Part 1 gave an overview of how nerve conditions are rated in general. This blog post, part 2, provides information about the nerves of the lower back, and part 3 will provide information related to the nerves of the upper back and arms.
Peripheral nerves are the nerves that travel from the spinal cord to the rest of the body. Peripheral nerves that are in the lower back travel into the legs and feet. VA disability claims involving nerves in the lower back and the legs can be complex due to the fact that the larger nerves split off into smaller nerves as they go down the leg. The following is a list of the peripheral nerves in the lower back that can be rated for VA disability purposes:
- Sciatic nerve: This is the largest single nerve in the entire human body. It runs from each side of the lower spine through the buttocks, down the back of the thigh, and down to the foot. The sciatic nerve’s job includes connected the spinal cord with the leg and foot muscles.
- Tibial nerve: The tibial nerve branches off the sciatic nerve just above the knee. It goes down the back of the leg and then around the ankle to ultimately pass through the tarsal tunnel into the inner foot. This nerve controls movements such as pointing and flexing the foot, turning the foot so the toes point inward, spreading and closing the toes, and curling the toes.
- Posterior tibial nerve: This nerve begins where the tibial nerve curves around the ankle. The posterial tibial nerve goes through the tarsal tunnel on the inside of the ankle and into the arch of the foot. This nerve controls movements such as turning the foot inward to that the toes point inward, pointing and flexing the toes, spreading and closing the toes, and curling the toes.
- Common peroneal nerve: This nerve also splits off from the sciatic nerve above the knee. It then goes around the kneecap and down the front of the shin. The common peroneal nerve controls movements such as pointing and flexing the foot, turning your feet so you can stand on the outer edge of the foot, and turning the feet outward.
- Deep peroneal nerve: This nerve breaks off from the common peroneal nerve right below the knee where it then goes down the leg into the foot and toes. It controls movements such as pointing and flexing your toes, and turning your feet so you stand on the outer edge.
- Superficial peroneal nerve: This nerve breaks off from the common peroneal nerve right below the knee, down the outside of the leg, and into the foot and toes. It controls movements such as pointing and flexing your toes, and turning your feet so you stand on the outer edge.
- Ilioguinal nerve: The ilioguinal nerve branches off from the spinal cord in the low back, where it then curves around the hips to the abdomen, and finally ends in the groin. This nerve is responsible for providing feeling to the skin in the upper thigh and groin areas.
- Obturator nerve: This nerve branches off from the spinal cord in the low back and goes down the leg into the inner thigh. The obturator nerve assists with things such as lifting your leg to the front, crossing the leg inward across the other leg, lifting your leg to the side, and turning the hip so your knee goes across the other leg or out to the side.
- Femoral nerve: The femoral nerve goes around the outside of the hip where it then travels down the thigh. Movements such as kicking the leg forward, straightening the leg at the knee, and lifting the torso from the hips are controlled by the femoral nerve.
- Internal saphenous nerve: This nerve comes off of the femoral nerve in the thigh and is responsible for providing feeling to the skin at the inside of the thigh and calf, and the top of the foot.
- Lateral femoral cutaneous nerve: The lateral femoral cutaneous nerve goes into the front and back of the thigh and is responsible for providing feeling to the skin in the front and back of the thigh.
As mentioned above, the nerves of the lower back and legs can be complex. For example, the sciatic nerve alone splits into five different nerves that have their own diagnostic codes and ratings available under the VA’s rating schedule. If the sciatic nerve is damaged in a place before one of the splits, then all of the nerves after it would also be damaged. However, if this is the case, you can only receive one rating under the sciatic nerve diagnostic code. In other words, if a veteran’s sciatic nerve is damaged before the tibial nerve branches off above the knee, the veteran cannot receive a rating for the sciatic nerve AND the tibial nerve. Instead, the veteran’s nerve condition would be rated according to the criteria set forth for the sciatic nerve. If the nerve damage occurs after a split from the sciatic nerve, then the damaged nerve is the nerve that is rated. For example, if the damage occurs AFTER the tibial nerve splits from the sciatic nerve, then the condition will be rated according to the criteria for the tibial nerve. The following table shows the different diagnostic codes associated with each of the peripheral nerves:
|Nerve Affected||Diagnostic Code for Paralysis of the Nerve||Diagnostic Code for Neuritis of the Nerve||Diagnostic Code for Neuralgia of the Nerve|
|Lateral femoral cutaneous||8529||8629||8729|
Lastly, don’t forget that nerve conditions can also be rated according to limitation of motion. For the sciatic nerve, tibial nerve, posterior tibial nerve, common peroneal nerve, deep peroneal nerve, and superficial peroneal nerve, be sure to check and see if you would be entitled to a higher rating under the criteria for limited motion of the ankle (diagnostic code 5721). For the obturator nerve, and femoral nerve check and see if you could get a higher rating under the criteria for limited motion of the hip (diagnostic code 5252 or 5253).