Rating Schedule for The Peripheral Nerves of the Low Back and Legs
The Nerves of the lower back and lower.
PYRAMIDING NOTES:
Nerves can only be rated under ONE Category; whichever is the primary disability.
There are a pair of nerves (each controlling a side of the body). As such, the veteran CAN get a separate rating for each leg! Know, the nerves ARE eligible for Bilateral factor.
Nerve Groupings
The following list shows which nerves are allowed to be rated separately and which must be rated together:
Lower extremity nerves boil down to 3 groupings. Nerves within groups 1 and 2 CANNOT be rated separately within their own groups. But a nerve in group 1 CAN be rated separately from groups 2 and 3; likewise a nerve in group 2 CAN be rated separately from groups 1 and 3. Finally, nerves in group 3 CAN be rated separately from ALL nerves, even those within group 3!
If more than one nerve is impaired within group 1; Veterans gets a single evaluation for group 1; whichever gives the highest evaluation.
If more than one nerve is impaired within group 2; Veterans gets a single evaluation for group 2; whichever gives the highest evaluation.
Categorizes & Severity Explained
Nerve conditions are placed into 1 of 3 categories which are then rated upon their severity.
RATER NOTES:
Most conditions are simply rated as paralysis of the nerve, as it offers the highest evaluations and generally covers most symptoms.
If a Veteran has a current diagnosis AND reports any symptoms, the severity MUST at least be mild! Even if the examiner notes there are no symptoms!
NEVER assign an evaluation higher than moderate if symptoms cannot be tested for or seen; It does NOT matter if the Veteran reports severe pain!
Moderate evaluations and above require symptoms which an examiner can test for. Be it decreased sensitivity, reduced reflexes, muscle weakness/atrophy, impairment of function (shaking, slow movements, joints are stiff), and/or loss of hair growth.
Do know, even if the Veteran does have a testable symptom; It does NOT mean that an evaluation of at least moderate is required or appropriate. There can be cases in which a mild evaluation is still the most appropriate decision.
IMPORTANT NOTE:
There can be a fair bit of differences of opinions as to how to rate nerve severity. So if you got a mild when you thought you should have gotten at least moderate, filing a Higher level review may be a good idea.
Paralysis (1)
Inability to control or sense.
Incomplete (Mild) - Feelings of tingling or mild pain. Some mild ROM impacts.
Incomplete (Moderate) - Feelings of tingling, numbness, moderate pain, or other symptoms that do interfere with ability to function.
Incomplete (Severe) - Ability to function is seriously limited. Symptoms might include things like poor blood circulation and loss of muscle mass.
Complete - No sensation or control, basically it is gone.
Neuritis (2)
Pain or numbness without nerve degeneration or objective signs of nerve dysfunction (the doctor seeing/finding it).
Mild - Loss of sensation, loss of muscle mass, or loss of reflexes. The total impact does not significantly impacts ability to function.
Moderate - Loss of sensation, loss of muscle mass, or loss of reflexes. The total impact significantly impacts ability to function.
Severe - Loss of sensation, loss of muscle mass, and loss of reflexes. The total impact seriously impacts ability to function.
Neuralgia (3)
Stabbing, burning, and often severe pain due to an irritated or damaged nerve.
Mild - Tingling or mild pain. The total impact does not really affect overall function.
Moderate - Tingling, numbness, or moderate to severe pain. That total impact significantly impacts ability to function.
The Sciatic Nerve (Ischiadic Nerve, Ischiatic Nerve, Sciatica)
Starts in the lower back and runs down each leg.
It is a major player in allowing leg, foot, and hip movements.
8520 Paralysis
| Rating |
Description |
|---|---|
| 10% | Incomplete (Mild). |
| 20% | Incomplete (Moderate). |
| 40% | Incomplete (Moderately-severe). |
| 60% | Incomplete (Severe - marked muscular atrophy). |
| 80% | Complete (Foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost). |
The Tibial Nerve (Internal Popliteal Nerve)
Branches off from the sciatic nerve just above the knee. It then goes down the back of the leg before it moves around the ankle to pass through the tarsal tunnel into the inner foot. It must be damaged before it moves around the ankle, to be rated under this schedule. If damaged after, it is rated under the Posterior Tibial Nerve.
