38 C.F.R. § 4.124a Schedule of ratings—neurological conditions and convulsive disorders.
Title 38 - Pensions, Bonuses, and Veterans' Relief
Title 38: Pensions, Bonuses, and Veterans' Relief
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings
Neurological Conditions and Convulsive Disorders
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§ 4.124a Schedule of ratings—neurological conditions and convulsive disorders.
[With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves]
Organic Diseases of the Central Nervous System------------------------------------------------------------------------ Rating------------------------------------------------------------------------8000 Encephalitis, epidemic, chronic: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 10 Brain, new growth of:8002 Malignant.................................................. 100 Note: The rating in code 8002 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating................................................ 308003 Benign, minimum............................................ 60 Rate residuals, minimum....................................... 108004 Paralysis agitans: Minimum rating................................................ 308005 Bulbar palsy............................................... 1008007 Brain, vessels, embolism of.8008 Brain, vessels, thrombosis of.8009 Brain, vessels, hemorrhage from: Rate the vascular conditions under Codes 8007 through 8009, 100 for 6 months................................................. Rate residuals, thereafter, minimum........................... 108010 Myelitis: Minimum rating................................................ 108011 Poliomyelitis, anterior: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 108012 Hematomyelia: For 6 months.................................................. 100 Rate residuals, minimum....................................... 108013 Syphilis, cerebrospinal.8014 Syphilis, meningovascular.8015 Tabes dorsalis. Note: Rate upon the severity of convulsions, paralysis, visual impairment or psychotic involvement, etc.8017 Amyotrophic lateral sclerosis: Minimum rating................................................ 308018 Multiple sclerosis: Minimum rating................................................ 308019 Meningitis, cerebrospinal, epidemic: As active febrile disease..................................... 100 Rate residuals, minimum....................................... 108020 Brain, abscess of: As active disease............................................. 100 Rate residuals, minimum....................................... 10 Spinal cord, new growths of:..................................8021 Malignant.................................................. 100 Note: The rating in code 8021 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating................................................ 308022 Benign, minimum rating..................................... 60 Rate residuals, minimum....................................... 108023 Progressive muscular atrophy: Minimum rating................................................ 308024 Syringomyelia: Minimum rating................................................ 308025 Myasthenia gravis: Minimum rating................................................ 30 Note: It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.8045 Brain disease due to trauma: Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045- 8207). Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.8046 Cerebral arteriosclerosis: Purely neurological disabilities, such as hemiplegia, cranial nerve paralysis, etc., due to cerebral arteriosclerosis will be rated under the diagnostic codes dealing with such specific disabilities, with citation of a hyphenated diagnostic code (e.g., 8046-8207). Purely subjective complaints such as headache, dizziness, tinnitus, insomnia and irritability, recognized as symptomatic of a properly diagnosed cerebral arteriosclerosis, will be rated 10 percent and no more under diagnostic code 9305. This 10 percent rating will not be combined with any other rating for a disability due to cerebral or generalized arteriosclerosis. Ratings in excess of 10 percent for cerebral arteriosclerosis under diagnostic code 9305 are not assignable in the absence of a diagnosis of multi-infarct dementia with cerebral arteriosclerosis. Note: The ratings under code 8046 apply only when the diagnosis of cerebral arteriosclerosis is substantiated by the entire clinical picture and not solely on findings of retinal arteriosclerosis.------------------------------------------------------------------------
Miscellaneous Diseases------------------------------------------------------------------------ Rating------------------------------------------------------------------------8100 Migraine: With very frequent completely prostrating and prolonged 50 attacks productive of severe economic inadaptability......... With characteristic prostrating attacks occurring on an 30 average once a month over last several months................ With characteristic prostrating attacks averaging one in 2 10 months over last several months.............................. With less frequent attacks.................................... 08103 Tic, convulsive: Severe........................................................ 30 Moderate...................................................... 