PARALYSIS OF THE SCIATIC NERVE

Summary

The veteran appeals the denial of an increased disability rating for bilateral axonal polyneuropathy of the sciatic nerves, seeking a rating higher than the 10 percent granted. The Board reviewed the evidence, including a March 2024 VA Peripheral Nerve Examination, to determine if the veteran's symptoms met the criteria for moderate or severe incomplete paralysis of the sciatic nerve under 38 C.F.R. § 4.124a, DC 8520. The VA examination documented mild incomplete paralysis, with normal muscle strength and reflexes, and only mild sensory deficits (pain, numbness, paresthesias in the right lower extremity). The Board noted that the definitions of 'moderate' and 'severe' paralysis require more significant symptoms, such as marked muscle atrophy, weakness, diminished reflexes, or substantial sensory changes, none of which were present. The Board concluded that the veteran's symptoms, limited to mild sensory deficits and normal motor function, did not meet the criteria for a rating higher than 10 percent prior to January 31, 2025. Therefore, the appeal for an increased rating was denied.

Rationale

Symptoms limited to mild sensory deficits (pain, numbness, paresthesias in right lower extremity).; Normal muscle strength and reflexes documented.; No findings indicative of moderate or greater severity, muscle atrophy, trophic changes, or significant sensory deficits.

Full Decision Text

Citation Nr: A26040515
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260106-609639
DATE: April 30, 2026

ORDER

Entitlement to a rating greater than 10 percent prior to January 31, 2025, for right lower extremity axonal polyneuropathy is denied.

Entitlement to a rating greater than 10 percent prior to January 31, 2025, for left lower extremity axonal polyneuropathy is denied.

FINDINGS OF FACT

1. Prior to January 31, 2025, the Veteran's right lower extremity axonal polyneuropathy manifested as mild incomplete paralysis of the sciatic nerve.

2. Prior to January 31, 2025, the Veteran's left lower extremity axonal polyneuropathy manifested as mild incomplete paralysis of the sciatic nerve.

CONCLUSIONS OF LAW

1. The criteria for a rating greater than 10 percent prior to January 31, 2025, for right lower extremity axonal polyneuropathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

2. The criteria for a rating greater than 10 percent prior to January 31, 2025, for left lower extremity axonal polyneuropathy are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision issued by a Department of Veterans Affairs (VA) regional office (RO).  In the January 6, 2026, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.  Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claim[s], 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 a rating greater than 10 percent prior to January 31, 2025, for right lower extremity axonal polyneuropathy 

2. Entitlement to a rating greater than 10 percent prior to January 31, 2025, for left lower extremity axonal polyneuropathy

Disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent, as far as can practicably be determined, the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  The basis of disability evaluations is the ability of the body, or the psyche, or a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.10, 3.321. 

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability.  38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (199
5; 38 C.F.R. § 4.1.  The basis of disability evaluations is the ability of the body, or the psyche, or a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.10, 3.321. 

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability.  38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991).  Where there is a question of which of two evaluations shall be applied, the higher evaluation is assigned if the disability more closely approximates the criteria for that rating.  38 C.F.R. § 4.7.  Otherwise, the lower rating is assigned.  Id.  Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet.  However, that is not the case where the Veteran has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability.  Separate ratings may be assigned for separate periods of time based on the facts found-a practice known as "staged rating."  Fenderson v. West, 12 Vet. App. 119, 126 (1999).  Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

Additionally, although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

The Veteran was granted service connection for right and left lower extremity axonal polyneuropathy in a December 2024 Board decision.  In the subsequent implementing rating decision (the decision on appeal), the disabilities were evaluated as 10 percent disabling, effective February 23, 2024.  In a June 2025 rating decision, the disabilities were increased to 40 percent disabling, effective January 31, 2025.  

Prior to January 31, 2025, the Veteran's right and left lower extremity axonal polyneuropathy is rated as 10 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8520.  Under DC 8520 for paralysis of the sciatic nerve, a 10 percent evaluation is assigned for mild incomplete paralysis, a 20 percent evaluation is assigned for moderate incomplete paralysis, a 40 percent evaluation is assigned for moderately severe incomplete paralysis, a 60 percent evaluation is assigned for severe incomplete paralysis with marked muscle atrophy, and an 80 percent evaluation is assigned for complete paralysis in which the foot dangles and drops, no active movement of muscles below the knee is possible, and flexion of the knee is weakened or lost.  

