VA Disability Ratings for Nerve Damage
What is Nerve Damage?
The body’s nervous system is a complex collection of nerves and cells (i.e., neurons) that transmit signals between different parts of the body. Nerves play an intricate role in all human activity, and therefore, nerve damage can be seriously debilitating and drastically affect an individual’s quality of life. Nerve damage presents with a wide variety of signs and symptoms. The specific symptoms may depend on the location and type of nerves that are affected. There are three types of nerves in the body:
These nerves control the involuntary or partially voluntary activities of the body (e.g., heart rate, blood pressure, digestion, temperature regulation). Damage to the autonomic nerves may produce the following symptoms:
- Inability to sense chest pain, such as angina or heart attack
- Too much sweating (i.e., hyperhidrosis) or too little sweating (i.e., anhidrosis)
- Dry eyes and mouth
- Bladder dysfunction
- Sexual dysfunction
These nerves control movements and actions by passing information form the brain and spinal cord to the body’s muscles. Damage to the motor nerves may result in the following symptoms:
- Muscle atrophy
- Twitching (i.e., fasciculation)
These nerves relay information from the skin and muscles back to the spinal cord and brain. Such information is then processed to allow an individual to feel pain and other bodily sensations. Finally, sensory nerve damage may produce the following symptoms:
- Tingling or prickling
- Problems with positional awareness
Overall, there are more than 100 different types of nerve damage, which may cause different types of impairment and thereby require different types of treatment. Furthermore, there are many possible causes such as:
- Autoimmune diseases (e.g., multiple sclerosis, Guillain-Barré, lupus)
- Drug side effects and toxic substances
- Motor neuron diseases (e.g., ALS or Lou Gehrig’s disease)
- Infectious diseases (e.g., Lyme disease, herpes viruses, hepatitis C)
VA Service Connection for Nerve Damage
Service connection for nerve damage can be established in a number of ways; however, arguably the most common way to do so is on a secondary basis. Secondary service connection can occur in the event that a veteran’s already service-connected condition causes or aggravates a non-service-connected condition. Conditions that are service-connected on a secondary basis are rated the same way as other service-connected conditions. Obtaining secondary service connection for nerve damage would mean that a veteran would have to first be service-connected for a condition such as diabetes or cancer (see more examples above). If a veteran is service-connected for their diabetes or cancer, and subsequently develops nerve damage, they should get secondary service connection for their nerve damage.
However, veterans can also establish service connection for nerve damage on a direct basis. Doing so entails the following: (1) providing evidence of a current diagnosis of nerve damage; (2) providing evidence of an in-service event, injury, or illness; and (3) providing a medical nexus opinion linking the diagnosed nerve damage to the in-service incurrence.
How VA Rates Nerve Damage
All nerve conditions are rated by VA based on the loss of function of the affected body part. There are three distinct categories nerve damage can be rated under:
- Paralysis – the most severe category; the nerve cannot function at all and can result in complete or partial paralysis
- Neuritis – the nerve can still function, but it is swollen, irritated, and painful; involves at least one of the following: (1) decreased ability to sense; (2) muscle atrophy; and/or (3) loss of reflexes
- Neuralgia – sharp pain due to an irritated or damaged nerve; can also cause tingling, numbness, etc.
Importantly, once it is determined which of the three categories the nerve damage falls under, it can then be rated either under that category or based on limited motion, whichever results in the higher disability rating. If the nerve damage is causing the limited motion, then only one rating can be assigned either under a nerve diagnostic code or under limited motion. However, if the limited motion is not caused by the nerve damage, then it can be rated separately, in addition to a nerve diagnostic code rating. Regardless, each of the three categories of nerve damage mentioned above are rated based on severity as follows:
- Complete – the nerve is completely paralyzed, and the body part cannot function at all (equivalent to if it was amputated)
- Incomplete, severe – the nerve is not completely paralyzed, and there are symptoms (e.g., poor blood circulation and muscle atrophy) that significantly limit the body part’s ability to function
- Incomplete, moderate – the nerve is not completely paralyzed, and there is tingling, numbness, moderate pain, or other symptoms that interfere with the body part’s functioning
- Incomplete, mild – the nerve is not completely paralyzed, and there is only tingling or mild pain in the affected body part
- Severe – all three types of main symptoms (i.e., loss of reflexes, muscle atrophy, and loss of sensation) are present and seriously limit the body part’s ability to function
- Moderate – one or more of the main symptoms are present and significantly interfere with the body part’s ability to fully function
- Mild – one or more of the main symptoms are present, but they are mild and do not interfere significantly with the body part’s functioning
- Moderate – tingling, numbness, moderate to severe pain, or other symptoms that significantly interfere with the body part’s ability to function
- Mild – only tingling or mild pain is present in the affected body part
Additional Considerations for VA Ratings for Nerve Damage
Additional considerations for rating nerve damage include the fact that for all nerve ratings for the arms only, a higher rating is given if the affected arm is the dominant arm. If an individual is ambidextrous, then the arm affected by the nerve damage will also be considered as the dominant arm and warrant a higher rating. Furthermore, each nerve is paired, meaning there are two of every nerve (i.e., one for each side of the body). As such, the bilateral factor may be applicable. The bilateral factor adds 10 percent to the rating of a disability that results from “disease or injury of both arms, or of both legs, or of other paired skeletal muscles.” To be eligible for the bilateral factor, the nerve damage must affect the functioning of:
- Two upper limbs OR two lower limbs (but not one from the upper body and one from the lower); and
- Those extremities must be on opposite sides of the body (left and right)
Again, if the bilateral factor is applicable with nerve damage, VA should calculate the veteran’s combined disability rating with the added 10 percent.
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