**§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]{.smallcaps}**

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 30

**8003** Benign, minimum 60

Rate residuals, minimum 10

**8004** Paralysis agitans:

Minimum rating 30

**8005** Bulbar palsy 100

**8007** Brain, vessels, embolism of.

**8008** Brain, vessels, thrombosis of.

**8009** Brain, vessels, hemorrhage from:

Rate the vascular conditions under Codes 8007 through 8009,

for 6 months 100

Rate residuals, thereafter, minimum 10

**8010** Myelitis:

Minimum rating 10

**8011** Poliomyelitis, anterior:

As active febrile disease 100

Rate residuals, minimum 10

**8012** Hematomyelia:

For 6 months 100

Rate residuals, minimum 10

**8013** 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 30

**8018** Multiple sclerosis:

Minimum rating 30

**8019** Meningitis, cerebrospinal, epidemic:

As active febrile disease 100

Rate residuals, minimum 10

**8020** 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 30

**8022** Benign, minimum rating 60

Rate residuals, minimum 10

**8023** Progressive muscular atrophy:

Minimum rating 30

**8024** Syringomyelia:

Minimum rating 30

**8025** 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** Residuals of traumatic brain injury (TBI):

There are three main areas of dysfunction that may result from TBI and
have profound effects on functioning: cognitive (which is common in
varying degrees after TBI), emotional/behavioral, and physical. Each of
these areas of dysfunction may require evaluation.

Cognitive impairment is defined as decreased memory, concentration,
attention, and executive functions of the brain. Executive functions are
goal setting, speed of information processing, planning, organizing,
prioritizing, self-monitoring, problem solving, judgment, decision
making, spontaneity, and flexibility in changing actions when they are
not productive. Not all of these brain functions may be affected in a
given individual with cognitive impairment, and some functions may be
affected more severely than others. In a given individual, symptoms may
fluctuate in severity from day to day. Evaluate cognitive impairment
under the table titled "Evaluation of Cognitive Impairment and Other
Residuals of TBI Not Otherwise Classified."

Subjective symptoms may be the only residual of TBI or may be associated
with cognitive impairment or other areas of dysfunction. Evaluate
subjective symptoms that are residuals of TBI, whether or not they are
part of cognitive impairment, under the subjective symptoms facet in the
table titled "Evaluation of Cognitive Impairment and Other Residuals of
TBI Not Otherwise Classified." However, separately evaluate any residual
with a distinct diagnosis that may be evaluated under another diagnostic
code, such as migraine headache or Meniere's disease, even if that
diagnosis is based on subjective symptoms, rather than under the
"Evaluation of Cognitive Impairment and Other Residuals of TBI Not
Otherwise Classified" table.

Evaluate emotional/behavioral dysfunction under §4.130 (Schedule of
ratings--mental disorders) when there is a diagnosis of a mental
disorder. When there is no diagnosis of a mental disorder, evaluate
emotional/behavioral symptoms under the criteria in the table titled
"Evaluation of Cognitive Impairment and Other Residuals of TBI Not
Otherwise Classified."

Evaluate physical (including neurological) dysfunction based on the
following list, under an appropriate diagnostic code: Motor and sensory
dysfunction, including pain, of the extremities and face; visual
impairment; hearing loss and tinnitus; loss of sense of smell and taste;
seizures; gait, coordination, and balance problems; speech and other
communication difficulties, including aphasia and related disorders, and
dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve
dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass
all possible residuals of TBI. For residuals not listed here that are
reported on an examination, evaluate under the most appropriate
diagnostic code. Evaluate each condition separately, as long as the same
signs and symptoms are not used to support more than one evaluation, and
combine under §4.25 the evaluations for each separately rated condition.
The evaluation assigned based on the "Evaluation of Cognitive Impairment
and Other Residuals of TBI Not Otherwise Classified" table will be
considered the evaluation for a single condition for purposes of
combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as
loss of use of an extremity, certain sensory impairments, erectile
dysfunction, the need for aid and attendance (including for protection
from hazards or dangers incident to the daily environment due to
cognitive impairment), being housebound, etc.

