Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 88917 

DEPARTMENT OF VETERANS 

AFFAIRS 

38 CFR Parts 3 and 4 

RIN 2900–AQ73 

Schedule for Rating Disabilities: 

Neurological Conditions and 

Convulsive Disorders 

AGENCY: Department of Veterans Affairs. 

ACTION: Proposed rule. 

SUMMARY: The Department of Veterans 

Affairs (VA) proposes to amend the 

portion of the VA Schedule for Rating 

Disabilities (VASRD or Rating Schedule) 

that addresses neurological conditions 

and convulsive disorders. The purpose 

of these changes is to incorporate 

medical advancements that have 

occurred since the last revision, update 

current medical terminology, and 

provide clear evaluation criteria. The 

proposed rule reflects advances in 

medical knowledge and 

recommendations contained in the 

report from the Institute of Medicine, 

part of the National Academy of 

Sciences, titled ‘‘A 21st Century System 

for Evaluating Veterans for Disability 

Benefits,’’ National Academies Press, 

2007. 

DATES: Comments must be received on 

or before January 13, 2025. 

ADDRESSES: Comments must be 

submitted through www.regulations.gov. 

Except as provided below, comments 

received before the close of the 

comment period will be available at 

www.regulations.gov for public viewing, 

inspection, or copying, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post the comments 

received before the close of the 

comment period on 

www.regulations.gov as soon as possible 

after they have been received. VA will 

not post on Regulations.gov public 

comments that make threats to 

individuals or institutions or suggest 

that the commenter will take actions to 

harm an individual. VA encourages 

individuals not to submit duplicative 

comments; however, we will post 

comments from multiple unique 

commenters even if the content is 

identical or nearly identical to other 

comments. Any public comment 

received after the comment period’s 

closing date is considered late and will 

not be considered in the final 

rulemaking. In accordance with the 

Providing Accountability Through 

Transparency Act of 2023, a plain 

language summary (not more than 100 

words in length) of this proposed rule 

is available at www.regulations.gov, 

under RIN 2900–AQ73. 

FOR FURTHER INFORMATION CONTACT: Gary 

Reynolds, M.D., Medical Officer, Part 4 

VASRD Staff (218), Compensation 

Service, Veterans Benefits 

Administration, Department of Veterans 

Affairs, 810 Vermont Avenue NW, 

Washington, DC 20420, 

218VASRDPMO.VBACO@va.gov, (202) 

461–9700. (This is not a toll-free 

telephone number.) 

SUPPLEMENTARY INFORMATION: VA has 

periodically revised portions of the 

Schedule for Rating Disabilities, to 

include the Neurological Conditions 

and Convulsive Disorders (herein 

referred to as the Neurological body 

system), since it was created in 1919. 

Important advances in the neurological 

sciences—particularly in the areas 

related to biochemistry, genetics, 

physiopathology, as well as 

electrodiagnosis and imaging of the 

nervous system—have produced drastic 

changes in the understanding of 

neurological diseases since the second 

half of the 20th century. The extent and 

repercussion of these advances triggered 

profound changes in approaches to 

diagnosis, classification of disease, and 

care of patients with neurological 

illnesses. As part of VA’s ongoing 

revision of the VA Schedule for Rating 

Disabilities (VASRD or rating schedule), 

VA proposes changes to 38 Code of 

Federal Regulations (38 CFR) §§ 4.120 

and 4.123–4.124a, which pertain to the 

neurological conditions and convulsive 

disorders. The proposed changes will: 

(1) update the medical terminology of 

certain neurological conditions and 

convulsive disorders; (2) add medical 

conditions frequently encountered but 

not currently found in the rating 

schedule; (3) refine evaluation criteria 

based on medical advances that have 

occurred since the last revision and 

current understanding of functional 

changes associated with or resulting 

from disease or injury 

(pathophysiology), and; (4) remove or 

modify certain diagnostic codes (DC) 

that are outdated or obsolete. 

I. Retitle and Revise §§ 4.120 

Evaluations by Comparison, 4.123 

Neuritis, Cranial or Peripheral, and 

4.124 Neuralgia, Cranial or Peripheral 

VA proposes to retitle and revise 

§ 4.120, Evaluations by comparison, 

because the approach to evaluating 

neurologic conditions has evolved over 

the time since this section was included 

in the 1945 rating schedule. See 29 FR 

6718, 6749–6750 (May 22, 1964). As 

medical understanding has increased, 

the additional knowledge permits VA to 

develop evaluation criteria within the 

individual diagnostic codes that more 

accurately consider motor, sensory, and 

mental impairment. The instructions 

contained in the last sentence of § 4.120, 

which apply to peripheral nerves, will 

be updated to better align with modern 

medical knowledge and relocated to the 

revised § 4.123, titled ‘‘Cranial and 

peripheral nerve impairment,’’ 

paragraph (a)(1). VA proposes to 

relocate instructions relating to organic 

diseases of the central nervous system to 

§ 4.120. See section II B. Orgranic 

diseases of the central nervous system 

below for additional detail. 

VA also proposes to retitle and revise 

§§ 4.123 Neuritis, cranial or peripheral 

and 4.124 Neuralgia, cranial or 

peripheral. These sections provide 

information regarding symptoms and 

evaluations associated with neuritis and 

neuralgia. Neuritis and neuralgia are 

used to describe symptoms associated 

with motor and sensory neuropathy 

involving cranial and peripheral nerves. 

However, VA proposes their removal in 

favor of more objective criteria to assess 

disability in the cranial and peripheral 

nerves. 

In the 1940s, the term neuritis was 

advanced by Dr. S.A. Kinnier Wilson as 

an all-encompassing term for most 

peripheral nerve conditions. Dr. S.A. 

Kinnier Wilson, ‘‘Neurology,’’ 279 

(Ninian Bruce ed., 1970). As the field of 

peripheral neuropathology evolved, it 

became apparent that use of the term 

neuritis was obsolete and should be 

replaced by neuropathy, the preferred 

term for peripheral nerve diseases. 

While neuritis is sometimes used as a 

synonym for neuropathy, this use is 

erroneous and should only be used for 

certain specified inflammatory diseases. 

Drs. A.K. Asbury & Peter Johnson, 

‘‘Neurology,’’ 258 (James Bennington 

ed., 1978). While the term neuragia is 

still used today, for compensation 

purposes, VA evaluates nerves affected 

by neuralgia by the sensory impairment 

caused by neuralgia, not the diagnosis 

itself. To that end, and as discussed in 

more detail below, VA proposes to 

remove neuritis as a separate ratable 

condition for both cranial nerves (DC 

series 8300) and peripheral nerves (DC 

series 8600) and neuralgia as a separate 

ratable condition for both cranial nerves 

(DC series 8400) and peripheral nerves 

(DC series 8700). VA will address 

evaluations for motor neuropathy and 

sensory neuropathy in revised § 4.123, 

as discussed below. 

The underlying purpose behind the 

§ 4.123 revision is to provide a central 

location for instructions specific to 

cranial and peripheral nerve conditions. 

This revision will promote rating 


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88918 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

quality and consistency. First, VA 

proposes to retitle the section as 

‘‘Cranial and peripheral nerve 

impairment.’’ Next, VA proposes 

informational language explaining, 

generally, how disabilities from cranial 

and peripheral nerve impairment are 

evaluated. After that, VA proposes to 

describe how disability from motor 

neuropathy (complete and incomplete 

paralysis) will be evaluated. Finally, VA 

proposes to describe how disability 

from sensory neuropathy will be 

evaluated. 

Concerning the general instructions 

described in the revised § 4.123, VA 

proposes to relocate to this section 

several instructions that are currently 

located in multiple areas. The current 

VASRD contains an instruction directly 

above diagnostic code 8205; this 

instruction explains that disability from 

lesions of peripheral portions of first, 

second, third, fourth, sixth, and eighth 

nerves are rated under the Organs of 

Special Sense. Additionally, it explains 

that the ratings for the cranial nerves are 

for unilateral involvement; when 

bilateral, combine but without the 

bilateral factor. VA proposes to revise 

these two sentences, add an additional 

sentence, and include them in § 4.123. 

Specifically, proposed § 4.123(a)(3) 

explains that a cranial nerve will be 

evaluated strictly as a cranial nerve, 

regardless of any portions which lie 

outside the cranium (skull). This is 

consistent with current medical practice 

which considers cranial nerves outside 

of the cranium as separate and distinct 

from other peripheral nerves. Proposed 

§ 4.123(a)(3) further explains that the 

evaluations in the rating schedule for 

the cranial nerves are for unilateral 

involvement; when bilateral 

involvement occurs, evaluate separately, 

then combine under § 4.25 without 

using the bilateral factor. While all 

cranial nerves begin inside the cranium, 

most exit the cranium to insert at 

various destinations, where they 

function in a manner similar to 

peripheral nerves. Nevertheless, VA 

proposes to evaluate the entire nerve, 

uniformly, as a cranial nerve. Proposed 

§ 4.123(a)(2) explains that disability 

from impairments of the first, second, 

third, fourth, sixth, and eighth cranial 

nerves will be rated under the Organs of 

Special Sense. Additionally, the current 

VASRD contains an instruction directly 

above diagnostic code 8510; this 

instruction states, in part, that ratings 

for the peripheral nerves are for 

unilateral involvement; when bilateral, 

combine with application of the 

bilateral factor. VA will add a reference 

to evaluate bilateral disabilities 

separately, then combine using § 4.25 

whenever bilateral involvement occurs; 

this will specify, as opposed to merely 

imply, how bilateral disabilities are to 

be evaluated. Additionally, VA will 

move the instruction to § 4.123(a)(4) 

because it is a general instruction since 

it applies to both motor and sensory 

impairment. Section 4.120 currently 

includes a sentence explaining that 

when rating peripheral nerve injuries 

and their residuals, attention should be 

given to the site and character of the 

injury, the relative impairment in motor 

function, trophic changes, or sensory 

disturbances. VA proposes the following 

changes to this sentence: clarify that the 

sentence applies to cranial and 

peripheral nerves; remove the reference 

to trophic changes, which do not 

consistently correlate to disability; 

replace the reference to motor function 

with a reference to movement or muscle 

strength, corresponding with the 

proposed evaluation criteria for cranial 

and peripheral motor nerve function, 

respectively; and relocate the sentence 

to § 4.123(a)(1). The purpose of these 

changes is to remedy confusion and 

inconsistent application of the 

instructions caused by the current 

placement of instructions in multiple 

locations. Therefore, VA proposes to 

combine them into a centralized 

location. 

Motor nerve impairment affects 

muscle function (typically by decreased 

muscle strength), which can have a 

significant impact on movement 

activities, including, but not limited to, 

walking and grasping. Therefore, VA 

proposes to focus the complete and 

incomplete paralysis sections of each 

cranial and peripheral nerve on motor 

nerve impairment. 

Concerning incomplete paralysis of 

cranial motor nerves, VA proposes to 

evaluate disability by replacing the 

current ‘‘severe’’ with ‘‘[a]ttempted 

movement with inability to complete 

such movement (muscle twitching 

present).’’ Additionally, VA proposes to 

revise the cranial evaluation criteria for 

‘‘moderate’’ incomplete paralysis with 

‘‘[m]uscle movement intact, but task 

performed with difficulty.’’ The 

proposed revisions replace subjective 

criteria with objective and measurable 

criteria, which will promote rating 

consistency and accuracy. 

Regarding cranial nerve notes, in the 

current VASRD, each cranial nerve 

criteria set contains a note describing 

functions of that particular nerve. These 

notes are currently placed after the 

‘‘paralysis, incomplete’’ diagnostic code 

section of the individual nerve. VA 

proposes to update the notes to provide 

more detailed examples of affected 

nerve functions and move them, placing 

them below the evaluation criteria of 

each individual cranial nerve. VA 

proposes this change because each note 

applies to both sensory and motor 

impairment of the particular cranial 

nerve. 

Concerning peripheral motor nerves, 

VA proposes to evaluate disability by 

replacing the current rating criteria, 

which refer to complete and incomplete 

paralysis at the severe, moderate, and 

mild incomplete paralysis level, with 

criteria that align with the Medical 

Research Council (MRC) Scale for 

Muscle Strength (this is also commonly 

referred to as manual muscle testing). 

This scale is universally known and 

used throughout the medical 

community to evaluate peripheral 

nerves. ‘‘How to Assess Muscle 

Strength,’’ Merck Manual, https://

www.merckmanuals.com/professional/ 

neurologic-disorders/neurologicexamination/how-to-assess-musclestrength?query=Medical, (last reviewed 

February 2018). The MRC grades muscle 

strength on a range from ‘‘0’’ 

(completely paralyzed) to ‘‘5’’ (normal 

muscle function). ‘‘To distinguish 

among the various degrees of muscle 

strength within a given level, this scale 

has been modified with the addition of 

intermediate levels (e.g., 4+ and 4¥).’’ 

Frontera, W.R. ‘‘Delisa’s Physical 

Medicine & Rehabilitation: Principles 

and Practice,’’ 5th Edition, p 74 (2010). 

Instead of ‘‘mild,’’ VA will use Grade 

4 muscle strength. This represents 

measurable muscle weakness. Instead of 

‘‘moderate,’’ VA will use Grade 3 

muscle strength. This represents muscle 

strength that can oppose gravity, but 

cannot oppose resistance greater than 

gravity. Instead of ‘‘moderately severe,’’ 

VA will use Grade 2+ muscle strength. 

This represents muscle strength that is 

unable to oppose gravity completely, 

though muscle strength with gravity 

eliminated is present. That is, muscle 

strength that is greater than Grade 2, but 

less than Grade 3. Only the sciatic nerve 

has a ‘‘moderately severe’’ category. 

