PARALYSIS OF THE SCIATIC NERVE

Summary

The Veteran served on active duty from March 2009 to March 2013. The Veteran sought higher ratings for bilateral sciatic nerve radiculopathy and bilateral femoral nerve radiculopathy. The Board reviewed the evidence of record from the time of the prior rating decision, including a VA Back Conditions Examination from August 2024 and the Veteran's medical records. The examination noted abnormal muscle strength, hypoactive reflexes, decreased and absent sensations, and severe pain and paresthesias affecting the bilateral sciatic and femoral nerves, but no muscle atrophy. The Board found that this symptomatology characterized the Veteran's left and right sciatic nerve radiculopathies as moderately severe incomplete paralysis, warranting a 40 percent rating, and the left and right femoral nerve radiculopathies as severe incomplete paralysis, warranting a 30 percent rating. The Board resolved any doubt in the Veteran's favor for these ratings. However, the Board found that the evidence did not support a higher rating, as the Veteran did not demonstrate marked muscular atrophy or complete paralysis for the sciatic nerve, nor complete paralysis of the quadriceps extensor muscles for the femoral nerve. The Board concluded that the evidence persuasively weighed against a higher rating, rendering the benefit of the doubt doctrine inapplicable for ratings above those granted. Therefore, the Board granted a 40 percent rating for each sciatic nerve radiculopathy and a 30 percent rating for each femoral nerve radiculopathy.

Rationale

Diminished muscle strength; Hypoactive reflexes; Decreased and absent sensations; Severe pain and paresthesias; No muscle atrophy

Full Decision Text

Citation Nr: A26040544
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250430-542971
DATE: April 30, 2026

ORDER

Entitlement to a 40 percent disabling rating for left lower extremity radiculopathy of the sciatic nerve is granted.

Entitlement to a 40 percent disabling rating for right lower extremity radiculopathy of the sciatic nerve is granted.

Entitlement to a 30 percent disabling rating for left lower extremity radiculopathy of femoral nerve is granted.

Entitlement to a 30 percent disabling rating for right lower extremity radiculopathy of femoral nerve is granted.

FINDINGS OF FACT

1. The Veteran's left lower extremity radiculopathy of the sciatic nerve has been characterized by no worse than moderately severe incomplete paralysis. 

2. The Veteran's right lower extremity radiculopathy of the sciatic nerve has been characterized by no worse than moderately severe incomplete paralysis.

3. The Veteran's left lower extremity radiculopathy of femoral nerve has been characterized by no worse than severe incomplete paralysis. 

4. The Veteran's right lower extremity radiculopathy of femoral nerve has been characterized by no worse than severe incomplete paralysis. 

CONCLUSIONS OF LAW

1. The criteria for a 40 percent disabling rating for left lower extremity radiculopathy of the sciatic nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 38 C.F.R. § 4.124a, Diagnostic Code 8520.  

2. The criteria for a 40 percent disabling rating for right lower extremity radiculopathy of the sciatic nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 38 C.F.R. § 4.124a, Diagnostic Code 8520.  

3. The criteria for a 30 percent disabling rating for left lower extremity radiculopathy of femoral nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 38 C.F.R. § 4.124a, Diagnostic Code 8526.  

4. The criteria for a 30 percent disabling rating for right lower extremity radiculopathy of femoral nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 38 C.F.R. § 4.124a, Diagnostic Code 8526.  

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 2009 to March 2013.

In January 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a January 2025 rating decision.  In April 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior January 2025 rating decision.  Therefore, the Board may only consider the evidence of record at the time of the January 2025 rating decision and any evidence submitted during an applicable evidentiary window. 

In April 2025, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the January 2025 AOJ decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  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
 filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the January 2025 AOJ decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  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. 

INCREASED RATING

The Veteran seeks a higher rating for his left lower extremity radiculopathy of the sciatic nerve, right lower extremity radiculopathy of the sciatic nerve, left lower extremity radiculopathy of the femoral nerve, and right lower extremity radiculopathy of the femoral nerve.  See April 2025 VA Form 10182.

Applicable Law

Disability ratings are determined by the application of a schedule of ratings that is based on average impairment of earning capacity.? 38?U.S.C. §?1155.? Percentage ratings are determined by comparing the manifestations of a particular disability with the requirements contained in VA's Schedule for Rating Disabilities.? The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from a disease or injury and the residual conditions in civilian occupations.? 38?U.S.C. §?1155;?38?C.F.R. §?4.1.?? 

Separate diagnostic codes identify the various disabilities and the criteria for specific ratings.? If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating.? Otherwise, the lower rating will be assigned.? 38?C.F.R. §?4.7.? In view of the number of atypical instances, it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified.? 38?C.F.R. §?4.21.? It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent with the facts shown in every case.? Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran.? 38?C.F.R. §?3.102, 4.3.?? 

