Nerve Damage in the Legs and Feet Claimed as Secondary to Diabetes

Step 3 of the method is secondary conditions. A secondary condition is one that grew out of a condition the VA already rates.

Nerve damage in the legs and feet claimed as secondary to diabetes is one of those claims. In the Board of Veterans' Appeals decisions we have indexed since 2019, it shows up in 3,561 issues. No pairing we index shows up in more.

Already rated for diabetes? Add it to the free Claim Map to see the conditions the Board has seen claimed with diabetes.

What a secondary claim needs

Here's the rule on secondary conditions, starting in the middle of its first sentence.

… disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.

Proximately due to means the first condition led to the second. Three things have to be in your file. A diagnosis of the nerve damage. Diabetes that is already service connected. And a medical opinion tying the one to the other that says why.

If your diabetes isn't service connected yet, there's nothing for the nerve damage to attach to. That isn't a reason to wait. File both, and say in writing that the nerve damage is claimed as secondary to the diabetes. Read Step 4 too, since type 2 diabetes is on the list of diseases tied to herbicide exposure.

The same rule holds a second route, aggravation, for nerve damage you already had that the diabetes made worse. It needs a baseline, which is medical evidence of how bad the nerve damage was before the diabetes started making it worse. Or it's the earliest record after that and before the evidence of how bad it is now.

How this nerve damage is rated

The sciatic nerve is diagnostic code 8520, and no nerve code in our data is cited more. Every ladder turns on two questions. Is the paralysis complete or incomplete, and if it's incomplete, how bad.

Complete paralysis of that nerve reads like this.

the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost

That rates 80. Incomplete paralysis has four steps below it. Severe, with marked muscular atrophy (wasting of the muscle), is 60. Moderately severe is 40, moderate is 20, and mild is 10. Those are percentages.

Other leg and foot nerves top out lower. Complete paralysis rates 40 for the common peroneal nerve (8521), the tibial nerve (8524) and the femoral nerve (8526). Among the leg nerves, only the sciatic has a moderately severe step. Which nerve and which step fit you is the rater's call on your records.

The Claim Map lists these nerve codes with their rating steps. Choose the thigh, lower leg or foot to find them.

The schedule defines incomplete paralysis this way.

The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.

Wholly sensory means numbness, tingling, and pain with nothing lost on the motor side. If that's all your record shows, the rating stays at the mild or the moderate step. Weakness, muscle loss, or a foot that won't lift is what carries it past them, and it has to be in the exam.

Neuritis and neuralgia

Neuritis of the sciatic nerve is code 8620 and neuralgia is 8720. Each uses that nerve's ladder with a lower ceiling. Neuritis is rated

on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis.

Without the changes that rule lists, such as lost reflexes and muscle atrophy, it stops at moderate, or moderately severe for the sciatic nerve. Neuralgia is rated

on the same scale, with a maximum equal to moderate incomplete paralysis.

So the word in your record matters.

Each leg is rated on its own

The nerve schedule rates one side at a time.

The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor.

A left leg and a right leg are two ratings, not one. Claim them that way.

When both legs carry a compensable rating, meaning above zero, the bilateral factor adds a tenth of their combined value on top. One leg on its own isn't bilateral. How the VA combines ratings works that arithmetic line by line, and the calculator runs it on your own numbers.

What our counts show

This pairing has its own page of Board counts, radiculopathy or neuropathy secondary to diabetes. Since 2019 the Board granted 765 of these issues and denied 728, which is 51 percent granted of the ones it decided.

Since 2019 it also sent 1,857 back for more work, which is 52 percent of the 3,561. More of these claims go back than get answered either way. A remand isn't a yes and it isn't a no. The claim goes back to the regional office for a new exam or a missing record, then gets decided again.

Across every year we have indexed, the pairing runs to 9,121 issues, 40 percent granted of the ones decided and 50 percent sent back.

Two things those counts are not. Every decision counted here is an appeal, so the regional office decided the claim first and the veteran disagreed. These are not the odds on a first claim. And past decisions don't predict yours.

One more count, off the radiculopathy, sciatica, and neuropathy page. Across every year we have indexed, 63 percent of granted issues and 66 percent of denied ones sit in decisions that mention a medical opinion. The denied share is the higher of the two. A mention is not a reason for the outcome. The first condition has its own page, diabetes.

The written playbook gives up to eight of your main conditions a chapter each. A chapter has the rating ladder and what the Board granted and denied in cases like yours. See what the playbook covers.

The doctor's opinion

A claim here needs a doctor to find that the diabetes led to or worsened the nerve damage. It isn't a finding of ours. Whether it's true for you is a question for your doctor.

An opinion that only says the two are connected leaves the rater nothing to weigh. Ask your doctor for the reasoning, how it happened in you and what in your records shows it.

The phrase to ask for is at least as likely as not. Step 1 covers that letter and the records that go with it.

What to do

1. Send VA an intent to file first. If your complete claim reaches VA within a year of it, VA counts the claim as filed on the day the intent to file arrived. It doesn't have to name a condition, so you don't need the diagnosis or the opinion to send it. It doesn't work for a supplemental claim, where you add evidence and ask VA to decide again.
2. Get the diagnosis in writing, for each leg. A nerve study is the plainest form of it. An EMG, short for electromyography, reads the electrical signal in a muscle. A nerve conduction study times a signal traveling down a nerve. If you've had either one, ask for the report by name.
3. Check that your diabetes is service connected. If it is, name it in the claim as the condition the nerve damage is secondary to.
4. Say what you've lost, not only what you feel.
5. File the claim with all of it attached, within a year of your intent to file.

The nine steps lays out the rest. I'm not your representative.