Peripheral Neuropathy (Lower Extremities)
Peripheral neuropathy of the lower extremities is rated based on the specific nerve affected and the severity of impairment. The lower extremity nerves fall into three groupings. Group 1 includes the sciatic, common peroneal, deep peroneal, superficial peroneal, posterior tibial, and tibial nerves. Group 2 includes the femoral and internal saphenous nerves. Group 3 includes the ilioinguinal, lateral femoral cutaneous, and obturator nerves. Nerves within Groups 1 and 2 cannot be rated separately within their own group, but a nerve in one group can be rated separately from nerves in the other groups. Group 3 nerves can each be rated separately from all other nerves. Each leg is rated independently, and the bilateral factor applies.
VA Rating Levels
Incomplete paralysis, mild: tingling or mild pain with minor impacts on function. For some smaller nerves (deep peroneal, superficial peroneal, ilioinguinal, obturator, saphenous, lateral femoral cutaneous), mild symptoms may rate at 0%.
Incomplete paralysis, moderate: symptoms (tingling, numbness, pain) that meaningfully interfere with the ability to function. Some nerves with limited function (posterior tibial, deep peroneal) have lower maximum ratings.
Incomplete paralysis, moderately severe to severe (depending on the nerve): significant functional limitation, poor circulation, or loss of muscle mass. Available for major nerves like the sciatic, peroneal, and femoral nerves.
Complete paralysis of the sciatic nerve: foot dangles and drops with no active movement below the knee. This is the maximum rating for the most impactful lower extremity nerve.
Exam Tips & Key Evidence
- →The specific nerve affected determines the rating scale and maximum possible rating. The sciatic nerve has the highest potential ratings (up to 80%).
- →Diabetic peripheral neuropathy is a very common secondary condition for veterans with service-connected diabetes. A specific DBQ exists for this condition.
- →Moderate and higher severity ratings require objectively testable symptoms such as decreased sensitivity, reduced reflexes, muscle weakness or atrophy, or impaired function.
- →Even if you report severe pain, the VA will not assign an evaluation higher than moderate unless the symptoms can be tested for and observed by the examiner.
- →Agent Orange-exposed veterans can claim peripheral neuropathy as presumptive if diagnosed within one year of last exposure at a severity of at least 10%.
Commonly Related Conditions
38 CFR Reference
38 CFR $ 4.124a, Diagnostic Codes 8520-8530