Neurological Overview

This rating schedule section includes: organic diseases and traumatic injury to the central nervous system; miscellaneous neurologic diseases; diseases of the cranial nerves; diseases of the peripheral nerves; and epileptic conditions. The central nervous system, peripheral nervous system and the autonomic nervous system are involved. The central nervous system includes the brain and spinal cord; the peripheral nervous system that includes nerves and ganglia outside of the brain and spinal cord; and the autonomic nervous system that distributes nerves to smooth muscles and internal organs, ultimately, acting to control unconscious, vital body functions.

The nervous system connects all functions of the body, enabling individuals to receive and adapt to input from internal and external environments. Information received from the environments is analyzed by the brain, and then is transmitted to appropriate body areas or parts. The basic component of the system is the nerve cell (neuron) which is the structural and functional unit.

Conduction of sensory impulses toward the brain and spinal cord are termed afferent neurons. Efferent neurons convey motor impulses away from the brain and spinal cord.

The brain is composed of neurons and supporting cells, and includes the cerebrum, cerebellum, and brainstem (medulla, pons, and midbrain). The brainstem provides the connection with the spinal cord. Bone, membranes (meninges), and cerebrospinal fluid protect the brain and spinal cord. The bony skull surrounds the brain and the spinal cord, and the spinal cord exits at the base of the structure. The vertebral column, consisting of vertebra, protects the spinal cord. The meninges form a covering for the cerebrum and the spinal column. Cerebrospinal fluid provides a cushion for the brain, but also serves to nourish cells and transport waste.

The brain serves to regulate and coordinate body activities. The cerebrum is divided into the left and right hemispheres, which are connected by the corpus callosum (a mass of nerve cells). Each of the hemispheres consists of four lobes; frontal lobe, temporal lobe, parietal lobe, and occipital lobe. Each of the lobes has specific functions, e.g., frontal-language, temporal-hearing, parietal-integration of sensations, and occipital-interpretation of visual stimuli. The cerebellum consists of two hemispheres and is connected to the brainstem by bundles of fibers. The cerebellum helps to control coordination and balance. The brainstem is the center for relaying messages to the upper and lower levels of the nervous system. Cranial nerves that control muscles of the face, eyes, tongue, ears, and throat exit from the brainstem. These nerves also transfer sensations from the structures listed above back to the brain.

The peripheral nervous system includes the cranial nerves, spinal nerves, and the autonomic nervous system. Twelve pairs of cranial nerves carry out the transmission of motor or sensory messages, or both. The primary areas are between the brain and the brainstem. There are 31 pairs of spinal nerves consisting of efferent and afferent neurons which carry messages to and from various parts of the body. The parts of the system are named in accordance with the spinal regions from which they branch. The spinal cord is the means through which signals are transferred back and forth between the brain and parts of the body.

The nerves of the autonomic nervous system carry messages to body organs from the brainstem. All smooth muscles are innervated. The parasympathetic and sympathetic systems are divisions of the autonomic nervous systems. Fibers for most of the body organs or structures are provided by each of the systems.

Neurological Conditions and Convulsive Disorders

General Considerations for Rating

  • Evaluations by comparison.

    Disability in this field is ordinarily to be rated 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, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 CFR §4.120 [Schedule of ratings-neurological conditions and convulsive disorders]

  • Additional Autonomic and Visceral Manifestations.

    With regard to etiology and manifestations as well as severity, the field of nervous and mental diseases includes as varied a group as any field in medicine. In regards to relationship to service or disabling effects, these diseases must be viewed not as a class, but individually, bearing in mind the etiology and clinical course of each separate disease. Consider conditions of infectious origin with regard to the circumstances of infection, the incubation period, etc. Diagnoses reflecting traumatic origin require trauma adequate to produce the result. There is a large group of diseases, such as multiple sclerosis, progressive muscular atrophy, and myasthenia gravis, in which increase, over a period of a few months, generally reflects mere natural progress. (M21-1MR, Part III, Subpart iv, Chapter 4, Section H, Topic 27 [Psychiatric Conditions])

  • Psychiatric conditions.