10 Mild.......................................................... 0 Note: Depending upon frequency, severity, muscle groups involved.8104 Paramyoclonus multiplex (convulsive state, myoclonic type): Rate as tic; convulsive; severe cases......................... 608105 Chorea, Sydenham's: Pronounced, progressive grave types........................... 100 Severe........................................................ 80 Moderately severe............................................. 50 Moderate...................................................... 30 Mild.......................................................... 10 Note: Consider rheumatic etiology and complications.8106 Chorea, Huntington's. Rate as Sydenham's chorea. This, though a familial disease, has its onset in late adult life, and is considered a ratable disability.8107 Athetosis, acquired. Rate as chorea.8108 Narcolepsy. Rate as for epilepsy, petit mal.------------------------------------------------------------------------
Diseases of the Cranial Nerves------------------------------------------------------------------------ Rating------------------------------------------------------------------------ Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor. Fifth (trigeminal) cranial nerve8205 Paralysis of: Complete...................................................... 50 Incomplete, severe............................................ 30 Incomplete, moderate.......................................... 10 Note: Dependent upon relative degree of sensory manifestation or motor loss.8305 Neuritis.8405 Neuralgia. Note: Tic douloureux may be rated in accordance with severity, up to complete paralysis. Seventh (facial) cranial nerve8207 Paralysis of: Complete.................................................... 30 Incomplete, severe.......................................... 20 Incomplete, moderate........................................ 10 Note: Dependent upon relative loss of innervation of facial muscles.8307 Neuritis.8407 Neuralgia. Ninth (glossopharyngeal) cranial nerve........................8209 Paralysis of: Complete...................................................... 30 Incomplete, severe............................................ 20 Incomplete, moderate.......................................... 10 Note: Dependent upon relative loss of ordinary sensation in mucous membrane of the pharynx, fauces, and tonsils.8309 Neuritis.8409 Neuralgia. Tenth (pneumogastric, vagus) cranial nerve....................8210 Paralysis of: Complete...................................................... 50 Incomplete, severe............................................ 30 Incomplete, moderate.......................................... 10 Note : Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart.8310 Neuritis.8410 Neuralgia. Eleventh (spinal accessory, external branch) cranial nerve.8211 Paralysis of: Complete...................................................... 30 Incomplete, severe............................................ 20 Incomplete, moderate.......................................... 10 Note: Dependent upon loss of motor function of sternomastoid and trapezius muscles.8311 Neuritis.8411 Neuralgia. Twelfth (hypoglossal) cranial nerve.8212 Paralysis of: Complete...................................................... 50 Incomplete, severe............................................ 30 Incomplete, moderate.......................................... 10 Note: Dependent upon loss of motor function of tongue.8312 Neuritis.8412 Neuralgia.------------------------------------------------------------------------
Diseases of the Peripheral Nerves------------------------------------------------------------------------ Rating Schedule of ratings ----------------- Major Minor------------------------------------------------------------------------The term ``incomplete paralysis,'' with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture 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. Upper radicular group (fifth and sixth cervicals)8510 Paralysis of: Complete; all shoulder and elbow movements lost or 70 60 severely affected, hand and wrist movements not affected........................................... Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208610 Neuritis.8710 Neuralgia. Middle radicular group8511 Paralysis of: Complete; adduction, abduction and rotation of arm, 70 60 flexion of elbow, and extension of wrist lost or severely affected.................................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208611 Neuritis.8711 Neuralgia. Lower radicular group8512 Paralysis of: Complete; all intrinsic muscles of hand, and some or 70 60 all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand).................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 40 30 Mild.............................................. 20 208612 Neuritis.8712 Neuralgia. All radicular groups8513 Paralysis of: Complete............................................ 90 80 Incomplete: Severe............................................ 70 60 Moderate.......................................... 40 30 Mild.............................................. 20 208613 Neuritis.8713 Neuralgia. The musculospiral nerve (radial nerve)8514 Paralysis of: Complete; drop of hand and fingers, wrist and 70 60 fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; can not extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity................. Incomplete: Severe............................................ 