Schedule of ratings-neurological conditions and convulsive disorders.

§ 4.124a Schedule of ratings—neurological conditions and convulsive disorders. [With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves] Organic Diseases of the Central Nervous System Rating 8000Encephalitis, epidemic, chronic: As active febrile disease 100 Rate residuals, minimum 10 Brain, new growth of: 8002Malignant 100 Note: The rating in code 8002 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating 30 8003Benign, minimum 60 Rate residuals, minimum 10 8004Paralysis agitans: Minimum rating 30 8005Bulbar palsy 100 8007Brain, vessels, embolism of. 8008Brain, vessels, thrombosis of. 8009Brain, vessels, hemorrhage from: Rate the vascular conditions under Codes 8007 through 8009, for 6 months 100 Rate residuals, thereafter, minimum 10 8010Myelitis: Minimum rating 10 8011Poliomyelitis, anterior: As active febrile disease 100 Rate residuals, minimum 10 8012Hematomyelia: For 6 months 100 Rate residuals, minimum 10 8013Syphilis, cerebrospinal. 8014Syphilis, meningovascular. 8015Tabes dorsalis. Note: Rate upon the severity of convulsions, paralysis, visual impairment or psychotic involvement, etc. 8017Amyotrophic lateral sclerosis: Minimum rating 30 8018Multiple sclerosis: Minimum rating 30 8019Meningitis, cerebrospinal, epidemic: As active febrile disease 100 Rate residuals, minimum 10 8020Brain, abscess of: As active disease 100 Rate residuals, minimum 10 Spinal cord, new growths of: 8021Malignant 100 Note: The rating in code 8021 will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology. Minimum rating 30 8022Benign, minimum rating 60 Rate residuals, minimum 10 8023Progressive muscular atrophy: Minimum rating 30 8024Syringomyelia: Minimum rating 30 8025Myasthenia gravis: Minimum rating 30 Note: It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses. 8045Brain disease due to trauma: Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045-8207). Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. 8046Cerebral 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 Rating 8100Migraine: 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 8103Tic, convulsive: Severe 30 Moderate 10 Mild 0 Note: Depending upon frequency, severity, muscle groups involved. 8104Paramyoclonus multiplex (convulsive state, myoclonic type): Rate as tic; convulsive; severe cases 60 8105Chorea, Sydenham's: Pronounced, progressive grave types 100 Severe 80 Moderately severe 50 Moderate 30 Mild 10 Note: Consider rheumatic etiology and complications. 8106Chorea, 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. 8107Athetosis, acquired. Rate as chorea. 8108Narcolepsy. Rate as for epilepsy, petit mal. Diseases of the Cranial Nerves Rating Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor. Fifth (trigeminal) cranial nerve 8205Paralysis of: Complete 50 Incomplete, severe 30 Incomplete, moderate 10 Note: Dependent upon relative degree of sensory manifestation or motor loss. 8305Neuritis. 8405Neuralgia. Note: Tic douloureux may be rated in accordance with severity, up to complete paralysis. Seventh (facial) cranial nerve 8207Paralysis of: Complete 30 Incomplete, severe 20 Incomplete, moderate 10 Note: Dependent upon relative loss of innervation of facial muscles. 8307Neuritis. 8407Neuralgia. Ninth (glossopharyngeal) cranial nerve 8209Paralysis of: Complete 30 Incomplete, severe 20 Incomplete, moderate 10 Note: Dependent upon relative loss of ordinary sensation in mucous membrane of the pharynx, fauces, and tonsils. 8309Neuritis. 8409Neuralgia. Tenth (pneumogastric, vagus) cranial nerve 8210Paralysis of: Complete 50 Incomplete, severe 30 Incomplete, moderate 10 Note : Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart. 8310Neuritis. 8410Neuralgia. Eleventh (spinal accessory, external branch) cranial nerve. 8211Paralysis of: Complete 30 Incomplete, severe 20 Incomplete, moderate 10 Note: Dependent upon loss of motor function of sternomastoid and trapezius muscles. 8311Neuritis. 8411Neuralgia. Twelfth (hypoglossal) cranial nerve. 8212Paralysis of: Complete 50 Incomplete, severe 30 Incomplete, moderate 10 Note: Dependent upon loss of motor function of tongue. 8312Neuritis. 8412Neuralgia. Diseases of the Peripheral Nerves Schedule of ratings Rating Major Minor 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. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. Upper radicular group (fifth and sixth cervicals) 8510Paralysis of: Complete; all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected 70 60 Incomplete: Severe 50 40 Moderate 40 30 Mild 20 20 8610Neuritis. 8710Neuralgia. Middle radicular group 8511Paralysis of: Complete; adduction, abduction and rotation of arm, flexion of elbow, and extension of wrist lost or severely affected 70 60 Incomplete: Severe 50 40 Moderate 40 30 Mild 20 20 8611Neuritis. 8711Neuralgia. Lower radicular group 8512Paralysis of: Complete; all intrinsic muscles of hand, and some or all of flexors of wrist and fingers, paralyzed (substantial loss of use of hand) 70 60 Incomplete: Severe 50 40 Moderate 40 30 Mild 20 20 8612Neuritis. 8712Neuralgia. All radicular groups 8513Paralysis of: Complete 90 80 Incomplete: Severe 70 60 Moderate 40 30 Mild 20 20 8613Neuritis. 8713Neuralgia. The musculospiral nerve (radial nerve) 8514Paralysis of: Complete; drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; can not extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity 70 60 Incomplete: Severe 50 40 Moderate 30 20 Mild 20 20 8614Neuritis. 8714Neuralgia. Note: Lesions involving only “dissociation of extensor communis digitorum” and “paralysis below the extensor communis digitorum,” will not exceed the moderate rating under code 8514. The median nerve 8515Paralysis of: Complete; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances 70 60 Incomplete: Severe 50 40 Moderate 30 20 Mild 10 10 8615Neuritis. 