Controls movement of the foot and toes.
8524 Paralysis
| Rating |
Description |
|---|---|
| 10% |
Incomplete (Mild). |
| 20% |
Incomplete (Moderate). |
| 30% |
Incomplete (Severe). |
| 40% |
Complete (Plantar flexion lost, frank adduction of foot 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. |
The Posterior Tibial Nerve
Starts where the tibial nerve curves around the ankle and continues into the arch of the foot. If damaged before it moves around the ankle and passes through the tarsal tunnel, then it is rated under the Tibial Nerve schedule.
Controls movement of the foot and toes.
8525 Paralysis
| Rating |
Description |
|---|---|
| 10% |
Incomplete (Mild or Moderate). |
| 20% |
Incomplete (Severe). |
| 30% |
Complete (Paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired). |
Common Peroneal Nerve (Common Fibular Nerve, External Popliteal Nerve, Lateral Popliteal Nerve, Peroneal Nerve)
Branches from the sciatic nerve just above the knee. It then moves around the kneecap to the front of the shin.
Controls movement of the foot.
8521 Paralysis
| Rating |
Description |
|---|---|
| 10% |
Incomplete (Mild). |
| 20% |
Incomplete (Moderate). |
| 30% |
Incomplete (Severe). |
| 40% |
Complete (Foot drop and slight droop of first phalanges of 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). |
The Deep Peroneal Nerve (Anterior Tibial Nerve, Deep Fibular Nerve)
Branches from common peroneal nerve just below the knee. It then moves down the leg and into the foot and toes.
Controls movement of the foot.
8523 Paralysis
| Rating |
Description |
|---|---|
| 0% |
Incomplete (Mild). |
| 10% |
Incomplete (Moderate). |
| 20% |
Incomplete (Severe). |
| 30% |
Complete (Dorsal flexion of foot lost). |
The Superficial Peroneal Nerve (Musculocutaneous nerve, Superficial Fibular Nerve)
Branches from common peroneal nerve just below the knee. It then moves outside of the leg and into the foot and toes.
Controls movement of the foot and toes.
8522 Paralysis
| Rating |
Description |
|---|---|
| 0% |
Incomplete (Mild). |
| 10% |
Incomplete (Moderate). |
| 20% |
Incomplete (Severe). |
| 30% |
Complete (Eversion of foot weakened). |
The Ilioinguinal Nerve (Ilio-inguinal Nerve)
Comes from the spinal cord and moves around the hips to the abdomen, ending in the groin.
Controls no movement but does provide feeling to the skin in the upper thigh and groin.
8530 Paralysis
| Rating |
Description |
|---|---|
| 0% |
Incomplete (Mild or Moderate). |
| 10% |
Incomplete (Severe) or Complete. |
The Femoral Nerve (Anterior Crural Nerve)
Comes from the spinal cord and moves around outside of the hip towards the abdomen, and then moves down the thigh.
Controls movement of the knee and leg.
8526 Paralysis
| Rating |
Description |
|---|---|
| 10% |
Incomplete (Mild). |
| 20% |
Incomplete (Moderate). |
| 30% |
Incomplete (Severe). |
| 40% |
Complete (Paralysis of quadriceps extensor muscles). |
The Internal Saphenous Nerve (Long Saphenous Nerve, Saphenous Nerve)
Branches off the femoral nerve in the thigh.
Does not controls movement, but does give feeling to the inside of the thigh, calf, and top of the foot.
8527 Paralysis
| Rating |
Description |
|---|---|
| 0% |
Incomplete (Mild or Moderate). |
| 10% |
Incomplete (Severe) or Complete. |
The Lateral Femoral Cutaneous Nerve (External Cutaneous Nerve, Lateral Cutaneous Nerve)
Comes from the spinal cord then moves around side of the hip and splits into two branches that go to the front and back of the thigh, it provides feeling to the skin of the front and back thigh.
Does not controls movement, but does give feeling to the front and back of the thigh.
8529 Paralysis
| Rating |
Description |
|---|---|
| 0% |
Incomplete (Mild or Moderate). |
| 10% |
Incomplete (Severe) or Complete. |
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