Brain & Nerves — VA Disability Ratings

How Brain & Nerves conditions are rated

Neurological conditions are rated under 38 CFR §4.124a, with the principles in §4.120 through §4.124. Section 4.120 says disability in this field is "ordinarily to be rated in proportion to the impairment of motor, sensory or mental function," and that for peripheral nerve injuries attention should go to "the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances."

Each peripheral nerve has its own code and a printed description of complete paralysis, followed by degrees of incomplete paralysis, typically mild, moderate and severe, with a moderately severe step for the sciatic nerve. Upper-extremity nerves carry separate figures for the major and minor arm, with handedness determined under §4.69. Incomplete paralysis means "a degree of lost or impaired function substantially less than the type picture for complete paralysis." When the involvement is wholly sensory, "the rating should be for the mild, or at most, the moderate degree." The figures are for one side; when both sides are affected, the ratings are combined with the bilateral factor.

Neuritis and neuralgia use the same nerve scale with lower ceilings, and each nerve has paired codes for them. Under §4.123, neuritis "characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain" is rated up to a "maximum equal to severe, incomplete, paralysis"; without those organic changes, the ceiling is moderate, or moderately severe for the sciatic nerve. Under §4.124, neuralgia, "characterized usually by a dull and intermittent pain," is capped at moderate incomplete paralysis, though tic douloureux may be rated up to complete paralysis of the affected nerve.

Seizures are rated under the General Rating Formula for Major and Minor Epileptic Seizures, from 10% for "A confirmed diagnosis of epilepsy with a history of seizures" up to 100% for an average of at least one major seizure a month over the last year. Section 4.121 requires that seizures "be witnessed or verified at some time by a physician," but their frequency may be shown by "competent, consistent lay testimony." When continuous medication is needed to control epilepsy, the minimum is 10%, and when both major and minor seizures occur, the rater uses the predominating type.

Migraine (DC 8100) turns on prostrating attacks: 10% for attacks "averaging one in 2 months over last several months," 30% for attacks "occurring on an average once a month over last several months," and 50% for "very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability." Less frequent attacks are 0%. The schedule does not define "prostrating."

Traumatic brain injury residuals (DC 8045) are sorted into three areas: cognitive, emotional/behavioral, and physical. Cognitive impairment and subjective symptoms are rated on a table of 10 facets, with levels from 0 to 3 and a highest level labeled "total," though not every facet has every level. The highest facet sets the rating: 0 is 0%, 1 is 10%, 2 is 40%, 3 is 70%, and any facet at "total" is 100%. Emotional and behavioral symptoms go under §4.130 when a mental disorder is diagnosed. Physical effects, and distinct diagnoses such as migraine, are rated under their own codes and combined, as long as the same signs and symptoms do not support more than one evaluation. If TBI and another condition share manifestations that cannot be clearly separated, Note (1) calls for a single evaluation under whichever criteria better assess overall functioning. Note (4) says the mild, moderate or severe label given at the time of injury "does not affect the rating assigned."