    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. 38 CFR §4.124 (a) [Schedule of ratings-neurological conditions and convulsive disorders]

  • Residuals of Traumatic Brain Injury (TBI)

    The designation of TBI as mild, moderate, or severe is made at or close to the time of the initial injury and is a determination of acute injury severity. Once this acute level of severity is determined, it does not change, regardless of the veteran's course of residuals. While this classification has a rough correlation with prognosis, it is not a strict correlation, so that TBI classified as mild, for example, does not necessarily equate to mild disability or mean that residuals will be mild. Classification of the level of severity has no bearing on C&P evaluations.

Regarding the requirements for clinical signs immediately following the traumatic event, note that only one of the five findings under the DoD/VA definition of TBI is needed for the diagnosis. Any one of the five findings listed below is sufficient for the diagnosis. If a patient meets criteria in more than one category of severity, the higher severity level is assigned.

  • Any period of loss of or a decrease in level of consciousness

  • Any loss of memory for events immediately before or after the injury

  • Any alteration in mental state at the time of the injury (such as confusion, disorientation, slowed thinking, etc.)

  • Neurological deficits that may or may not be transient (such as weakness, loss of balance, change in vision, praxis, paresis/paralysis, sensory loss, aphasia)

  • Intracranial lesion (direct injury to brain tissue)

While discussions of the evaluation of residuals of TBI into mild versus moderate or severe TBI, it is the actual findings in each case that determine what types of conditions will need evaluation and therefore which set of guidelines are most appropriate to follow.

Avoid pyramiding. Evaluate each residual disability separately as long as the same signs and symptoms are not used to support more than one evaluation. Then, combine the evaluations. Symptoms of cognitive impairment and mental disorders such as depression and PTSD often overlap. In such cases, a single evaluation taking into account both conditions may be the most appropriate way to evaluate them.

When there is no diagnosis of a mental disorder, or when there is a diagnosis of a mental disorder but there are behavioral/emotional symptoms that are reported to be residuals of TBI, and not attributed to a mental disorder, evaluate them under "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified". In that case, do not also assign an evaluation based on the same behavioral/emotional symptoms as noted in provisions 38 CFR 4.14.

Do not overlook the additional injuries that may also be present in a veteran with TBI - burns, shrapnel wounds, fractures, amputations, spine injuries, etc. Please request separate examination to determine the residuals of these injuries and base your evaluation on the examiners findings. (Also note the new changes in the rating schedule dealing with scars.)

Problematic Issues

  • Fibromyalgia

  • Myasthenia Gravis

  • Multiple Sclerosis

  • Nerve Damage

  • Tic Douloureux

  • Residuals of Traumatic Brain Injury (TBI)

Organic Disease

Diagnostic Code Name VA Exam Acronym
8000 Encephalitis, epidemic, chronic Brain & Spinal Cord E, ENLI
8002 Brain, malignant Brain & Spinal Cord ---
8003 Brain, benign, minimum Brain & Spinal Cord ---
8004 Paralysis agitans Brain & Spinal Cord PAJ
8005 Bulbar palsy Brain & Spinal Cord ---
8007 Brain, vessels, embolism of Brain & Spinal Cord ---
8008 Brain, vessels, thrombosis of Brain & Spinal Cord ---
8009 Brain, vessels, hemorrhage from Brain & Spinal Cord ---
8010 Myelitis Brain & Spinal Cord ---
8011 Poliomyelitis, anterior Brain & Spinal Cord POLIO, PM
8012 Hematomyelia Brain & Spinal Cord ---
8013 Syphilis, cerebrospinal Brain & Spinal Cord SY, SYPH, VDS
8014 Syphilis, meningovascular Brain & Spinal Cord SY, SYPH, VDS
8015 Tabes dorsalis Brain & Spinal Cord ---
8017 Amyotrophic lateral sclerosis Brain & Spinal Cord ALS
8018 Multiple sclerosis Brain & Spinal Cord MS
8019 Meningitis, cerebrospinal, epidemic Brain & Spinal Cord MEGI
8020 Brain, abscess of Brain & Spinal Cord ---
8021 Spinal cord, malignant Brain & Spinal Cord ---
8022 Spinal cord, benign, minimum rating Brain & Spinal Cord ---
8023 Progressive muscular atrophy Brain & Spinal Cord ---
8024 Syringomyelia Brain & Spinal Cord ---
8025 Myasthenia gravis Brain & Spinal Cord MG
8045 Residuals of Traumatic Brain Injury (TBI) Traumatic Brain Injury TBI
8046 Cerebral arteriosclerosis Brain & Spinal Cord ---

