PARALYSIS OF SCIATIC NERVE

PAUL R. CASEY · 2026 · Case ID: 26003480

MIXED

Summary

The veteran, who served with multiple periods of active duty between June 1985 and March 2012, appeals the denial of an increased rating for his low back disability and the grant of service connection for left-sided sciatic radiculopathy. The Board granted a 20 percent evaluation for right-sided sciatic radiculopathy prior to August 10, 2020, finding that the Veteran's symptoms met the criteria for moderate incomplete paralysis of the sciatic nerve. The Board also granted service connection for left-sided sciatic radiculopathy secondary to the service-connected low back disability, noting the Veteran's credible lay statements and the VA examiner's findings of left-sided radicular symptoms, despite the examiner's ultimate conclusion against a diagnosis. The Board denied an increased rating for the low back disability beyond the existing 40 percent evaluation, finding that the evidence did not support a higher rating or ankylosis of the spine. The Board considered the Veteran's lay reports of pain, fatigue, stiffness, and functional loss, but concluded the evidence did not approximate unfavorable ankylosis or a higher degree of limitation. The Board also addressed the potential for separate ratings for neuritis and neuralgia, finding that separate ratings would be duplicative and violate anti-pyramiding rules.

Rationale

Symptoms met criteria for moderate incomplete paralysis; Aligned with DC 8520 benchmarks; Symptoms remained moderate in severity over appeal period

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8520

Docket No.

17-16 746

Full Decision Text

Citation Nr: 26003480
Decision Date: 03/17/26 Archive Date: 03/17/26

DOCKET NO. 17-16 746
DATE: March 17, 2026

ORDER

Entitlement to a disability evaluation of 20 percent for right-sided sciatic radiculopathy prior to August 10, 2020, is granted.

Entitlement to service connection for left-sided sciatic radiculopathy secondary to a low back disability is granted.

Entitlement to a disability evaluation in excess of 40 percent for a low back disability is denied.

FINDINGS OF FACT

1. Throughout the period at issue, the Veteran's right-sided sciatic radiculopathy as manifested by moderate incomplete paralysis of the sciatic nerve, but not moderately severe or severe incomplete paralysis, or complete paralysis or their functional equivalents.

2. The persuasive evidence of record indicates the Veteran's current left-sided sciatic radiculopathy is etiologically related to his low back disability.

3. The Veteran's low back is not ankylosed at any level, nor does the evidence reflect the functional equivalent of ankylosis of any level of the spine during the appeal period.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a disability evaluation of 20 percent for right-sided sciatic radiculopathy prior to August 10, 2020, but no higher, are met. 38?U.S.C. §§?1155, 5107;?38?C.F.R. §§?3.102, 3.321, 4.1, 4.7, 4.130, Diagnostic Code (DC) 8520.

2. The criteria for service connection for a left-sided sciatic disability as secondary to a service-connected lower back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to a disability evaluation in excess of 40 percent for a low back disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.7, 4.130, DC 5242.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had multiple periods of active duty between June 1985 and March 2012.

The matter of entitlement to an increased evaluation for low back disability was before the Board in December 2024, at which time the Board granted increase, but did not address the issue of entitlement to increase for associated right lower extremity radiculopathy, or of entitlement to a separate evaluation for the left lower extremity. The Veteran appealed this aspect of the Board decision to the Court of Appeals for Veterans' Claims (Court) which, pursuant to a Joint Motion for Partial Remand (JMPR), remanded the matter to the Board to address that oversight.

Because the grant of entitlement to an increased evaluation for the low back did not constitute a grant of the maximum theoretically available benefit, the Board shall also herein address the matter of entitlement to increase for the low back.

Increased Rating

1. Increase for right lower extremity radiculopathy

Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity.?38?U.S.C. §?1155;?38?C.F.R. §?4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes.?38?C.F.R. §?4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski,?1?Vet. App.?589?(1991). The Court has held that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield,?21?Vet. App.?505?(2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Fenderson v. West,?12?Vet. App.?119, 126?(1999).?

Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.
of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield,?21?Vet. App.?505?(2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Fenderson v. West,?12?Vet. App.?119, 126?(1999).?

The record reflects that the Veteran's service-connected low back condition has involved neurological manifestations during the appeal period, which dates from the effective date for the disability at issue, November 24, 2013, through August 10, 2020. The Veteran has consistently advanced complaints of pain radiating to his right leg, and providers have diagnosed the Veteran with sciatica affecting both the right leg, which finding has been confirmed on VA examinations.

