PARALYSIS OF SCIATIC NERVE

Summary

The veteran, who served from June 1976 to July 1980, appeals the denial of an increased rating for bilateral lower extremity radiculopathy (sciatic nerve) prior to August 18, 2022. The Board reviewed the case following a Court of Appeals remand directing specific consideration of the M-21-1 manual's guidance for rating peripheral nerve conditions. The Veteran contended that severe constant pain warranted a higher rating. Evidence from a March 2022 VA examination indicated bilateral sciatic nerve radiculopathy with severe constant pain, moderate numbness, and mild paresthesias/dysesthesias, but also noted full strength, normal reflexes, and no atrophy in both lower extremities. The Board applied the VA Schedule for Rating Disabilities, specifically DC 8520 for sciatic nerve impairment, and guidance from the M-21-1 manual. The Board found that the absence of non-sensory symptoms like atrophy or significant motor/reflex impairment limited the rating to mild incomplete paralysis (10 percent). While pain was continuous, other sensory symptoms were mixed or mild, and the examiner noted only an 'impact' on activities rather than impossibility. The Board concluded that the symptomatology did not represent the most significant cases of sensory impairment, and therefore, the criteria for a higher rating were not met. The benefit of the doubt doctrine was not applied as the evidence preponderated against the claim. Consequently, the denial of an increased rating for left and right leg radiculopathy prior to August 18, 2022, was upheld.

Rationale

Evidence indicates only mild incomplete paralysis; Absence of non-sensory symptoms (atrophy, significant motor/reflex impairment); Symptoms did not represent most significant cases of sensory impairment

Full Decision Text

Citation Nr: A26040632
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 240227-421084
DATE: April 30, 2026

ORDER

Entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for left leg radiculopathy (sciatic nerve) is denied.

Entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for right leg radiculopathy (sciatic nerve) is denied.

FINDINGS OF FACT

1. Prior to August 18, 2022, the Veteran's left leg radiculopathy (sciatic nerve) was manifest by no more than mild incomplete paralysis.

2. Prior to August 18, 2022, the Veteran's right leg radiculopathy (sciatic nerve) was manifest by no more than mild incomplete paralysis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for left leg radiculopathy (sciatic nerve) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8520.

2. The criteria for entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for right leg radiculopathy (sciatic nerve) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1976 to July 1980.

These matters come to the Board on remand from a Court of Appeals for Veterans Claims (the Court) decision which granted a Joint Motion for Partial Remand (JMPR) and vacated those portions of a March 2025 Board decision related to the rating of the Veteran's bilateral lower extremity sciatic nerve radiculopathy prior to August 18, 2022. In granting the JMPR, the Court directed the Board to address the proper rating for the Veteran's bilateral lower extremity sciatic radiculopathy, and to specifically contemplate and assess the application of relevant portions of the M-21-1 adjudication manual. 

In the February 2024 notice of disagreement (NOD), the Veteran appealed a February 2024 rating decision, which was itself issued after a higher-level review (HLR) of a May 2023 rating decision. The Board notes that the Veteran listed both rating decision as on appeal for these issues, but treats only the most recent merits-decision on the issue as that on appeal. Terry v. McDonough, 37 Vet. App. 1, 12-13 (2023). The evidentiary window for either decision would be the same. 

In his NOD, the Veteran selected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the May 2023 agency of original jurisdiction (AOJ) decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to HLR, 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 rating in excess of 10 percent prior to August 18, 2022, for left leg radiculopathy (sciatic nerve) is denied. 

2. Entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for right leg radiculopathy (sciatic nerve) is denied. 

The Veteran and his representative contend that severe constant pain noted during the rating period on appeal entitled the Veteran to a higher initial rating. 

Factual Background

Although outside of the rating period on appeal
 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 rating in excess of 10 percent prior to August 18, 2022, for left leg radiculopathy (sciatic nerve) is denied. 

2. Entitlement to an initial rating in excess of 10 percent prior to August 18, 2022, for right leg radiculopathy (sciatic nerve) is denied. 

The Veteran and his representative contend that severe constant pain noted during the rating period on appeal entitled the Veteran to a higher initial rating. 