Miscellaneous Diseases

Diagnostic Code Name VA Exam Acronym
8100 Migraine Neurological, miscellaneous MIGR, MIHAC
8103 Tic, convulsive Neurological, miscellaneous ---
8104 Paramyoclonus multiplex (convulsive state, myoclonic type) Neurological, miscellaneous ---
8105 Chorea, sydenham's Neurological, miscellaneous ---
8106 Chorea, huntington's Neurological, miscellaneous ---
8107 Athetosis, acquired Neurological, miscellaneous ---
8108 Narcolepsy Neurological, miscellaneous ---

Cranial Nerve Diseases

Diagnostic Code Category Name VA Exam
8205 Fifth (trigeminal) Cranial Nerve Fifth (trigeminal) cranial nerve-Paralysis of Cranial Nerves
8305 Fifth (trigeminal) Cranial Nerve Fifth (trigeminal) cranial nerve-Neuritis Cranial Nerves
8405 Fifth (trigeminal) Cranial Nerve Fifth (trigeminal) cranial nerve-Neuralgia Cranial Nerves
8207 Seventh (facial) Cranial Nerve Seventh (facial) cranial nerve-Paralysis of Cranial Nerves
8307 Seventh (facial) Cranial Nerve Seventh (facial) cranial nerve-Neuritis Cranial Nerves
8407 Seventh (facial) Cranial Nerve Seventh (facial) cranial nerve-Neuralgia Cranial Nerves
8209 Ninth (glossopharyngeal) Cranial Nerve Ninth (glossopharyngeal) cranial nerve-Paralysis of Cranial Nerves
8309 Ninth (glossopharyngeal) Cranial Nerve Ninth (glossopharyngeal) cranial nerve-Neuritis Cranial Nerves
8409 Ninth (glossopharyngeal) Cranial Nerve Ninth (glossopharyngeal) cranial nerve-Neuralgia Cranial Nerves
8210 Tenth (pneumogastric, vagus) Cranial Nerve Tenth (pneumogastric, vagus) cranial nerve-Paralysis of Cranial Nerves
8310 Tenth (pneumogastric, vagus) Cranial Nerve Tenth (pneumogastric, vagus) cranial nerve-Neuritis Cranial Nerves
8410 Tenth (pneumogastric, vagus) Cranial Nerve Tenth (pneumogastric, vagus) cranial nerve-Neuralgia Cranial Nerves
8211 Eleventh (spinal accessory, external branch) Cranial Nerve Eleventh (spinal accessory, external branch) cranial nerve-Paralysis of Cranial Nerves
8311 Eleventh (spinal accessory, external branch) Cranial Nerve Eleventh (spinal accessory, external branch) cranial nerve-Neuritis Cranial Nerves
8411 Eleventh (spinal accessory, external branch) Cranial Nerve Eleventh (spinal accessory, external branch) cranial nerve-Neuralgia Cranial Nerves
8212 Twelfth (hypoglossal) Cranial Nerve Twelfth (hypoglossal) cranial nerve-Paralysis of Cranial Nerves
8312 Twelfth (hypoglossal) Cranial Nerve Twelfth (hypoglossal) cranial nerve-Neuritis Cranial Nerves
8412 Twelfth (hypoglossal) Cranial Nerve Twelfth (hypoglossal) cranial nerve-Neuralgia Cranial Nerves

