VA Disability Rating for Tibial Nerve (Posterior Tibial Nerve) Paralysis
Diagnostic Code 8524 · 38 CFR §4.124a
What Is It?
The tibial nerve is one of the two main branches of the sciatic nerve. It runs down the back of your lower leg and controls the muscles that point your foot downward, curl your toes, and turn your foot inward. It also provides sensation to the sole of your foot. When this nerve is damaged, you lose the ability to push off when walking, stand on your tiptoes, and feel the bottom of your foot. Veterans may develop tibial nerve damage from knee injuries, lower leg fractures, deep lacerations to the back of the leg, blast injuries, or compartment syndrome during service.
Rating Criteria
| Rating | Criteria |
|---|---|
| 40% | Complete paralysis with inability to plantar flex the foot, flex the toes, or turn the foot inward, plus loss of sensation on the sole |
| 30% | Severe incomplete paralysis with marked weakness in pushing off during walking and significant sole numbness |
| 20% | Moderate incomplete paralysis with noticeable plantar flexion weakness or substantial sensory loss |
| 10% | Mild incomplete paralysis with some weakness or numbness on the bottom of the foot |
Evidence Needed
- Medical records documenting tibial nerve injury connected to military service
- Electromyography and nerve conduction study results for the tibial nerve
- Strength testing for plantar flexion and toe flexion
- Sensory testing results for the sole of the foot
- Gait analysis showing push-off weakness during walking
C&P Exam Tips
- Show the examiner that you cannot stand on your tiptoes or have difficulty doing so
- Demonstrate weakness in pushing your foot downward against resistance
- Describe the numbness on the bottom of your foot and how it affects balance
- Explain how the weakness changes your walking pattern, especially on stairs
- Mention any burns or injuries to the sole of your foot from loss of protective sensation
How to File
File under DC 8524 for tibial nerve paralysis. Include nerve conduction studies that specifically test the tibial nerve pathway. Explain the service-connected event that caused the nerve damage and describe how the loss of push-off strength and sole sensation affects your daily functioning.
Common Mistakes
Confusing tibial nerve damage with plantar fasciitis since both affect the bottom of the foot Not testing for sensory loss on the sole in addition to motor weakness Failing to demonstrate the inability to stand on tiptoes during the exam Not connecting the tibial nerve damage to a known knee or leg injury from service
Frequently Asked Questions
Is tarsal tunnel syndrome related to tibial nerve damage?
Tarsal tunnel syndrome is compression of the tibial nerve as it passes behind the inner ankle bone. It is a specific type of tibial nerve problem. If you have tarsal tunnel syndrome from a service-connected injury, it would be rated under DC 8525 for the posterior tibial nerve at the ankle level.
Why is loss of sensation on the sole dangerous?
Without feeling on the bottom of your foot, you may not notice cuts, blisters, burns, or other injuries. This is especially concerning for veterans with diabetes or circulation problems. Document any foot injuries that resulted from the loss of protective sensation.