Factual Background

Although outside of the rating period on appeal, evidence from before the Veteran was granted service connection may be instructive as to the state of the Veteran's disability at the time of service connection. 

In June 2014, the Veteran was noted to have no limp as well as full strength, normal reflexes and sensation to light touch in both lower extremities after tests at a VA medical center. 

In November 2020, the Veteran reported left side pain to VA medical center staff. At that time, they again assessed his lower extremities and reported that the Veteran had full strength in both lower extremities, as well as normal sensation to touch. In July 2021, the VA medical center noted that the Veteran's gait was normal. 

In March 2022, the Veteran was provided with a VA examination for his back, which included an assessment of related bilateral lower extremity radiculopathy. The examiner diagnosed bilateral lower extremity radiculopathy, involving the sciatic nerve, and noted that it impacted the Veteran's ability - along with his back disability - to walk, stand, sit, sleep, and drive. The Veteran's legs were noted to have no atrophy, full strength, normal sensation to light touch, and normal reflexes. The examiner also endorsed bilateral leg symptoms of severe constant pain, with moderate numbness, mild paresthesias and/or dysesthesias, but no intermittent pain and no other symptoms. 

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 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 radiculopathy 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"
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.

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.  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.

Further, the M21-1 makes plain the directive of 38 C.F.R. § 4.124a that where impairment is wholly sensory, the ratings available under DC 8520 are limited to those representing mild and moderate incomplete paralysis - that is a 10 or 20 percent rating. See id. at Part V, Subpart iii, Chapter 12, Section A.2.a, b. ("When impairment is wholly sensory, the evaluation should be that specified for the mild, or at most, the moderate degree of incomplete paralysis for the nerve.... In cases where a peripheral nerve disability is only manifested by sensory impairment, 38 CFR 4.124a directs decision makers to assign the evaluation corresponding with the mild or at most the moderate degree of impairment.") (emphasis in original). 

These sections also provide guidance on those symptoms which are non-sensory, "such as reflex abnormality, weakness, or muscle atrophy." Id. at V.iii.12.A.2.b. 

Here, for the initial rating period - ranging from December 
 Subpart iii, Chapter 12, Section A.2.a, b. ("When impairment is wholly sensory, the evaluation should be that specified for the mild, or at most, the moderate degree of incomplete paralysis for the nerve.... In cases where a peripheral nerve disability is only manifested by sensory impairment, 38 CFR 4.124a directs decision makers to assign the evaluation corresponding with the mild or at most the moderate degree of impairment.") (emphasis in original). 

These sections also provide guidance on those symptoms which are non-sensory, "such as reflex abnormality, weakness, or muscle atrophy." Id. at V.iii.12.A.2.b. 

Here, for the initial rating period - ranging from December 2021, the date of service connection, to August 2022, when the Veteran's bilateral lower extremity rating under DC 8520 increased to 20 percent - the record shows an absence of non-sensory symptoms. The VA medical center assessment closest in time to that period - from November 2020 - shows the Veteran had full strength, normal reflexes, and intact sensation to touch in both lower extremities. The March 2022 VA exam reflects the same lack of non-sensory symptoms. The VA examiner at that time indicated that the Veteran had no atrophy, full strength, normal sensation to light touch, and normal reflexes in his bilateral lower extremities. Thus, by the plain terms of the regulations and the M-21-1, the Veteran's bilateral lower extremity radiculopathy affecting the sciatic nerves is limited to "at most the moder degree of impairment." See M21-1, Part V, Subpart iii, Chapter 12, Section A.2.a-c; see also 38 C.F.R. § 4.124a. So, the Board turns to an assessment of whether the Veteran is entitled to a mild or moderate rating for his bilateral lower extremity radiculopathy. 

Before proceeding, the Board pauses to state that it considers those symptoms - as relevant here - not defined in the M-21-1 as "non-sensory" to be "sensory." In specific, the Board here treats pain, numbness, and paresthesias and/or dysesthesias as sensory symptoms. Pain and numbness can plainly be described as sensory, and paresthesias and dysesthesias are both sensory by definition. See DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, 577, 1383 (32d ed. 2012) (defining "dysesthesias" as "an unpleasant abnormal sensation produced by normal stimuli" and "paresthesias" as "an abnormal touch sensation, such as burning [or] prickling... often in the absence of an external stimulus.").

