
Incomplete:
Severe............................................ 50 40
Moderate.......................................... 40 30
Mild.............................................. 20 208611 Neuritis.8711 Neuralgia.
Lower radicular group
8512 Paralysis of:
Complete; all intrinsic muscles of hand, and some or 70 60
all of flexors of wrist and fingers, paralyzed
(substantial loss of use of hand)..................
Incomplete:
Severe............................................ 50 40
Moderate.......................................... 40 30
Mild.............................................. 20 208612 Neuritis.8712 Neuralgia.
All radicular groups
8513 Paralysis of:
Complete............................................ 90 80
Incomplete:
Severe............................................ 70 60
Moderate.......................................... 40 30
Mild.............................................. 20 208613 Neuritis.8713 Neuralgia.
The musculospiral nerve (radial nerve)
8514 Paralysis of:
Complete; drop of hand and fingers, wrist and 70 60
fingers perpetually flexed, the thumb adducted
falling within the line of the outer border of the
index finger; can not extend hand at wrist, extend
proximal phalanges of fingers, extend thumb, or
make lateral movement of wrist; supination of hand,
extension and flexion of elbow weakened, the loss
of synergic motion of extensors impairs the hand
grip seriously; total paralysis of the triceps
occurs only as the greatest rarity.................
Incomplete:
Severe............................................ 50 40
Moderate.......................................... 30 20
Mild.............................................. 20 208614 Neuritis.8714 Neuralgia.
Note: Lesions involving only ``dissociation of extensor communis
digitorum'' and ``paralysis below the extensor communis digitorum,''
will not exceed the moderate rating under code 8514.
The median nerve
8515 Paralysis of:
Complete; the hand inclined to the ulnar side, the 70 60
index and middle fingers more extended than
normally, considerable atrophy of the muscles of
the thenar eminence, the thumb in the plane of the
hand (ape hand); pronation incomplete and
defective, absence of flexion of index finger and
feeble flexion of middle finger, cannot make a
fist, index and middle fingers remain extended;
cannot flex distal phalanx of thumb, defective
opposition and abduction of the thumb, at right
angles to palm; flexion of wrist weakened; pain
with trophic disturbances..........................
Incomplete:
Severe............................................ 50 40
Moderate.......................................... 30 20
Mild.............................................. 10 108615 Neuritis.8715 Neuralgia.
The ulnar nerve
8516 Paralysis of:
Complete; the ``griffin claw'' deformity, due to 60 50
flexor contraction of ring and little fingers,
atrophy very marked in dorsal interspace and thenar
and hypothenar eminences; loss of extension of ring
and little fingers cannot spread the fingers (or
reverse), cannot adduct the thumb; flexion of wrist
weakened...........................................
Incomplete:
Severe............................................ 40 30
Moderate.......................................... 30 20
Mild.............................................. 10 108616 Neuritis.8716 Neuralgia.
Musculocutaneous nerve
8517 Paralysis of:
Complete; weakness but not loss of flexion of elbow 30 20
and supination of forearm..........................
Incomplete:
Severe............................................ 20 20
Moderate.......................................... 10 10
Mild.............................................. 0 08617 Neuritis.8717 Neuralgia.
Circumflex nerve
8518 Paralysis of:
Complete; abduction of arm is impossible, outward 50 40
rotation is weakened; muscles supplied are deltoid
and teres minor....................................
Incomplete:
Severe............................................ 30 20
Moderate.......................................... 10 10
Mild.............................................. 0 08618 Neuritis.8718 Neuralgia.
Long thoracic nerve
8519 Paralysis of:
Complete; inability to raise arm above shoulder 30 20
level, winged scapula deformity....................
Incomplete:
Severe............................................ 20 20
Moderate.......................................... 10 10
Mild.............................................. 0 0
Note: Not to be combined with lost motion above shoulder level.
