PERIPHERAL NERVE DISORDERS

THOMAS H. O'SHAY · 2025 · Case ID: A25091565

MIXED

Summary

The veteran, who served from April 1986 to July 1990 and again from September 2010 to June 2011, appealed the denial of an increased rating for peripheral neuropathy of the left lower extremity and the denial of a rating higher than 10 percent for peripheral neuropathy of the right lower extremity. The veteran claimed that his conditions were more severe than indicated by the initial ratings and that the ameliorative effects of medication were not properly considered. Post-service medical records from February 2021 indicated radiating pain in the right leg, with medication providing only partial relief. Subsequent examinations in November 2021 and February 2022 noted similar symptoms. The March 2022 VA examination diagnosed bilateral lower extremity neuropathy secondary to service-connected lower back disability, finding mild incomplete paralysis in each leg and noting decreased reflexes. The veteran sought a higher rating, arguing the exam did not capture symptoms at their worst and medication effects were ignored. A February 2024 VA examination found moderate incomplete paralysis of the right sciatic nerve and mild incomplete paralysis of the left sciatic nerve, with severe intermittent pain in the right leg and moderate in the left, though sensory and reflex exams were largely normal. The Board granted an initial 20 percent rating for the right lower extremity neuropathy, citing the examiner's finding of moderate incomplete paralysis and the Veteran's more severe pain complaints in that leg, applying the benefit of the doubt. However, the Board denied a higher rating for the left lower extremity, finding the evidence did not support moderate incomplete paralysis or higher ratings due to normal reflexes and strength testing, limiting it to a 10 percent rating.

Rationale

Examiner noted moderate incomplete paralysis of right sciatic nerve; Veteran reported more severe pain in right leg; Benefit of the doubt applied due to history of more severe right leg complaints

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8520

Docket No.

250303-521675

Full Decision Text

Citation Nr: A25091565
Decision Date: 10/22/25 Archive Date: 10/22/25

DOCKET NO. 250303-521675
DATE: October 22, 2025

ORDER

Entitlement to an initial 20 percent rating, but not higher, for peripheral neuropathy of the right lower extremity is granted.

Entitlement to a rating in excess of 10 percent for peripheral neuropathy of the left lower extremity is denied.

FINDINGS OF FACT

1. The Veteran's peripheral neuropathy of the right lower extremity is manifest by no more than moderate incomplete paralysis.

2. The Veteran's peripheral neuropathy of the left lower extremity is manifest by no more than mild incomplete paralysis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial disability rating of 20 percent, but no higher, for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.124a, Diagnostic Code (DC) 8520.

2. The criteria for entitlement to a rating in excess of 10 percent for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.124a, DC 8520.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1986 to July 1990, and from September 2010 to June 2011.

This matter comes to the Board on appeal of a March 2024 rating decision. This rating decision was issued following a finding of a pre-decisional duty to assist error in an April 2023 higher-level review (HLR) of an April 2022 rating decision. This converted the claim into a Supplemental Claim. In March 2025, the Veteran appealed the March 2024 rating decision via the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the March 2024 agency of original jurisdiction (AOJ) Supplemental Claim decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to an initial 20 percent rating, but not higher, for peripheral neuropathy of the right lower extremity is granted.

2. Entitlement to a rating in excess of 10 percent for peripheral neuropathy of the left lower extremity is granted.

The Veteran and his representative have contended that he is entitled to increased ratings for neuropathy of each lower extremity. Specifically, they contend that the Veteran's condition is more severe than indicated in the rankings, and that the ameliorative effects of medication have not been discounted in consideration of the appropriate rating.

Factual Background

The Veteran's post-service medical records show that the Veteran complained of radiating pain, at least down his right leg, as early as February 2021. At that time, he reported that when sitting in a car for a long period of time, he would have pain in his right hip that would then radiate down his leg. He also reported at that time that he used medication to treat his pain, which helped his hip, but he did not report that the medication helped the radiating pain.

In November 2021, he again reported pain that radiated down his right leg from his hip and knee during long car trips, and that medication helped. The Veteran reported similar pain in February 2022, and reported that medication only helped "some."

In his March 2022 claim application, the Veteran reported nerve pain that radiated from his lower back in both hips, and that also traveled down his right leg. In March 2022, the Veteran was afforded a VA examination to determine the nature and etiology of his claimed lower extremity neuropathy. The examiner determined that the Veteran had bilateral lower extremity neuropathy that was secondary to his service-connected lower back disability. The Veteran reported to the examiner that his pain medication did not help with his radicular pain. The examiner determined that the Veteran's bilateral lower extremity neuropathy affected only his sciatic nerve and manifested with only mild incomplete paralysis in each leg. The examiner had also noted that the Veteran had mild constant and intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in each leg. However, the Veteran's lower extremity strength and sensations were all normal. The Veteran's reflexes in both ankles and knees were lower than normal.

In January 2023, the Veteran requested HLR of an AOJ rating decision which had granted service connection for bilateral lower extremity neuropathy, with each leg separately rated at 10 percent. The Veteran and his representative contended that his disability picture was more severe than 10 percent suggested, that the exam did not address symptoms at their worst, and that the examiner had not considered the ameliorative effects of medication.

