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On November 12, 2024, the VA published proposed changes to Central Nervous System ratings for neurological conditions and convulsive disorders.
These changes are part of a decade-long effort to modernize the VA Schedule for Rating Disabilities (VASRD), aligning it with advancements in medical science, updated terminology, and clearer evaluation criteria.
This is a critical update for veterans, as the Neurological System includes conditions affecting the brain, spinal cord, cranial nerves, and peripheral nerves.
In this high-value blog post from VA disability expert Brian Reese, we’ll cover the proposed VA rating changes for the Central Nervous System, along with diagnostic code updates and new diagnostic codes.
Let’s begin!
Table of Contents
Summary of Key Points
- Modernization of Neurological Ratings: The VA’s proposed updates aim to modernize the VA Schedule for Rating Disabilities (VASRD) by incorporating current medical knowledge, improving clarity in rating criteria, and addressing outdated terminology like “neuritis” and “neuralgia,” replacing them with “neuropathy.”
- Introduction of New Diagnostic Codes: New diagnostic codes are proposed for previously unaddressed conditions such as dystonia, essential tremor, Parkinson’s Plus syndromes, and Primary Lateral Sclerosis (PLS), ensuring proper evaluation and tracking of these conditions.
- Revised Evaluation Criteria: The updates introduce objective, measurable standards such as the Hoehn-Yahr Scale for Parkinson’s disease and Functional Limitations for movement disorders. Minimum ratings for conditions like Parkinson’s disease (30%) and stroke residuals (10%) are now explicitly defined regardless of examination findings.
- Simplification of Claims Processing: Obsolete or redundant diagnostic codes are being removed, while the inclusion of a General Rating Formula for Specified Neurologic Conditions (GRF) aims to streamline evaluations for complex movement disorders, ensuring fair and consistent ratings.
Why is the VA Making These VASRD Updates?
The last major revisions to the Neurological System section of the 38 CFR, Part 4, VA Schedule for Rating Disabilities occurred decades ago, and since then, medical advancements have transformed the understanding and treatment of neurological conditions.
These updates aim to:
- Align the VASRD with current medical knowledge and standards.
- Improve clarity and consistency in rating criteria.
- Ensure that veterans are evaluated fairly and transparently.
- Simplify the claims process by reducing redundant diagnostic codes.
Pro Tip: The VA is accepting public comments on these proposed changes until January 13, 2025. If you have insights or concerns, submit them here.
Key Objectives of the Proposed Rating Changes
Here’s a breakdown of the major updates:
- Modernized Medical Terminology: Outdated terms like “neuritis” and “neuralgia” will be replaced with medically accurate terminology, such as “neuropathy,” to reflect current scientific understanding.
- Enhanced Evaluation Criteria: New evaluation criteria incorporate objective measures such as muscle strength and sensory deprivation standards, ensuring consistency and fairness in ratings.
- Inclusion of New Medical Conditions: Diagnostic codes will be added for conditions not previously covered, including dystonia, essential tremors, and primary lateral sclerosis (PLS), providing clearer guidance for these diagnoses.
- Removal of Obsolete Codes: Diagnostic codes that no longer align with medical advancements or are redundant will be eliminated.
- Unconditional Minimums: Clarify when no residual symptoms are required for a minimum rating.
- Conditional Minimums: Clarify when ascertainable residuals are required to qualify for a minimum rating.
Movement Disorders: New VA Rating System
The VA is introducing a dedicated rating system for movement disorders, including Parkinson’s disease, dystonia, and essential tremors.
Conditions are rated using either of the following:
#1. Hoehn-Yahr Scale:
Assigns ratings based on the progression of the disorder:
- Stage 1: 0% VA Rating
- Stage 2: 10% VA Rating
- Stage 3: 30% VA Rating
- Stages 4 & 5: 100% VA Rating
#2. Functional Limitations:
Evaluates the impact on daily activities, such as mobility, posture, or mental functioning:
- 100% VA Rating: Daily assistance required.
- 60% VA Rating: Use of assistive devices daily.
- 30% VA Rating: Periodic use of assistive devices.
- 10% VA Rating: Impairments like tremors, slurred speech, or motor deficits.
*UPDATED* Diagnostic Codes for the Central Nervous System VA Disability Ratings
Below is a detailed breakdown of the updated diagnostic codes for the central nervous system, including revised VA ratings and criteria.
DC 8000: Encephalitis, Infectious
Description: Renamed from “Encephalitis, epidemic, chronic” to “Encephalitis, infectious.” The code now covers a broader category, including viral, bacterial, fungal, or parasitic infections causing brain irritation and swelling.