50 40 Moderate.......................................... 30 20 Mild.............................................. 20 208614 Neuritis.8714 Neuralgia. Note: Lesions involving only ``dissociation of extensor communis digitorum'' and ``paralysis below the extensor communis digitorum,'' will not exceed the moderate rating under code 8514. The median nerve8515 Paralysis of: Complete; the hand inclined to the ulnar side, the 70 60 index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances.......................... Incomplete: Severe............................................ 50 40 Moderate.......................................... 30 20 Mild.............................................. 10 108615 Neuritis.8715 Neuralgia. The ulnar nerve8516 Paralysis of: Complete; the ``griffin claw'' deformity, due to 60 50 flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened........................................... Incomplete: Severe............................................ 40 30 Moderate.......................................... 30 20 Mild.............................................. 10 108616 Neuritis.8716 Neuralgia. Musculocutaneous nerve8517 Paralysis of: Complete; weakness but not loss of flexion of elbow 30 20 and supination of forearm.......................... Incomplete: Severe............................................ 20 20 Moderate.......................................... 10 10 Mild.............................................. 0 08617 Neuritis.8717 Neuralgia. Circumflex nerve8518 Paralysis of: Complete; abduction of arm is impossible, outward 50 40 rotation is weakened; muscles supplied are deltoid and teres minor.................................... Incomplete: Severe............................................ 30 20 Moderate.......................................... 10 10 Mild.............................................. 0 08618 Neuritis.8718 Neuralgia. Long thoracic nerve8519 Paralysis of: Complete; inability to raise arm above shoulder 30 20 level, winged scapula deformity.................... Incomplete: Severe............................................ 20 20 Moderate.......................................... 10 10 Mild.............................................. 0 0 Note: Not to be combined with lost motion above shoulder level.8619 Neuritis.8719 Neuralgia. Note: Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings.------------------------------------------------------------------------
------------------------------------------------------------------------ Rating------------------------------------------------------------------------ Sciatic nerve8520 Paralysis of: Complete; the foot dangles and drops, no active movement 80 possible of muscles below the knee, flexion of knee weakened or (very rarely) lost....................................... Incomplete: Severe, with marked muscular atrophy....................... 60 Moderately severe.......................................... 40 Moderate................................................... 20 Mild....................................................... 108620 Neuritis.8720 Neuralgia. External popliteal nerve (common peroneal)8521 Paralysis of: Complete; foot drop and slight droop of first phalanges of 40 all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes..................................... Incomplete: Severe..................................................... 30 Moderate................................................... 20 Mild....................................................... 108621 Neuritis.8721 Neuralgia. Musculocutaneous nerve (superficial peroneal)8522 Paralysis of: Complete; eversion of foot weakened.......................... 30 Incomplete: Severe..................................................... 20 Moderate................................................... 10 Mild....................................................... 08622 Neuritis.8722 Neuralgia. Anterior tibial nerve (deep peroneal)8523 Paralysis of: Complete; dorsal flexion of foot lost........................ 30 Incomplete: Severe..................................................... 20 Moderate................................................... 10 Mild....................................................... 08623 Neuritis.8723 Neuralgia. Internal popliteal nerve (tibial)8524 Paralysis of: Complete; plantar flexion lost, frank adduction of foot 40 impossible, flexion and separation of toes abolished; no muscle in sole can move; in lesions of the nerve high in popliteal fossa, plantar flexion of foot is lost............ Incomplete: Severe..................................................... 30 Moderate................................................... 20 Mild....................................................... 108624 Neuritis.8724 Neuralgia. Posterior tibial nerve8525 Paralysis of: Complete; paralysis of all muscles of sole of foot, 30 frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired......................................... Incomplete: Severe..................................................... 20 Moderate................................................... 10 Mild....................................................... 108625 Neuritis.8725 Neuralgia. Anterior crural nerve (femoral)8526 Paralysis of: Complete; paralysis of quadriceps extensor muscles........... 40 Incomplete: Severe..................................................... 30 Moderate................................................... 