In March 2023, the Veteran reported to VA medical center staff that he felt numbness and tingling from his lower back into both legs at night, and mainly down his right leg when driving. In an August 2023 total disability application, the Veteran reported that his bilateral lower extremity neuropathy prevented him from moving up and down and from walking on concrete all day while working.

In January 2024, the Veteran was given a new VA examination - which incorrectly labeled the Veteran's disability as diabetic peripheral neuropathy, an error which was corrected in a February 2024 exam - which noted the Veteran's use of medication and described his pain as starting in his hips and radiating down his legs. The Veteran reported that his pain rendered him unable to sit for more than a half-hour. This examiner also noted that the Veteran had mild numbness in both legs, as well as severe intermittent pain in his right leg and mild intermittent pain in his left leg. Other than decreased light touch sensitivity, sensory and strength exams of the Veteran's legs were normal.

In February 2024, the Veteran's bilateral neuropathic leg disability was confirmed as bilateral lower extremity neuropathy (not diabetic). The examiner noted that the Veteran used medication to treat his pain. In addition to the medication previously noted by VA examiners and medical center staff, the examiner also noted use of an additional pain medication as needed. The February 2024 examiner indicated that only the Veteran's sciatic nerve was impacted by his disability. The examiner reported that the Veteran's right lower extremity sciatic nerve was affected by moderate incomplete paralysis, and his left lower extremity sciatic nerve suffered from mild incomplete paralysis. The examiner also separately noted that the Veteran's right lower extremity neuropathy was more severe than his left. The Veteran's legs were both normal on sensory and reflex exams, and the Veteran's ankle plantar flexion and dorsiflexion were normal for both legs. His knee extension was limited on both legs. The Veteran's left leg showed mild numbness, and it was noted that the Veteran had severe intermittent pain in the right lower extremity, and moderate intermittent pain in the left lower extremity. The examiner's reporting was based on both an in-person examination and a review of the Veteran's records.

Analysis

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations
4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In addition, separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," regardless whether it is an initial rating case or not. Hart v. Mansfield, 21 Vet. App. 505 (2007).

The Veteran's neuropathy of the bilateral lower extremities is rated under DC 8520 for the sciatic nerve.

Under DC 8520, complete paralysis of the sciatic nerve is demonstrated when the foot dangles and drops, when there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. This is evaluated as 80 percent disabling. Severe incomplete paralysis, with marked muscular atrophy, is evaluated as 60 percent disabling. Moderately severe paralysis is evaluated as 40 percent disabling. Moderate paralysis merits a 20 percent evaluation, and mild paralysis warrants a 10 percent rating. 38 C.F.R. § 4.124a, DC 8520.

The term "incomplete paralysis," with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124a.

The Board observes that the words "mild," "moderate," and "severe" as used in the various codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6.

Here, the record does not indicate entitlement to a rating in excess of 10 percent for the Veteran's left lower extremity, though a 20 percent initial rating is appropriate for the right lower extremity. It is easiest to understand the applicable ratings by eliminating highest ratings first. The record clearly shows non-entitlement to an 80 percent rating for either leg, as there is no evidence of non-movement below the knee, no foot dangling or dropping has been noted, nor complete paralysis of the legs nor limited knee flexion. The record also does not show entitlement to a 60 percent rating as there is no evidence of marked atrophy of either leg.

The question becomes closer when assessing entitlement to ratings between 10 and 40 percent. Although generally not bound by it, the Board finds the provisions on rating this disability in the M21-1 Manual to be instructive here.

The Board notes that "VA's Adjudication Procedures Manual provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions," and "although the Board is not bound by the M21-1, the standards provided in the M21-1 are 'relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims,' which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision." Chavis v. McDonough, 34 Vet. App. 1, 17-18 (2021) (citing Healy v. McDonough, 33 Vet. App. 321 (2021) and Overton v. Wilkie, 30 Vet. App. 257, 264 (2018)).

"Mild" is the default evaluation assigned based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment. In general, it is a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area
claims,' which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision." Chavis v. McDonough, 34 Vet. App. 1, 17-18 (2021) (citing Healy v. McDonough, 33 Vet. App. 321 (2021) and Overton v. Wilkie, 30 Vet. App. 257, 264 (2018)).

"Mild" is the default evaluation assigned based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment. In general, it is a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially may also be consistent with mild incomplete paralysis.

"Moderate" is the maximum evaluation available for the most significant cases of sensory-only impairment and is characterized by symptoms described by the claimant and medically graded as significantly disabling and involving a larger area of nerve distribution. Other sign or symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

"Moderately severe" is available as a potential rating here, as it is limited to involvement of the sciatic nerve. It is characterized by motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability is expected. Atrophy may be present but is not required.

"Severe" is characterized by motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes can be seen in severe long-standing neuropathy cases. Although severe incomplete paralysis cases should show findings substantially less than those for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs or symptoms that resemble some of those expected in cases of complete paralysis of the nerve. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve. See M21-1, Part V, Subpart iii, Chapter 12, Section A.2.c.