Instead of ‘‘severe,’’ VA will use Grade 

2 muscle strength. This represents 

muscle strength that, though present, 

cannot oppose gravity at all. Complete 

paralysis will be identified as Grade 0 

muscle strength (no muscle contraction 

or complete paralysis) or Grade 1 

muscle strength (meaning a flicker or 

trace of contraction). Id. The proposed 

revisions replace subjective criteria with 

objective and measurable criteria, which 

will promote rating consistency and 

accuracy. 

Regarding peripheral nerve 

instructions, in the current VASRD, 

there is a three-sentence instruction 


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Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 88919 

directly above DC 8510; this instruction 

explains, in part, that incomplete 

paralysis with peripheral nerve injuries 

indicates a degree of impaired function 

substantially less than the type picture 

for complete paralysis, whether due to 

varied level of the nerve lesion or to 

partial regeneration. VA proposes to 

leave this sentence intact with two 

aesthetic revisions. These revisions 

involve changing ‘‘picture’’ to 

‘‘pictured’’ and ‘‘level’’ to ‘‘levels.’’ VA 

believes these revisions will enable the 

verbiage to flow more smoothly without 

changing the meaning. The third 

sentence will remain intact, with the 

addition of a reference to § 4.25 in the 

third sentence, as discussed above. Both 

sentences will be moved to this 

instructional section. The remaining 

sentence will be removed, as it refers to 

sensory nerve evaluation criteria that 

VA is proposing to revise. The purpose 

of these changes is to remedy confusion 

and inconsistent application of the 

instructions caused by the current 

placement of instructions in multiple 

locations. Therefore, VA proposes to 

combine them into the most appropriate 

location. 

Currently, each peripheral nerve 

includes a description in the entry for 

complete paralysis. For example, the 

entry for complete paralysis for DC 8510 

for the upper radicular group (fifth and 

sixth cervicals) contains a description of 

all shoulder and elbow movements lost 

or severely affected, hand and wrist 

movements not affected. VA proposes to 

remove all peripheral nerve 

descriptions. Since VA is changing the 

subjective criteria to objective criteria 

and examiners are aware of the muscles 

affected by each nerve, VA believes the 

descriptions are no longer needed. 

Concerning sensory neuropathy, 

sensory nerve impairment affects the 

ability to notice sensations, to include 

but not limited to, sharpness, heat, or 

coldness, and it can also produce 

abnormal spontaneous sensations, to 

include but not limited to, burning, 

tingling, and pain (pins and needles). 

Therefore, VA proposes to focus the 

sensory neuropathy sections of each 

nerve on sensory nerve impairment and 

remove neuritis and neuralgia as 

separate ratable conditions. Having 

separate diagnostic codes for neuritis 

and neuralgia requires VA to change the 

diagnostic code a veteran is rated under 

when the impairment associated with 

the condition changes, which creates 

additional work and complexity with no 

benefit to the veteran or VA. VA 

proposes to remove the diagnostic codes 

for neuritis and neuralgia, retitle the 

diagnostic codes addressing paralysis, 

and address motor and sensory 

impairment as criteria under the retitled 

diagnostic codes. Additionally, in light 

of the removal of DCs 8619 and 8719, 

VA proposes to number the notes that 

will appear under DC 8519. 

In the current VASRD, the 

instructions under § 4.124, Neuralgia, 

cranial or peripheral, consist of three 

sentences. The first two sentences 

provide information regarding 

symptoms associated with neuralgia and 

instructions regarding the maximum 

evaluations for neuralgia. The last 

sentence provides rating instructions for 

tic douloureux. VA proposes to address 

sensory impairments in a new section, 

§ 4.123(c). Instead of defining neuralgia, 

§ 4.123(c)(1) will address altered 

sensation, with or without pain, on the 

basis of incomplete or complete sensory 

neuropathy. VA proposes to delete the 

last sentence of § 4.124, which 

addresses tic douloureux, because it is 

redundant. A note under the entry for 

the fifth (trigeminal) cranial nerve 

provides instructions on how to 

evaluate tic douloureux. 

The current evaluation criteria focus 

on neuritis, neuralgia, and degrees of 

paralysis, with a maximum rating for 

neuritis equal to severe, incomplete, 

paralysis of the nerve involved, and a 

maximum rating for neuralgia equal to 

moderate incomplete paralysis. There is 

also an instruction at the beginning of 

the schedule of ratings for diseases of 

the peripheral nerves indicating that the 

rating should be for the mild, or at most, 

the moderate degree when the 

involvement is wholly sensory. Certain 

cranial and all peripheral nerves are 

evaluated using neuritis, neuralgia, and 

degrees of paralysis, regardless if the 

nerve has only sensory function, only 

muscle function, or both sensory 

function and muscle function (found in 

mixed nerves). There are several 

problems with the current approach. 

While both neuritis and neuralgia 

involve distorted sensation, the 

disability associated with these 

distorted sensations cannot be 

quantified by objective diagnostic 

testing and is unpredictable. 

Furthermore, the evaluation criteria for 

pure sensory nerves are the same as for 

pure motor nerves and mixed nerves, 

which is incorrect from a medical 

science perspective. For example, the 

external cutaneous nerve of the thigh 

and the obturator nerve have the same 

evaluation criteria (varying degrees of 

paralysis, which currently form the 

basis for rating neuritis and neuralgia), 

even though it is scientifically incorrect 

to evaluate a pure sensory nerve, such 

as the external cutaneous nerve of the 

thigh, for paralysis. It is this difficulty 

with measurement, unpredictability, 

and inappropriate application of certain 

evaluation criteria that VA seeks to 

remedy with the following proposed 

changes. 

VA proposes to change the sensory 

evaluation criteria to a more easily 

measured sensory deprivation standard. 

Impairment of sensory function will be 

quantified as either incomplete or 

complete sensory deprivation. This 

simplifies the evaluation criteria and is 

much more easily measured during 

physical examination. These criteria 

will be applied to certain cranial nerves 

as well as all peripheral nerves. Muscle 

function in certain cranial nerves and 

all peripheral nerves will be evaluated 

in isolation using the previously 

discussed methods. 

Using the incomplete/complete 

characterization of sensory deprivation 

described above, VA proposes to use a 

more straightforward description for 

disability when sensory neuropathy is 

involved. VA will consider sensory 

neuropathy as incomplete when 

sensation is impaired, although not 

absent, or when unpleasant sensations 

are experienced by the nerve such as 

dysesthesia, numbness, or paresthesia. 

Dysesthesia refers to any unpleasant 

sensation produced by a stimulus that is 

normally painless. Numbness refers to a 

sense of heaviness, weakness, or 

deadness in part of the body. 

Paresthesia refers to abnormal 

spontaneous sensations such as burning, 

tingling, pins and needles, etc. Clinical 

Neurology, 11th Edition, 2021, Chapter 

10: Sensory Disorders. editors 

Greenberg, D.A., Aminoff, M.J., and 

Simon, R.P. 

VA will consider sensory neuropathy 

complete when sensation is absent. In 

cranial nerves, which have compensable 

evaluations at the moderate evaluation 

level, VA will assign an evaluation at 

the moderate evaluation level if there is 

incomplete or complete sensory 

neuropathy. However, this will not be 

applied to the eleventh cranial nerve, 

also known as the spinal accessory 

nerve, because it only has a muscle 

function. For peripheral nerves, which 

mostly have compensable evaluations at 

the mild evaluation level, VA will 

assign an evaluation similar to the mild 

evaluation if there is incomplete sensory 

neuropathy. VA will assign an 

evaluation similar to the moderate 

evaluation if there is complete sensory 

neuropathy. Where the evaluation of a 

peripheral nerve remains the same 

whether it is at the mild or moderate 

evaluation level (DCs 8525, 8527, 8528, 

8529, and 8530), VA will assign an 

evaluation at the moderate evaluation if 

there is incomplete or complete sensory 

neuropathy. 


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88920 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

II. Schedule of Ratings—Neurological 

Conditions and Convulsive Disorders 

A. Location of Section 

Currently, the schedule of ratings for 

the Neurological body system is located 

in 38 CFR 4.124a. When the 1945 VA 

Schedule for Rating Disabilities was 

originally published in title 38 of the 

Code of Federal Regulations in 1964, VA 

organized it such that specific body 

systems started at specific locations. 

The Musculoskeletal body system, for 

example, began in § 4.40 even though 

the preceding section was § 4.31, 

leaving sections §§ 4.32 through 4.39 

without content. See 29 FR 6718, 6722 

(May 22, 1964). VA also designed the 

Rating Schedule so that the Mental 

Disorders body system started with 

§ 4.125; however, due to the number of 

sections necessary to establish the 

Neurological body system, which 

precedes the Mental Disorders body 

system, the schedule of ratings for 

neurological conditions and convulsive 

disorders was placed in § 4.124a. See 29 

FR 6718, 6749–53 (May 22, 1964). As 

proposed above, disability previously 

addressed in § 4.124 will now be 

addressed in the revision of § 4.123, 

which makes § 4.124 available. 

Therefore, VA also proposes to relocate 

the Schedule of Ratings from § 4.124a to 

§ 4.124 and remove § 4.124a. VA 

proposes corresponding revisions to the 

references to § 4.124a in 38 CFR 

3.809(d) and 38 CFR 4.71a, DC 5244. 

B. Organic Diseases of the Central 

Nervous System 

Currently, the introductory 

instruction under § 4.124a provides 

guidance concerning how to evaluate 

residuals of organic diseases of the 

central nervous system. There is a note 

currently located under DC 8025, 

Myasthenia gravis, which also provides 

guidance concerning how to evaluate 

residuals of organic diseases of the 

central nervous system. VA proposes to 

consolidate both notes, revising them 

and relocating them to § 4.120. VA 

further proposes to specify the 

diagnostic codes to which the 

instructions apply in order to promote 

consistent application of the VASRD. 

First, VA proposes to clarify when 

ascertainable residuals are required. For 

diagnostic codes 8000–8036, there are 2 

categories of diagnostic codes that 

consider minimum evaluations: 

unconditional and conditional 

minimums. Unconditional minimum 

diagnostic codes are 8002, 8004, 8007, 

8010, 8018, 8021, 8023, 8024, and 8025. 

The aforementioned diagnostic codes do 

not require ascertainable residuals for a 

minimum evaluation, and will not 

require ascertainable residuals in this 

proposed regulation. 

For DCs 8004 and 8007, which have 

unconditional minimums within the 

proposed General Rating Formula, VA 

proposes Note (1) to direct the rater to 

grant a minimum evaluation of 30 

percent for Parkinson’s disease (8004), 

regardless of examination findings. VA 

proposes Note (2) to direct the rater to 

grant a minimum evaluation of 10 

percent for stroke residuals (8007), 

regardless of examination findings. No 

minimum evaluations will be available 

for DCs 8026, 8027, and 8028. 

Conditional minimum DCs 8000, 

8003, 8011, 8012, 8019, 8020, 8022, and 

new 8036 all require ascertainable 

residuals. Examples of ascertainable 

residuals to be considered include, but 

are not limited to, psychotic 

manifestations, loss of use of an 

extremity (partial or complete), as well 

as abnormal speech, vision, gait, or 

coordination. Finally, in the portion of 

the instruction addressing 

determinations as to the presence of 

residuals not capable of objective 

verification, VA proposes to specify that 

such determinations must be 

approached on the basis of disability 

related to the diagnosis recorded, rather 

than simply the diagnosis recorded, as 

the current instruction provides. The 

revised language is more consistent with 

38 CFR 4.1, which provides that the 

rating schedule is primarily a guide in 

the evaluation of disability resulting 

from diseases and injuries encountered 

as a result of or incident to military 

service. 

In regard to peripheral nerves and 

paralysis, VA proposes to replace the 

reference to mild, moderate, severe, or 

complete paralysis of peripheral nerves 

with a reference to complete or 

incomplete paralysis to account for 

changes in the way paralysis of 

peripheral nerves will be evaluated as 

referenced above. 

With respect to ratings in excess of 

the prescribed minimum ratings, VA 

proposes to replace the current language 

directing raters to cite the diagnostic 

codes utilized as bases of evaluation in 

addition to the codes identifying the 

diagnoses with a reference to § 4.27, as 

that section includes instructions for the 

use of diagnostic code numbers when a 

disease is rated on the basis of residual 

conditions. 

C. Diagnostic Code 8000, Encephalitis, 

Infectious 

Current DC 8000 is titled 

‘‘Encephalitis, epidemic, chronic.’’ The 

use of the term ‘‘epidemic’’ was used to 

describe an outbreak of encephalitis 

lethargica from 1918 to 1930. Dr. R.R. 

Dourmashkin, ‘‘What Caused the 1918– 

1930 Epidemic of Encephalitis 

Lethargica?,’’ 90 Journal of the Royal 

Society of Medicine 515, 515–520 

(1997). Since that outbreak, a recurrence 

of the epidemic has not been reported. 

‘‘Encephalitis Lethargica Information 

Page,’’ National Institute of Health— 

National Institute of Neurological 

Disorders and Stroke, https://

www.ninds.nih.gov/health-information/ 

disorders/encephalitis (last visited 

September 18, 2024). Given the 

infrequency with which this specific 

type of encephalitis occurs, VA 

proposes to rename DC 8000 as 

‘‘Encephalitis, infectious’’ to better 

reflect the disabilities currently 

evaluated under this DC. 

As a broader disease category, 

infectious encephalitis refers to an 

irritation and swelling of the brain 

caused by viral, bacterial, fungal, or 

parasitic infection. Symptoms of this 

disease can be quite severe and include 

loss of consciousness, seizures, 

paralysis, and sudden change in mental 

functions. The residuals of infectious 

encephalitis vary from full recovery to 

permanent disabilities and, in some 

cases, death. ‘‘Encephalitis,’’ National 

Institute of Health—U.S. National 

Library of Medicine (Aug. 31, 2016), 

https://medlineplus.gov/ency/article/ 

001415.htm (last visited April 3, 2018). 