8715Neuralgia. The ulnar nerve 8516Paralysis of: Complete; the “griffin claw” deformity, due to flexor contraction of ring and little fingers, atrophy very marked in dorsal interspace and thenar and hypothenar eminences; loss of extension of ring and little fingers cannot spread the fingers (or reverse), cannot adduct the thumb; flexion of wrist weakened 60 50 Incomplete: Severe 40 30 Moderate 30 20 Mild 10 10 8616Neuritis. 8716Neuralgia. Musculocutaneous nerve 8517Paralysis of: Complete; weakness but not loss of flexion of elbow and supination of forearm 30 20 Incomplete: Severe 20 20 Moderate 10 10 Mild 0 0 8617Neuritis. 8717Neuralgia. Circumflex nerve 8518Paralysis of: Complete; abduction of arm is impossible, outward rotation is weakened; muscles supplied are deltoid and teres minor 50 40 Incomplete: Severe 30 20 Moderate 10 10 Mild 0 0 8618Neuritis. 8718Neuralgia. Long thoracic nerve 8519Paralysis of: Complete; inability to raise arm above shoulder level, winged scapula deformity 30 20 Incomplete: Severe 20 20 Moderate 10 10 Mild 0 0 Note: Not to be combined with lost motion above shoulder level. 8619Neuritis. 8719Neuralgia. Note: Combined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. Rating Sciatic nerve 8520Paralysis of: Complete; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost 80 Incomplete: Severe, with marked muscular atrophy 60 Moderately severe 40 Moderate 20 Mild 10 8620Neuritis. 8720Neuralgia. External popliteal nerve (common peroneal) 8521Paralysis of: Complete; foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes 40 Incomplete: Severe 30 Moderate 20 Mild 10 8621Neuritis. 8721Neuralgia. Musculocutaneous nerve (superficial peroneal) 8522Paralysis of: Complete; eversion of foot weakened 30 Incomplete: Severe 20 Moderate 10 Mild 0 8622Neuritis. 8722Neuralgia. Anterior tibial nerve (deep peroneal) 8523Paralysis of: Complete; dorsal flexion of foot lost 30 Incomplete: Severe 20 Moderate 10 Mild 0 8623Neuritis. 8723Neuralgia. Internal popliteal nerve (tibial) 8524Paralysis of: Complete; plantar flexion lost, frank adduction of foot impossible, flexion and separation of toes abolished; no muscle in sole can move; in lesions of the nerve high in popliteal fossa, plantar flexion of foot is lost 40 Incomplete: Severe 30 Moderate 20 Mild 10 8624Neuritis. 8724Neuralgia. Posterior tibial nerve 8525Paralysis of: Complete; paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired 30 Incomplete: Severe 20 Moderate 10 Mild 10 8625Neuritis. 8725Neuralgia. Anterior crural nerve (femoral) 8526Paralysis of: Complete; paralysis of quadriceps extensor muscles 40 Incomplete: Severe 30 Moderate 20 Mild 10 8626Neuritis. 8726Neuralgia. Internal saphenous nerve 8527Paralysis of: Severe to complete 10 Mild to moderate 0 8627Neuritis. 8727Neuralgia. Obturator nerve 8528Paralysis of: Severe to complete 10 Mild or moderate 0 8628Neuritis. 8728Neuralgia. External cutaneous nerve of thigh 8529Paralysis of: Severe to complete 10 Mild or moderate 0 8629Neuritis. 8729Neuralgia. Ilio-inguinal nerve 8530Paralysis of: Severe to complete 10 Mild or moderate 0 8630Neuritis. 8730Neuralgia. 8540Soft-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 Rating A thorough study of all material in §§ 4.121 and 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action. 8910Epilepsy, grand mal. Rate under the general rating formula for major seizures. 8911Epilepsy, petit mal. Rate under the general rating formula for minor seizures. Note (1): A major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness. Note (2): A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type). General Rating Formula for Major and Minor Epileptic Seizures: Averaging at least 1 major seizure per month over the last year 100 Averaging at least 1 major seizure in 3 months over the last year; or more than 10 minor seizures weekly 80 Averaging at least 1 major seizure in 4 months over the last year; or 9-10 minor seizures per week 60 At least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly 40 At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months 20 A confirmed diagnosis of epilepsy with a history of seizures 10 Note (1): When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy. Note (2): In the presence of major and minor seizures, rate the predominating type. Note (3): There will be no distinction between diurnal and nocturnal major seizures. 8912Epilepsy, Jacksonian and focal motor or sensory. 8913Epilepsy, diencephalic. Rate as minor seizures, except in the presence of major and minor seizures, rate the predominating type. 8914Epilepsy, 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 9307). 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 9307). Epilepsy and Unemployability: (1) Rating specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult of attainment due to employer reluctance to the hiring of the epileptic. (2) Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment. (3) The assent of the claimant should first be obtained for permission to conduct this economic and social survey. The purpose of this survey is to secure all the relevant facts and data necessary to permit of a true judgment as to the reason for his or her unemployment and should include information as to: (a) Education; (b) Occupations prior and subsequent to service; (c) Places of employment and reasons for termination; (d) Wages received; (e) Number of seizures. (4) Upon completion of this survey and current examination, the case should have rating board consideration. Where in the judgment of the rating board the veteran's unemployability is due to epilepsy and jurisdiction is not vested in that body by reason of schedular evaluations, the case should be submitted to the Director, Compensation and Pension Service. (Authority: 38 U.S.C. 1155) [29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992]