1. What This Condition Is
Peripheral neuropathy is damage to the peripheral nerves -- the nerves outside the brain and spinal cord that carry signals to the arms, legs, hands, and feet. Bilateral means both sides of the body are affected. Symptoms include burning pain, numbness, tingling, weakness, and loss of balance or coordination.
Veterans develop peripheral neuropathy from multiple causes: Agent Orange exposure, diabetes (which is itself an Agent Orange presumptive), certain toxic exposures covered under the PACT Act, nerve damage from spinal injuries, and medication side effects. Because it is bilateral, you have the opportunity to rate each affected extremity separately, which can significantly increase your combined rating.
2. VA Rating Criteria
Peripheral neuropathy is rated under 38 CFR § 4.124a, Schedule of Ratings for Neurological Conditions and Convulsive Disorders.
Important structural note: Each affected nerve is rated separately for each extremity. Bilateral conditions are rated independently and then combined, with the bilateral factor applied under 38 CFR § 4.26.
The most commonly applied diagnostic codes for lower extremity peripheral neuropathy are:
DC 8620 -- Neuritis, Sciatic Nerve (lower extremity, sensory/pain dominant)
| Rating | Criteria |
|---|---|
| 10% | Mild incomplete paralysis (sensory symptoms, mild) |
| 20% | Moderate incomplete paralysis |
| 40% | Moderately severe incomplete paralysis |
| 60% | Severe incomplete paralysis with marked muscular atrophy |
| 80% | Complete paralysis (foot drop, no active movement below knee) |
DC 8621 -- Neuritis, Common Peroneal Nerve (foot drop, dorsiflexion loss)
| Rating | Criteria |
|---|---|
| 10% | Mild incomplete paralysis |
| 20% | Moderate incomplete paralysis |
| 30% | Severe incomplete paralysis |
| 40% | Complete paralysis with foot drop |
DC 8630 -- Neuritis, Tibial Nerve (plantar surface, heel)
| Rating | Criteria |
|---|---|
| 10% | Mild incomplete paralysis |
| 20% | Moderate incomplete paralysis |
| 30% | Severe incomplete paralysis |
| 40% | Complete paralysis |
For upper extremity neuropathy, the applicable codes include DC 8515 (radial/musculospiral nerve), DC 8513 (median nerve), and DC 8516 (ulnar nerve), rated similarly by degree of incomplete or complete paralysis. Note: DC 8510 and DC 8512 are brachial plexus radicular group codes (Upper and Lower Radicular Groups respectively), not individual peripheral nerve codes -- ensure your examiner uses the correct code for your specific nerve involvement.
Regulatory note: 38 CFR § 4.124a states that when involvement is purely sensory, the rating should be for mild or at most moderate degree. If you have both sensory and motor symptoms, document both clearly at your exam.
Bilateral factor: After combining bilateral extremity ratings, add 10% of the combined value under 38 CFR § 4.26 before combining with other disabilities.
3. What to Expect at Your C&P Exam
The examiner will perform or review a neurological examination. Expect tests of sensation (light touch, pinprick, vibration), strength testing in the affected limbs, reflex testing, and coordination assessments. If you have foot drop or balance issues, these will be documented.
Be specific about symptoms: burning versus numbness versus weakness are clinically distinct and affect the rating. Describe whether the symptoms are constant or intermittent, whether they worsen with activity, and how they limit your daily function (standing, walking, holding objects, balance).
If you have had nerve conduction studies (NCS) or electromyography (EMG), bring those results. These objective tests document the severity and distribution of nerve damage and carry significant evidentiary weight.
4. Evidence You Need to Win
Diagnosis: A current diagnosis of peripheral neuropathy from a neurologist, physiatrist, or treating physician, ideally supported by NCS/EMG results documenting the affected nerve distributions and severity.
Service connection pathway:
For veterans with Agent Orange exposure and co-existing Type 2 diabetes, peripheral neuropathy files as secondary to diabetes under 38 CFR § 3.310. The diabetes is the presumptive; the neuropathy flows from it. A treating neurologist or endocrinologist should provide a nexus statement linking the neuropathy to the service-connected diabetes.
For direct service connection (no diabetes), you need an in-service event or toxic exposure linked to the neuropathy via a medical nexus. The PACT Act expanded burn pit and toxic exposure claims -- neuropathy secondary to documented toxic exposures may qualify.