Terms such as "mild," "moderate," and "severe" used in various Diagnostic Codes are not defined in the Rating Schedule.  In the absence of express definition, words are given their ordinary meaning.  Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)).  Therefore, "mild" is defined as "gentle in nature or behavior;" "not being or involving what is extreme."  Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/m
 such as "mild," "moderate," and "severe" used in various Diagnostic Codes are not defined in the Rating Schedule.  In the absence of express definition, words are given their ordinary meaning.  Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)).  Therefore, "mild" is defined as "gentle in nature or behavior;" "not being or involving what is extreme."  Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/mild, Definitions 1 and 2(b) (last visited July 15, 2025).  "Moderate" is defined as "not violent, severe, or intense;" "limited in scope or effect."  Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/moderate, Definitions 3 and 5 (last visited July 15, 2025).  And "severe" is defined as "of a great degree." https://www.merriam-webster.com/dictionary/severe, Definition 8 (last visited July 15, 2025).  Although the use of similar terminology by medical professionals is considered, it is not dispositive of an issue.  Instead, all evidence is evaluated in an increased rating claim.  38 U.S. C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

Although the Board is not bound by the VA Adjudication Procedure Manual, M21-1 (M21-1), it must, nonetheless, consider and address the "relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims therein."  Chavis v. McDonough, 34 Vet. App. 1, 17-18 (citing Healy v. McDonough, 33 Vet. App. 312, 321 (2021)).  See also Overton v. Wilkie, 30 Vet. App. 257, 264 (2018).  The M21-1, III.iv.4.N.4.c (November 16, 2017) defines the terminology in 38 C.F.R. § 4.124a, DC 8510-8730.  According to M21-1, as mild is the lowest level of evaluation for each nerve, it is the default assigned based on the symptoms, however slight, provided they were sufficient to support a diagnosis of the peripheral nerve impairment for service connection purposes.  In general, "mild" applies to 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.

With respect to "moderate" symptoms, the M21-1 indicates that symptoms will likely be described by the claimant 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.

With regard to "severe" symptoms, the M21-1 indicates that 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.  For the sciatic nerve, marked muscular atrophy is expected. 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 or 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 (38 C.F.R. § 4.123). See M21-1, Part V, Subpart iii, Chapter 12, Section A -Neurological Conditions and Convulsive Disorders (va.gov).

Ratings for peripheral neurological disorders and their residuals must consider the site and character of the injury, the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and
 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 (38 C.F.R. § 4.123). See M21-1, Part V, Subpart iii, Chapter 12, Section A -Neurological Conditions and Convulsive Disorders (va.gov).

Ratings for peripheral neurological disorders and their residuals must consider the site and character of the injury, the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.    

In furtherance of his claim, and relevant to the period on appeal, the Veteran underwent a VA Peripheral Nerve Examination in March 2024.  In the report, the VA examiner documented bilateral mild incomplete paralysis of the sciatic nerve.  The Veteran reported intermittent pain, tingling, and numbness.  The examination report documented no paresthesias or dysesthesias of the left lower extremity but mild paresthesias or dysesthesias of the right lower extremity.  Both the right and left lower extremity were documented as having mild intermittent pain, and mild numbness.  Muscle strength and reflexes were normal and, muscle atrophy and trophic changes were not appreciated.  However, decreased sensation was noted in the foot or toes. 

Prior to January 31, 2025, there are no findings indicative of sciatic nerve incomplete paralysis of the left and right lower extremity of a moderate or greater severity.  There is no finding of muscular atrophy, trophic changes, decreased muscle strength, decreased reflexes, or significant sensory deficits. Indeed, the findings of record evidence mild sensory impact exclusively (e.g., pain, numbness, paresthesias and dysesthesias). Both his left and right knee extension, ankle plantar flexion, and ankle dorsiflexion were normal.  His knee and ankle reflexes on the left and right were normal.  He experienced normal sensations of the knee, thigh, and lower leg and ankle.  Only the foot or toes exhibited decreased sensation.  In both the left and right lower extremities, the Veteran experienced, exclusively, sensory deficits, namely intermittent pain and numbness.  He also experienced paresthesias (pins and needles) or dysesthesia (uncomfortable sensation) in the right lower extremity.  However, muscle strength was normal and reflexes were not impacted.  

The Veteran did not experience significant sensory changes, nor were his reflexes or motor ability impacted as would be expected in cases of moderate disability.  He also did not experience the reflex or motor changes expected to combine with sensory changes to establish moderately severe incomplete paralysis.  As noted above, both his left and right knee extension, ankle plantar flexion, and ankle dorsiflexion were normal.  His knee and ankle reflexes on the left and right lower extremities were normal.  He experienced normal sensations of the bilateral thigh, knee, and lower leg and ankle in both the left and right lower extremities.  

Finally, the Veteran did not exhibit symptoms associated with severe incomplete paralysis such as muscle atrophy, weakness or diminished or hyperactive reflexes (bilateral knee extension, ankle plantar flexion, and ankle dorsiflexion were normal and bilateral knee and ankle reflexes were normal), and he did not exhibit trophic changes.  As noted above, muscular atrophy is expected in severe cases involving the sciatic nerve.

Accordingly, entitlement to a rating greater than 10 percent prior to January 31, 2025, is denied.

 

 

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Sloley, Z. N.

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.