Nerve damage is a common condition that impacts veterans and is a consequence of various injuries, diseases or exposures to toxins during military service.
This article will provide information about various different types of nerve damage and how each is rated by the VA, along with the implications for additional benefits and connecting secondary conditions for higher ratings.
How VA Rates Nerve Damage
There are three categories that a nerve condition can be rated under:
Paralysis of the nerve
- Complete paralysis – The nerve is completely paralyzed AND the affected body part cannot function at all.
- Incomplete (severe) paralysis – The nerve is not completely paralyzed, and there are symptoms such as poor blood circulation and muscle atrophy which seriously limit the body part’s ability to function.
- Incomplete (moderate) paralysis – The nerve is not completely paralyzed, and there are symptoms such as tingling, numbness, and moderate pain which significantly affect the body part’s ability to fully function.
- Incomplete (mild) paralysis – The nerve is not completely paralyzed, and the only symptoms present are tingling or mild pain.
Neuritis
The nerve can still function, but it is swollen, irritated, and very painful. Neuritis of the nerve involves at least one of the following; 1) a decreased ability to sense, 2) muscle atrophy, and/or 3) loss of reflexes. There are several degrees of neuritis:
- Severe – All three symptoms (loss of sensation, muscle atrophy, and loss of reflexes) are present, and seriously limit the affected body part’s ability to function.
- Moderate – One or more of the main symptoms are present and they definitely and significantly interfere with the affected body part’s ability to function.
- Mild – One or more of the main symptoms are present but are only mild and do not significantly interfere with the affected body part’s ability to function.
Neuralgia
The nerve causes occasional or constant pain. Additional symptoms may include tingling and numbness. Neuralgia can be:
- Moderate – Symptoms such as tingling, numbness, and moderate to severe pain which definitely and significantly interfere with the affected body part’s ability to function.
- Mild – Symptoms such as tingling or mild pain. There may also be slight or mild limitations involving the movement of the affected body part, but the limitations do not really affect the body part’s overall functioning.
Are Nerve Condition Ratings Affected by the Specific Nerve?
All nerve conditions are rated according to the above categories, but the ultimate rating assigned to a nerve condition depends on the actual nerve affected. If a veteran has radiculopathy affecting the sciatic nerve, the VA will decide which category best approximates the symptoms the veteran is experiencing, and then will look at the rating criteria associated with that category for the sciatic nerve.
So, when rating a nerve condition, the VA looks at three things:
- the VA first decides whether the condition should be rated under paralysis, neuritis, or neuralgia;
- the VA decides the corresponding level of severity; and
- the VA looks at the actual nerve affected.
The Bilateral Factor
When checking to see whether you’ve received the correct rating for your nerve condition, be sure to check and see if the VA remembered to apply the bilateral factor. If your nerve condition affects both sides of the body, you should receive a separate rating for each side affected along with receiving the additional bilateral factor.
For example, if your nerve condition affects both the left leg and the right leg, you should have a rating for each leg, and the bilateral factor should be applied to your overall combined rating.
What if you have limited motion and a separate nerve condition?
Ratings for nerve conditions are based on the loss of function of the certain body part affected. This becomes especially important when looking at the paralysis ratings. Just because the nerve itself is completely paralyzed, does not mean the condition will be rated as completely paralyzed.
In order for the condition to be rated as completely paralyzed, the body part affected by the nerve condition must be paralyzed. So, if a nerve in the shoulder is completely paralyzed, but the shoulder can still move, then it would be rated under one of the incomplete paralysis criteria. However, if the shoulder can no longer move the arm or function at all, THEN the nerve condition will be rated under paralysis.
A nerve condition can be rated under paralysis, neuritis, or neuralgia, or it can be rated according to limited motion caused by the condition, whichever results in the higher rating.
If the limited motion is a result of the nerve condition, you cannot receive a rating under one of the three nerve categories AND under limited motion; you can only receive one rating. On the other hand, if the limited motion is NOT caused by the nerve condition, you can receive two separate ratings; one for the nerve condition, and one for the limited motion.
What Is the VA Rating for Nerve Damage by Type of Nerve?
Spinal Nerve Damage
Spinal nerve damage, or radiculopathy, is typically caused by nerve compression in the spine. This leads to:
- Pain that radiates from the spine to limbs.