By reference to these definitions, as applied to the rating criteria directly, it becomes clear that a 40 percent rating is not warranted for either leg. The record does not reflect loss of strength in either leg. Although the March 2022 exam showed decreased reflexes in the right and left ankle and absent reflexes in the knee, the Veteran's reflexes were noted to be normal in the January 2024 exam report as well as in the February 2024 exam. The probative evidence, then, weighs towards finding that the Veteran's lower extremity reflexes were generally normal, and so suggest less than a 40 percent rating, especially because there is no weakness or other motor impairment.

For the same reason, the record does not show entitlement to a 20 percent rating for the left lower extremity. The record at no point shows an assessment by a medical professional that the Veteran's left lower extremity was subject to moderate incomplete paralysis. Further, as noted above, the record generally shows the Veteran's reflexes and strength testing to be normal for the left lower extremity. Further, only the January 2024 exam shows any sensory involvement, with decreased sensitivity to light touch, but no other sensory involvement, apart from pain. Further, this rating criteria contemplates that the effect of the incomplete paralysis may lead a Veteran to describe his impairment as significant, which the Veteran has done here with descriptions of the pain in his legs leading to functional impairment limited to an inability to stay in one position, but not incomplete loss of function. Because the record does not show entitlement to a 20 percent rating for the left lower extremity peripheral neuropathy, the Veteran is limited to a 10 percent rating under DC 8520.

However, in the February 2024 exam, the Veteran's incomplete paralysis of the lower right extremity was noted to be moderate. Apart from the level of pain reported, the Veteran's right and left lower extremities were generally identical in the notations of flexion limitations, strength, and reflexes. Only the pain in the Veteran's right leg has historically been worse - or more present - than that in the left leg. However, the rating criteria on their face do not contemplate levels of pain, and discussion of pain in the M21-1 guidance is limited to discussion of neuritis, not paralysis. Yet, the Board recognizes that pain itself can contribute to a functional limitation, as is also stated in the general guidance on ratings. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Thus, the higher level of pain experienced by the Veteran in his right leg, as well as the fact that the examiner indicated a higher level of paralysis, and that the record reflects a longstanding reporting that the right leg was more seriously affected than the left, all suggest that the Veteran's right leg may warrant a higher rating than his left. Giving the Veteran the benefit of the doubt, because the record reflects that since the Veteran began reporting lower extremity radiculopathy he has complained more of the right leg than the left, and because the examinations have been roughly consistent over the period of service connection (other than the earliest exam's reflex determinations and the level of paralysis indicated of the right leg), the Board finds that the Veteran is entitled to an initial 20 percent rating for his right lower extremity neuropathy.

The Board is satisfied that these ratings contemplate the ameliorative effects of medication as well. The record has mixed references to the medication that the Veteran takes for pain. In February and November 2021, the Veteran reported that his medication helped but this was in a discussion of radicula pain down the Veteran's lower extremities, as well as pain localized to his back or hip. In February 2022, the Veteran reported that the medication helped localized pain and radicular pain only "some." On only one occasion, as the March 2022 exam, was the Veteran asked specifically about the medication's effect on his radicular, neuropathic pains down his extremities, and the Veteran reported that it didn't help much, but did help with restless legs. The Board finds that the combined effect of this evidence is to show that medication had little effect on the Veteran's service-connected lower extremity neuropathy, especially as related to the rating criteria, and discounting any ameliorative effects would have no impact the assigned rating because the medication has minimal effect, and because the rating criteria considers pain but this is not the main driver of the criteria as described above. Contrary to the representative's argument that this was not the case, the Board finds that the ratings here assigned or confirmed conform to the directives of Jones v. Shinseki. 26 Vet. App. 56 (2012).

To the extent that the Veteran may believe that he is entitled to higher ratings, the Board finds the objective medical findings by skilled professionals are more persuasive which, as indicated above, do not support higher ratings.

The Board has also considered whether the claims raise a separate claim for total disability due to individual unemployability (TDIU) based solely on the Veteran's lower extremity neuropathy. This is the only possible relevant TDIU claim because the Veteran has already been granted TDIU based on multiple disabilities from before the date of service connection for the lower extremity neuropathy. The Board finds that although the Veteran has described functional impacts and limitations caused by his bilateral lower extremity neuropathy, he has not claimed nor has the record raised that these alone render him totally unable to work, and so an implicit TDIU claim is not found here. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

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Thus, for the above reasons the evidence is persuasively against the claim for an increased left lower extremity neuropathy rating, the benefit-of-the-doubt doctrine is not for application, and entitlement to an increased rating is not warranted. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim is denied.

Additionally, for the above reasons the evidence is persuasively in favor of the claim for an increased right lower extremity neuropathy rating, the benefit-of-the-doubt doctrine is not for application, and entitlement to an initial 20 percent rating. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App
claim for an increased left lower extremity neuropathy rating, the benefit-of-the-doubt doctrine is not for application, and entitlement to an increased rating is not warranted. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The claim is denied.

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Kronick

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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