In the case of an initial rating, the entire evidentiary record from the time of a veteran's claim for service connection to the present is of importance in determining the proper evaluation of disability, and staged ratings are to be considered in order to reflect the changing level of severity of a disability during this period.? Fenderson v. West, 12?Vet. App.?119 (1999).  In deciding this appeal, the Board has considered whether separate ratings for different periods of time are warranted, a practice of assigning ratings referred to as staging ratings.? See id; see also Hart v. Mansfield,?21?Vet. App. 505 (2008). ?? 

Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant.? See 38?U.S.C. §?5107;?38?C.F.R. §?3.102; see also Lynch v. McDonough, 21 F.4th 776 (2021).? 

Diagnostic Codes 8520 & 8526

The Veteran is in receipt of a 20 percent rating for both left lower extremity radiculopathy of the sciatic nerve and right lower extremity radiculopathy of the sciatic nerve under rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520.  He is also in receipt of a 20 percent rating for both left lower extremity radiculopathy of the femoral nerve and right lower extremity radiculopathy of the femoral nerve rated under 38 C.F.R. § 4.124a, Diagnostic Code 8526.  

For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve.  The term "incomplete paralysis" indicates a degree of
 for both left lower extremity radiculopathy of the sciatic nerve and right lower extremity radiculopathy of the sciatic nerve under rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520.  He is also in receipt of a 20 percent rating for both left lower extremity radiculopathy of the femoral nerve and right lower extremity radiculopathy of the femoral nerve rated under 38 C.F.R. § 4.124a, Diagnostic Code 8526.  

For diseases of the peripheral nerves, disability ratings are based on whether there is complete or incomplete paralysis of the particular nerve.  The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration.  See 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves.  When the involvement is wholly sensory, the rating should be for the mild, or at most the moderate degree.  Id.  

Neurological impairments affecting the sciatic nerve are evaluated under Diagnostic Codes 8520 (paralysis), 8620 (neuritis) and 8720 (neuralgia), using the criteria under Diagnostic Code 8520.  Complete paralysis of the sciatic nerve is evidenced by the foot dangled and dropped, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost and warrants a maximum 80 percent rating.  Diagnostic Code 8520 provided a 10 percent rating for mild incomplete paralysis, a 20 percent rating for moderate incomplete paralysis, a 40 percent rating for conditions considered "moderately severe," and a 60 percent rating for conditions considered "severe, with marked muscular atrophy."  38 C.F.R. § 4.124a, Diagnostic Code 8520.

Neurological impairments affecting the femoral nerve are evaluated under Diagnostic Codes 8526 (paralysis), 8626 (neuritis), and 8726 (neuralgia), using the criteria under Diagnostic Code 8526.  Complete paralysis of the femoral nerve is evidenced by paralysis of quadriceps extensor muscles and warrants a maximum 40 percent rating.  Diagnostic Code 8526 provided a 10 percent rating for mild incomplete paralysis, a 20 percent rating for moderate incomplete paralysis, and a 30 percent rating for severe incomplete paralysis.  38 C.F.R. § 4.124a, Diagnostic Code 8526.  

The Board observes that the words "mild," "moderate" and "severe" as used in the various diagnostic 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.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Although the Board has at times attempted to define these terms using dictionary definitions, those definitions are problematic because they "do little to explain the Board's understanding of these terms and do not 'disclos[e] that benchmark it employed to reach [its] conclusion.'" Casey v. McDonough, No. 21-7569, 2023 U.S. App. Vet. Claims LEXIS 98, *5 (Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018)) (discussing the Board's attempt to define the terms slight, mild, moderate, and severe in Diagnostic Code 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). With regard to Diagnostic Code 8520, although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing the analysis, [they] are not alone sufficient to explain the Board's decision absent an articulated connection to specific evidence." Lemon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims L
 to define the terms slight, mild, moderate, and severe in Diagnostic Code 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). With regard to Diagnostic Code 8520, although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing the analysis, [they] are not alone sufficient to explain the Board's decision absent an articulated connection to specific evidence." Lemon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims LEXIS 1998, *7 (Dec. 16, 2022) (mem dec) (Toth, J.).  As explained in Lemon, these regulations leave gaps in defining the relevant terms that are filled by VA's Adjudication Manual, M21-1.

The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases," Overton v. Wilkie, 30 Vet. App. 257, 264 (2018).  Clearly relevant to this case are M21-1 provisions regarding evaluations of paralysis of the sciatic nerve.  The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. iii, ch. 12, sec. A.2.c.  Additionally, moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution."  Id.  M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate."  Id.  Also, the M21-1 provides that a moderately severe evaluation (that is, a 40 percent rating) is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id.  Atrophy may, but need not, be present for a moderately severe rating.