DBQ: Request that the C&P examiner complete the Peripheral Nerves DBQ. The current version is available at va.gov/find-forms.
NCS/EMG records: If you have had electrodiagnostic testing, submit the complete report. The nerve conduction velocity, amplitude, and distribution findings directly document severity.
Buddy statements: VA Form 21-4138 statements from family members or coworkers describing how neuropathy affects your walking, balance, grip, or ability to perform tasks are valuable functional evidence.
Personal statement: Describe your daily symptoms in specific terms -- burning at night that wakes you up, inability to feel the floor, dropping objects, falling. Quantify how often and how long.
5. Secondary Conditions to Consider
Diabetes mellitus Type 2: If neuropathy is your entry point and you have diabetes, you may have an unrated primary condition. File for the diabetes as the primary claim (with Agent Orange presumptive if qualifying service applies), then file the neuropathy as secondary.
Falls and resulting injuries: Peripheral neuropathy causes balance deficits and fall risk. Fractures, joint injuries, or traumatic brain injuries resulting from neuropathy-related falls may be filed as secondary conditions under 38 CFR § 3.310.
Depression and anxiety: Chronic burning pain from neuropathy is a documented driver of depression. Secondary mental health claims are well-supported with a treating provider's nexus opinion.
Sleep disorders: Neuropathic pain is most severe at night. Chronic sleep disruption from neuropathy supports a secondary sleep disorder claim.
Loss of use / Special Monthly Compensation (SMC): If neuropathy results in loss of use of a hand or foot (defined in 38 CFR § 3.350 as being without equally effective use), SMC benefits under 38 USC 1114 may apply. This can substantially increase monthly compensation.
Gait abnormalities and knee/hip conditions: Altered gait from foot neuropathy places abnormal stress on knees and hips. Secondary joint claims with a treating provider's biomechanical nexus may be viable.
6. Common Mistakes That Kill Claims
Filing bilateral as a single claim. Each affected extremity is rated independently. File for the right leg and left leg separately. If you have four-extremity involvement, file for all four. Failing to do this leaves ratings on the table.
Not getting NCS/EMG testing. Neuropathy claims are strengthened dramatically by objective electrodiagnostic evidence. If you have not had nerve conduction studies, ask your neurologist for this testing before your C&P exam.
Describing only sensory symptoms. Purely sensory involvement caps the rating at mild to moderate under 38 CFR § 4.124a. If you have any motor involvement (weakness, foot drop, coordination loss), document it explicitly. Mixed sensory and motor presentations support higher ratings.
Missing the secondary neuropathy pathway. If you have service-connected diabetes and peripheral neuropathy but have only filed for diabetes, you may be leaving significant combined ratings unclaimed. File neuropathy as secondary to diabetes under 38 CFR § 3.310.
Not applying the bilateral factor. After your bilateral extremity ratings are combined, 38 CFR § 4.26 requires a 10% bilateral factor adjustment. Confirm your rating decision applied this correctly.
7. FWD Assist Resources
The following FWD Assist HQ books are directly relevant to a bilateral peripheral neuropathy claim:
- Secondary Conditions: The Hidden Ratings Most Veterans Miss -- Covers the secondary neuropathy pathway from diabetes and toxic exposures, and how to build the evidence chain.
- The PACT Act Veteran's Guide -- Covers burn pit and toxic exposure claims that may support direct service connection for neuropathy.
- The C&P Exam Playbook -- Prepares you for the neurological examination and how to accurately report sensory and motor symptoms.
- Nexus Letters: The Veteran's Complete Guide -- Covers how to get a treating neurologist's IMO for secondary service connection.
- SMC: Special Monthly Compensation -- If neuropathy is severe enough to affect use of an extremity, this covers SMC eligibility, loss of use ratings, and how to file.
Visit fwdassisthq.com for the full catalog.
8. Get Help Without a Claim Shark
Free accredited representation is available through the DAV, VFW, American Legion, AMVETS, and your county veterans service office.
Under 38 USC 5905, anyone charging upfront fees before an initial VA decision is violating federal law. Accredited attorneys and claims agents are capped at 20% of past-due benefits recovered after an initial decision.
Check accreditation at va.gov/ogc/accreditation.asp before paying anyone for claims help.
FWD Assist HQ provides education, not representation. For active claims, work with an accredited representative.