Rating Schedule for The Peripheral Nerves of the Low Back and Legs
The nerves of the upper back and arms. These nerves originate from the neck (cervical spine).
IMPORTANT NOTE:
If a Veteran it ambidextrous then whatever side is affected will be considered dominant.
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 rating for each arm! Know, the nerves ARE eligible for Bilateral factor.
You can only get ONE nerve evaluation per arm, no matter how many groups/individual nerves are impaired!
Groups & Individual Nerve Ratings
If a group of nerves are damaged they may be rated as a group. To be rated as a group, most or all of the nerves within the group must be affected.
Otherwise, if just some within a group are affected; the Veteran will get a singular evaluation based on the highest rated singular nerve.
Upper Radicular Group (Fifth and Sixth Cervicals)
Middle Radicular Group (Seventh Cervical)
Lower Radicular Group (Eighth Cervical and First Thoracic)
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.
Upper Radicular Group (Fifth and Sixth Cervicals)
Comes from the spinal cord at the base of the neck from the fifth and sixth cervical vertebrae.
This group includes:
Axillary (Circumflex) nerve
Long thoracic nerve
Median nerve
Musculocutaneous nerve
Radial (Musculospiral) nerve
Controls movement involved in:
Bending the elbow
Raising and lowering the arm to the side
Rotating the arm away from the body
Turning the forearm up or down
8510 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 20% | 20% | Incomplete (Mild). |
| 40% | 30% | Incomplete (Moderate). |
| 50% | 40% | Incomplete (Moderately-severe). |
| 70% | 60% | Complete (All shoulder and elbow movements lost or severely affected, hand and wrist movements not affected). |
Middle Radicular Group (Seventh Cervical)
Comes from the spinal cord at the base of the neck from the seventh cervical vertebrae.
This group includes:
Long thoracic nerve
Median nerve
Musculocutaneous nerve
Radial (Musculospiral) nerve
Controls movement involved in:
Bending the elbow
Lifting the hand up at the wrist
Raising the arm to the side
Turning the forearm up or down
8511 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 20% |
20% |
Incomplete (Mild). |
| 40% |
30% |
Incomplete (Moderate). |
| 50% |
40% |
Incomplete (Severe). |
| 70% |
60% |
Complete (Adduction, abduction and rotation of arm, flexion of elbow, and extension of wrist lost or severely affected). |
Lower Radicular Group (Eighth Cervical and First Thoracic)
Comes from the spinal cord at the base of the neck from the eighth cervical and first thoracic vertebrae.
This group includes:
Median nerve
Radial (Musculospiral) nerve
Ulnar nerve
Controls movement involved in:
Bending the hand up and down at the wrist
Curling the fingers
Moving the thumb straight outward away from the palm
Opening and closing the fingers
Turning the hand from side-to-side at the wrist
8512 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 20% | 20% | Incomplete (Mild). |
| 40% | 30% | Incomplete (Moderate). |
| 50% | 40% | Incomplete (Severe). |
| 70% | 60% | Complete (All intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand)). |
The Radial Nerve (Musculospiral Nerve)
Controls movement involved in:
Bending the elbow
Lifting the hand upward at the wrist
Moving the thumb straight outward away from the palm
Turning the forearm up or down
Turning the hand from side-to-side at the wrist
8514 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 20% | 20% | Incomplete (Mild). |
| 30% |
20% | Incomplete (Moderate). |
| 50% |
40% | Incomplete (Severe). |
| 70% |
60% | Complete (Drop of hand and fingers, wrist and 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). |
The Median Nerve
Controls movement involved in:
Bending the hand down at the wrist
Curling the fingers
Turning the forearm up and down
8515 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 10% | 10% | Incomplete (Mild). |
| 30% |
20% | Incomplete (Moderate). |
| 50% |
40% | Incomplete (Severe). |
| 70% |
60% | Complete (Hand inclined to the ulnar side, the 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). |
The Ulnar Nerve
Controls movement involved in:
Bending the hand down at the wrist
Curling the fingers
Lifting the hand upward at the wrist
Opening and closing the fingers
8516 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 10% | 10% | Incomplete (Mild). |
| 30% | 20% | Incomplete Moderate). |
| 40% | 30% | Incomplete (Severe). |
| 60% |
50% | Complete (The “griffin claw” deformity, due to 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). |
The Musculocutaneous Nerve
Controls movement involved in:
Bending the elbow
Turning the forearm so the palm faces up.
8517 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 0% | 0% | Incomplete (Mild). |
| 10% | 10% | Incomplete (Moderate). |
| 20% |
20% | Incomplete (Severe). |
| 30% | 20% | Complete (Weakness but not loss of flexion of elbow and supination of forearm). |
The Axillary Nerve (Circumflex Nerve)
Controls movement involved in:
Lifting the arm to the side
Twisting the arm out from the body
8518 Paralysis
| Dominant Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 0% | 0% | Incomplete (Mild). |
| 10% |
10% | Incomplete (Moderate). |
| 30% |
20% | Incomplete (Severe). |
| 50% |
40% | Complete (Abduction of arm is impossible, outward rotation is weakened; muscles supplied are deltoid and teres minor). |
The Long Thoracic Nerve (External respiratory nerve of Bell, Posterior Thoracic Nerve)
Controls movement involved in:
Lifting overhead
Punching
Throwing
And other motions of the shoulder bone
8519 Paralysis
| Rating |
Non-Dominant Rating |
Description |
|---|---|---|
| 0% | 0% | Incomplete (Mild). |
| 10% | 10% | Incomplete (Moderate). |
| 20% |
20% | Incomplete (Severe). |
| 30% | 20% | Complete (Inability to raise arm above shoulder level, winged scapula deformity). |
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