DC 8520 addresses incomplete and complete paralysis of the sciatic nerve, and assigns a 10 percent evaluation for mild incomplete paralysis, a 20 percent evaluation for moderate incomplete paralysis, a 40 percent evaluation for moderately severe incomplete paralysis, a 60 percent evaluation for severe incomplete paralysis with marked muscular atrophy, and a maximum 80 percent evaluation for complete paralysis. The preamble to that portion of the rating schedule dealing with disability of the peripheral nerves advises, "[w]hen the involvement [of the affected nerve root] is wholly sensory, the rating should be for the mild, or at most, the moderate degree."

The Board notes that the terms "mild," "moderate," "moderately severe," and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just.? 38?C.F.R. §?4.6.? Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue.???

VA's Adjudication Procedures Manual (M21-1) provides benchmarks for evaluating the?severity?of peripheral nerve conditions.? See?M21-1, V.iii.12. A.2.c. The Manual indicates with regard to "mild" as follows: As this is the lowest level of evaluation for each nerve this is the default assigned based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment for service connection purposes.? In general, look for 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 could also be consistent with mild incomplete paralysis.??

The Manual indicates with regard to "moderate:" Symptoms will likely be described by the claimants and medically graded as significantly disabling.? In such cases a larger area in the nerve distribution may be affected by sensory symptoms.? Other sign/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.??

Finally, the Manual indicates with regard to "severe:"? In general, expect 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 may be seen in?severe?longstanding neuropathy cases.? Even though?severe?incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for?severe?incomplete paralysis may contain signs/symptoms resembling 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.??

Although the Board is?not?bound?by the?M21-1, those standards 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, 34 Vet. App. at18 (quoting Healey v. McDonough, 33?Vet. App.?
paralysis may contain signs/symptoms resembling 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.??

The?United States Court of Appeals for the Federal Circuit?has held that the M21 does?not?"carry the force of law."? DAV v. Sec'y of Veterans Affairs,?859 F.3d 1072, 1077?(2017).? It is "an internal manual used to convey guidance to VA adjudicators. It is?not?intended to establish substantive rules beyond those contained in statute and regulation."? Id.?(quoting?72 Fed. Reg. 66,218, 66,219?(Nov. 27, 2007)).??

The M21 provisions do?not?go through the regular rulemaking procedures and is little more than evidence as to how VBA applies law and regulation in practices; it is?not?binding on the Board as it is?not?a regulation, instruction of the Secretary, or OGC opinion. ?Id.; see also?38 U.S.C. § 7104?(c).? The regulations further clarify that the Board "is?not?bound?by Department manuals, circulars, or similar administrative issues."? 38 C.F.R. § 20.105.??

In Overton v. Wilkie,?30?Vet. App.?257, 264?(2018), however, the Court held that the Board is required to discuss "any relevant provisions contained in the [M-21] as part of its duty to provide adequate reasons or bases, but because it is?not bound by those provisions, it must make its own determination before it chooses to rely on an [M-21] provision as a factor to support its decision."? The Court has stated, on at least two prior occasions, that, where the rating applicable rating criteria contains terms that are undefined, the Board must define those terms as it applies them to the veteran at hand in order to satisfy its obligation to provide adequate reasons or bases.? Johnson v. Wilkie,?30?Vet. App.?245, 25455?(2018); Spellers v. Wilkie, 30 Vet. App.?211, 21920?(2018).??

The Veteran is in receipt of a 10 percent evaluation for the entire period at issue, and appeals now for increase. A VA examiner with whom he met in December 2014 noted radicular symptoms including moderate intermittent pain and moderate numbness, characterizing the condition as moderate overall.

VA and private treatment records during this period also note the Veteran's radicular pain on the right. For instance, September 2013 private treatment records note current lumbar radicular pain, "primarily L4 on the right side," adding the Veteran had received steroid injections for symptom management.

An August 2020 VA examination reflects similar findings to those made by the earlier examiner, including moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness, as well as a positive straight-leg raise test on the right.

A review of this evidence does not indicate any significant worsening over the course of the period at issue, but rather is suggestive of symptomatology that has remained moderate in severity over that period.

As noted above, DC 8520 provides for a 20 percent evaluation for moderate incomplete paralysis of the sciatic nerve, and that characterization accords best with the above-described evidence.

Critically, no treating or examining provider characterized the Veteran's radicular symptoms as "severe" or "moderately severe" in any respect during the appeal period, nor does objective evidence exist indicating a substantially greater degree of limitation than that indicated in the aforementioned VA examination reports. Further, there is no objective evidence in this case indicating that nerve root involvement is more than wholly sensory. As noted above, in such cases, the rating assigned should be for, at least, the moderate degree.

