CLAIM RECON INTEL

DC 8520 | 38 C.F.R. § 4.124a | M21-1, Part IV.ii.3

OVERVIEW

Sciatica refers to pain radiating along the sciatic nerve from the lower back through the hip and down the leg. It is rated under DC 8520 (paralysis of the sciatic nerve). Sciatica is not a diagnosis itself but a symptom of sciatic nerve compression, most commonly from lumbar disc herniation, spinal stenosis, or piriformis syndrome. The rating criteria are identical to radiculopathy -- based on the degree of nerve paralysis from mild to complete.

RATING CRITERIA (5 LEVELS)

KEY EVIDENCE TO GATHER

-EMG/NCV studies showing sciatic nerve involvement

-MRI showing lumbar disc herniation or stenosis compressing the nerve root

-Documentation of radiating pain pattern from lower back through buttock and down the leg

-Physical exam findings (positive straight leg raise, decreased reflexes, sensory deficit)

-Treatment records for nerve pain medications

SECONDARY CONDITIONS (2 MAPPED)

C&P EXAM TIPS (4)

1.Sciatica is claimed as radiculopathy secondary to your lumbar spine condition. It is NOT claimed as a standalone primary condition.

2.Each leg is rated separately. If both legs are affected, you get two separate ratings plus bilateral factor.

3.EMG/NCV testing provides the strongest evidence. Get this done before your C&P exam.

4.Describe your symptoms precisely: which leg, where the pain starts and ends, numbness distribution, weakness.

DOLLAR IMPACT

Bilateral sciatica at 20% each with bilateral factor adds approximately $345/mo over a standalone lumbar spine rating. At 40% each, the addition is closer to $800/mo.