Neurological

Akathisia and other medication induced movement disorders have no dedicated diagnostic code. VA rates them by analogy under 38 CFR 4.20, most often to the convulsive tic criteria of diagnostic code 8103, which run 0, 10, and 30 percent based on frequency, severity, and the muscle groups involved. Because akathisia is usually caused by psychiatric medication, it is typically claimed as secondary to the service connected condition that medication treats.

ALS carries a 100 percent rating under diagnostic code 8017 from the date of diagnosis. ALS in any veteran with 90 days or more of active service is presumed service connected under 38 CFR 3.318.

Bell's palsy (facial nerve paralysis) is rated under diagnostic code 8207 at 10, 20, or 30 percent based on severity of incomplete or complete paralysis.

Brachial plexus injury is rated under 38 CFR 4.124a DC 8513 at 20 to 90 percent (major) or 20 to 80 percent (minor) based on severity (mild, moderate, severe, or complete paralysis).

Cerebellar ataxia is rated under 38 CFR 4.124a by analogy to the organic diseases of the central nervous system: a 10 percent minimum for residuals, with higher ratings built from the specific residuals (limb weakness or incoordination under the peripheral nerve codes, speech, vision, bladder) combined under 38 CFR 4.25.

Stroke residuals are rated under diagnostic code 8008 at a minimum 10 percent, with separate ratings for each residual deficit such as hemiparesis, aphasia, or cognitive impairment.

Cervicogenic headaches are rated by analogy to migraines under diagnostic code 8100, or as part of a cervical spine condition residual.

Cluster headaches are rated by analogy to migraines under diagnostic code 8100 at 0, 10, 30, or 50 percent based on prostrating attack frequency.

Cold injury residuals (frostbite and related cold-weather injuries) are rated under 38 CFR 4.104, DC 7122, separately for each affected body part, with each rating combinable under 38 CFR 4.25.

Complex regional pain syndrome is rated by analogy to neuralgia or peripheral nerve damage based on the affected nerve distribution, with separate ratings for each affected nerve.

Paralysis of the lower cranial nerves is rated on the loss each causes: the glossopharyngeal and vagus nerves (diagnostic codes 8209, 8210) at up to 50 percent complete for swallowing and voice loss, the spinal accessory (8211) at up to 30 percent for shoulder elevation loss, and the hypoglossal (8212) at up to 50 percent for tongue paralysis. Incomplete paralysis rates 10 to 30 percent by severity. The trigeminal and facial nerves have their own pages.

Cubital tunnel syndrome (ulnar nerve compression at the elbow) is rated under diagnostic code 8516 at 10, 20, 30, 40, 50, or 60 percent based on degree of paralysis and dominance.

Dysautonomia has no diagnostic code of its own; it is rated by analogy under 38 CFR 4.124a (often DC 8025, myasthenia gravis, which sets a 30 percent minimum) or under the code for its dominant manifestation, such as cardiovascular (38 CFR 4.104) or digestive symptoms. There are no fixed 10 or 60 percent tiers for dysautonomia; above any minimum, each residual is rated on its own code and combined.

Dystonia is rated by analogy under 38 CFR 4.124a at 0 to 30 percent based on severity of involuntary muscle contractions and functional impairment.

Encephalitis is rated under diagnostic code 8000 at 100 percent while the infection is active and febrile, then on residuals with a minimum rating of 10 percent. Residuals such as seizures, cognitive impairment, weakness, and personality change are rated under their own codes and combined.

Major (grand mal) epilepsy is rated under diagnostic code 8910 based on seizure frequency, with ratings from 10 percent to 100 percent.

Essential tremor is rated under 38 CFR 4.124a DC 8103 (convulsive tic) by analogy at 0 to 30 percent depending on severity and functional impact.