No changes to the evaluation criteria are 

proposed. 

D. Diagnostic Code 8002, Brain, New 

Growth of, Malignant and Diagnostic 

Code 8003, Brain, New Growth of, 

Benign 

Current DC 8002 is titled 

‘‘Malignant,’’ and current DC 8003 is 

titled ‘‘Benign, minimum.’’ VA proposes 

changes to these diagnostic codes to 

correct current poor formatting. Both are 

intended to be read in conjunction with 

the general category of ‘‘Brain, new 

growth of.’’ To clarify the conditions 

covered under these DCs, VA proposes 

to rename these disabilities as DC 8002, 

‘‘Brain, new growth of, malignant,’’ and 

DC 8003, ‘‘Brain, new growth of, 

benign.’’ 

Current DC 8002 also contains a note 

that is located between the 100 percent 

and the 30 percent evaluation levels. 

Previously, this diagnostic code had a 

100 percent evaluation level and its note 

contained information regarding the 30 

percent minimum rating. See 43 FR 

45348, 45362 (Oct. 2, 1978). However, 

revisions to Part 4 have placed the note 

between the 100 percent and the 30 

percent evaluation levels. Notes are 

typically found after evaluative criteria. 

Therefore, VA proposes to relocate this 

note after the 30 percent evaluation 


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level and to revise it to ensure that 

rating personnel understand how it 

applies to the both the 100 percent and 

30 percent evaluation levels. 

Current DC 8003 provides a minimum 

evaluation of 60 percent in the presence 

of a benign growth of the brain and then 

directs raters to evaluate based upon 

residuals, with a minimum evaluation 

of 10 percent. VA proposes to clarify the 

60 percent evaluation by indicating that 

it applies during the presence of an 

active benign growth of the brain or 

during active treatment. By adding this 

additional information to the 60 percent 

evaluation criteria, VA will promote 

consistency of evaluations and avoid 

premature re-evaluation of the disability 

prior to successful treatment of the 

benign growth. VA proposes no other 

changes to these diagnostic codes. 

E. Diagnostic Code 8004, Parkinson’s 

Disease (Paralysis Agitans) 

Current DC 8004 is titled ‘‘Paralysis 

agitans,’’ which is Latin for shaking 

palsy. While these terms are accurate 

descriptors of the disability, the more 

commonly used and accepted medical 

terminology is Parkinson’s disease (PD). 

To clarify the disability evaluated under 

this diagnostic code as well as to make 

the VASRD more user-friendly to nonmedical personnel, VA proposes to 

rename this diagnostic code 

‘‘Parkinson’s disease.’’ VA proposes to 

preserve the historical reference in 

parentheses. 

VA also proposes to adopt evaluation 

criteria that reflect a modern 

understanding of this condition within 

a proposed general rating formula 

(GRF). VA proposes the creation of a 

GRF for certain movement disorders 

within the neurological body system 

due to the similarities of disabling 

effects and high frequency of 

misdiagnosis. By implementing a GRF, 

the rating process will be standardized 

as well as simplified based on disability 

presentation for a group of conditions. 

Additionally, the use of a GRF for these 

movement disorders will ensure the 

avoidance of pyramiding when more 

than one movement disorder is service 

connected. Pyramiding occurs when 

two or more evaluation percentages are 

awarded for the same disability under 

various diagnoses. In accordance with 

38 CFR 4.14, pyramiding must be 

avoided. When two or more movement 

disorders are service-connected, unless 

none of the symptomatology of a 

movement disorder is duplicative of or 

overlapping with the symptomatology of 

another movement disorder, one 

evaluation percentage will be awarded 

based on the highest level of disability 

represented by the rating criteria that 

more nearly approximates the disability 

picture attributable to the serviceconnected movement disorders. 38 CFR 

4.7. VA proposes to title the GRF 

‘‘General Rating Formula for Specified 

Neurologic Conditions (DCs 8004, 8007, 

8026, 8027, and 8028)’’. VA proposes 0, 

10, 30, 60, and 100 percent evaluations 

to the newly proposed GRF, and it will 

be placed immediately below DC 8004. 

Lastly, specific to PD, VA proposes to 

continue the minimum 30 percent 

evaluation for a formal diagnosis of PD, 

as explained in the first note following 

the proposed GRF. 

Recent advances in the understanding 

of PD have produced several assessment 

scales that describe discrete levels of 

increasing disability. The Revised 

Unified Parkinson’s Disease Rating 

Scale (2008) is a sophisticated, complex 

scale widely used by clinicians. The 

level of sophistication and specificity, 

however, is not required to describe 

occupationally significant disability. 

The Hoehn-Yahr Parkinson’s Disease 

scale, which has been in use since 1967, 

is far simpler to use and apply. VA 

proposes to base the disability criteria 

on this scale with direct reference to 

Hoehn-Yahr stages and descriptions of 

functional limitation associated with 

that severity of disease. VA recognizes 

that this scale was specifically 

developed for PD. However, other 

movement disorder evaluation tools are 

similar to Hoehn-Yahr. Thus, it was 

determined this was a reliable tool to 

adapt to multiple movement disorders. 

Parkinson’s Resource Organization, The 

Five Stages of Parkinson’s Disease, 

http://www.parkinsonsresource.org/wpcontent/uploads/2012/01/The-FIVEStages-of-Parkinsons-Disease.pdf, May 

2002. In addition, where appropriate, 

VA considered and incorporated 

features of other movement disorder 

scales. Those additions are noted under 

the specific movement disorder 

discussions below. The GRF will list the 

evaluation criteria first, followed by 

several notes. 

The first note will direct raters to 

evaluate all cases of PD with a 

minimum rating of 30 percent. A second 

note is specific to stroke residuals rated 

under DC 8007 and directs raters to 

evaluate stroke residuals with a 

minimum rating of 10 percent. A third 

note defines activities of daily living. A 

fourth note instructs the rater how to 

evaluate symptoms versus separate and 

distinct diagnoses. For example, when 

an impairment such as depression is 

noted as a symptom versus a formal 

diagnosis, then it will be evaluated 

using the GRF for Specified Neurologic 

Conditions. Conversely, if there is a 

formal diagnosis, then the disorder will 

be evaluated separately under § 4.130 

(Schedule of ratings—mental disorders). 

These instructions mirror the current 

instructions related to the Residuals of 

Traumatic Brain Injury. The fifth note 

addresses overlap of manifestations. It 

instructs rating specialists to evaluate 

comorbid conditions together when they 

cannot be delineated. These instructions 

also mirror the current instructions 

related to the Residuals of Traumatic 

Brain Injury. The sixth note reminds 

raters to consider special monthly 

compensation. 

VA proposes the rating criteria under 

the GRF to consist of the following. A 

100 percent evaluation will be given for 

‘‘Hoehn-Yahr stage 4 or stage 5, or; the 

inability to live independently because 

of neurologically-related disability.’’ A 

60 percent evaluation will be given for 

‘‘Impairment of mobility (e.g., transfers, 

balance, or gait) requiring daily use of 

an assistive device such as a wheelchair, 

brace(s), crutch(es), cane(s), or walker.’’ 

A 30 percent evaluation will be given 

for ‘‘Hoehn-Yahr stage 3, or; impairment 

of mobility (e.g., transfers, balance, or 

gait) requiring less than daily use of an 

assistive device such as a wheelchair, 

brace(s), crutch(es), cane(s), or walker.’’ 

A 10 percent evaluation will be given 

for ‘‘Hoehn-Yahr stage 2, or; impairment 

in at least one of the following areas: 

facial expression (e.g., masking, 

blinking, or eye motion abnormalities); 

speech (e.g., soft voice, slurring, 

difficulty speaking or swallowing); 

posture (e.g., stooping, instability); 

mobility not requiring an assistive 

device (e.g., decreased speed with 

transfers, gait ataxia, unstable balance); 

problems initiating or controlling motor 

movements (e.g., stiffness, tremors); 

cognitive (e.g., memory or executive 

problems); mental (e.g., anxiety, 

depression, social phobia); sensory 

abnormalities (e.g., olfactory deficits); 

involuntary muscle contractions 

resulting in pain and impairment, such 

as but not limited to, spontaneous neck 

turning or writing difficulty.’’ A 0 

percent evaluation will be given for 

‘‘Hoehn-Yahr stage 1, or; formal 

diagnosis without impairment.’’ 

F. Diagnostic Code 8007, Stroke 

(Ischemic, Hemorrhagic, or 

Thrombotic), Including Cerebral 

Infarction or Cerebrovascular Accident 

(Brain, Vessels, Embolism, Thrombosis, 

and Hemorrhage); Diagnostic Code 8008 

Brain, Vessels, Thrombosis of (Delete); 

Diagnostic Code 8009 Brain, Vessels, 

Hemorrhage From (Delete) 

VA proposes to combine three DCs 

(8007, Brain, vessels, embolism of; 8008, 

Brain, vessels, thrombosis of; and 8009, 

Brain, vessels, hemorrhage from) under 


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DC 8007 and rename it as ‘‘Stroke 

(ischemic, hemorrhagic, or thrombotic), 

including cerebral infarction or 

cerebrovascular accident (Brain, vessels, 

embolism, thrombosis, and 

hemorrhage).’’ Since most clinicians 

document the condition as ‘‘stroke’’ 

rather than embolism, thrombosis, or 

hemorrhage, raters are unable to 

distinguish which title most accurately 

aligns with ‘‘stroke,’’ which means there 

is a risk that rating specialists will not 

consistently apply these DCs. For 

example, three raters evaluate three 

veterans diagnosed with residuals of a 

stroke. One rater chooses to use DC 

8007; another uses DC 8008; and the 

other uses DC 8009. All three 

disabilities currently have the same 

evaluation criteria. Therefore, the 

veterans are not at a disadvantage from 

receiving one DC over the other. 

However, for statistical purposes, 

combining these three DCs would 

promote consistency in future research 

associated with stroke residuals. 

Because all three of the current 

diagnostic codes evaluate stroke 

residuals in the same way, VA proposes 

to combine them in order to create 

diagnostic code application consistency. 

Additionally, while the distinction 

concerning the type of stroke is a 

medical necessity for treatment 

purposes, it is irrelevant for rating 

purposes. This proposed update will 

create more consistent data tracking for 

disability compensation research 

purposes. 

Currently, rating personnel grant a 

100 percent evaluation for the first six 

months, then assign a minimum rating 

of 10 percent for stroke residuals, unless 

an evaluation of residuals under 

separate body systems results in a 

higher evaluation. Under the proposed 

changes, whenever diagnostic imaging, 

which is part of standard care for a 

stroke, identifies a stroke, rating 

personnel will continue to grant a 100 

percent evaluation for the first six 

months; they will also continue to 

assign a minimum 10 percent for stroke 

residuals regardless of examination 

findings. Rating personnel will assign 

evaluations higher than the minimum in 

accordance with the General Rating 

Formula for Specified Neurologic 

Conditions (GRF). As explained in the 

fourth note of the GRF, if a residual is 

a symptom of the stroke, it will be 

evaluated as such. Contrarily, if a 

residual has a separate and distinct 

formal diagnosis, it will be service 

connected and evaluated separately. For 

example, if depression is noted as a 

symptom, it will be evaluated as part of 

the minimum 10 percent evaluation. 

However, if depression is a separate and 

distinct formal diagnosis, it will be 

service connected on a secondary basis 

and evaluated under § 4.130 (Schedule 

of ratings—mental disorders). See DC 

8004 for details about the GRF. 

G. Diagnostic Code 8018, Multiple 

Sclerosis and Other Demyelinating 

Diseases of the Central Nervous System 

VA proposes to revise the title for this 

diagnostic code. The new title will be 

Multiple sclerosis (MS) and other 

demyelinating diseases of the Central 

Nervous System. The underlying basis 

for this revision is the existence of two 

conditions which present with 

disabilities similar to MS. VA proposes 

to evaluate neuromyelitis optica 

spectrum disorder (NMOSD) under this 

DC. Previously, NMOSD was rated 

analogously with DC 8010, Myelitis. 

Myelin oligodendrocyte glycoprotein 

antibody—associated disease (MOGAD) 

is the other condition to be captured 

with this DC. Like NMOSD, MOGAD 

also presents with a similar disability 

picture to MS. Wu, H. and Fisher, K., 

Current Diagnosis & Treatment Pediatric 

Neurology, Chapter 35. 2023. 

H. Diagnostic Code 8021, Spinal Cord, 

New Growths of, Malignant and 

Diagnostic Code 8022, Spinal Cord, New 

Growths of, Benign 

Current DC 8021 is titled 

‘‘Malignant,’’ and current DC 8022 is 

titled ‘‘Benign.’’ VA proposes changes to 

these DCs to correct current poor 

formatting. Both were intended to be 

read in conjunction with the general 

category ‘‘Spinal cord, new growths of.’’ 

For the same reasons set forth above in 

the discussion for DC 8002, VA 

proposes to rename DC 8021 ‘‘Spinal 

cord, new growths of, malignant,’’ and 

DC 8022 ‘‘Spinal cord, new growths of, 

benign.’’ VA also proposes to clarify the 

60 percent evaluation criteria for DC 

8022 for the same reasons set forth in 

the discussion for DC 8003. 

Additionally, current DC 8021 also 

contains a note that is located between 

the 100 percent and the 30 percent 

evaluation levels. Previously, this DC 

had a 100 percent evaluation level and 

its note contained information regarding 

the 30 percent minimum rating. See 43 

FR 45348, 45362 (Oct. 2, 1978). 

However, revisions to Part 4 have 

placed the note between the 100 percent 

and the 30 percent evaluation levels. 