20 Mild....................................................... 108626 Neuritis.8726 Neuralgia. Internal saphenous nerve8527 Paralysis of: Severe to complete........................................... 10 Mild to moderate............................................. 08627 Neuritis.8727 Neuralgia. Obturator nerve8528 Paralysis of: Severe to complete........................................... 10 Mild or moderate............................................. 08628 Neuritis.8728 Neuralgia. External cutaneous nerve of thigh8529 Paralysis of: Severe to complete........................................... 10 Mild or moderate............................................. 08629 Neuritis.8729 Neuralgia. Ilio-inguinal nerve8530 Paralysis of: Severe to complete........................................... 10 Mild or moderate............................................. 08630 Neuritis.8730 Neuralgia.8540 Soft-tissue sarcoma (of neurogenic origin)................ 100 Note: The 100 percent rating will be continued for 6 months following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. At this point, if there has been no local recurrence or metastases, the rating will be made on residuals.------------------------------------------------------------------------
The Epilepsies------------------------------------------------------------------------ Rating------------------------------------------------------------------------ A thorough study of all material in §§ 4.121 and 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action.8910 Epilepsy, grand mal. Rate under the general rating formula for major seizures.8911 Epilepsy, petit mal. Rate under the general rating formula for minor seizures. Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness. Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (``pure'' petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type). General Rating Formula for Major and Minor Epileptic Seizures: Averaging at least 1 major seizure per month over the last 100 year....................................................... Averaging at least 1 major seizure in 3 months over the last 80 year; or more than 10 minor seizures weekly................ Averaging at least 1 major seizure in 4 months over the last 60 year; or 9-10 minor seizures per week...................... At least 1 major seizure in the last 6 months or 2 in the 40 last year; or averaging at least 5 to 8 minor seizures weekly..................................................... At least 1 major seizure in the last 2 years; or at least 2 20 minor seizures in the last 6 months........................ A confirmed diagnosis of epilepsy with a history of seizures 10 Note (1): When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy. Note (2): In the presence of major and minor seizures, rate the predominating type. Note (3): There will be no distinction between diurnal and nocturnal major seizures.8912 Epilepsy, Jacksonian and focal motor or sensory.8913 Epilepsy, diencephalic. Rate as minor seizures, except in the presence of major and minor seizures, rate the predominating type.8914 Epilepsy, psychomotor. Major seizures: Psychomotor seizures will be rated as major seizures under the general rating formula when characterized by automatic states and/or generalized convulsions with unconsciousness. Minor seizures: Psychomotor seizures will be rated as minor seizures under the general rating formula when characterized by brief transient episodes of random motor movements, hallucinations, perceptual illusions, abnormalities of thinking, memory or mood, or autonomic disturbances.------------------------------------------------------------------------Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome will be rated separately under the appropriate diagnostic code (e.g., 9304 or 9326). In the absence of a diagnosis of non-psychotic organic psychiatric disturbance (psychotic, psychoneurotic or personality disorder) if diagnosed and shown to be secondary to or directly associated with epilepsy will be rated separately. The psychotic or psychroneurotic disorder will be rated under the appropriate diagnostic code. The personality disorder will be rated as a dementia (e.g., diagnostic code 9304 or 9326).Epilepsy and Unemployability: (1) Rating specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult of attainment due to employer reluctance to the hiring of the epileptic.(2) Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment.(3) The assent of the claimant should first be obtained for permission to conduct this economic and social survey. The purpose of this survey is to secure all the relevant facts and data necessary to permit of a true judgment as to the reason for his or her unemployment and should include information as to:(a) Education;(b) Occupations prior and subsequent to service;(c) Places of employment and reasons for termination;(d) Wages received;(e) Number of seizures.(4) Upon completion of this survey and current examination, the case should have rating board consideration. Where in the judgment of the rating board the veteran's unemployability is due to epilepsy and jurisdiction is not vested in that body by reason of schedular evaluations, the case should be submitted to the Director, Compensation and Pension Service.
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(Authority: 38 U.S.C. 1155)
[29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005]
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