**Evaluation of Cognitive Impairment and Subjective Symptoms**

The table titled "Evaluation of Cognitive Impairment and Other Residuals
of TBI Not Otherwise Classified" contains 10 important facets of TBI
related to cognitive impairment and subjective symptoms. It provides
criteria for levels of impairment for each facet, as appropriate,
ranging from 0 to 3, and a 5th level, the highest level of impairment,
labeled "total." However, not every facet has every level of severity.
The Consciousness facet, for example, does not provide for an impairment
level other than "total," since any level of impaired consciousness
would be totally disabling. Assign a 100-percent evaluation if "total"
is the level of evaluation for one or more facets. If no facet is
evaluated as "total," assign the overall percentage evaluation based on
the level of the highest facet as follows: 0 = 0 percent; 1 = 10
percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70
percent evaluation if 3 is the highest level of evaluation for any
facet.

**Note (1):** There may be an overlap of manifestations of conditions
evaluated under the table titled "Evaluation Of Cognitive Impairment And
Other Residuals Of TBI Not Otherwise Classified" with manifestations of
a comorbid mental or neurologic or other physical disorder that can be
separately evaluated under another diagnostic code. In such cases, do
not assign more than one evaluation based on the same manifestations. If
the manifestations of two or more conditions cannot be clearly
separated, assign a single evaluation under whichever set of diagnostic
criteria allows the better assessment of overall impaired functioning
due to both conditions. However, if the manifestations are clearly
separable, assign a separate evaluation for each condition.

**Note (2):** Symptoms listed as examples at certain evaluation levels
in the table are only examples and are not symptoms that must be present
in order to assign a particular evaluation.

**Note (3):** "Instrumental activities of daily living" refers to
activities other than self-care that are needed for independent living,
such as meal preparation, doing housework and other chores, shopping,
traveling, doing laundry, being responsible for one's own medications,
and using a telephone. These activities are distinguished from
"Activities of daily living," which refers to basic self-care and
includes bathing or showering, dressing, eating, getting in or out of
bed or a chair, and using the toilet.

**Note (4):** The terms "mild," "moderate," and "severe" TBI, which may
appear in medical records, refer to a classification of TBI made at, or
close to, the time of injury rather than to the current level of
functioning. This classification does not affect the rating assigned
under diagnostic code 8045.

**Note (5):** A veteran whose residuals of TBI are rated under a version
of § 4.124a, diagnostic code 8045, in effect before October 23, 2008 may
request review under diagnostic code 8045, irrespective of whether his
or her disability has worsened since the last review. VA will review
that veteran's disability rating to determine whether the veteran may be
entitled to a higher disability rating under diagnostic code 8045. A
request for review pursuant to this note will be treated as a claim for
an increased rating for purposes of determining the effective date of an
increased rating awarded as a result of such review; however, in no case
will the award be effective before October 23, 2008. For the purposes of
determining the effective date of an increased rating awarded as a
result of such review, VA will apply 38 CFR 3.114, if applicable.

**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.

**[Evaluation of Cognitive Impairment and Other Residuals of
TBI]{.smallcaps}**

**[Not Otherwise Classified]{.smallcaps}**

Facets of cognitive

impairment and other

residuals of TBI not Level of

otherwise classified impairment Criteria

Memory, attention, 0 No complaints of impairment of memory,

concentration, executive attention, concentration, or executive

functions. functions.

1 A complaint of mild loss of memory (such as

having difficult following a conversation, recalling

recent conversations, remembering names of new

acquaintances, or finding words, or often misplacing

items), attention, concentration, or executive

functions, but without objective evidence on testing.

2 Objective evidence on testing of mild impairment of

memory, attention, concentration, or executive

functions resulting in mild functional impairment.

3 Objective evidence on testing of moderate

impairment of memory, attention, concentration, or

executive functions resulting in moderate functional

impairment.

Total Objective evidence on testing of severe impairment

of memory, attention, concentration, or executive

functions resulting in severe functional impairment.

Judgment 0 Normal.

