Upper Extremity Peripheral Nerves: How VA Rates Arm & Hand Nerves

A foundational concept in upper extremity ratings is the major and minor arm rule under 38 CFR 4.69. The major arm is the veteran's dominant arm; the minor arm is the non-dominant arm. Because impairment of the dominant arm creates greater functional loss in writing, fine motor control, and occupational performance, the rating schedule assigns higher percentage evaluations to the major arm for complete, severe, and moderate nerve impairment across all upper extremity diagnostic codes.

The median nerve controls forearm pronation, wrist flexion, thumb opposition, and sensation across the palmar surface of the thumb, index, middle, and radial half of the ring finger. Under DC 8515, complete paralysis is rated 70% major / 60% minor, characterized by the hand kept in supination, loss of pronation, inability to flex the index finger, and severe thenar muscle atrophy (the ape hand deformity). Incomplete severe paralysis is rated 50% major / 40% minor; moderate incomplete is rated 30% major / 20% minor; and mild incomplete is rated 10% major / 10% minor.

The ulnar nerve innervates the intrinsic muscles of the hand responsible for finger spread and grip strength, as well as sensation to the small finger and ulnar ring finger. Under DC 8516, complete paralysis is rated 60% major / 50% minor, characterized by the classic claw hand deformity (benediction hand), atrophy of the interosseous muscles and hypothenar eminence, and loss of pinch strength. Incomplete severe paralysis is rated 40% major / 30% minor; moderate incomplete is rated 30% major / 20% minor; and mild incomplete is rated 10% major / 10% minor.

The radial nerve innervates the extensor muscles of the wrist, fingers, and thumb, and provides sensation to the dorsum of the hand. Under DC 8514, complete paralysis is rated 70% major / 60% minor, characterized by complete wrist drop, inability to extend the hand or fingers, and marked flexion deformity. Incomplete severe paralysis is rated 50% major / 40% minor; moderate incomplete is rated 30% major / 20% minor; and mild incomplete is rated 10% major / 10% minor.

Upper extremity nerve damage frequently develops secondary to cervical spine conditions under 38 CFR 3.310. Degenerative disc disease or cervical spondylosis at C5-C7 frequently compresses exiting nerve roots, manifesting as peripheral neuropathy in the median or radial distribution. In addition, focal compression syndromes, such as carpal tunnel syndrome (median nerve) or cubital tunnel syndrome (ulnar nerve), are rated using these identical diagnostic codes.