How the Board ruled on radiculopathy and peripheral neuropathy claims, 2021–2025

Radiculopathy / peripheral neuropathy (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

45.5% granted of 5,057 decided cases (margin of error 44.1–46.8%). 2,299 granted, 2,758 denied, 5,807 sent back to VA (remanded, not decided), 1,136 dismissed.

What convinced the Board in granted cases

• The Board granted when it found the veteran's reports of numbness, tingling or radiating pain starting in service and continuing since to be competent and credible, even with gaps in the medical records. (7 of 13 decisions read; e.g. A24014486, 24020967, 22042996)
• A favorable medical opinion that considered the service records and the veteran's statements outweighed a negative opinion. The negative opinion was given little weight because it was conclusory, rested only on missing documentation, or ignored the veteran's account of continuous symptoms. (4 of 13 decisions read; e.g. A23011038, 21063891, A24026806)
• Treatment records from the veteran's own providers helped tip the evidence into balance. In one case a primary care doctor noted no other cause for the neuropathy. (3 of 13 decisions read; e.g. A24013055, A25010621, A25013875)

Common reasons in denied cases

• The Board denied because there was no medical diagnosis of radiculopathy or neuropathy in the claimed limb during the appeal period, and the veteran's belief that they had it was not a competent diagnosis. (8 of 18 decisions read; e.g. A21002719, A21016178, 21025398)
• The condition first appeared years after service, service records showed normal neurological findings or no complaints, and no medical opinion or literature linked it to service. (7 of 18 decisions read; e.g. 24003121, 21018461, A21000117)
• A reasoned VA opinion against the claim was unrebutted, and the veteran's own opinion on cause was found not competent on a complex medical question. (4 of 18 decisions read; e.g. 21018461, A25003338, A24065574)

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Radiculopathy / peripheral neuropathy (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

29.5% granted of 491 decided cases (margin of error 25.7–33.7%). 145 granted, 346 denied, 667 sent back to VA (remanded, not decided), 44 dismissed.

What convinced the Board in granted cases

• The Board granted when a private doctor, often a neurologist, linked the neuropathy to the exposure after reviewing the records and the veteran's account, especially when testing ruled out other common causes or onset was unusually early. (11 of 15 decisions read; e.g. 21034177, A22017307, 21005552)
• When a favorable opinion and a negative VA opinion were both reasonable, the Board found the evidence evenly balanced and granted; some VA examiners also gave favorable opinions themselves. (4 of 15 decisions read; e.g. 21005552, 21013300, A24069846)
• Credible testimony about being in sprayed areas, setting foot in Vietnam, or having symptoms soon after returning helped establish exposure or early onset. (4 of 15 decisions read; e.g. 21055537, 21040402, A24069846)

Common reasons in denied cases

• The Board denied when VA opinions, sometimes citing medical literature, found no link or a more likely cause such as diabetes or an unknown cause, and private notes gave no rationale or no opinion linked the condition. (5 of 15 decisions read; e.g. 21025650, 21053406, 21003224)
• Many claims failed because exposure was not shown (no Vietnam, Korea DMZ or contamination proof), or symptoms began decades after service, too late for the early-onset presumption. (8 of 15 decisions read; e.g. 21044346, A25022516, A25039303)
• Other claims failed because there was no current neuropathy diagnosis, and the veteran's own belief that he had it was not accepted as medical evidence. (4 of 15 decisions read; e.g. 21017949, 23011740, 21020584)

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Radiculopathy / peripheral neuropathy secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

53% granted of 2,124 decided cases (margin of error 50.9–55.1%). 1,126 granted, 998 denied, 2,544 sent back to VA (remanded, not decided), 159 dismissed.

What convinced the Board in granted cases

• The Board gave strong weight to opinions that explained the mechanism, such as spine arthritis or disc narrowing pressing on nerve roots, and that drew on clinical findings, the records, medical literature and the veteran's account. (5 of 11 decisions read; e.g. A25005627, 21064130, 21030227)
• Private opinions carried the claim when VA opinions used the wrong standard or gave no full rationale, or when no adequate contrary opinion existed in the record. (3 of 11 decisions read; e.g. A24010376, A24030105, 23041190)
• Many grants rested on a VA examiner's own favorable finding that leg radiculopathy came from the service-connected back, sometimes even with a brief rationale. (5 of 11 decisions read; e.g. 21064130, 21030227, 24004516)