1 Mildly impaired judgment. For complex or

unfamiliar decisions, occasionally unable to

identify, understand, and weigh the alternatives,

understand the consequences of choices, and make a

reasonable decision.

2 Moderately impaired judgment. For complex

or unfamiliar decisions, usually unable to identify,

understand, and weigh the alternatives, understand

the consequences of choices, and make a reasonable

decision, although has little difficulty with simple

decisions.

3 Moderately severely impaired judgment. For even

routine and familiar decisions, occasionally unable

to identify, understand, and weigh the alternatives,

understand the consequences of choices, and make a

reasonable decision.

Total Severely impaired judgment. For even routine and

familiar decisions, usually unable to identify,

understand, and weigh the alternatives, understand

the consequences of choices, and make a reasonable

decision. For example, unable to determine

appropriate clothing for current weather conditions

or judge when to avoid dangerous situations or

activities.

Social interaction 0 Social interaction is routinely appropriate.

1 Social interaction is occasionally inappropriate.

2 Social interaction is frequently inappropriate.

3 Social interaction is inappropriate most or all of the

time.

Orientation 0 Always oriented to person, time, place, and

situation.

1 Occasionally disoriented to one of the four aspects

(person, time, place, situation) of orientation.

2 Occasionally disoriented to two of the four aspects

(person, time, place, situation) of orientation or

often disoriented to one aspect of orientation.

3 Often disoriented to two or more of the four aspects

(person, time, place, situation) of orientation.

Total Consistently disoriented to two or more of the four

aspects (person, time, place, situation) of

orientation.

Motor activity (with intact 0 Motor activity normal.

motor and sensory system).

1 Motor activity normal most of the time, but mildly

slowed at times due to apraxia (inability to perform

previously learned motor activities, despite normal

motor function).

2 Motor activity mildly decreased or with moderate

slowing due to apraxia.

3 Motor activity moderately decreased due to apraxia.

Total Motor activity severely decreased due to apraxia.

Visual spatial orientation 0 Normal.

1 Mildly impaired. Occasionally gets lost in

unfamiliar surroundings, has difficulty reading maps

or following directions. Is able to use assistive

devices such as GPS (global positioning system).

2 Moderately impaired. Usually gets lost in unfamiliar

surroundings, has difficulty reading maps, following

directions, and judging distance. Has difficulty

using assistive devices such as GPS (global

positioning system).

3 Moderately severely impaired. Gets lost even in

familiar surroundings, unable to use assistive

devices such as GPS (global positioning system).

Total Severely impaired. May be unable to touch or name

own body parts when asked by the examiner,

identify the relative position in space of two

different objects, or find the way from one room to

another in a familiar environment.

Subjective symptoms 0 Subjective symptoms that do not interfere with

work; instrumental activities of daily living; or

work, family, or other close relationships. Examples

are: mild or occasional headaches, mild anxiety.

1 Three or more subjective symptoms that mildly

interfere with work; instrumental activities of daily

living; or work, family, or other close relationships.

Examples of findings that might be seen at this level

of impairment are: intermittent dizziness, daily mild

to moderate headaches, tinnitus, frequent insomnia,

hypersensitivity to sound, hypersensitivity to light.

2 Three or more subjective symptoms that moderately

interfere with work; instrumental activities of daily

living; or work, family, or other close relationships.

Examples of findings that might be seen at this level

of impairment are: marked fatigability, blurred or

double vision, headaches requiring rest periods

during most days.

Neurobehavioral effects 0 One or more neurobehavioral effects that do
not

interfere with workplace interaction or social

interaction. Examples of neurobehavioral effects

are: Irritability, impulsivity, unpredictability, lack of

motivation, verbal aggression, physical aggression,

belligerence, apathy, lack of empathy, moodiness,

lack of cooperation, inflexibility, and impaired

awareness of disability. Any of these effects may

range from slight to severe, although verbal and

physical aggression are likely to have a more

serious impact on workplace interaction and social

interaction than some of the other effects.

1 One or more neurobehavioral effects that

occasionally interfere with workplace interaction,

social interaction, or both but do not preclude them.

