Meningovascular Syphilis — VA Disability Rating (DC 8014)
Diagnostic Code 8014 · 38 CFR §4.124a
What Is It?
Meningovascular syphilis is the form of late-stage neurosyphilis in which the inflammation involves the small and medium arteries supplying the brain and spinal cord, producing a vasculitis pattern that leads to strokes, transient ischemic attacks, and focal neurological deficits. Clinically it can resemble a hypertensive or atherosclerotic stroke, but the mechanism is syphilitic inflammation of the arterial wall (Heubner endarteritis) rather than atherothrombotic disease. Treatment with intravenous penicillin halts further vasculitic damage, but the strokes that have already occurred leave permanent residuals. 38 CFR §4.124a opens the neurological schedule with a bracketed instruction: disability from the diseases it lists "may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function," referring the rater to the appropriate body system of the schedule for each manifestation. Inside the 8000–8025 block the schedule prints either a single flat percentage, a single minimum rating, or no percentage at all — there is no severity ladder anywhere in it. A Note closing the block adds two conditions: the minimum ratings for residuals require ascertainable residuals, and when a rating above the minimum is assigned, the diagnostic codes used as the basis of that evaluation must be cited alongside the code identifying the diagnosis. DC 8014's rating cell in §4.124a is empty — the schedule prints no flat percentage and no minimum for it — so the evaluation is built from the stroke residuals under the codes that govern them: hemiparesis and hemiplegia by comparison with the peripheral nerve and paralysis codes, aphasia and other speech loss under the codes for those functions, visual field defects under §4.79, and cognitive or mood residuals under §4.130.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 8014 assigns no percentages of its own — its rating cell in §4.124a is empty. The evaluation is built from the stroke residuals under their own codes: motor loss by comparison with the mild, moderate, severe, or complete paralysis of the relevant peripheral nerves as §4.124a's preamble directs, speech and swallowing loss under the codes for those functions, visual impairment under §4.79, and cognitive or mood residuals under §4.130. The preamble sets the range at 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function, and the block's closing Note requires the codes used as the basis of evaluation to be cited alongside DC 8014. |
Evidence Needed
Serology (RPR/VDRL with confirmatory FTA-ABS or TP-PA) establishes the syphilis diagnosis. CSF analysis with elevated protein, lymphocytic pleocytosis, and a positive CSF VDRL confirms CNS involvement. MRI or CT angiography of the brain shows the arteritic pattern — focal narrowing of small and medium cerebral arteries — distinguishing meningovascular syphilis from atherosclerotic stroke. Stroke imaging documents the location and extent of each ischemic lesion. Because the percentage comes from the residuals rather than from DC 8014 itself, the decisive evidence is a neurological examination characterizing each deficit from each stroke event: strength and sensation by limb and nerve distribution, speech and language assessment, visual fields, and neuropsychological testing where cognition is affected. Penicillin treatment records confirm the antibiotic course.
C&P Exam Tips
Bring serology, CSF, brain imaging including angiographic studies, the neurology consult, and a stroke history with dates and resulting deficits. Then make sure each deficit is documented on its own terms — which limb, which nerve distribution, which visual field, what the language testing showed — because those are the findings the percentage is built from. If more than one stroke has occurred, document each. Ask that the rating decision cite the codes used for each residual, which is what the Note closing the 8000–8025 block requires. Distinguishing syphilitic from atherosclerotic stroke matters for the nexus and for prognosis, so bring the angiographic findings and the risk-factor history together.
How to File
File VA Form 21-526EZ listing meningovascular syphilis under DC 8014 and reference 38 CFR §4.124a. List each residual separately — the specific motor deficit, the speech or language loss, the visual field defect, the cognitive or mood residual — because DC 8014 carries no percentage of its own. Attach serology, CSF analysis, brain imaging including angiography, the neurology consult, and the stroke history with the deficits each event produced.
Common Mistakes
Filing without CSF analysis and angiographic brain imaging, which together distinguish meningovascular syphilis from ordinary atherosclerotic stroke. Listing only the diagnosis and not the residuals, when the residuals are the entire evaluation on a code whose rating cell is empty. Treating individual strokes as separate claims rather than as residuals of one underlying disease. Accepting a decision that does not cite the codes used for each residual, which §4.124a's closing Note requires.
Frequently Asked Questions
How do I distinguish meningovascular syphilis from ordinary stroke?
The distinguishing features are serology and CSF VDRL confirming syphilis with CNS involvement; angiographic imaging showing a small- and medium-vessel arteritis pattern rather than a large-vessel atherosclerotic pattern; an age and risk-factor profile that does not fit atherothrombotic disease; and the treatment response, since intravenous penicillin halts further events in meningovascular syphilis. A neurology consult plus serology is the standard workup.
What percentage does DC 8014 pay?
None on its own. The rating cell beside "8014 Syphilis, meningovascular" in 38 CFR §4.124a is empty. §4.124a's opening instruction sets the range at 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function, and directs the rater to the appropriate body system for each manifestation — including, for partial loss of use of a limb from a neurological lesion, rating by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves. So the figure comes from what the stroke residuals earn under their own codes.
Will penicillin treatment reverse my deficits?
Intravenous penicillin halts the progression of the vasculitis and prevents further strokes, but it does not reverse damage from strokes that have already occurred. The deficits present at the time of treatment generally persist. Rehabilitation may produce some functional improvement over the first year, with a plateau typical thereafter, and the evaluation reflects the post-rehabilitation steady state.