Peripheral Nerve Diseases - Upper Extremity

Diagnostic Code Category Name VA Exam
8510 Upper Radicular Group Upper radicular group (fifth and sixth cervicals), Paralysis of Peripheral Nerves
8610 Upper Radicular Group Upper radicular group (fifth and sixth cervicals), Neuritis Peripheral Nerves
8710 Upper Radicular Group Upper radicular group (fifth and sixth cervicals), Neuralgia Peripheral Nerves
8511 Middle Radicular Group Middle radicular group, Paralysis of Peripheral Nerves
8611 Middle Radicular Group Middle radicular group, Neuritis Peripheral Nerves
8711 Middle Radicular Group Middle radicular group, Neuralgia Peripheral Nerves
8512 Lower Radicular Group Lower radicular group, Paralysis of Peripheral Nerves
8612 Lower Radicular Group Lower radicular group, Neuritis Peripheral Nerves
8712 Lower Radicular Group Lower radicular group, Neuralgia Peripheral Nerves
8513 All Radicular Groups All radicular groups, Paralysis of Peripheral Nerves
8613 All Radicular Groups All radicular groups, Neuritis Peripheral Nerves
8713 All Radicular Groups All radicular groups, Neuralgia Peripheral Nerves
8514 The Musculospiral Nerve (radial) The musculospiral nerve (radial nerve), Paralysis of Peripheral Nerves
8614 The Musculospiral Nerve (radial) The musculospiral nerve (radial nerve), Neuritis Peripheral Nerves
8714 The Musculospiral Nerve (radial) The musculospiral nerve (radial nerve), Neuralgia Peripheral Nerves
8515 The Median Nerve The median nerve, Paralysis of Peripheral Nerves
8615 The Median Nerve The median nerve, Neuritis Peripheral Nerves
8715 The Median Nerve The median nerve, Neuralgia Peripheral Nerves
8516 The Ulnar Nerve The ulnar nerve, Paralysis of Peripheral Nerves
8616 The Ulnar Nerve The ulnar nerve, Neuritis Peripheral Nerves
8716 The Ulnar Nerve The ulnar nerve, Neuralgia Peripheral Nerves
8517 Musculocutaneous Nerve Musculocutaneous nerve, Paralysis of Peripheral Nerves
8617 Musculocutaneous Nerve Musculocutaneous nerve, Neuritis Peripheral Nerves
8717 Musculocutaneous Nerve Musculocutaneous nerve, Neuralgia Peripheral Nerves
8518 Circumflex Nerve Circumflex nerve, Paralysis of Peripheral Nerves
8618 Circumflex Nerve Circumflex nerve, Neuritis Peripheral Nerves
8718 Circumflex Nerve Circumflex nerve, Neuralgia Peripheral Nerves
8519 Long Thoracic Nerve Long thoracic nerve, Paralysis of Peripheral Nerves
8619 Long Thoracic Nerve Long thoracic nerve, Neuritis Peripheral Nerves
8719 Long Thoracic Nerve Long thoracic nerve, Neuralgia Peripheral Nerves