2 One or more neurobehavioral effects that frequently

interfere with workplace interaction, social

interaction, or both but do not preclude them.

3 One or more neurobehavioral effects that interfere

with or preclude workplace interaction, social

interaction, or both on most days or that

occasionally require supervision for safety of self or

others.

Communication 0 Able to communicate by spoken and written

language (expressive communication), and to

comprehend spoken and written language.

1 Comprehension or expression, or both, of either

spoken language or written language is only

occasionally impaired. Can communicate complex

ideas.

2 Inability to communicate either by spoken language,

written language, or both, more than occasionally

but less than half of the time, or to comprehend

spoken language, written language, or both, more

than occasionally but less than half of the time. Can

generally communicate complex ideas.

3 Inability to communicate either by spoken language,

written language, or both, at least half of the time

but not all of the time, or to comprehend spoken

language, written language, or both, at least half of

the time but not all of the time. May rely on gestures

or other alternative modes of communication. Able

to communicate basic needs.

Total Complete inability to communicate either by spoken

language, written language, or both, or to

comprehend spoken language, written language, or

both. Unable to communicate basic needs.

Consciousness Total Persistently altered state of consciousness, such as

vegetative state minimally responsive state, coma.

**[Miscellaneous Diseases]{.smallcaps}**

Rating

**8100** Migraine:

With very frequent completely prostrating and prolonged attacks

productive of severe economic inadaptability 50

With characteristic prostrating attacks occurring on an average once

a month over last several
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30

With characteristic prostrating attacks averaging one in 2 months over

last several months 10

With less frequent attacks 0

**8103** 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 60

**8105** 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]{.smallcaps}**

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 nerve**

**8205** 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 nerve**

**8207** 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]{.smallcaps}**

The term "incomplete paralysis" with this and other peripheral nerve
injuries 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. When the involvement is wholly sensory, the rating should
be for the mild, or at most, the moderate degree. The following ratings
for the peripheral nerves are for unilateral involvement; when
bilateral, combine with application of the bilateral factor.

Rating

*Major Minor*

**Upper radicular group (fifth and sixth cervicals)**

**8510** Paralysis of:

Complete; all shoulder and elbow movements lost or severely

affected, hand and wrist movements not affected 70 60

Incomplete:

Severe 50 40

Moderate 40 30

Mild 20 20

**8610** Neuritis

**8710** Neuralgia

**Middle radicular group**

**8511** Paralysis of:

Complete; adduction, abduction, and rotation of arm, flexion of

elbow, and extension of wrist lost or severely affected 70 60

Incomplete:

Severe 50 40

Moderate 40 30

Mild 20 20

**8611** Neuritis

**8711** Neuralgia

**Lower radicular group**

**8512** Paralysis of

Complete; all intrinsic muscles of hand, and some or all of

flexors of wrist and fingers, paralyzed (substantial loss of use

of hand) 70 60

**8512** Paralysis of (cont.)

Incomplete:

Severe 50 40

Moderate 40 30

Mild 20 20

**8612** Neuritis

**8712** Neuralgia

**All radicular groups**

**8513** Paralysis of:

Complete 90 80

Incomplete:

Severe 70 60

Moderate 40 30

Mild 20 20

**8613** Neuritis

**8713** Neuralgia

**The musculospiral nerve (radial nerve)**

**8514** Paralysis of:

Complete; drop of hand and fingers, wrist and 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 70 60

Incomplete:

Severe 50 40

Moderate 30 20

Mild 20 20

**8614** 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 nerve**

**8515** Paralysis of:

Complete; the hand inclined to the ulnar side, the 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 70 60

Incomplete:

Severe 50 40

Moderate 30 20

Mild 10 10

**8615** Neuritis

**8715** Neuralgia

**The ulnar nerve**

**8516** Paralysis of:

Complete; the "griffin claw" deformity, due to 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 60 50

Incomplete:

Severe 40 30

Moderate 30 20

Mild 10 10

**8616** Neuritis

**8716** Neuralgia

**Musculocutaneous nerve**

**8517** Paralysis of:

Complete; weakness but not loss of flexion of elbow and

supination of forearm 30 20

Incomplete:

Severe 20 20

Moderate 10 10

Mild 0 0

**8617** Neuritis

**8717** Neuralgia

**Circumflex nerve**

**8518** Paralysis of:

Complete; abduction of arm is impossible, outward rotation is

weakened; muscles supplied are deltoid and teres minor 50 40

Incomplete:

Severe 30 20

Moderate 10 10

Mild 0 0

**8618** Neuritis

**8718** Neuralgia

**Long thoracic nerve**

**8519** Paralysis of:

Complete; inability to raise arm above shoulder level, winged

scapula deformity 30 20

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.

**Sciatic nerve.**

**8520** Paralysis of:

Complete; the foot dangles and drops, no active movement possible

of muscles below the knee, flexion of knee weakened or (very

rarely) lost 80

Incomplete:

Severe, with marked muscular atrophy 60

Moderately severe 40

Moderate 20

Mild 10

**8620** Neuritis.

**8720** Neuralgia.

**External popliteal nerve (common peroneal).**

**8521** Paralysis of:

Complete; foot drop and slight droop of first phalanges of 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 40

Incomplete:

Severe 30

Moderate 20

Mild 10

**8621** Neuritis

**8721** Neuralgia.

**Musculocutaneous nerve (superficial peroneal).**

**8522** Paralysis of:

Complete; eversion of foot weakened 30

Incomplete:

Severe 20

Moderate 10

Mild 0

**8622** Neuritis.

**8722** Neuralgia.

**Anterior tibial nerve (deep peroneal).**

**8523** Paralysis of:

Complete; dorsal flexion of foot lost 30

Incomplete:

Severe 20

Moderate 10

Mild 0

**8623** Neuritis.

**8723** Neuralgia.

**Internal popliteal nerve (tibial).**

**8524** Paralysis of:

Complete; plantar flexion lost, frank adduction of foot 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 40

Incomplete:

Severe 30 Moderate 20 Mild 10

**8624** Neuritis.

**8724** Neuralgia.

**Posterior tibial nerve.**

**8525** Paralysis of:

Complete; paralysis of all muscles of sole of foot, frequently with
painful

paralysis of a causalgic nature; toes cannot be flexed; adduction

is weakened; plantar flexion is impaired 30

Incomplete:

Severe 20

Moderate 10

Mild 10

**8625** Neuritis.

**8725** Neuralgia.

**Anterior crural nerve (femoral).**

**8526** Paralysis of:

Complete; paralysis of quadriceps extensor muscles 40

Incomplete:

Severe 30

Moderate 20

Mild 10

**8626** Neuritis.

**8726** Neuralgia.

**Internal saphenous nerve.**

**8527** Paralysis of:

Severe to complete 10

Mild to moderate 0

**8627** Neuritis.

**8727** Neuralgia.

**Obturator nerve.**

**8528** Paralysis of:

Severe to complete 10

Mild or moderate 0

**8628** Neuritis.

**8728** Neuralgia.

**External cutaneous nerve of thigh.**

**8529** Paralysis of:

Severe to complete 10

Mild or moderate 0

**8629** Neuritis.

**8729** Neuralgia.

**Ilio-inguinal nerve.**

**8530** Paralysis of:

Severe to complete 10

Mild or moderate 0

**8630** 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]{.smallcaps}**

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 year 100

Averaging at least 1 major seizure in 3 months over the last year;

or more than 10 minor seizures weekly 80

Averaging at least 1 major seizure in 4 months over the last year;

or 9-10 minor seizures per week 60

At least 1 major seizure in the last 6 months or 2 in the last year;

or averaging at least 5 to 8 minor seizures weekly 40

At least 1 major seizure in the last 2 years; or at least 2 minor
seizures

in the last 6 months 20

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
psychoneurotic 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.

(Authority: 38 U.S.C. 1155)

\[29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975;
41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan.
30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR
51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20,
2005; 73 FR 54705, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008\]

**Supplement *Highlights* references**: 39(1), 45(1).

*Next Section is §4.125*

Reserved