8619 Neuritis.8719 Neuralgia.
Note: Combined nerve injuries should be rated by reference to the
major involvement, or if sufficient in extent, consider radicular
group ratings.------------------------------------------------------------------------ ------------------------------------------------------------------------
Rating------------------------------------------------------------------------
Sciatic nerve
8520 Paralysis of:
Complete; the foot dangles and drops, no active movement 80
possible of muscles below the knee, flexion of knee weakened
or (very rarely) lost.......................................
Incomplete:
Severe, with marked muscular atrophy....................... 60
Moderately severe.......................................... 40
Moderate................................................... 20
Mild....................................................... 108620 Neuritis.8720 Neuralgia.
External popliteal nerve (common peroneal)
8521 Paralysis of:
Complete; foot drop and slight droop of first phalanges of 40
all toes, cannot dorsiflex the foot, extension (dorsal
flexion) of proximal phalanges of toes lost; abduction of
foot lost, adduction weakened; anesthesia covers entire
dorsum of foot and toes.....................................
Incomplete:
Severe..................................................... 30
Moderate................................................... 20
Mild....................................................... 108621 Neuritis.8721 Neuralgia.
Musculocutaneous nerve (superficial peroneal)
8522 Paralysis of:
Complete; eversion of foot weakened.......................... 30
Incomplete:
Severe..................................................... 20
Moderate................................................... 10
Mild....................................................... 08622 Neuritis.8722 Neuralgia.
Anterior tibial nerve (deep peroneal)
8523 Paralysis of:
Complete; dorsal flexion of foot lost........................ 30
Incomplete:
Severe..................................................... 20
Moderate................................................... 10
Mild....................................................... 08623 Neuritis.8723 Neuralgia.
Internal popliteal nerve (tibial)
8524 Paralysis of:
Complete; plantar flexion lost, frank adduction of foot 40
impossible, flexion and separation of toes abolished; no
muscle in sole can move; in lesions of the nerve high in
popliteal fossa, plantar flexion of foot is lost............
Incomplete:
Severe..................................................... 30
Moderate................................................... 20
Mild....................................................... 108624 Neuritis.8724 Neuralgia.
Posterior tibial nerve
8525 Paralysis of:
Complete; paralysis of all muscles of sole of foot, 30
frequently with painful paralysis of a causalgic nature;
toes cannot be flexed; adduction is weakened; plantar
flexion is impaired.........................................
Incomplete:
Severe..................................................... 20
Moderate................................................... 10
Mild....................................................... 108625 Neuritis.8725 Neuralgia.
Anterior crural nerve (femoral)
8526 Paralysis of:
Complete; paralysis of quadriceps extensor muscles........... 40
Incomplete:
Severe..................................................... 30
Moderate................................................... 20
Mild....................................................... 10
8626 Neuritis.8726 Neuralgia.
Internal saphenous nerve
8527 Paralysis of:
Severe to complete........................................... 10
Mild to moderate............................................. 08627 Neuritis.8727 Neuralgia.
Obturator nerve
8528 Paralysis of:
Severe to complete........................................... 10
Mild or moderate............................................. 08628 Neuritis.8728 Neuralgia.
External cutaneous nerve of thigh
8529 Paralysis of:
Severe to complete........................................... 10
Mild or moderate............................................. 08629 Neuritis.8729 Neuralgia.
Ilio-inguinal nerve
8530 Paralysis of:
Severe to complete........................................... 10
Mild or moderate............................................. 08630 Neuritis.8730 Neuralgia.8540 Soft-tissue sarcoma (of neurogenic origin)................ 100
Note: The 100 percent rating will be continued for 6 months following
the cessation of surgical, X-ray, antineoplastic chemotherapy or
other therapeutic procedure. At this point, if there has been no
local recurrence or metastases, the rating will be made on residuals.------------------------------------------------------------------------
The Epilepsies------------------------------------------------------------------------
Rating------------------------------------------------------------------------
A thorough study of all material in Sec. Sec. 4.121 and
4.122 of the preface and under the ratings for epilepsy is
necessary prior to any rating action.8910 Epilepsy, grand mal.