Notes are typically found after 

evaluative criteria. Therefore, VA 

proposes to relocate this note after the 

30 percent evaluation level and to revise 

it to ensure that rating personnel 

understand how it applies to the both 

the 100 percent and 30 percent 

evaluation levels. VA proposes no other 

changes to these DCs. 

I. Diagnostic Code 8025, Myasthenia 

Gravis 

VA proposes to relocate and modify 

the note currently located directly 

below the rating criteria of DC 8025. It 

will be relocated to the introductory 

instruction under § 4.124. Refer to the 

above section, ‘‘B. Organic diseases of 

the central nervous system,’’ and § 4.124 

for further details concerning this 

instruction. 

J. New Diagnostic Code 8026, 

Parkinson’s Plus, or Secondary 

Parkinsonism Syndromes 

VA proposes to add a new DC 8026, 

titled ‘‘Parkinson’s plus, or secondary 

parkinsonism syndromes,’’ in order to 

account for impairment due to this 

condition in the veteran population. 

Parkinson’s plus syndromes cause 

similar symptoms and impairment to 

Parkinson’s disease, but have other 

features that make them different. 

Parkinson’s plus syndromes have 

several causes, which include but are 

not limited to different location of 

protein buildup, brain injury, 

encephalitis, meningitis, stroke, 

medications, and chemical poisonings. 

Parkinson’s plus syndromes can cause 

impairment in facial expressions, 

problems with initiating or controlling 

motor movements, paralysis, vocal 

impairment, stiffness, and tremor. 

Treatment for Parkinson’s plus 

syndromes, as well as the likelihood 

and extent of residual disability, 

depends on the underlying cause of the 

disorder. This is in contrast to primary 

Parkinson’s, or Parkinson’s disease, 

where there is a predictable progression. 

For this reason, Parkinson’s plus 

syndrome will not have a minimum 

evaluation. ‘‘Secondary Parkinsonism,’’ 

National Institute of Health—U.S. 

National Library of Medicine (Jan. 19, 

2018), https://medlineplus.gov/ency/ 

article/000759.htm (last visited April 3, 

2018). VA is proposing a specific 

diagnostic code for Parkinson’s plus 

syndromes to allow for proper tracking 

of Parkinson’s plus and Parkinson’s 

disease in the veteran population. 

Parkinson’s plus will be evaluated 

under the General Rating Formula for 

Specified Neurologic Conditions (GRF). 

See DC 8004 for details about the GRF. 

K. New Diagnostic Code 8027, Essential 

Tremor 

VA proposes to add a new DC 8027, 

titled ‘‘Essential tremor,’’ in order to 

account for impairment due to this 

condition. There is currently no 

standalone diagnostic code to account 


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for essential tremor, forcing rating 

personnel to rely on analogous coding 

and leading to inconsistent evaluations. 

‘‘Tremor is defined as a rhythmical, 

involuntary, oscillatory movement of a 

body part and is one of the most 

frequent movement disorders.’’ Teive, 

H.A.G., ‘‘Essential Tremor: 

phenotypes,’’ (18) S1, pp 140–142, 140, 

Parkinsonism and Related Disorders 

(2012). ‘‘Essential tremor (ET) is one of 

the most common neurological diseases 

and the [most common] cause of 

pathological tremor.’’ Id. ‘‘Historically[,] 

ET was defined as a benign entity.’’ Id. 

However, recently it ‘‘was suggested 

that it is time to remove the ‘benign’ 

from the ET label, as it has been shown 

to be progressive in nature and quite 

disabling for most patients.’’ Id. ‘‘In the 

last [several] years[,] ET has evolved 

into two different meanings.’’ Id. First, 

‘‘the classical ET, as a 

monosymptomatic disorder, and 

second, a heterogeneous disorder, the 

Essential Tremors, or a family of 

diseases.’’ Id. Currently, ‘‘ET can be 

classified with both motor and nonmotor elements. Tremor may occur also 

in the legs, feet, trunk, jaw, chin, 

tongue, and voice. Although postural 

and kinetic tremors are the main 

features of ET, intentional tremor and 

tremor at rest may also occur in some 

patients. Other motor features described 

in patients with ET are gait ataxia, 

postural instability[,] and eye-motion 

abnormalities. Non-motor features 

include cognitive (memory and 

executive problems and dementia), 

psychiatric (anxiety, depression[,] and 

social phobia), and sensory 

abnormalities (olfactory deficits [and] 

hearing loss).’’ Id. 

In developing evaluation criteria for 

ET, one of the most significant 

challenges is little, if any, outcomes 

research that would assist in criteria 

development. However, there are two 

well-recognized tools VA used to 

research this condition. The first tool is 

the International Classification of 

Functioning, Disability, and Health 

(2001), published by the World Health 

Organization, that provided terminology 

and definitions. According to this 

resource, ET involves the dysfunction of 

specific elements within the central 

nervous system. The tremors with ET 

are the impairments resulting from that 

nervous system dysfunction. Those 

tremors cause activity limitations and 

participation restrictions that can lead 

to earnings loss. The second tool is the 

6th Edition Guides to the Evaluation of 

Permanent Impairment (2008), 

published by the American Medical 

Association. The guide has impairment 

tables for the upper extremities, gait, 

and station. These tools were 

considered in the creation of a general 

rating formula. 

Another significant challenge in 

developing evaluation criteria for ET is 

the high rate of misdiagnosis with other 

movement disorders, such as dystonia 

and Parkinson’s disease. Misdiagnosis 

occurs in up to 50 percent of cases, with 

Parkinson’s disease (particularly in 

elderly patients) and dystonia 

(tremulous cervical dystonia) being the 

most common disorders mistaken for 

ET. Therefore, VA proposes the creation 

and use of a General Rating Formula for 

Specified Neurologic Conditions (GRF) 

for this and other movement disorders, 

allowing evaluation to focus on the 

symptoms and impairment present, 

even when misdiagnosis and/or a 

change in diagnosis occurs. See 

diagnostic code 8004 for details about 

the GRF. Teive, H.A.G., ‘‘Essential 

Tremor: phenotypes,’’ (18) S1, pp 140– 

142, Parkinsonism and Related 

Disorders (2012). 

L. New Diagnostic Code 8028, Dystonia 

VA proposes to add a new DC 8028, 

titled ‘‘Dystonia,’’ in order to account 

for impairment due to this condition. 

There is currently no standalone 

diagnostic code to account for dystonia, 

forcing rating personnel to rely on 

analogous coding and leading to 

inconsistent evaluations. 

Dystonia causes involuntary muscle 

contractions that lead to slow, 

repetitive, and sometimes painful 

movement or abnormal posture. 

Dystonia can affect only one muscle, 

groups of muscles (torticollis), or 

muscles throughout the entire body. The 

specific symptoms and impairment 

experienced depend highly on the type 

of dystonia and the muscles affected, 

but can include difficulty walking, 

involuntary neck turning, difficulty 

speaking, writing, and uncontrollable 

blinking. Some cases of dystonia only 

affect a muscle group when performing 

a specific action. ‘‘Dystonias Fact 

Sheet,’’ National Institute of Health— 

National Institute of Neurological 

Disorders and Stroke (June 3, 2014), 

https://www.ninds.nih.gov/healthinformation/disorders/tremor#tocwhere-can-i-find-more-informationabout-tremor- (last visited September 

18, 2024). 

The Dystonia Study Group composed 

of renowned international movement 

disorder experts developed the unified 

dystonia rating scale and the global 

dystonia rating scale to serve as 

instruments to medically assess 

dystonia severity. ‘‘Rating Scales for 

Dystonia: A Multicenter Assessment,’’ 

Comella C et al., 2003 Movement 

Disorders 18 No.3 pp 303–12. These 

scales were considered during the 

creation of the general rating formula. 

Due to similarity and overlap of 

symptoms with other movement 

disorders, along with the high 

prevalence of misdiagnosis, VA 

proposes application of a General Rating 

Formula for Specified Neurologic 

Conditions (GRF). See DC 8004 for 

details about the GRF. 

M. New Diagnostic Code 8036, Primary 

Lateral Sclerosis 

VA proposes to add a new DC 8036, 

titled ‘‘Primary lateral sclerosis,’’ in 

order to account for impairment due to 

this condition. There is currently no 

standalone diagnostic code to account 

for primary lateral sclerosis (PLS). A 

standalone diagnostic code will permit 

more accurate tracking of this condition, 

and its associated disability. 

PLS is a motor neuron disease that 

affects the upper motor neurons in the 

arms, legs, and face. Individuals with 

PLS first experience loss of muscle 

control in the feet and legs, then the 

disease progresses up the trunk and into 

the arms, hands, and the muscles that 

control speech, swallowing, and 

chewing. PLS can be differentiated from 

amyotrophic lateral sclerosis in that it 

only affects the upper motor neurons 

and progresses gradually. While there is 

no cure for PLS, it is not considered a 

fatal disease, and many individuals 

maintain the ability to walk without 

assistance, although they may 

eventually need a cane or walker due to 

the development of high degrees of 

spasticity. Due to the wide range of 

symptoms and severity upon 

confirmation of diagnosis, VA proposes 

to evaluate PLS according to the 

residual impairment under the 

appropriate diagnostic code with a 

minimum rating of 10 percent when 

there are ascertainable residuals. See R. 

Ramanathan, et al., ‘‘Demographics and 

clinical characteristics of primary lateral 

sclerosis: case series and a review of 

literature,’’ Neurodegener. Dis. Manag., 

vol 8(1), pp 17–23. 2018. 

N. Diagnostic Code 8103, Hemifacial 

Spasm (Tic, Convulsive) 

Current DC 8103 is titled ‘‘Tic, 

convulsive,’’ a facial nerve disorder that 

causes involuntary spasms and 

contractions of the facial nerves. For 

consistency, clarity, and ease of use of 

the VASRD by non-medical personnel, 

VA proposes to rename this diagnostic 

code ‘‘Hemifacial spasm.’’ Hemifacial 

spasm, an alternative name for 

convulsive tic, provides a much more 

explicit indication as to the condition to 

be evaluated under this diagnostic code 


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in terms of the anatomical location to be 

considered. VA proposes to preserve the 

historical reference to the nomenclature 

in parentheses. VA proposes no other 

changes to this diagnostic code. 

O. Diagnostic Code 8104, 

Paramyoclonus Multiplex (Convulsive 

State, Myoclonic Type) 

The current evaluation criteria for DC 

8104, Paramyoclonus multiplex 

(convulsive state, myoclonic type), 

directs rating personnel to rate this 

condition as convulsive tic, which is DC 

8103. As discussed above, VA is 

updating this term to hemifacial spasm 

in order to reflect current medical 

terminology. As such, VA proposes to 

replace ‘‘tic; convulsive’’ in the 

evaluation criteria of DC 8104 to 

maintain consistency throughout this 

portion of the VASRD. VA proposes no 

other changes to this DC. 

P. Diagnostic Code 8107, Athetosis, 

Acquired 

Current DC 8107, Athetosis, acquired, 

directs rating personnel to evaluate this 

condition as chorea. To clarify these 

instructions and promote consistency in 

evaluations, VA proposes to specify that 

this condition should be evaluated as 

Sydenham’s chorea, matching the title 

of the DC that provides the appropriate 

evaluation criteria. VA proposes no 

other changes to this DC. 

Q. Title Changes to Certain Peripheral 

Nerves 

To reflect current medical 

terminology, VA proposes to update the 

names of the following peripheral 

nerves. The proposed titles are the 

current accepted nomenclature to 

describe these nerves. VA proposes to 

preserve the historical reference to the 

nomenclature in parentheses. 

Diagnostic code Current title for nerve Proposed title for nerve 

8514 ..................................... Musculospiral nerve (radial nerve) .................................. Radial nerve (musculospiral).1

8518 ..................................... Circumflex nerve ............................................................. Axillary nerve (circumflex).2

8521 ..................................... External popliteal nerve (common peroneal) .................. Common peroneal nerve (external popliteal).3

8522 ..................................... Musculocutaneous nerve (superficial peroneal) ............. Superficial peroneal nerve (musculocutaneous).1

8523 ..................................... Anterior tibial nerve (deep peroneal) .............................. Deep peroneal nerve (anterior tibial).1

8524 ..................................... Internal popliteal nerve (tibial) ......................................... Tibial nerve (internal popliteal).4

8526 ..................................... Anterior crural nerve (femoral) ........................................ Femoral nerve (anterior crural).5

8527 ..................................... Internal saphenous nerve ............................................... Saphenous nerve (internal saphenous).1

8529 ..................................... External cutaneous nerve of thigh .................................. Lateral cutaneous nerve of the thigh (external cutaneous).5

1 ‘‘Dorland’s Illustrated Medical Dictionary,’’ 1123 (Douglas M. Anderson et al. eds., 27th ed. 1988). 

2Wolf, J., ‘‘Segmental Neurology’’, page 20, 1981. 

3 ‘‘Common Peroneal Nerve Dysfunction,’’ National Institute of Health—U.S. National Library of Medicine (Aug. 7, 2017), https://

medlineplus.gov/ency/article/000791.htm (last visited April 3, 2018). 4 ‘‘Dorland’s Illustrated Medical Dictionary,’’ 1124 (Douglas M. Anderson et al. eds., 27th ed. 1988). 

5 ‘‘Dorland’s Illustrated Medical Dictionary,’’ 1120 (Douglas M. Anderson et al. eds., 27th ed. 1988). 

