Veterans with peripheral neuropathy often look at one modest percentage and assume that is the whole claim. The schedule rates each affected nerve in each limb separately, combines them under 38 CFR 4.25, and adds the bilateral factor when both arms or both legs are involved. Four limbs of diabetic neuropathy is four ratings, not one, and the combined result often far exceeds what any single number suggests.
How VA rates peripheral neuropathy
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord, most often felt as numbness, burning, tingling, or weakness in the feet, legs, hands, or arms. VA rates it under the peripheral nerve codes in the neurological schedule (38 CFR 4.124a), choosing the code for the specific nerve affected. Neuropathy of the lower leg and foot, for example, is commonly rated under the sciatic nerve, diagnostic code 8520.
The sciatic nerve scale (DC 8520)
- Mild incomplete paralysis: 10 percent.
- Moderate incomplete paralysis: 20 percent.
- Moderately severe incomplete paralysis: 40 percent.
- Severe incomplete paralysis, with marked muscular atrophy: 60 percent.
- Complete paralysis, where the foot dangles and drops: 80 percent.
Other nerves use the same mild, moderate, and severe framework but with their own percentage ceilings, so the rating depends on which nerve is involved and how badly.
The sensory-only rule
The schedule defines incomplete paralysis and adds an important limit: when the involvement is wholly sensory, the rating should be for the mild, or at most the moderate, degree. Because diabetic and other peripheral neuropathies are often purely sensory at first, this rule frequently caps the early rating at the moderate level until there is objective weakness or atrophy.
Each limb is rated separately
Peripheral neuropathy usually affects more than one limb. Each extremity is rated separately and then combined under 38 CFR 4.25, and when both arms or both legs are involved VA applies the bilateral factor under 38 CFR 4.26. A veteran with neuropathy in both feet and both hands can hold four separate nerve ratings that combine, which often adds up to far more than any single rating suggests.
It is very often secondary to diabetes
Peripheral neuropathy is one of the most common secondary conditions under 38 CFR 3.310, frequently flowing from service connected diabetes. When the neuropathy is linked in the record to diabetes or another service connected condition, it is rated on its own for each affected nerve, on top of the rating for the underlying disease.
The nuances most veterans miss
- The code follows the specific nerve, so the rating ceiling depends on which nerve is damaged.
- Wholly sensory neuropathy is capped at moderate, so atrophy or weakness is needed for the higher levels.
- Each limb is rated separately and combined, with the bilateral factor for paired arms or legs.
- Neuropathy is very often secondary to diabetes and is rated in addition to the diabetes rating.
- A thorough examination documenting which nerves and limbs are affected, whether through nerve studies, clinical evaluation, or both, is what captures the full, combined picture.