- Numbness or weakness in the extremities.
What Is the VA Rating for Spinal Nerve Damage?
VA ratings for spinal nerve damage can range from 10% to 60%, based on the extent of functional impairment.
Cranial Nerve Damage
Damage to cranial nerves can affect facial muscles, vision, hearing and swallowing.
The VA ratings for cranial nerve damage range from 0% to 60%, depending on the specific cranial nerve affected and the degree of functional loss experienced.
Peripheral Nerve Damage
Peripheral nerve damage affects nerves outside the brain and spinal cord, with symptoms such as pain and sensory loss. It is rated by VA from 10% to as high as 100% in severe cases, based on impact on motor function and daily activities.
Rating Peripheral Nerve Damage Correctly
Peripheral nerves are the nerves that travel from the spinal cord to the rest of the body. VA disability claims involving nerves in the lower back and the legs can be complex due to the fact that the larger nerves split off into smaller nerves as they go down the leg.
Peripheral Nerves in the Lower Back That Can Be Rated for VA Disability
- Sciatic nerve: This is the largest single nerve in the entire human body. It runs from each side of the lower spine through the buttocks, down the back of the thigh, and down to the foot. The sciatic nerve’s job includes connecting the spinal cord with the leg and foot muscles.
- Tibial nerve: The tibial nerve branches off the sciatic nerve just above the knee. It goes down the back of the leg and then around the ankle to ultimately pass through the tarsal tunnel into the inner foot. This nerve controls movements such as pointing and flexing the foot, turning the foot so the toes point inward, spreading and closing the toes, and curling the toes.
- Posterior tibial nerve: This nerve begins where the tibial nerve curves around the ankle. The posterial tibial nerve goes through the tarsal tunnel on the inside of the ankle and into the arch of the foot. This nerve controls movements such as turning the foot inward to that the toes point inward, pointing and flexing the toes, spreading and closing the toes, and curling the toes.
- Common peroneal nerve: This nerve also splits off from the sciatic nerve above the knee. It then goes around the kneecap and down the front of the shin. The common peroneal nerve controls movements such as pointing and flexing the foot, turning your feet so you can stand on the outer edge of the foot, and turning the feet outward.
- Deep peroneal nerve: This nerve breaks off from the common peroneal nerve right below the knee where it then goes down the leg into the foot and toes. It controls movements such as pointing and flexing your toes and turning your feet, so you stand on the outer edge.
- Superficial peroneal nerve: This nerve breaks off from the common peroneal nerve right below the knee, down the outside of the leg, and into the foot and toes. It controls movements such as pointing and flexing your toes and turning your feet, so you stand on the outer edge.
- Ilioguinal nerve: The ilioguinal nerve branches off from the spinal cord in the low back, where it then curves around the hips to the abdomen, and finally ends in the groin. This nerve is responsible for providing feeling to the skin in the upper thigh and groin areas.
- Obturator nerve: This nerve branches off from the spinal cord in the lower back and goes down the leg into the inner thigh. The obturator nerve assists with things such as lifting your leg to the front, crossing the leg inward across the other leg, lifting your leg to the side, and turning the hip so your knee goes across the other leg or out to the side.
- Femoral nerve: The femoral nerve goes around the outside of the hip where it then travels down the thigh. Movements such as kicking the leg forward, straightening the leg at the knee, and lifting the torso from the hips are controlled by the femoral nerve.
- Internal saphenous nerve: This nerve comes off of the femoral nerve in the thigh and is responsible for providing feeling to the skin at the inside of the thigh and calf, and the top of the foot.
- Lateral femoral cutaneous nerve: The lateral femoral cutaneous nerve goes into the front and back of the thigh and is responsible for providing feeling to the skin in the front and back of the thigh.
For the sciatic nerve, tibial nerve, posterior tibial nerve, common peroneal nerve, deep peroneal nerve, and superficial peroneal nerve, be sure to check and see if you would be entitled to a higher rating under the criteria for limited motion of the ankle. For the obturator nerve, and femoral nerve check and see if you could get a higher rating under the criteria for limited motion of the hip.
Peripheral Nerves of the Upper Body
The peripheral nerves in the upper back and neck go into the shoulders and arms.