Foot drop from common peroneal (fibular) nerve injury is rated under diagnostic code 8521: 40 percent for complete paralysis with foot drop and inability to dorsiflex, 30 percent for severe incomplete paralysis, 20 percent for moderate, and 10 percent for mild incomplete paralysis.

Residuals of Guillain-Barre syndrome are rated under 38 CFR 4.124a, by reference to the residual nerve dysfunction (peripheral neuropathy DCs 8515 through 8730).

Huntington's chorea is rated under diagnostic code 8106 from 10 percent for mild disease to 100 percent for pronounced, progressive disease, considering the combined motor, cognitive, and psychiatric picture. As a progressive disease, ratings are not reduced without sustained improvement, which this condition does not produce.

Pseudotumor cerebri is rated by analogy under 38 CFR 4.124a DC 8100 (migraine) when headaches predominate, with separate rating for any vision residuals.

Intercostal neuralgia has no diagnostic code of its own, so VA rates it by analogy under a built up code such as 8799-8719, borrowing a peripheral nerve scale. Under 38 CFR 4.124, neuralgia that is purely sensory is capped at the moderate incomplete paralysis level, which on this scale is 10 percent; higher ratings require findings beyond pain, rated as paralysis of the nerve.

Meralgia paresthetica (compression of the lateral femoral cutaneous nerve of the thigh) is rated under 38 CFR 4.124a, DC 8529, at 0 percent for mild or moderate symptoms and 10 percent for severe to complete paralysis of that nerve. Because the nerve is purely sensory, DC 8529 caps at 10 percent, but if the impairment actually traces to the femoral nerve (DC 8526) or sciatic nerve (DC 8520), a higher rating may apply under those codes.

Migraines with aura are rated under diagnostic code 8100, the same as standard migraines, based on the frequency of prostrating attacks.

Migraines are rated under diagnostic code 8100 from 0 to 50 percent based on the frequency of prostrating attacks and their economic impact.

Multiple sclerosis has a minimum rating of 30 percent under diagnostic code 8018, plus additional ratings for each residual such as visual loss, motor weakness, fatigue, or bowel and bladder symptoms.

Progressive muscular dystrophy is rated under diagnostic code 8023 with a minimum rating of 30 percent, and higher by rating the actual impairments: weakness in each extremity, swallowing, breathing, and heart involvement, each under its own code.

Myasthenia gravis carries a 30 percent minimum rating under diagnostic code 8025 when there are ascertainable residuals. The code has no fixed 60 or 100 percent tiers; ratings above the minimum are built by rating the documented residuals, such as swallowing impairment, breathing muscle weakness, eye muscle involvement, or limb weakness, under the codes for those functions, with the codes used cited in the decision.

Narcolepsy is rated by analogy to epilepsy (petit mal) at 10, 20, 40, 60, 80, or 100 percent based on the frequency of sleep attacks per week or month.

Occipital neuralgia has no diagnostic code of its own. When it presents mainly as headache pain, VA rates it by analogy under 38 CFR 4.124a, DC 8199-8100 (the migraine criteria), at 0, 10, 30, or 50 percent based on how often you have prostrating attacks and their effect on your ability to work. It is frequently secondary to a service connected neck (cervical spine) condition or to head trauma.

Parkinson's disease has a minimum rating of 30 percent under diagnostic code 8004, with additional ratings assigned for residuals such as tremor, gait disturbance, and cognitive impairment.

Parkinsonism is rated under diagnostic code 8004 with a minimum rating of 30 percent, and higher when individual manifestations such as tremor, rigidity, speech change, or cognitive impairment are rated under their own codes and combine above 30. The National Defense Authorization Act for Fiscal Year 2021 added parkinsonism, including parkinsonian features, to the Agent Orange presumptive list alongside Parkinson's disease.

Each peripheral nerve has its own diagnostic code (8510 to 8530 for paralysis, 8610 to 8730 for neuritis and neuralgia), rated mild, moderate, or severe for incomplete injury, with a fixed percent for complete paralysis: sciatic 80, median 70/60 by handedness, radial and ulnar 70/60 and 60/50, peroneal and tibial 40, femoral 30. Mild incomplete paralysis of any nerve starts at 10 percent.