R. Diagnostic Code 8514, Paralysis of 

the Musculospiral (Radial) Nerve 

Current DC 8514 addresses motor 

impairment from diseases affecting the 

musculospiral nerve. The current 

evaluation criteria include a note that 

references dissociation of extensor 

communis digitorum and paralysis 

below the extensor communis 

digitorum, as well as instructing 

evaluations of these findings should not 

exceed a moderate rating. As stated 

previously, this nerve will be retitled as 

the radial nerve. Additionally, the note 

will be revised, as the evaluation criteria 

will be revised to employ the grade of 

muscle strength as the means to 

distinguish evaluation levels, with the 

maximum evaluation level 

corresponding to Grade 3 muscle 

strength for dissociation of extensor 

communis digitorum and paralysis 

below the extensor communis 

digitorum. 

S. Diagnostic Code 8520, Paralysis of 

the Sciatic Nerve 

Current DC 8520 addresses motor 

impairment due to diseases of the 

sciatic nerve. The nerve referenced by 

this diagnostic code stimulates the 

muscles of the entire lower extremity. 

While all other peripheral nerve criteria 

consist of mild, moderate, and severe, 

this one includes an extra category 

labeled moderately severe. In order to 

preserve the current evaluation levels 

and account for this extra category, VA 

proposes to revise the incomplete 

paralysis criteria at the 60 percent, 40 

percent, 20 percent, and 10 percent 

levels. A 60 percent evaluation will be 

granted for muscles that have grade 2 

strength (previously labeled severe). A 

40 percent evaluation will be granted for 

muscles that have grade 2+ strength 

(previously labeled moderately severe). 

A 20 percent evaluation will be granted 

for muscles that have grade 3 strength 

(previously labeled moderate). A 10 

percent evaluation will be granted for 

muscles that have grade 4 strength 

(previously labeled mild). Refer to the 

discussion above regarding § 4.123 for 

further details concerning the grading 

scale for motor impairment. 

T. Diagnostic Code 8527, Sensory 

Neuropathy of the Internal Saphenous 

Nerve 

Current DC 8527 addresses paralysis 

of the internal saphenous nerve. 

Paralysis refers to the lack of muscle 

function in muscle fibers. Posterior 

roots of the spinal nerves, including the 

saphenous nerve, do not have motor 

fibers, making it a pure sensory nerve. 

M. De Maeseneer, et al., ‘‘Normal 

Anatomy and Compression Areas of 

Nerves of the Foot and Ankle: US and 

MR Imaging With Anatomic 

Correlation,’’ Radiographics, vol 35, 

1474–1475, 1469–1482 (2015). As a 

purely sensory nerve, the saphenous 

nerve has no muscle involvement and 

therefore using paralysis to describe 

impairment of this nerve is medically 

inaccurate. VA proposes to retitle DC 

8527 to improve medical accuracy, and 

motor neuropathy will not be included 

in the criteria for this nerve. Because 

this nerve currently has a compensable 

rating only at the severe to complete 

paralysis level and sensory neuropathy, 

wholly sensory evaluations, will only be 

rated up to the moderate level, this 

nerve will no longer have a 

compensable rating. 

U. Diagnostic Code 8529, Sensory 

Neuropathy of the External Cutaneous 

Nerve of the Thigh 

Current DC 8529 addresses paralysis 

of the external cutaneous nerve of the 

thigh. Current medical terminology 

refers to this nerve as the lateral 

cutaneous nerve of the thigh, or LCNT. 

This nerve is part of the lumbar plexus. 

‘‘It functions primarily as a sensory 

nerve and its composition varies among 

individuals with several different 


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combinations of lumbar nerves that 

originate from L1 to L3. The LCNT then 

emerges at the lateral border of the 

psoas major, crosses the iliacus, to the 

anterior superior iliac spine. The nerve 

then passes under the inguinal ligament 

and over the sartorius muscle and enters 

the thigh as it divides into an anterior 

and posterior branch.’’ Cheatham, S., et 

al. ‘‘Meralgia Paresthetica: A Review of 

the Literature,’’ International Journal of 

Sports Physical Therapy, 8(6): 884, 

December 2013. Paralysis refers to the 

lack of muscle function in muscle fibers. 

This nerve lacks motor fibers. As a 

purely sensory nerve, it has no muscle 

involvement and therefore using 

paralysis to describe impairment of this 

nerve is medically inaccurate. VA 

proposes to retitle DC 8529 to improve 

medical accuracy, and motor 

neuropathy will not be included in the 

criteria for this nerve. Because this 

nerve currently has a compensable 

rating only at the severe to complete 

paralysis level and sensory neuropathy, 

wholly sensory evaluations, will only be 

rated up to the moderate level, this 

nerve will no longer have a 

compensable rating. 

V. Diagnostic Code 8540, Soft Tissue 

Sarcoma of Neurogenic Origin 

VA proposes to place a section 

subheading, ‘‘Other Neoplasms of the 

Neurological System,’’ just above this 

diagnostic code as a separator between 

diagnostic codes for peripheral nerves 

and other neoplasms of the neurological 

system. No other changes are proposed 

for this DC. 

W. Diagnostic Code 8910, Epilepsy, 

Grand Mal (Including Tonic-Clonic 

Seizures) 

Current DC 8910 is titled ‘‘Epilepsy, 

grand mal.’’ VA proposes to update the 

title of this code to indicate that this 

includes tonic-clonic seizures. Tonicclonic seizures involve the entire body, 

and the terminology is synonymous 

with grand mal seizures. ‘‘Generalized 

tonic-clonic seizure,’’ National Institute 

of Health—U.S. National Library of 

Medicine (September 3, 2019), https://

medlineplus.gov/ency/article/ 

000695.htm (last visited September 10, 

2019). VA proposes no other changes to 

this DC. 

X. Diagnostic Code 8911, Epilepsy, Petit 

Mal (Including Absence Seizures) 

Current DC 8911 is titled ‘‘Epilepsy, 

petit mal.’’ VA proposes to update the 

title of this code to indicate that this 

includes absence seizures. Absence 

seizures typically last only a few 

seconds and may involve staring 

episodes, also called absence spells. 

Absence seizure is used synonymously 

with petit mal seizures. ‘‘Absence 

Seizure,’’ National Institute of Health— 

U.S. National Library of Medicine 

(September 3, 2019), http://

www.nlm.nih.gov/medlineplus/ency/ 

article/000696.htm (last visited 

September 10, 2019). VA proposes no 

other changes to this DC. 

Y. Non-Substantial Changes to 

Relocated 38 CFR 4.124a 

VA will also make some nonsubstantial changes to relocated 38 CFR 

4.124a. In 2008, DC 8045, Residuals of 

traumatic brain injury (TBI), was revised 

to include a table titled ‘‘Evaluation of 

Cognitive Impairment and Other 

Residuals of TBI Not Otherwise 

Classified.’’ See 73 FR 54693, 54705– 

54708 (September 23, 2008). This table 

was added after the table titled ‘‘Organic 

Diseases of the Central Nervous 

System.’’ This had the effect of placing 

DC 8046, Cerebral arteriosclerosis, 

between the evaluation criteria of DC 

8045, Residuals of traumatic brain 

injury, and the newly added table for 

TBI residuals. To improve readability 

and ease of use for both DCs 8045 and 

8046, VA proposes to relocate the table 

titled ‘‘Evaluation of Cognitive 

Impairment and Other Residuals of TBI 

Not Otherwise Classified’’ directly 

below the evaluation criteria for DC 

8045. 

Z. Military Occupational Blast Exposure 

VA is currently in the process of 

investigating the potential neurological 

residuals of repeated exposure to lowlevel military occupational blasts or 

Military Occupational Blast Exposure. 

VA invites public comment on this 

subject. 

Executive Orders 12866, 13563 and 

14094 

Executive Order 12866 (Regulatory 

Planning and Review) directs agencies 

to assess the costs and benefits of 

available regulatory alternatives and, 

when regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, and other advantages; 

distributive impacts; and equity). 

Executive Order 13563 (Improving 

Regulation and Regulatory Review) 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. Executive Order 

14094 (Executive Order on Modernizing 

Regulatory Review) supplements and 

reaffirms the principles, structures, and 

definitions governing contemporary 

regulatory review established in 

Executive Order 12866 of September 30, 

1993 (Regulatory Planning and Review), 

and Executive Order 13563 of January 

18, 2011 (Improving Regulation and 

Regulatory Review). The Office of 

Information and Regulatory Affairs has 

determined that this rulemaking is a 

significant regulatory action under 

Executive Order 12866, Section 3(f)(1), 

as amended by Executive Order 14094. 

The Regulatory Impact Analysis 

associated with this rulemaking can be 

found as a supporting document at 

www.regulations.gov. 

Regulatory Flexibility Act 

The Secretary hereby certifies that 

this proposed rule would not have a 

significant economic impact on a 

substantial number of small entities as 

they are defined in the Regulatory 

Flexibility Act (5 U.S.C. 601–612). 

The factual basis for this certification 

is based on the fact that no small 

entities or businesses determine the 

rating criteria revisions or assign 

evaluations for disability claims. 

Therefore, pursuant to 5 U.S.C. 605(b), 

the initial and final regulatory flexibility 

analysis requirements of 5 U.S.C. 603 

and 604 do not apply. 

Unfunded Mandates 

The Unfunded Mandates Reform Act 

of 1995 requires, at 2 U.S.C. 1532, that 

agencies prepare an assessment of 

anticipated costs and benefits before 

issuing any rule that may result in the 

expenditure by State, local, and tribal 

governments, in the aggregate, or by the 

private sector, of $100 million or more 

(adjusted annually for inflation) in any 

one year. This proposed rule would 

have no such effect on State, local, and 

tribal governments, or on the private 

sector. 

Paperwork Reduction Act (PRA) 

This proposed rule contains no 

provisions constituting a collection of 

information under the Paperwork 

Reduction Act of 1995 (44 U.S.C. 3501– 

3521). 

Assistance Listing 

The Assistance Listing numbers and 

titles for the programs affected by this 

document are 64.102, Compensation for 

Service-Connected Deaths for Veterans’ 

Dependents; 64.105, Pension to 

Veterans, Surviving Spouses, and 

Children; 64.109, Veterans 

Compensation for Service-Connected 

Disability; and 64.110, Veterans 

Dependency and Indemnity 

Compensation for Service-Connected 

Death. 


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88926 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

List of Subjects 

38 CFR Part 3 

Administrative practice and 

procedure, Claims, Disability benefits. 

38 CFR Part 4 

Disability benefits, Pensions, 

Veterans. 

Signing Authority 

Denis McDonough, Secretary of 

Veterans Affairs, approved and signed 

this document on October 29, 2024, and 

authorized the undersigned to sign and 

submit the document to the Office of the 

Federal Register for publication 

electronically as an official document of 

the Department of Veterans Affairs. 

Luvenia Potts, 

Regulation Development Coordinator, Office 

of Regulation Policy & Management, Office 

of General Counsel, Department of Veterans 

Affairs. 

For the reasons stated in the 

preamble, VA proposes to amend 38 

CFR parts 3 and 4 as set forth below: 

PART 3—ADJUDICATION 

Subpart A—Pension, Compensation, 

and Dependency and Indemnity 

Compensation 

■ 1. The authority citation for part 3 

continues to read as follows: 

Authority: 38 U.S.C. 501(a), unless 

otherwise noted. 

■ 2. Amend § 3.809 by revising 

paragraph (d) to read as follows: 

§ 3.809 Specially adapted housing under 

38 U.S.C. 2101(a)(2)(A)(i). 

* * * * * 

(d) Amyotrophic lateral sclerosis. VA 

considers § 3.809(b) satisfied if the 

veteran or member of the Armed Forces 

serving on active duty has serviceconnected amyotrophic lateral sclerosis 

rated 100 percent disabling under 38 

CFR 4.124, diagnostic code 8017. 

* * * * * 

PART 4—SCHEDULE FOR RATING 

DISABILITIES 

Subpart B—Disability Ratings 

■ 3. The authority citation for part 4 

continues to read as follows: 

Authority: 38 U.S.C. 1155, unless 

otherwise noted. 

■ 4. In § 4.71a, amend the table The 

Spine by revising the entry for 

diagnostic code 5244 under General 

Rating Formula for Diseases and Injuries 

of the Spine to read as follows: 

§ 4.71a Schedule of ratings— 

musculoskeletal system. 

* * * * * 

THE SPINE

Rating 

General Rating Formula for Diseases and Injuries of the Spine 

* * * * * * * 

5244 Traumatic paralysis, complete: 

Paraplegia: Rate under diagnostic code 5110. 

Quadriplegia: Rate separately under diagnostic codes 5109 and 5110 and combine evaluations in accordance with § 4.25. 

Note: If traumatic paralysis does not cause loss of use of both hands or both feet, it is incomplete paralysis. Evaluate residuals of incomplete traumatic paralysis under the appropriate diagnostic code (e.g., § 4.124, Diseases of the Peripheral 

Nerves). 

*******

■ 5. Revise § 4.120 to read as follows: 

§ 4.120 Minimum evaluations for organic 

diseases of the central nervous system. 

(a) Necessity of residuals for 

minimum evaluations. The minimum 

evaluations for diagnostic codes 8002, 

8004, 8007, 8010, 8018, 8021, 8023, 

8024, and 8025 do not require 

ascertainable residuals. However, 

ascertainable residuals are required to 

provide the minimum evaluation for 

diagnostic codes 8000, 8003, 8011, 

8012, 8019, 8020, 8022, and 8036. 

(b) Definition. Ascertainable residuals 

include, but are not limited to, 

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 complete or incomplete paralysis 

of peripheral nerves. Determinations as 

to the presence of subjective residuals 

not capable of objective verification, 

e.g., headaches, dizziness, fatigability, 

must be approached on the basis of 

disability related to the diagnosis 

recorded. VA will only accept subjective 

residuals when they are consistent with 

the disease and not more likely 

attributable to another disease or no 

disease. 