- Radial nerve: This is one of the most significant nerves in the shoulder, arm, and hand. The radial nerve controls movements such as bending the elbow, turning the forearm up or down, lifting the hand upward at the wrist, turning the hand from side to side, and moving the thumb straight away from the palm.
- Median nerve: This nerve is in the forearm and hand and passes through the carpal tunnel in the wrist. It is the nerve affected by carpal tunnel syndrome and controls movements such as turning the forearm up or down, curling the fingers, and bending the hand down at the wrist.
- Ulnar nerve: One of the biggest nerves in the arm, passing behind the elbow, through the wrist, and to the little finger and ring fingers. The ulnar nerve controls movements such as curling the fingers, bending the hand down at the wrist, opening and closing the fingers, and lifting the hand upward.
- Musculocutaneous nerve: The musculocutaneous nerve is found in the arm, and assists other nerves control movements in the elbow and forearm
- Axillary nerve: This nerve controls the deltoid and teres minor muscles that are found in the upper arm.
- Long thoracic nerve: This nerve is responsible for controlling the muscles in the rib cage underneath the arm. It is necessary for movements such as lifting overhead, throwing, punching, and/or other movements involving the scapula bone. The long thoracic nerve also plays a role in expanding the ribs when breathing.
As with all nerve conditions, the VA looks at which specific nerve is affected in order to rate the condition. However, when rating conditions involving the peripheral nerves of the upper back/neck and the arms, the VA also considers whether an entire group of nerves is affected. The following nerve groups (called radicular groups) are involved with rating the nerves of the upper back/neck and arms:
- Upper radicular group: The upper radicular group includes the long thoracic nerve, median nerve, radial nerve, musculocutaneous nerve, axillary nerve, and all nerves that offshoot from these. The nerves of the upper radicular group are associated with movements such as raising and lowering the arm to the side, bending the elbow, turning the forearm up or down, and rotating the arm away from the body.
- Middle radicular group: This group includes the long thoracic nerve, musculocutaneous nerve, median nerve, and radial nerve and controls movements such as raising the arm to the side, lifting the hand up at the wrist, bending the elbow, and turning the forearm up or down.
- Lower radicular group: The radial nerve, median nerve, and ulnar nerve make up the lower radicular group. The lower radicular group nerves control the ability to bend the hand up at the wrist, turn the hand from side to side at the wrist, curl the fingers, bend the hand down at the wrist, open and close the fingers, and move the thumb straight away from the palm of the hand.
Each peripheral nerve of the upper back/neck and the arms contains their own diagnostic codes for rating purposes. If all or most of the nerves in a particular radicular group are affected, then the VA will rate the condition according to the radicular group affected (upper, middle, or lower).
For each nerve or each radicular group affected, be sure to check and see if you would be able to receive a higher rating based on the limitation of motion. The peripheral nerves of the upper back/neck and arms are associated with limited motion in the shoulder, elbow, forearm, wrist, and fingers.
Additionally, when dealing with the upper peripheral nerves, the VA rating criteria will consider whether the side of the body affected is the veteran’s dominant arm/hand.
Lastly, when deciding whether to rate a nerve condition according to a specific nerve versus a radicular group, look at whether the majority of movements associated with a certain group are affected.
If only a couple nerves in one of the radicular groups are affected, the condition should be rated according to the specific nerve affected. A good rule of thumb is to make sure that the nerve or radicular group the VA uses for rating best approximates the overall function of the arm that has been affected.
Maximizing Nerve Damage Ratings and Benefits
Nerve damage can lead to secondary health issues, which can also be rated by the VA, potentially increasing overall disability ratings.
Secondary Conditions Related to Nerve Damage
- Chronic pain syndrome
- Musculoskeletal problems
- Bladder or bowel dysfunction
- Psychological conditions like depression
- Skin conditions due to sensory loss
TDIU for Severe Nerve Damage
Veterans whose nerve damage severely limits their ability to work might qualify for Total Disability Individual Unemployability (TDIU).
This designation allows for compensation at the 100% disability rate, even if the veteran’s combined disability rating is lower.
Veterans are encouraged to explore this option if their nerve damage prevents them from maintaining gainful employment.
Click here to learn all you need to know about IU benefits.
Cassandra Crosby, an Accredited Agent and claims advocate for Matthew Hill & Shelly Mark’s teams, reviewed the information provided in this post.