Peripheral Nerve Diseases - Lower Extremity

Diagnostic Code Category Name VA Exam
8520 Sciatic Nerve Sciatic nerve, Paralysis of Peripheral Nerves
8620 Sciatic Nerve Sciatic nerve, Neuritis Peripheral Nerves
8720 Sciatic Nerve Sciatic nerve, Neuralgia Peripheral Nerves
8521 External Popliteal Nerve (common peroneal) External popliteal nerve (common peroneal), Paralysis of Peripheral Nerves
8621 External Popliteal Nerve (common peroneal) External popliteal nerve (common peroneal), Neuritis Peripheral Nerves
8721 External Popliteal Nerve (common peroneal) External popliteal nerve (common peroneal), Neuralgia Peripheral Nerves
8522 Musculocutaneous Nerve (superficial peroneal) Musculocutaneous nerve (superficial peroneal), Paralysis of Peripheral Nerves
8622 Musculocutaneous Nerve (superficial peroneal) Musculocutaneous nerve (superficial peroneal), Neuritis Peripheral Nerves
8722 Musculocutaneous Nerve (superficial peroneal) Musculocutaneous nerve (superficial peroneal), Neuralgia Peripheral Nerves
8523 Anterior Tibial Nerve (deep peroneal) Anterior tibial nerve (deep peroneal), Paralysis of Peripheral Nerves
8623 Anterior Tibial Nerve (deep peroneal) Anterior tibial nerve (deep peroneal), Neuritis Peripheral Nerves
8723 Anterior Tibial Nerve (deep peroneal) Anterior tibial nerve (deep peroneal), Neuralgia Peripheral Nerves
8524 Internal Popliteal Nerve (tibial) Internal popliteal nerve (tibial), Paralysis of Peripheral Nerves
8624 Internal Popliteal Nerve (tibial) Internal popliteal nerve (tibial), Neuritis Peripheral Nerves
8724 Internal Popliteal Nerve (tibial) Internal popliteal nerve (tibial), Neuralgia Peripheral Nerves
8525 Posterior Tibial Nerve Posterior tibial nerve, Paralysis of Peripheral Nerves
8625 Posterior Tibial Nerve Posterior tibial nerve, Neuritis Peripheral Nerves
8725 Posterior Tibial Nerve Posterior tibial nerve, Neuralgia Peripheral Nerves
8526 Anterior Crural Nerve (femoral) Anterior crural femoral, Paralysis of Peripheral Nerves
8626 Anterior Crural Nerve (femoral) Anterior crural femoral, Neuritis Peripheral Nerves
8726 Anterior Crural Nerve (femoral) Anterior crural femoral, Neuralgia Peripheral Nerves
8527 Internal Saphenous Nerve Internal saphenous nerve, Paralysis of Peripheral Nerves
8627 Internal Saphenous Nerve Internal saphenous nerve, Neuritis Peripheral Nerves
8727 Internal Saphenous Nerve Internal saphenous nerve, Neuralgia Peripheral Nerves
8528 Obturator Nerve Obturator nerve, Paralysis of Peripheral Nerves
8628 Obturator Nerve Obturator nerve, Neuritis Peripheral Nerves
8728 Obturator Nerve Obturator nerve, Neuralgia Peripheral Nerves
8529 External Cutaneous Nerve of Thigh External cutaneous nerve of thigh, Paralysis of Peripheral Nerves
8629 External Cutaneous Nerve of Thigh External cutaneous nerve of thigh, Neuritis Peripheral Nerves
8729 External Cutaneous Nerve of Thigh External cutaneous nerve of thigh, Neuralgia Peripheral Nerves
8530 Ilio-inguinal Nerve Ilio-inguinal nerve, Paralysis of Peripheral Nerves
8630 Ilio-inguinal Nerve Ilio-inguinal nerve, Neuritis Peripheral Nerves
8730 Ilio-inguinal Nerve Ilio-inguinal nerve, Neuralgia Peripheral Nerves
8540 Soft-tissue Sarcoma (of neurogenic origin) Soft-tissue sarcoma (of neurogenic origin) Peripheral Nerves

Epilepsies

Diagnostic Code Name VA Exam Acronym
8910 Epilepsy, grand mal Epilepsy & Narcolepsy GM
8911 Epilepsy, petit mal Epilepsy & Narcolepsy PM
8912 Epilepsy, Jacksonian and focal motor or sensory Epilepsy & Narcolepsy ---
8913 Epilepsy, diencephalic Epilepsy & Narcolepsy ---
8914 Epilepsy, psychomotor Epilepsy & Narcolepsy ---