Rate under the general rating formula for major seizures.8911 Epilepsy, petit mal.
Rate under the general rating formula for minor seizures.
Note (1): A major seizure is characterized by the generalized
tonic-clonic convulsion with unconsciousness.
Note (2): A minor seizure consists of a brief interruption in
consciousness or conscious control associated with staring or
rhythmic blinking of the eyes or nodding of the head
(``pure'' petit mal), or sudden jerking movements of the
arms, trunk, or head (myoclonic type) or sudden loss of
postural control (akinetic type).
General Rating Formula for Major and Minor Epileptic Seizures:
Averaging at least 1 major seizure per month over the last 100
year.......................................................
Averaging at least 1 major seizure in 3 months over the last 80
year; or more than 10 minor seizures weekly................
Averaging at least 1 major seizure in 4 months over the last 60
year; or 9-10 minor seizures per week......................
At least 1 major seizure in the last 6 months or 2 in the 40
last year; or averaging at least 5 to 8 minor seizures
weekly.....................................................
At least 1 major seizure in the last 2 years; or at least 2 20
minor seizures in the last 6 months........................
A confirmed diagnosis of epilepsy with a history of seizures 10
Note (1): When continuous medication is shown necessary for
the control of epilepsy, the minimum evaluation will be 10
percent. This rating will not be combined with any other
rating for epilepsy.
Note (2): In the presence of major and minor seizures, rate
the predominating type.
Note (3): There will be no distinction between diurnal and
nocturnal major seizures.8912 Epilepsy, Jacksonian and focal motor or sensory.8913 Epilepsy, diencephalic.
Rate as minor seizures, except in the presence of major and
minor seizures, rate the predominating type.8914 Epilepsy, psychomotor.
Major seizures:
Psychomotor seizures will be rated as major seizures under
the general rating formula when characterized by automatic
states and/or generalized convulsions with unconsciousness.
Minor seizures:
Psychomotor seizures will be rated as minor seizures under
the general rating formula when characterized by brief
transient episodes of random motor movements,
hallucinations, perceptual illusions, abnormalities of
thinking, memory or mood, or autonomic disturbances.------------------------------------------------------------------------Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome
will be rated separately under the appropriate diagnostic code (e.g.,
9304 or 9326). In the absence of a diagnosis of non-psychotic organic
psychiatric disturbance (psychotic, psychoneurotic or personality
disorder) if diagnosed and shown to be secondary to or directly
associated with epilepsy will be rated separately. The psychotic or
psychroneurotic disorder will be rated under the appropriate
diagnostic code. The personality disorder will be rated as a dementia
(e.g., diagnostic code 9304 or 9326).
Epilepsy and Unemployability: (1) Rating specialists must bear in mind
that the epileptic, although his or her seizures are controlled, may
find employment and rehabilitation difficult of attainment due to
employer reluctance to the hiring of the epileptic.(2) Where a case is encountered with a definite history of unemployment,
full and complete development should be undertaken to ascertain
whether the epilepsy is the determining factor in his or her inability
to obtain employment.(3) The assent of the claimant should first be obtained for permission
to conduct this economic and social survey. The purpose of this survey
is to secure all the relevant facts and data necessary to permit of a
true judgment as to the reason for his or her unemployment and should
include information as to:(a) Education;(b) Occupations prior and subsequent to service;(c) Places of employment and reasons for termination;(d) Wages received;(e) Number of seizures.(4) Upon completion of this survey and current examination, the case
should have rating board consideration. Where in the judgment of the
rating board the veteran's unemployability is due to epilepsy and
jurisdiction is not vested in that body by reason of schedular
evaluations, the case should be submitted to the Compensation Service
or the Director, Pension and Fiduciary Service. (Authority: 38 U.S.C. 1155) [29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005; 73 FR 54705, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 76 FR 78824, Dec. 20, 2011; 79 FR 2100, Jan. 13, 2014]
Mental Disorders