(c) Ratings in excess of the minimum 

evaluation. When one or more 

compensable evaluations assigned for 

the residuals of the diagnostic codes 

noted in this section meet or exceed the 

minimum evaluation for that diagnostic 

code, then the minimum evaluation for 

that diagnostic code is no longer 

applicable. When a rating in excess of 

the prescribed minimum rating is 

assigned based on the presence of 

ascertainable residuals, the diagnostic 

codes associated with the evaluation of 

those residuals must be cited in 

accordance with § 4.27. 

■ 6. Revise § 4.123 to read as follows: 

§ 4.123 Cranial and peripheral nerve 

impairment. 

(a) General. (1) In rating cranial and 

peripheral nerve injuries and their 

residuals, attention should be given to 

the site and character of the injury, the 

relative impairment in movement or 

muscle strength, and sensory 

disturbances. 

(2) Disability from impairments of the 

first, second, third, fourth, sixth, and 

eighth cranial nerves will be rated under 

the Organs of Special Sense. 

(3) A cranial nerve will be evaluated 

strictly as a cranial nerve, regardless of 

any portions which lie outside the 

cranium (skull). The evaluations in the 

rating schedule for the cranial nerves 

are for unilateral involvement; when 

bilateral, evaluate separately, then 


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combine using § 4.25 but without 

application of the bilateral factor. 

(4) The evaluations in the rating 

schedule for the peripheral nerves are 

for unilateral involvement; when 

bilateral, evaluate separately, then 

combine using § 4.25 with application 

of the bilateral factor. 

(b) Motor neuropathy (complete and 

incomplete paralysis). 

(1) General. The evaluation criteria for 

impairment to muscle function, with or 

without pain, of both cranial and 

peripheral nerves will be categorized as 

either complete paralysis or incomplete 

paralysis. 

(2) Cranial nerves. Complete paralysis 

for cranial nerves is characterized by the 

complete inability to move. Incomplete 

paralysis is characterized as either 

movement with difficulty, or attempted 

movement with inability to complete 

such movement (muscle twitching 

present). 

(3) Peripheral nerves. VA will 

evaluate peripheral nerve motor 

neuropathy using the Medical Research 

Council (MRC) Scale for Muscle 

Strength (commonly referred to as 

manual muscle testing). Complete 

paralysis for peripheral nerves will be 

identified as Grade 0 or Grade 1 muscle 

strength (no movement for Grade 0 and 

a flicker or trace of contraction for Grade 

1). Incomplete paralysis will be 

determined by the following muscle 

strength grades: Grade 2 (only able to 

move if gravity is eliminated; unable to 

move at all against gravity), Grade 2+, 

which only applies to DC 8520 Sciatic 

nerve, (muscle strength, which, though 

present, can only partially move against 

gravity), Grade 3 (only able to move 

against gravity; unable to move against 

resistance), or Grade 4 (weakness is 

present, but able to move against 

resistance and gravity). If muscle 

strength falls in between grades (Grade 

+ or ¥) for peripheral nerves other than 

Grade 2+ for DC 8520, then evaluate as 

follows: (1). for a¥grade, reduce the 

grade by one integer (e.g., Grade 3¥ 

shall be evaluated as Grade 2), and (2.) 

for a + grade, maintain the current grade 

(e.g., a Grade 3+ shall be evaluated as 

Grade 3). 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 levels of 

the nerve lesion or to partial 

regeneration. 

(4) Mixed nerves. When mixed nerves 

within a single diagnostic code are 

involved, an evaluation for both motor 

and sensory neuropathy is not 

permitted. The evaluation should be 

based on motor neuropathy with or 

without sensory neuropathy 

involvement. 

(c) Sensory neuropathy (complete and 

incomplete). 

(1) General. Impairments, with or 

without pain, to the sensory function of 

the cranial and peripheral nerves may 

be categorized as either incomplete or 

complete sensory neuropathy. 

(2) Complete sensory neuropathy. 

Complete sensory neuropathy is 

characterized by the complete absence 

of sensation in an affected nerve. 

(3) Incomplete sensory neuropathy. 

Incomplete sensory neuropathy involves 

sensation that is impaired, but not 

absent, or unpleasant sensations 

experienced by the nerve such as 

dysesthesia, numbness, or paresthesia. 

Dysesthesia refers to any unpleasant 

sensation produced by a stimulus that is 

normally painless. Numbness refers to a 

sense of heaviness, weakness, or 

deadness in part of the body. 

Paresthesia refers to abnormal 

spontaneous sensations such as burning, 

tingling, pins and needles, etc. VA will 

only accept subjective sensations when 

they are consistent with the disease and 

not more likely attributable to another 

disease or no disease. 

§ 4.124 [Removed] 

■ 7. Remove § 4.124. 

§ 4.124a [Redesignated as § 4.124] 

■ 8. Redesignate § 4.124a as § 4.124. 

■ 9. Revise and republish newly 

redesignated § 4.124 to read as follows: 

§ 4.124 Schedule of ratings—Neurological 

conditions and convulsive disorders. 

ORGANIC DISEASES OF THE CENTRAL NERVOUS SYSTEM

Rating 

Guidance for rating organic diseases of the central nervous system is located under § 4.120. 

8000 Encephalitis, infectious: 

As active febrile disease .............................................................................................................................................................. 100 

Rate residuals, minimum .............................................................................................................................................................. 10 

8002 Brain, new growth of, malignant .............................................................................................................................................. 100 

Minimum rating ............................................................................................................................................................................. 30 

Note: The 100 percent evaluation 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 or the minimum rating, whichever results in a higher evaluation. 

8003 Brain, new growth of, benign: 

Minimum during active disease or during a treatment phase ...................................................................................................... 60 

Rate residuals, minimum .............................................................................................................................................................. 10 

General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 8028): 

Hoehn-Yahr stage 4 or stage 5, or; the inability to live independently because of neurologically-related disability .................. 100 

Impairment of mobility (e.g., transfers, balance, or gait) requiring daily use of an assistive device such as a wheelchair, 

brace(s), crutch(es), cane(s), or walker .................................................................................................................................... 60 

Hoehn-Yahr stage 3, or; impairment of mobility (e.g., transfers, balance, or gait) requiring less than daily use of an assistive 

device such as a wheelchair, brace(s), crutch(es), cane(s), or walker .................................................................................... 30 

Hoehn-Yahr stage 2, or; impairment in at least one of the following areas: ............................................................................... 10 

• facial expression (e.g., masking, blinking, or eye motion abnormalities); 

• speech (e.g., soft voice, slurring, difficulty speaking or swallowing); 

• posture (e.g., stooping, instability); 

• mobility not requiring an assistive device (e.g., decreased speed with transfers, gait ataxia, unstable balance); 

• problems initiating or controlling motor movements (e.g., stiffness, tremors); 

• cognitive (e.g., memory or executive problems); 

• mental (e.g., anxiety, depression, social phobia); 

• sensory abnormalities (e.g., olfactory deficits); 

• involuntary muscle contractions resulting in pain and impairment, such as but not limited to, spontaneous neck turning or writing difficulty 

Hoehn-Yahr stage 1, or; formal diagnosis without impairment .................................................................................................... 0 


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ORGANIC DISEASES OF THE CENTRAL NERVOUS SYSTEM—Continued 

Rating 

Note (1): Regardless of examination findings, the minimum rating for Parkinson’s disease (DC 8004) shall be 30 percent. 

Note (2): Regardless of examination findings, the minimum rating for stroke residuals (DC 8007) shall be 10 percent. 

Note (3): Activities of daily living (ADLs) 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): Evaluate any residual under the appropriate body system when there is a formal diagnosis of a condition. When there 

is no formal diagnosis, evaluate the residual under the General Rating Formula for Specified Neurologic Conditions. For example, evaluate emotional 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 symptoms under the General Rating 

Formula for Specified Neurologic Conditions. 

Note (5): There may be an overlap of manifestations of conditions evaluated under the General Rating Formula for Specified 

Neurologic Conditions 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 (6): Consider the need for special monthly compensation. 

Note (7): When evaluating a neurological condition under the General Rating Formula for Specified Neurological Conditions 

based on subjective symptoms and not a Hoehn-Yahr stage, a medical opinion finding that the subjectively reported symptom(s) is consistent with the claimed disease and not another disease or no disease is required. 

8004 Parkinson’s disease (paralysis agitans): 

Rate under the General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 8028).

8005 Bulbar palsy ............................................................................................................................................................................. 100 

8007 Stroke (ischemic, hemorrhagic, or thrombotic), including cerebral infarction or cerebrovascular accident (Brain, vessels, 

embolism, thrombosis, and hemorrhage): 

During and for six months following a stroke, documented by diagnostic imaging .................................................................... 100 

Thereafter, rate under the General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 

8028). 

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 ................................................................................................................................................... 100 

Note: Consider the need for special monthly compensation. 

8018 Multiple sclerosis and and other demyelinating diseases of the central nervous system: 

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 

8021 Spinal cord, new growths of, malignant ................................................................................................................................... 100 

Minimum rating ............................................................................................................................................................................. 30 

Note: The 100 percent evaluation 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 or the minimum rating, whichever results in a higher evaluation. 

8022 Spinal cord, new growths of, benign: 

Minimum during active disease or during a treatment phase ...................................................................................................... 60 

Rate residuals, minimum .............................................................................................................................................................. 10 

8023 Progressive muscular atrophy: 

Minimum rating ............................................................................................................................................................................. 30 

8024 Syringomyelia: 

Minimum rating ............................................................................................................................................................................. 30 

8025 Myasthenia gravis: 

Minimum rating ............................................................................................................................................................................. 30 

8026 Parkinson’s plus, or secondary parkinsonism syndromes. 

Rate under the General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 8028).

8027 Essential tremor. 

Rate under the General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 8028).

8028 Dystonia. 

Rate under the General Rating Formula for Specified Neurologic Conditions (DCs 8004, 8007, 8026, 8027, and 8028).

8036 Primary lateral sclerosis: 

Rate residuals, minimum .............................................................................................................................................................. 10 

8045 Residuals of traumatic brain injury (TBI): 


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ORGANIC DISEASES OF THE CENTRAL NERVOUS SYSTEM—Continued 

Rating 

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 OTHER RESIDUALS OF TBI NOT OTHERWISE CLASSIFIED

Facets of cognitive impairment 

and other residuals of TBI not 

otherwise classified 

Level of 

impairment Criteria 

Memory, attention, concentration, executive functions.0 No complaints of impairment of memory, attention, concentration, or executive functions. 

1 A complaint of mild loss of memory (such as having difficulty 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. 


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EVALUATION OF COGNITIVE IMPAIRMENT AND OTHER RESIDUALS OF TBI NOT OTHERWISE CLASSIFIED—Continued 

Facets of cognitive impairment 

and other residuals of TBI not 

otherwise classified 

Level of 

impairment Criteria 

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 motor 

and sensory system).

0 Motor activity normal. 

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. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 88931 

EVALUATION OF COGNITIVE IMPAIRMENT AND OTHER RESIDUALS OF TBI NOT OTHERWISE CLASSIFIED—Continued 

Facets of cognitive impairment 

and other residuals of TBI not 

otherwise classified 

Level of 

impairment Criteria 

Consciousness ........................... Total Persistently altered state of consciousness, such as vegetative state, minimally responsive 

state, coma. 

Rating 

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 

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 months ................................. 30 

With characteristic prostrating attacks averaging one in 2 months over last several months .................................................... 10 

With less frequent attacks ............................................................................................................................................................ 0 

8103 Hemifacial spasm (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 hemifacial spasm; 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 Sydenham’s chorea. 

8108 Narcolepsy. 

Rate as for epilepsy, petit mal. 

Diseases of the Cranial Nerves 

Guidance for rating cranial nerves is located under § 4.123. 

Fifth (trigeminal) cranial nerve 

8205 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 50 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 30 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Sensory neuropathy, complete or incomplete .............................................................................................................................. 10 

Note (1): Tic douloureux may be rated under DC 8205 in accordance with severity, up to complete paralysis. 

Note (2): Rate dependent upon relative loss of sensation or muscle function. Examples of nerve functions include, but are 

not limited to, movement and sensation to the scalp, forehead, nose, cheeks, lower eye lid, nasal mucosa, upper lip, 

upper teeth, palate, anterior tongue, skin over mandible and lower teeth, and muscles of mastication. 

Seventh (facial) cranial nerve 

8207 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 30 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 20 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Sensory neuropathy, complete, or incomplete ............................................................................................................................. 10 

Note: Rate dependent upon relative loss of sensation or muscle function. Examples of nerve functions include, but are not 

limited to, facial expressions, taste, and production/drainage of tears. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
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Rating 

Ninth (glossopharyngeal) cranial nerve 

8209 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 30 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 20 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Sensory neuropathy, complete, or incomplete ............................................................................................................................. 10 

Note: Rate dependent upon relative loss of ordinary sensation or muscle function. Examples of nerve functions include, but 

are not limited to, taste and sensing carotid blood pressure. 

Tenth (pneumogastric, vagus) cranial nerve 

8210 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 50 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 30 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Sensory neuropathy, complete, or incomplete ............................................................................................................................. 10 

Note: Rate dependent upon relative loss of sensation or muscle function. Examples of nerve functions include, but are not 

limited to, speech and taste, along with movement and sensation to the larynx, pharynx, thoracic viscera, and abdominal 

viscera. 

Eleventh (spinal accessory, external branch) cranial nerve 

8211 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 30 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 20 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Note: Rate dependent upon relative loss of muscle function. Examples of nerve functions include, but are not limited to, 

movement of the sternocleidomastoid and trapezius muscles. 

Twelfth (hypoglossal) cranial nerve 

8212 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis ....................................................................................................................................................................... 50 

Incomplete paralysis: 

Attempted movement with inability to complete such movement (muscle twitching present) ............................................. 30 

Muscle movement intact, but task performed with difficulty ................................................................................................. 10 

Sensory neuropathy, complete, or incomplete ............................................................................................................................. 10 

Note: Rate dependent upon relative loss of sensation or muscle function. Examples of nerve functions include, but are not 

limited to, movement and sensation to the tongue. 