The Board has also considered whether a separate rating or ratings could be assigned for neuralgia or neuritis in the right and or left lower extremity.? In Banschbach v. McDonough, the Court contemplated the question of "whether separate evaluations for paralysis
ically, no treating or examining provider characterized the Veteran's radicular symptoms as "severe" or "moderately severe" in any respect during the appeal period, nor does objective evidence exist indicating a substantially greater degree of limitation than that indicated in the aforementioned VA examination reports. Further, there is no objective evidence in this case indicating that nerve root involvement is more than wholly sensory. As noted above, in such cases, the rating assigned should be for, at least, the moderate degree.

The Board has also considered whether a separate rating or ratings could be assigned for neuralgia or neuritis in the right and or left lower extremity.? In Banschbach v. McDonough, the Court contemplated the question of "whether separate evaluations for paralysis, neuritis, and neuralgia are permissible under the relevant diagnostic codes or whether they are prohibited under the rule against pyramiding."? 37?Vet. App.?422 (2024).? The Court held that the "assignment of a paralysis rating under [38 C.F.R.] § 4.124a does not preclude as a matter of law separate evaluations for neuritis and neuralgia of the same nerve," id. at 429, but the Court also acknowledged that "if it can be shown that separate ratings for neuritis and neuralgia would end up compensating 'the same manifestation under different diagnoses,' 38 C.F.R. § 4.14, then the anti-pyramiding provision may prove relevant." Id.?

Although the Court's holding in Banschbach permits separate ratings for neuropathy, neuritis, and neuralgia, the holding does not mandate separate ratings for neuropathy, neuritis, and neuralgia. Id.?

As noted above, neuritis is characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain.? Here, there was no muscle atrophy, nor constant pain. The August 2020 examiner noted a loss of reflexes in the right ankle.

Next, as noted, neuralgia is characterized usually by dull and intermittent pain.? As noted above the Veteran expressed dull and intermittent pain on his right side.

Here, the Veteran's ratings already encompass symptoms of pain and a loss of reflexes and the Board finds that separate ratings under Diagnostic Code 8620 and 8720 would be duplicative and compensate for the same symptomology twice.? Banschbach,?37?Vet. App.?422; see also?38 C.F.R. § 4.14.?

Accordingly, in sum, the Board finds warranted entitlement to a 20 percent evaluation for right-sided sciatica associated with a low back disability, and to that extent, the appeal is granted.

2. Service connection for left lower extremity radiculopathy

Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309.

For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the
a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309.

Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The Veteran asserts that he is entitled to service connection for left-sided sciatica associated with his service-connected low back disability.

The VA examiner with whom the Veteran met in August 2020 noted the presence of left-sided radicular symptoms, which findings mirror the Veteran's credible lay statements, but concluded ultimately that the Veteran did not have a radicular condition affecting the left lower extremity. That finding was not explained adequately, nor reconciled with the findings reported or the Veteran's lay statements. Thus, while the Board notes the evidence of symptoms in the report, it accords little weight to the examiner's ultimate conclusion.

Given the examiner's findings and the Veteran's credible lay statements, the Board is loath to remand the matter for clarity when the evidence currently of record supports entitlement to service connection. Accordingly, the Board will find warranted entitlement to service connection for left lower extremity radiculopathy, and to that extent the appeal will be granted.

3. Entitlement to a disability evaluation in excess of 40 percent for the Veteran's lumbar spine disability

The Veteran's low back disability is currently evaluated as 40 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5242, which refers the adjudicator to the General Rating Formula for the Spine. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code, as they have been in this case. Id. at Note 1.

Unfavorable ankylosis is defined as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching." Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint.

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 40 percent for the Veteran's low back disability. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, fatigue, stiffness, and lost range of motion. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the evidence of record would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine, and no treating or examining provider has ever suggested a degree of limitation commensurate with ankylosis at any level of the spine. As the regulations summarized above reflect, there is no basis for a rating in excess of 40 percent for a lumbar spine condition apart from ankylosis or its functional equivalent.

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As such, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess
, and lost range of motion. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the evidence of record would not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine, and no treating or examining provider has ever suggested a degree of limitation commensurate with ankylosis at any level of the spine. As the regulations summarized above reflect, there is no basis for a rating in excess of 40 percent for a lumbar spine condition apart from ankylosis or its functional equivalent.

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As such, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 40 percent for a low back disability. As the evidence of record persuasively weighs against a rating in excess of 40 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

Paul R. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Z. Sahraie, Counsel

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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