Symptoms: Loss of consciousness, seizures, paralysis, and changes in mental function.
Evaluation Criteria:
- Rate at 100% during active disease and for the first three months following the end of the active period.
- Reevaluated based on residuals; minimum rating of 10% if residual symptoms exist.
DC 8002: Brain, New Growth of, Malignant
Description: Covers malignant brain tumors.
Evaluation Criteria:
- Rate at 100% during active disease or treatment for the first two years after the last treatment.
- Reevaluated based on residuals; minimum rating of 30% applies if ascertainable residuals exist.
DC 8003: Brain, New Growth of, Benign
Description: Clarified to specify that a 60% rating applies during active disease or treatment (e.g., surgery). Reevaluated after treatment.
Evaluation Criteria:
- Rate at 60% for active benign tumor or during treatment.
- Minimum rating of 10% for residual symptoms.
DC 8004: Parkinson’s Disease
Description: Renamed from “Paralysis agitans” to “Parkinson’s disease.” Now evaluated under the General Rating Formula for Specified Neurologic Conditions (GRF).
Evaluation Criteria:
- 100% Rating: Hoehn-Yahr stage 4 or 5, or inability to live independently.
- 60% Rating: Requires daily use of assistive devices like a wheelchair, cane, or walker.
- 30% Rating: Hoehn-Yahr stage 3 or requires occasional use of assistive devices.
- Note: the new minimum rating is 30% percent for Parkinson’s disease (DC 8004, regardless of examination findings.
DC 8007: Stroke (Ischemic, Hemorrhagic, or Thrombotic)
Description: Combines DC 8007 (embolism), DC 8008 (thrombosis), and DC 8009 (hemorrhage). Renamed to include all stroke types.
Evaluation Criteria:
- 100% Rating: During active stroke and for six months afterward.
- Reevaluated after six months under the GRF; minimum rating of 10% applies for residual symptoms.
- Note: the new minimum rating is 10% for stroke residuals (DC 8007), regardless of examination findings.
DC 8018: Multiple Sclerosis and Other Demyelinating Diseases
Description: Expanded to include NMOSD and MOGAD alongside MS.
Evaluation Criteria:
- Rated based on residual symptoms under the Central Nervous Rating System.
- Minimum rating of 30% for confirmed diagnosis with ascertainable residuals.
DC 8021 & 8022: Spinal Cord New Growths (Malignant & Benign)
Description:
- DC 8021 (Malignant): Applies to active malignant spinal cord tumors.
- DC 8022 (Benign): Minimum 10% for residual symptoms.
Evaluation Criteria:
- DC 8021: 100% during active disease or treatment, minimum 30% afterward.
- DC 8022: 60% during active disease or treatment, reevaluated after treatment for residuals.
*NEW* Diagnostic Codes for the Central Nervous System VA Disability Ratings
Below is a detailed breakdown of the new diagnostic codes for the central nervous system, including new VA ratings and criteria:
DC 8026: Parkinson’s Plus or Secondary Parkinsonism Syndromes
Description: Covers Parkinson’s-like conditions caused by other factors (e.g., encephalitis, stroke, medications).
Evaluation Criteria:
- Rated under the GRF, no minimum rating unless residuals exist.
DC 8027: Essential Tremor
Description: Newly created for essential tremor, which causes involuntary, rhythmic oscillations in body parts.
Evaluation Criteria:
- Rated under the GRF.
DC 8028: Dystonia
Description: For involuntary muscle contractions causing abnormal postures or repetitive movements.
Evaluation Criteria:
- Rated under the GRF.
DC 8036: Primary Lateral Sclerosis (PLS)
Description: A motor neuron disease affecting upper motor neurons, causing progressive muscle weakness.
Evaluation Criteria:
- Rated based on residual symptoms under the Central Nervous Rating System.
- Minimum rating of 10% for ascertainable residuals.
DC 8103: Hemifacial Spasm
Description: Renamed from “Convulsive Tic” to specify that it applies only to facial spasms.
Evaluation Criteria:
- 30% Rating: Severe symptoms.
- 10% Rating: Moderate symptoms.
- 0% Rating: Mild symptoms.
DC 8910 & 8911: Epilepsy
Description:
- DC 8910 renamed to include “Tonic-Clonic Seizures.”
- DC 8911 renamed to include “Absence Seizures.”
Evaluation Criteria:
- No changes to the current VA rating percentages for epilepsy.
Read the Proposed 38 CFR Parts 3 and 4 Rating Changes for Neurological Conditions and Convulsive Disorders
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