Schedule of ratings 

Rating 

Major Minor 

Diseases of the Peripheral Nerves 

Guidance for rating peripheral nerves, along with a description of the grading system, is located under § 4.123. 

Upper radicular group (fifth and sixth cervicals) 

8510 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 70 60 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 50 40 

Grade 3 ............................................................................................................................................................................. 40 30 

Grade 4 ............................................................................................................................................................................. 20 20 

Sensory neuropathy, complete ................................................................................................................................................. 40 30 

Sensory neuropathy, incomplete .............................................................................................................................................. 20 20 

Middle radicular group 

8511 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 70 60 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 50 40 

Grade 3 ............................................................................................................................................................................. 40 30 

Grade 4 ............................................................................................................................................................................. 20 20 

Sensory neuropathy, complete ................................................................................................................................................. 40 30 

Sensory neuropathy, incomplete .............................................................................................................................................. 20 20 

Lower radicular group 

8512 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 70 60 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 50 40 

Grade 3 ............................................................................................................................................................................. 40 30 

Grade 4 ............................................................................................................................................................................. 20 20 

Sensory neuropathy, complete ................................................................................................................................................. 40 30 

Sensory neuropathy, incomplete .............................................................................................................................................. 20 20 


khammond on DSKJM1Z7X2PROD with PROPOSALS
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Schedule of ratings 

Rating 

Major Minor 

All radicular groups 

8513 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 90 80 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 70 60 

Grade 3 ............................................................................................................................................................................. 40 30 

Grade 4 ............................................................................................................................................................................. 20 20 

Sensory neuropathy, complete ................................................................................................................................................. 40 30 

Sensory neuropathy, incomplete .............................................................................................................................................. 20 20 

Radial nerve (musculospiral) 

8514 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 70 60 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 50 40 

Grade 3 ............................................................................................................................................................................. 30 20 

Grade 4 ............................................................................................................................................................................. 20 20 

Sensory neuropathy, complete ................................................................................................................................................. 30 20 

Sensory neuropathy, incomplete .............................................................................................................................................. 20 20 

Note: Lesions involving only ‘‘dissociation of extensor communis digitorum’’ and ‘‘paralysis below the extensor communis 

digitorum,’’ will not exceed Grade 3 for diagnostic code 8514. 

The median nerve 

8515 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 70 60 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 50 40 

Grade 3 ............................................................................................................................................................................. 30 20 

Grade 4 ............................................................................................................................................................................. 10 10 

Sensory neuropathy, complete ................................................................................................................................................. 30 20 

Sensory neuropathy, incomplete .............................................................................................................................................. 10 10 

The ulnar nerve 

8516 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 60 50 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 40 30 

Grade 3 ............................................................................................................................................................................. 30 20 

Grade 4 ............................................................................................................................................................................. 10 10 

Sensory neuropathy, complete ................................................................................................................................................. 30 20 

Sensory neuropathy, incomplete .............................................................................................................................................. 10 10 

Musculocutaneous nerve 

8517 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 30 20 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 20 20 

Grade 3 ............................................................................................................................................................................. 10 10 

Grade 4 ............................................................................................................................................................................. 0 0 

Sensory neuropathy, complete ................................................................................................................................................. 10 10 

Sensory neuropathy, incomplete .............................................................................................................................................. 0 0 

Axillary nerve (circumflex) 

8518 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 50 40 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 30 20 

Grade 3 ............................................................................................................................................................................. 10 10 

Grade 4 ............................................................................................................................................................................. 0 0 

Sensory neuropathy, complete ................................................................................................................................................. 10 10 

Sensory neuropathy, incomplete .............................................................................................................................................. 0 0 

Long thoracic nerve 

8519 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ........................................................................................................................................... 30 20 

Incomplete paralysis: 

Grade 2 ............................................................................................................................................................................. 20 20 

Grade 3 ............................................................................................................................................................................. 10 10 

Grade 4 ............................................................................................................................................................................. 0 0 

Sensory neuropathy, complete ................................................................................................................................................. 10 10 

Sensory neuropathy, incomplete .............................................................................................................................................. 0 0 

Note (1): Not to be combined with lost motion above shoulder level. 

Note (2): Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
88934 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

Rating 

Sciatic nerve 

8520 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 80 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 60 

Grade 2+ ............................................................................................................................................................................... 40 

Grade 3 ................................................................................................................................................................................. 20 

Grade 4 ................................................................................................................................................................................. 10 

Sensory neuropathy, complete ..................................................................................................................................................... 20 

Sensory neuropathy, incomplete .................................................................................................................................................. 10 

Common peroneal nerve (external popliteal) 

8521 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 40 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 30 

Grade 3 ................................................................................................................................................................................. 20 

Grade 4 ................................................................................................................................................................................. 10 

Sensory neuropathy, complete ..................................................................................................................................................... 20 

Sensory neuropathy, incomplete .................................................................................................................................................. 10 

Superficial peroneal nerve (musculocutaneous) 

8522 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 30 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 20 

Grade 3 ................................................................................................................................................................................. 10 

Grade 4 ................................................................................................................................................................................. 0 

Sensory neuropathy, complete ..................................................................................................................................................... 10 

Sensory neuropathy, incomplete .................................................................................................................................................. 0 

Deep peroneal nerve (anterior tibial) 

8523 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 30 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 20 

Grade 3 ................................................................................................................................................................................. 10 

Grade 4 ................................................................................................................................................................................. 0 

Sensory neuropathy, complete ..................................................................................................................................................... 10 

Sensory neuropathy, incomplete .................................................................................................................................................. 0 

Tibial nerve (internal popliteal) 

8524 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 40 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 30 

Grade 3 ................................................................................................................................................................................. 20 

Grade 4 ................................................................................................................................................................................. 10 

Sensory neuropathy, complete ..................................................................................................................................................... 20 

Sensory neuropathy, incomplete .................................................................................................................................................. 10 

Posterior tibial nerve 

8525 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 30 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 20 

Grade 3 or Grade 4 ............................................................................................................................................................... 10 

Sensory neuropathy, complete or incomplete .............................................................................................................................. 10 

Femoral nerve (anterior crural) 

8526 Motor neuropathy (complete and incomplete paralysis): 

Complete paralysis (Grade 0 or 1) ............................................................................................................................................... 40 

Incomplete paralysis: 

Grade 2 ................................................................................................................................................................................. 30 

Grade 3 ................................................................................................................................................................................. 20 

Grade 4 ................................................................................................................................................................................. 10 

Sensory neuropathy, complete ..................................................................................................................................................... 20 

Sensory neuropathy, incomplete .................................................................................................................................................. 10 

Saphenous nerve (internal saphenous) 

8527 Sensory neuropathy, complete or incomplete ......................................................................................................................... 0 

Obturator nerve 

8528 Motor neuropathy (complete and incomplete paralysis): 

Grade 0, Grade 1, or Grade 2 .............................................................................................................................................. 10 

Grade 3 or Grade 4 ............................................................................................................................................................... 0 

Sensory neuropathy, complete or incomplete .............................................................................................................................. 0 


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Rating 

Lateral cutaneous nerve of the thigh (external cutaneous) 

8529 Sensory neuropathy, complete or incomplete ......................................................................................................................... 0 

Ilio-inguinal nerve 

8530 Motor neuropathy (complete and incomplete paralysis): 

Grade 0, Grade 1, or Grade 2 .............................................................................................................................................. 10 

Grade 3 or Grade 4 ............................................................................................................................................................... 0 

Sensory neuropathy, complete or incomplete .............................................................................................................................. 0 

Other Neoplasms of the Neurological System 

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 

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 (including tonic-clonic seizures). 

Rate under the general rating formula for major seizures. 

8911 Epilepsy, petit mal (including absence seizures). 

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 

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 Compensation Service or the Director, Pension and Fiduciary Service. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
88936 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

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

■ 10. Amend Appendix A to part 4 by: 

■ a. Revising the entry for diagnostic 

code 5244; 

■ b. Adding, in numerical order, entries 

for §§ 4.120 and 4.123; 

■ c. Redesignating the entries for 

§ 4.124a (all diagnostic codes listed 

under § 4.124a) as new entries for 

§ 4.124; 

■ d. Revising and republishing newly 

redesignated § 4.124; and 

■ e. Adding, in numerical order, a new 

entry for § 4.124a. 

The revisions and additions read as 

follows: 

APPENDIX A TO PART 4—TABLE OF AMENDMENTS AND EFFECTIVE DATES SINCE 1946 

Sec. Diagnostic code No. 

*******

5244 Added February 7, 2021; note [Effective date of final rule]. 

*******

4.120 ..................................... .................................... Title and revised [Effective date of final rule].

4.123 ..................................... .................................... Title and revised [Effective date of final rule].

4.124 ..................................... .................................... Re-designated from § 4.124a [Effective date of final rule]. 

8000 Title [Effective date of final rule]. 

8002 Criteria September 22, 1978; title, note [Effective date of final rule]. 

8003 Title, criteria [Effective date of final rule]. 

8004 Title, criteria, notes [Effective date of final rule]. 

8007 Title, criteria [Effective date of final rule]. 

8008 Removed [Effective date of final rule]. 

8009 Removed [Effective date of final rule]. 

8018 Title [Effective date of final rule]. 

8021 Criteria September 22, 1978; criteria October 1, 1961; criteria March 10, 1976; criteria 

March 1, 1989; title, note [Effective date of final rule]. 

8022 Title, criteria [Effective date of final rule]. 

8025 Note removed [Effective date of final rule]. 

8026 Added [Effective date of final rule]. 

8027 Added [Effective date of final rule]. 

8028 Added [Effective date of final rule]. 

8036 Added [Effective date of final rule]. 

8045 Criterion and evaluation October 23, 2008. 

8046 Added October 1, 1961; criterion March 10, 1976; criterion March 1, 1989. 

8100 Evaluation June 9, 1953. 

8103 Title [Effective date of final rule]. 

8104 Criteria [Effective date of final rule]. 

8107 Criteria [Effective date of final rule]. 

8205 Title, criteria, notes [Effective date of final rule]. 

8207 Title, criteria, note [Effective date of final rule]. 

8209 Title, criteria, note [Effective date of final rule]. 

8210 Title, criteria, note [Effective date of final rule]. 

8211 Title, criteria, note [Effective date of final rule]. 

8212 Title, criteria, note [Effective date of final rule]. 

8305 Removed [Effective date of final rule]. 

8307 Removed [Effective date of final rule]. 

8309 Removed [Effective date of final rule]. 

8310 Removed [Effective date of final rule]. 

8311 Removed [Effective date of final rule]. 

8312 Removed [Effective date of final rule]. 

8405 Removed [Effective date of final rule]. 

8407 Removed [Effective date of final rule]. 

8409 Removed [Effective date of final rule]. 

8410 Removed [Effective date of final rule]. 

8411 Removed [Effective date of final rule]. 

8412 Removed [Effective date of final rule]. 

8510 Title, criteria [Effective date of final rule]. 

8511 Title, criteria [Effective date of final rule]. 

8512 Title, criteria [Effective date of final rule]. 

8513 Title, criteria [Effective date of final rule]. 

8514 Title, criteria, note [Effective date of final rule]. 

8515 Title, criteria [Effective date of final rule]. 

8516 Title, criteria [Effective date of final rule]. 

8517 Title, criteria [Effective date of final rule]. 

8518 Title, criteria [Effective date of final rule]. 

8519 Title, criteria, notes [Effective date of final rule]. 

8520 Title, criteria [Effective date of final rule]. 

8521 Title, criteria [Effective date of final rule]. 

8522 Title, criteria [Effective date of final rule]. 

8523 Title, criteria [Effective date of final rule]. 

8524 Title, criteria [Effective date of final rule]. 

8525 Title, criteria [Effective date of final rule]. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 88937 

APPENDIX A TO PART 4—TABLE OF AMENDMENTS AND EFFECTIVE DATES SINCE 1946—Continued 

Sec. Diagnostic code No. 

8526 Title, criteria [Effective date of final rule]. 

8527 Title, criteria [Effective date of final rule]. 

8528 Title, criteria [Effective date of final rule]. 

8529 Title, criteria [Effective date of final rule]. 

8530 Title, criteria [Effective date of final rule]. 

8610 Removed [Effective date of final rule]. 

8611 Removed [Effective date of final rule]. 

8612 Removed [Effective date of final rule]. 

8613 Removed [Effective date of final rule]. 

8614 Removed [Effective date of final rule]. 

8615 Removed [Effective date of final rule]. 

8616 Removed [Effective date of final rule]. 

8617 Removed [Effective date of final rule]. 

8618 Removed [Effective date of final rule]. 

8619 Removed [Effective date of final rule]. 

8620 Removed [Effective date of final rule]. 

8621 Removed [Effective date of final rule]. 

8622 Removed [Effective date of final rule]. 

8623 Removed [Effective date of final rule]. 

8624 Removed [Effective date of final rule]. 

8625 Removed [Effective date of final rule]. 

8626 Removed [Effective date of final rule]. 

8627 Removed [Effective date of final rule]. 

8628 Removed [Effective date of final rule]. 

8629 Removed [Effective date of final rule]. 

8630 Removed [Effective date of final rule]. 

8710 Removed [Effective date of final rule]. 

8711 Removed [Effective date of final rule]. 

8712 Removed [Effective date of final rule]. 

8713 Removed [Effective date of final rule]. 

8714 Removed [Effective date of final rule]. 

8715 Removed [Effective date of final rule]. 

8716 Removed [Effective date of final rule]. 

8717 Removed [Effective date of final rule]. 

8718 Removed [Effective date of final rule]. 

8719 Removed [Effective date of final rule]. 

8720 Removed [Effective date of final rule]. 

8721 Removed [Effective date of final rule]. 

8722 Removed [Effective date of final rule]. 

8723 Removed [Effective date of final rule]. 

8724 Removed [Effective date of final rule]. 

8725 Removed [Effective date of final rule]. 

8726 Removed [Effective date of final rule]. 

8727 Removed [Effective date of final rule]. 

8728 Removed [Effective date of final rule]. 

8729 Removed [Effective date of final rule]. 

8730 Removed [Effective date of final rule]. 

8910 Added October 1, 1961; evaluation September 9, 1975; title [Effective date of final rule]. 

8911 Added October 1, 1961; evaluation September 9, 1975; title [Effective date of final rule]. 

8912 Added October 1, 1961; evaluation September 9, 1975. 

8913 Added October 1, 1961; evaluation September 9, 1975. 

8914 Added October 1, 1961; evaluation September 9, 1975. 

4.124a ................................... .................................... Re-designated as § 4.124 [Effective date of final rule]. 