Peripheral neuropathy is rated under the nerve codes that apply to the affected nerve group, with ratings from 10 percent up depending on severity.

Peripheral neuropathy of the upper extremity is commonly rated under diagnostic code 8515 (median nerve) at 10 to 70 percent based on the degree of paralysis and whether the dominant or non-dominant arm is affected.

Post-herpetic neuralgia has no diagnostic code of its own. VA rates it by analogy under the neuralgia code for the affected nerve, using a built up code such as 8799-8719 when an intercostal nerve distribution is involved. The available percentages depend on which nerve is affected, and under 38 CFR 4.124 neuralgia that is purely sensory is capped at the moderate incomplete paralysis level for that nerve.

Post-polio syndrome is rated under the anterior poliomyelitis code, diagnostic code 8011, which sets a 10 percent minimum for ascertainable residuals. The real rating usually comes from the residuals themselves: each affected nerve or muscle group is evaluated under its own code and the results are combined.

Post-traumatic headache is rated by analogy to migraine under diagnostic code 8100 at 0, 10, 30, or 50 percent based on prostrating attack frequency.

Restless leg syndrome is rated by analogy to diagnostic code 8103 (convulsive tic) at 0, 10, or 30 percent based on severity and treatment requirements.

Seizure disorders are rated under diagnostic codes 8910 and 8911 at 10, 20, 40, 60, 80, or 100 percent based on the frequency of major and minor seizures over the past 12 months.

Spinal cord injury is rated by mapping each affected nerve, body system, and residual function to the diagnostic codes in 38 CFR 4.124a, with separate ratings for paralysis, bowel and bladder, autonomic dysfunction, and sensory loss combined under 38 CFR 4.25.

Syringomyelia is rated under 38 CFR 4.124a, diagnostic code 8024, which sets a 30 percent minimum. Ratings above the minimum come from rating the actual motor and sensory residuals under the codes for the affected nerves or functions and combining them under 38 CFR 4.25; the code has no fixed 60 or 100 percent tiers.

Tarsal tunnel syndrome (posterior tibial nerve compression at the ankle) is rated under diagnostic code 8525 at 10, 20, or 30 percent based on degree of paralysis.

Tension-type headaches are rated by analogy to migraines under diagnostic code 8100 at 0, 10, 30, or 50 percent. The rating turns on documented prostrating attacks, episodes that force you to stop and rest, not on how often your head hurts.

Tourette's syndrome is rated by analogy under 38 CFR 4.124a DC 8103 at 0 to 30 percent based on tic severity and functional impact.

Transverse myelitis is rated under 38 CFR 4.124a by analogy to the organic diseases of the central nervous system (commonly DC 8019 or a spinal cord code): a 10 percent minimum for residuals, with motor, sensory, bladder, and bowel residuals each rated separately under their own diagnostic codes and combined under 38 CFR 4.25. There are no fixed 30, 60, or 100 percent residual tiers in the code.

Trigeminal neuralgia (cranial nerve V neuralgia) is rated under diagnostic code 8405 at 10, 30, or 50 percent based on severity.

Ulnar nerve palsy is rated under 38 CFR 4.124a, diagnostic code 8516: 10 percent for mild incomplete paralysis on either side, 30/20 percent for moderate and 40/30 percent for severe incomplete paralysis (dominant/non-dominant), and 60 percent (dominant) or 50 percent (non-dominant) for complete paralysis with the claw hand deformity.

Wrist drop from radial (musculospiral) nerve injury is rated under diagnostic code 8514: complete paralysis with drop of the hand and fingers rates 70 percent on the dominant side (60 on the other), severe incomplete 50/40, moderate 30/20, and mild 20 percent either side.