As concluded by the Court in Lemon, given the relevance of these provisions to rating disabilities of the peripheral nerves, "the Board's failure to mention the M21-1's relevant guidance in this area constitutes clear error."  Lemon, at *7-*8. See also Bethea, 2 Vet. App. at 254. The Board has therefore reviewed the M21-1 definitions and finds them instructive in the instant case.

Factual Background 

The Veteran underwent a Back Conditions Examination in August 2024.  The examiner noted the Veteran's lumbar spine condition and radiculopathies.  The Veteran's muscle strength testing was abnormal, but he had active movement.  He did not have muscle atrophy.  His reflex exam was abnormal and hypoactive.  His sensory exam was abnormal with decreased and absent sensations.  He had severe constant pain, severe intermittent pain, severe paresthesias and dysesthesias, and severe numbness of the bilateral sciatic nerves and bilateral femoral nerves.  The examiner did not find there were any other signs of symptoms of the Veteran's radiculopathy.  The Veteran endorsed difficulty with standing, walking, lifting, sitting, and driving extended periods.  He further endorsed difficulty ascending and descending stairs during flare ups and a reduced ability to efficiently complete occupational tasks.  See August 2024 Back Conditions Examination. 

The Veteran's medical records corroborate the findings regarding radiculopathies found in the August 2024 Back Conditions examination, including no muscle atrophy.  See generally CAPRI Records. 

Analysis

After careful review and consideration of the pertinent evidence, the Board finds that the Veteran's left and right lower extremity radiculopathy of the sciatic nerve has been characterized by no worse than moderately severe incomplete paralysis warranting a 40 percent disabling rating and that the left and right lower extremity radiculopathy of the femoral nerve has been characterized by no worse than severe incomplete paralysis warranting a 30 percent disabling rating.  Specifically, the examination showed that the Veteran had diminished muscle strength, hypoactive reflexes, decreased and absent sensations, and severe constant pain, intermittent pain, paresthesias and dysesthesias, and numbness of the bilateral sciatic and femoral nerves.  Notably, he did not have muscle atrophy; however, the Veteran's impaired motor and reflex impairment reflected the higher, moderately severe
ity radiculopathy of the sciatic nerve has been characterized by no worse than moderately severe incomplete paralysis warranting a 40 percent disabling rating and that the left and right lower extremity radiculopathy of the femoral nerve has been characterized by no worse than severe incomplete paralysis warranting a 30 percent disabling rating.  Specifically, the examination showed that the Veteran had diminished muscle strength, hypoactive reflexes, decreased and absent sensations, and severe constant pain, intermittent pain, paresthesias and dysesthesias, and numbness of the bilateral sciatic and femoral nerves.  Notably, he did not have muscle atrophy; however, the Veteran's impaired motor and reflex impairment reflected the higher, moderately severe incomplete paralysis limitation for his sciatic nerve radiculopathies and severe incomplete paralysis limitation for his femoral nerve radiculopathies.

Based on the specific facts of this case and resolving all doubt in favor of the Veteran, the Board finds that a 40 percent rating, but no higher, is warranted for both the left and right lower extremity radiculopathy of the sciatic nerve and that a 30 percent rating, but no higher, is warranted for both the left and right lower extremity radiculopathy of the femoral nerve.  See 38?U.S.C. §?5107;?38?C.F.R. §?3.102; Lynch, 21 F.4th at 776.? 

As to a higher rating for sciatic nerve radiculopathies, the Veteran does not contend and his examination and medical records do not show that he has marked muscular atrophy or complete paralysis.  As to a higher rating for femoral nerve radiculopathies, the record does not indicate, and the Veteran does not contend he has paralysis of quadriceps extensor muscles.  The Board acknowledges the severity of the Veteran's radiculopathies.  However, his overall symptomatology does not reach the level of severe with marked muscular atrophy incomplete paralysis for sciatic nerve radiculopathies and does not reach the level of complete paralysis of quadriceps extensor muscles for femoral nerve radiculopathies.  

The evidence is neither evenly balanced nor approximately so with regard to whether entitlement to a rating in excess of 40 percent for both left and right lower extremity radiculopathy of the sciatic nerve and 30 percent for both left and right lower extremity radiculopathy of the femoral nerve is warranted.  Rather, the evidence persuasively weighs against a higher rating.  The benefit of the doubt doctrine, codified in 38?U.S.C. §?5107(b), is therefore not for application as to this claim.? See Lynch,?21 F.4th at 776 (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application). 

 

 

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Ti'a Smith, Associate 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.