Here, the Board finds that the Veteran's symptomatology warrants only a mild - or 10 percent - rating for his bilateral lower extremity radiculopathy during the rating period on appeal. Although the Veteran describes constant pain in both lower extremities, his other sensory symptoms are a mix of no impact (sensation to light touch), mild (paresthesias and/or dysesthesias), and moderate (numbness). In other words, his sensory symptoms are of mixed severity, even if continuous.

Importantly, the VA examiner also indicated only that the Veteran's radiculopathy "impact[ed]" his ability to walk, stand, sit, sleep, or drive, but did not describe these activities as impossible for the Veteran. 

While it is true that the M-21-1 directs the application of a moderate, 20 percent, rating for continuous symptoms, it goes on to say that these symptoms are "assigned a higher medical grade reflecting greater impairment," and that a moderate rating is reserved for those sensory symptoms which are "significantly disabling." M21-1, Part V, Subpart iii, Chapter 12, Section A.2.b-c. Further, the M-21-1 states that this rating is for the "the most significant cases of sensory-only impairment." Id..

Given that only the symptom of pain is noted to be continuous, while others are moderate, mild, or absent, without any reference to duration or frequency, the Board finds that the Veteran's indicated symptoms are not among the most significant cases of sensory impairment, even where the pain is severe and other sensory symptoms are indicated to be of mild or moderate severity, but without a significant functional impact. However, in September 2022, the Veteran was given a separate exam specifically for his bilateral lower extremity radiculopathy - which did result in a higher evaluation and showed worsened symptoms - and even there, his sensory symptoms are described as "frequent," not continuous. 

A mild evaluation is further supported by the fact
-only impairment." Id..

Given that only the symptom of pain is noted to be continuous, while others are moderate, mild, or absent, without any reference to duration or frequency, the Board finds that the Veteran's indicated symptoms are not among the most significant cases of sensory impairment, even where the pain is severe and other sensory symptoms are indicated to be of mild or moderate severity, but without a significant functional impact. However, in September 2022, the Veteran was given a separate exam specifically for his bilateral lower extremity radiculopathy - which did result in a higher evaluation and showed worsened symptoms - and even there, his sensory symptoms are described as "frequent," not continuous. 

A mild evaluation is further supported by the fact that the examiner indicated only an "impact" on activities, without further qualifying that level of impact, or any indication that the Veteran is not able to perform these activities, albeit with pain. That the Veteran has maintained full strength and normal reflexes, and was without lower extremity atrophy also suggests minimal functional impact beyond pain. The Board finds further support for this position in the general rating principle that pain that causes a functional impairment, but which does not meet any rating criteria, entitles the Veteran only to a minimum compensable rating. 38 C.F.R. § 4.59; see also Mitchell v. Shinseki, 25 Vet. App. 32, 4243 (2011) (holding that pain alone does not constitute functional loss and is just one fact to be considered when evaluating functional impairment). Finally, the Board notes that the Veteran's back pain for this rating period, as described in the March 2022 exam, is separately service-connected and rated, and results in the same functional impairment - that is, the impact on walking, standing, sitting, sleeping, and driving. Where the examiner has not separated out these impacts, it might have been impermissible pyramiding to compensate the disabilities separately, except for the separate pain in the legs as manifested by radiculopathy. Thus, compensating for pain alone would be logical, though this is not the precise basis for the 10 percent rating. 

As a final matter, the Board notes that the VA exam indicates that the Veteran treats his back and leg pain with topical treatments and over-the-counter pain medication, but there is no indication that these impact the Veteran's functioning, such that the Board finds a mild rating includes consideration of any effects of medication. Jones v. Shinseki, 26 Vet. App. 56, 61-63 (2012). 

Based on the above, including by reference to applicable sections of the M-21, specifically, Part V, Subpart iii, Chapter 12, Section A.2.a, b, c, and d, the Board finds that the evidence is persuasively against the claim for increased left and right lower extremity radiculopathy ratings prior to August 18, 2022, 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 claims are 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.