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Nexus Letters for Peripheral Neuropathy
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA neurological evaluations and independent medical opinions • Last updated: June 2026
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Numbness, tingling, burning, the pins and needles that start in the feet and creep up. Peripheral neuropathy is nerve damage, and for a lot of veterans it traces back to service: to diabetes, to Agent Orange or burn-pit exposure, or to an injury. It is common, and it is often under-rated or missed.
A nexus letter draws the line. Our physicians connect your nerve damage to your service, or to a service-connected cause like diabetes, in the language the VA expects. One flat fee of $1,500, and the first consultation is free.
How VA Rates Peripheral Neuropathy
The VA rates nerve damage under 38 C.F.R. § 4.124a, by how badly the nerve works and which nerve is affected. The table below uses the sciatic nerve (DC 8520), which runs down the leg and is the most commonly rated. Other nerves use the same mild-to-complete ladder, with their own percentages.
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 80% | Complete paralysis of the nerve. The foot dangles and drops, and there is no real movement below the knee. | ~$2,102/mo |
| 60% | Severe incomplete paralysis, with marked muscle wasting. | ~$1,435/mo |
| 40% | Moderately severe incomplete paralysis. | ~$796/mo |
| 20% | Moderate incomplete paralysis. | ~$357/mo |
| 10% | Mild incomplete paralysis. Numbness, tingling, or mild weakness in the limb. | ~$180/mo |
Two things to know. First, each affected limb is rated on its own, so two legs and two arms can each carry a rating, and they combine. Second, if your symptoms are all sensory (numbness and tingling, but no real weakness or muscle loss), the rating is usually capped at mild, or at most moderate. The exact percentage depends on which nerve is hit and how badly, which a doctor measures at the exam, often with a nerve test (an EMG or nerve conduction study).
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
Making a VA Disability Claim for Peripheral Neuropathy
A VA disability claim for peripheral neuropathy needs three things to line up:
A current diagnosis
A diagnosis of peripheral neuropathy, usually backed by a nerve test such as an EMG or nerve conduction study.
A service connection
Either a cause in service (an injury or a toxic exposure), or a link to a service-connected condition such as diabetes.
A medical nexus
A qualified opinion that the nerve damage is 'at least as likely as not' connected to your service or to a service-connected cause.
For neuropathy, the nexus often turns on the cause. Diabetic neuropathy, for example, is connected by tying it to service-connected diabetes. A nexus letter supplies that opinion in writing. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect Peripheral Neuropathy to Service
There are a few ways to tie nerve damage to your service. For neuropathy, the secondary path, especially through diabetes, is often the strongest.
Secondary connection
Another service-connected condition caused the nerve damage (38 C.F.R. § 3.310).
- Diabetes. Diabetic peripheral neuropathy is one of the most common secondary nerve claims. If your diabetes is service-connected, the neuropathy usually follows.
- Medications. Some drugs for a service-connected condition, such as certain chemotherapy, can damage nerves.
Direct connection
The nerve damage started in service.
- Toxic exposure. Agent Orange, burn pits, and other toxic exposures can be linked to nerve damage. Your exposure history can be the key to the claim.
- An injury. A wound or crush injury that damaged a nerve directly.
Aggravation
You had nerve problems before service, and service made them permanently worse.
- Worsened by service. Symptoms got worse during active duty, beyond normal change over time.
Secondary Conditions
Neuropathy usually has a cause behind it, and it can cause problems of its own. Documenting both directions helps your combined rating.
Peripheral neuropathy may be secondary to
- Diabetes. The most common cause of service-connected neuropathy. The diabetes is rated on its own, the nerve damage separately.
- Toxic exposure. Agent Orange, burn pits, and other exposures can be linked to nerve damage.
- Medications. Some treatments for a service-connected condition can damage nerves.
Conditions that may follow neuropathy
- Falls and injuries. Numb feet and weak legs make falls more likely.
- Foot ulcers and wounds. Lost feeling in the feet can lead to sores that are slow to heal, especially with diabetes.
- Depression or anxiety. Chronic pain and lost function wear on mood and can be claimed as secondary.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. For neuropathy, the nerve test and the proof of the cause carry the claim.
Frequently Asked Questions
How does the VA rate peripheral neuropathy?
By how badly the nerve works and which nerve is affected, under 38 C.F.R. 4.124a. For the sciatic nerve in the leg (DC 8520), it runs from 10% for mild incomplete paralysis up to 80% for complete paralysis. Each affected limb is rated on its own and combined.
Is neuropathy from diabetes covered?
Yes, and it is one of the most common secondary nerve claims. If your diabetes is service-connected, the neuropathy it causes can be service-connected too, under 38 C.F.R. 3.310. The diabetes and the nerve damage are rated separately.
Can I get a rating for each limb?
Yes. Neuropathy is rated nerve by nerve and limb by limb. Numbness in both feet and both hands can carry up to four separate ratings, which then combine.
What if my symptoms are only numbness?
Numbness and tingling with no real weakness or muscle loss is usually rated mild, or at most moderate. Weakness, muscle wasting, and lost function push the rating higher. A nerve test documents the difference.
Do I need a nexus letter?
Often, yes, especially to tie the neuropathy to its cause, like service-connected diabetes or a toxic exposure. A nexus letter supplies that opinion, and it is usually what decides the claim.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help your claim.
Numb feet are not just getting older.
Let our physicians prepare a neuropathy nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 2026 VA disability compensation rates (VA.gov) https://www.va.gov/disability/compensation-rates/veteran-rates/
- 38 CFR 4.124a, Schedule of ratings, neurological conditions, including the peripheral nerve codes (eCFR) https://www.ecfr.gov/current/title-38/section-4.124a
- 38 CFR 4.123, Neuritis (eCFR) https://www.ecfr.gov/current/title-38/section-4.123
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107