* * * * * * * 

■ 11. Amend Appendix B to part 4 by 

revising and republishing the entries in 

the table under ‘‘Neurological Conditions and Convulsive Disorders’’ 

to read as follows: 


khammond on DSKJM1Z7X2PROD with PROPOSALS
88938 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

APPENDIX B TO PART 4—NUMERICAL INDEX OF DISABILITIES

Diagnostic code No. 

*******

Neurological Conditions and Convulsive Disorders 

Organic Diseases of the Central Nervous System 

8000 ...................................... Encephalitis, infectious. 

8002 ...................................... Brain, new growth of, malignant. 

8003 ...................................... Brain, new growth of, benign. 

8004 ...................................... Parkinson’s disease (paralysis agitans). 

8005 ...................................... Bulbar palsy. 

8007 ...................................... Stroke (ischemic, hemorrhagic, or thrombotic), including cerebral infarction or cerebrovascular accident. 

8010 ...................................... Myelitis. 

8011 ...................................... Poliomyelitis, anterior. 

8012 ...................................... Hematomyelia. 

8013 ...................................... Syphilis, cerebrospinal. 

8014 ...................................... Syphilis, meningovascular 

8015 ...................................... Tabes dorsalis. 

8017 ...................................... Amyotrophic lateral sclerosis. 

8018 ...................................... Multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD). 

8019 ...................................... Meningitis, cerebrospinal, epidemic. 

8020 ...................................... Brain, abscess. 

8021 ...................................... Spinal cord, new growths of, malignant. 

8022 ...................................... Spinal cord, new growths of, benign. 

8023 ...................................... Progressive muscular atrophy. 

8024 ...................................... Syringomyelia. 

8025 ...................................... Myasthenia gravis. 

8026 ...................................... Parkinson’s plus, or secondary parkinsonism syndromes. 

8027 ...................................... Essential tremor. 

8028 ...................................... Dystonia. 

8036 ...................................... Primary lateral sclerosis. 

8045 ...................................... Residuals of traumatic brain injury (TBI). 

8046 ...................................... Cerebral arteriosclerosis. 

Miscellaneous Diseases 

8100 ...................................... Migraine. 

8103 ...................................... Hemifacial spasm (tic, convulsive). 

8104 ...................................... Paramyoclonus multiplex (convulsive state, myoclonic type). 

8105 ...................................... Chorea, Sydenham’s. 

8106 ...................................... Chorea, Huntington’s. 

8107 ...................................... Athetosis, acquired. 

8108 ...................................... Narcolepsy. 

The Cranial Nerves 

8205 ...................................... Fifth (trigeminal), motor neuropathy. 

8207 ...................................... Seventh (facial), motor neuropathy. 

8209 ...................................... Ninth (glossopharyngeal), motor neuropathy. 

8210 ...................................... Tenth (pneumogastric, vagus), motor neuropathy. 

8211 ...................................... Eleventh (spinal accessory, external branch), motor neuropathy. 

8212 ...................................... Twelfth (hypoglossal), motor neuropathy. 

Peripheral Nerves 

8510 ...................................... Upper radicular group, motor neuropathy. 

8511 ...................................... Middle radicular group, motor neuropathy. 

8512 ...................................... Lower radicular group, motor neuropathy. 

8513 ...................................... All radicular groups, motor neuropathy. 

8514 ...................................... Radial nerve (musculospiral), motor neuropathy. 

8515 ...................................... Median nerve, motor neuropathy. 

8516 ...................................... Ulnar nerve, motor neuropathy. 

8517 ...................................... Musculocutaneous nerve, motor neuropathy. 

8518 ...................................... Axillary nerve (circumflex), motor neuropathy. 

8519 ...................................... Long thoracic nerve, motor neuropathy. 

8520 ...................................... Sciatic nerve, motor neuropathy. 

8521 ...................................... Common peroneal nerve (external popliteal), motor neuropathy. 

8522 ...................................... Superficial peroneal nerve (musculocutaneous), motor neuropathy. 

8523 ...................................... Deep peroneal nerve (anterior tibial), motor neuropathy. 

8524 ...................................... Tibial nerve (internal popliteal), motor neuropathy. 

8525 ...................................... Posterior tibial nerve, motor neuropathy. 

8526 ...................................... Femoral nerve (anterior crural), motor neuropathy. 

8527 ...................................... Saphenous nerve (internal saphenous), sensory neuropathy. 


khammond on DSKJM1Z7X2PROD with PROPOSALS
Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 88939 

APPENDIX B TO PART 4—NUMERICAL INDEX OF DISABILITIES—Continued 

Diagnostic code No. 

8528 ...................................... Obturator nerve, motor neuropathy. 

8529 ...................................... Lateral cutaneous nerve of the thigh (external cutaneous), sensory neuropathy. 

8530 ...................................... Ilio-inguinal nerve, motor neuropathy. 

Other Neoplasms of the Neurological System 

8540 ...................................... Soft tissue sarcoma (Neurogenic origin). 

The Epilepsies 

8910 ...................................... Epilepsy, grand mal (includes tonic-clonic seizures). 

8911 ...................................... Epilepsy, petit mal (includes absence seizures). 

8912 ...................................... Jacksonian and focal motor or sensory. 

8913 ...................................... Diencephalic. 

8914 ...................................... Psychomotor. 

* * * * * * * 

■ 12. Amend Appendix C to part 4 by: 

■ a. Adding, in alphabetical order, an 

entry for ‘‘Dystonia’’; 

■ b. Removing the entry for ‘‘Embolism, 

brain’’; 

■ c. Revising the entry for 

‘‘Encephalitis, epidemic’’; 

■ d. Under the entry for ‘‘Epilepsies’’, 

revising the entries for ‘‘Grand mal’’ and 

‘‘Petit mal’’; 

■ e. Adding, in alphabetical order, 

entries for ‘‘Essential tremor’’ and 

‘‘Hemifacial spasm (tic, convulsive)’’; 

■ f. Removing the entry for 

‘‘Hemorrhage’’; 

■ g. Adding, in alphabetical order, an 

entry for ‘‘Intraocular hemorrhage’’; 

■ h. Adding, in alphabetical order, an 

entry for ‘‘Motor/sensory neuropathy’’; 

■ i. Revising the entry for ‘‘Multiple 

sclerosis’’; 

■ j. Removing the entry for ‘‘Neuralgia’’; 

■ k. Removing the entry for ‘‘Neuritis’’; 

■ l. Adding an entry for ‘‘Optic 

neuropathy’’; 

■ m. Under the entry for ‘‘Paralysis’’, 

removing the entry for ‘‘Agitans’’; 

■ n. Removing the entry for ‘‘Paralysis, 

nerve’’; 

■ o. Revising the entry for 

‘‘Paramyoclonus multiplex’’; 

■ p. Adding, in alphabetical order, 

entries for ‘‘Parkinson’s disease 

(paralysis agitans)’’, ‘‘Parkinson’s plus, 

or secondary parkinsonism syndromes’’, 

‘‘Primary lateral sclerosis’’, and ‘‘Stroke 

(ischemic, hemorrhagic, or thrombotic), 

including cerebral infarction or 

cerebrovascular accident’’; and 

■ q. Removing the entries for 

‘‘Thrombosis, brain’’ and ‘‘Tic, 

convulsive’’. 

The revisions and additions read as 

follows: 

APPENDIX C TO PART 4—ALPHABETICAL INDEX OF DISABILITIES

Diagnostic code No. 

*******

Dystonia ................................................................................................................................................................................... 8028 

*******

Encephalitis, infectious ............................................................................................................................................................ 8000 

*******

Epilepsies: 

*******

Grand mal (includes tonic-clonic seizures) ...................................................................................................................... 8910 

*******

Petit mal (includes absence seizures) ............................................................................................................................. 8911 

*******

Essential tremor ....................................................................................................................................................................... 8027 

*******

Hemifacial spasm (tic, convulsive) .......................................................................................................................................... 8103 

*******

Intraocular hemorrhage ........................................................................................................................................................... 6007 

*******

Motor/sensory neuropathy: 

Cranial nerves: 

Eleventh (spinal accessory, external branch) ........................................................................................................... 8211 

Fifth (trigeminal) ........................................................................................................................................................ 8205 

Ninth (glossopharyngeal) .......................................................................................................................................... 8209 


khammond on DSKJM1Z7X2PROD with PROPOSALS
88940 Federal Register / Vol. 89, No. 218 / Tuesday, November 12, 2024 / Proposed Rules 

APPENDIX C TO PART 4—ALPHABETICAL INDEX OF DISABILITIES—Continued 

Diagnostic code No. 

Seventh (facial) ......................................................................................................................................................... 8207 

Tenth (pneumogastric, vagus) .................................................................................................................................. 8210 

Twelfth (hypoglossal) ................................................................................................................................................ 8212 

Peripheral nerves: 

All radicular groups ................................................................................................................................................... 8513 

Axillary (circumflex) ................................................................................................................................................... 8518 

Common peroneal (external popliteal) ...................................................................................................................... 8521 

Deep peroneal (anterior tibial) .................................................................................................................................. 8523 

Femoral (anterior crural) ........................................................................................................................................... 8526 

Ilio-inguinal ................................................................................................................................................................ 8530 

Lateral cutaneous nerve of the thigh (external cutaneous) ...................................................................................... 8529 

Long thoracic ............................................................................................................................................................. 8519 

Lower radicular group ............................................................................................................................................... 8512 

Median ....................................................................................................................................................................... 8515 

Middle radicular group ............................................................................................................................................... 8511 

Musculocutaneous ..................................................................................................................................................... 8517 

Obturator ................................................................................................................................................................... 8528 

Posterior tibial ............................................................................................................................................................ 8525 

Radial (musculospiral) ............................................................................................................................................... 8514 

Saphenous (internal saphenous) .............................................................................................................................. 8527 

Sciatic ........................................................................................................................................................................ 8520 

Superficial peroneal (musculocutaneous) ................................................................................................................. 8522 

Tibial (internal popliteal) ............................................................................................................................................ 8524 

Ulnar .......................................................................................................................................................................... 8516 

Upper radicular group ............................................................................................................................................... 8510 

*******

Multiple sclerosis and other demyelinating diseases of the central nervous system ............................................................. 8018 

*******

Optic neuropathy ..................................................................................................................................................................... 6026 

*******

Paramyoclonus multiplex (convulsive state, myoclonic type) ................................................................................................. 8104 

*******

Parkinson’s disease (paralysis agitans) .................................................................................................................................. 8004 

Parkinson’s plus, or secondary parkinsonism syndromes ...................................................................................................... 8026 

*******

Primary lateral sclerosis .......................................................................................................................................................... 8036 

*******

Stroke (ischemic, hemorrhagic, or thrombotic), including cerebral infarction or cerebrovascular accident ........................... 8007 

*******

[FR Doc. 2024–25665 Filed 11–8–24; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 51 

[EPA–HQ–OAR–2023–0295; FRL–10823–01– 

OAR] 

RIN 2060–AW00 

Air Quality: Revision to the Regulatory 

Definition of Volatile Organic 

Compounds—Exclusion of (Z)-1- 

chloro-2,3,3,3-tetrafluoropropene 

(HCFO-1224yd(Z)) 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed rule. 

SUMMARY: The U.S. Environmental 

Protection Agency (EPA) is proposing to 

revise the EPA’s regulatory definition of 

volatile organic compounds (VOC) 

under the Clean Air Act (CAA). This 

action proposes to add (Z)-1-chloro2,3,3,3-tetrafluoropropene (also known 

as HCFO-1224yd(Z); CAS number 

111512–60–8) to the list of compounds 

excluded from the regulatory definition 

on the basis that this compound makes 

a negligible contribution to tropospheric 

ozone (O3) formation. 

DATES: Comments must be received on 

or before January 13, 2025. 

ADDRESSES: You may send comments, 

identified by Docket ID No. EPA–HQ– 

OAR–2023–0295, by any of the 

following methods: 

• Federal eRulemaking Portal: 

https://www.regulations.gov/ (our 

preferred method). Follow the online 

instructions for submitting comments. 

• Mail: U.S. Environmental 

Protection Agency, EPA Docket Center, 

Docket No. EPA–HQ–OAR–2023–0295, 

Office of Air and Radiation Docket, Mail 

Code 28221T, 1200 Pennsylvania 

Avenue NW, Washington, DC 20460. 

• Hand Delivery or Courier: EPA 

Docket Center, WJC West Building, 

Room 3334, 1301 Constitution Avenue 

NW, Washington, DC 20004. The Docket 

Center’s hours of operations are 8:30 

a.m.–4:30 p.m., Monday–Friday (except 

Federal Holidays). 

Instructions: All submissions received 

must include the Docket ID No. for this 


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