Paralysis, Neuritis, & Neuralgia: How VA Selects Nerve Diagnostic Codes

In 38 CFR 4.124a, the VA organizes each anatomical peripheral nerve under three separate 4-digit code series: 85xx for paralysis, 86xx for neuritis, and 87xx for neuralgia. For example, the median nerve is assigned DC 8515 for paralysis, DC 8615 for neuritis, and DC 8715 for neuralgia. While each code family rates the same underlying anatomical structure, the specific code selected by the adjudicator reflects the predominant clinical manifestation documented on examination.

The paralysis codes (85xx) apply when nerve injury produces objective motor dysfunction, muscular weakness, flaccidity, drop deformities (such as wrist drop or foot drop), or denervation muscle atrophy. Complete paralysis represents total loss of motor innervation to the muscles supplied by that nerve. Incomplete paralysis is graded as severe, moderately severe, moderate, or mild based on preserved strength and functional utility.

The neuritis codes (86xx) apply to active inflammatory, toxic, or degenerative processes affecting the nerve trunk. Clinically, neuritis produces a combination of sensory loss, persistent pain, diminished or absent deep tendon reflexes, and variable muscle weakness. Adjudicators apply 86xx codes when the clinical record documents ongoing nerve inflammation, such as post-surgical neuropathy, diabetic peripheral neuritis, or toxic nerve degeneration.

The neuralgia codes (87xx) apply when the predominant clinical symptom is subjective sensory disturbance: sharp throbbing pain, burning sensations, pins-and-needles paresthesias, or cutaneous hypersensitivity without substantial motor loss. A critical regulatory rule in 38 CFR 4.124a establishes a strict rating ceiling: ratings for neuralgia cannot exceed the evaluation assigned for moderate incomplete paralysis of that nerve (typically capped at 10% or 20%). A veteran suffering purely from sensory pain cannot achieve a severe (40% to 60%) or complete (70% to 80%) rating under an 87xx code without objective motor paralysis.

The C&P examiner documents whether nerve impairment involves sensory loss only, motor weakness only, or a combination of both. When motor weakness is demonstrated on physical exam (such as reduced manual muscle testing grades or muscle wasting), the rater will assign an 85xx or 86xx code rather than an 87xx code, unlocking access to higher compensable tiers. Veterans whose claims are rated under neuralgia should review their DBQ to ensure documented motor weakness was not overlooked by the adjudicator.