Common reasons in denied cases

• The Board denied when no competent medical evidence linked the nerve condition to service or a service-connected condition, and the veteran's own belief about cause was not competent medical evidence. (6 of 13 decisions read; e.g. 21016194, 21046211, 21008646)
• Reasoned VA opinions that reviewed the record were favored, including over a less specialized positive opinion, and were otherwise unrebutted. (5 of 13 decisions read; e.g. 21066745, A21004808, 21016194)
• Other denials found no diagnosis of the claimed nerve condition (or symptoms already covered by an existing rating), or the underlying condition, often diabetes, was not service-connected. (7 of 13 decisions read; e.g. A25024945, 21051287, 23019309)

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Radiculopathy / peripheral neuropathy secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

54% granted of 722 decided cases (margin of error 50.4–57.6%). 390 granted, 332 denied, 771 sent back to VA (remanded, not decided), 45 dismissed.

What convinced the Board in granted cases

• Treatment records that diagnosed 'diabetic peripheral neuropathy' or 'neuropathy due to diabetes' were often enough on their own for the Board to find the link, even without a formal nexus opinion. (9 of 16 decisions read; e.g. A23016391, A25021828, A21005526)
• A medical opinion, VA or private, stated that diabetes caused the neuropathy, and no persuasive opinion said otherwise. (8 of 16 decisions read; e.g. A24025444, 21048059, 23050040)
• VA exams that found no neuropathy got little or no weight when they ignored treatment records or private findings showing a diagnosis, or skipped relevant testing; private opinions based on exam and testing (such as nerve biopsy) were favored. (5 of 16 decisions read; e.g. 24031269, A24025617, A23016391)

Common reasons in denied cases

• The Board found no current neuropathy in the claimed limb, usually because a VA exam or nerve testing was normal and only the veteran's own report suggested it. (8 of 20 decisions read; e.g. A22016551, 22046166, 21028401)
• The claim failed at an earlier step: diabetes itself was not service connected (often because herbicide exposure was not shown), or nothing tied the neuropathy to service. (7 of 20 decisions read; e.g. 23025146, A24008535, A24032637)
• No medical evidence tied the neuropathy to diabetes: only the veteran's own belief, the neuropathy started before the diabetes, or testing pointed to another cause such as nerve entrapment. (5 of 20 decisions read; e.g. A22015708, 21009091, A21006784)

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Radiculopathy / peripheral neuropathy secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

60.4% granted of 675 decided cases (margin of error 56.7–64.1%). 408 granted, 267 denied, 748 sent back to VA (remanded, not decided), 50 dismissed.

What convinced the Board in granted cases

• Once the low back condition itself was service connected, often in the same decision, the Board found the leg radiculopathy followed from it based on medical evidence tying the leg nerve symptoms to the spine. (9 of 15 decisions read; e.g. 24018368, A25022656, 22051944)
• An examiner, treating doctor or private physician said the leg nerve symptoms came from the lumbar spine (for example disc disease or stenosis), and no competent opinion said otherwise. (6 of 15 decisions read; e.g. 21072516, 24003627, 21004714)
• Negative VA exams were outweighed when treatment records showed repeated radiculopathy or sciatica diagnoses backed by MRI or nerve testing, or when the VA opinion ignored the veteran's reports of symptoms since service. (4 of 15 decisions read; e.g. A23027026, 21050227, 21014692)

Common reasons in denied cases

• The Board found no current radiculopathy in the claimed leg or arm, usually because VA exams showed normal reflexes, sensation or nerve testing, and the veteran's own report could not establish the diagnosis. (11 of 22 decisions read; e.g. A21005619, 21037644, 23041029)
• The low back condition itself was not service connected, so radiculopathy could not be granted as secondary to it. (9 of 22 decisions read; e.g. A23005191, A23006025, A24069677)
• A thorough VA opinion explained that the nerve problem came from something other than the service-connected back, such as non-service-connected diabetes, an unknown cause, or a neck rather than low back source. (4 of 22 decisions read; e.g. 21034184, 21019837, 23018191)

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Radiculopathy / peripheral neuropathy secondary to neck (cervical spine)

Secondary (caused or worsened by a service-connected condition)

55.4% granted of 177 decided cases (margin of error 48.0–62.5%). 98 granted, 79 denied, 182 sent back to VA (remanded, not decided), 22 dismissed.

What convinced the Board in granted cases

• The Board granted when medical evidence, such as imaging, nerve testing (EMG), or a treating doctor's exam, tied the arm nerve symptoms to nerve compression from the neck. (6 of 15 decisions read; e.g. 21036143, 21009380, 23010371)
• In several grants the main question was the neck itself; once the neck condition was service connected in the same decision, the arm radiculopathy followed on a secondary basis. (5 of 15 decisions read; e.g. A24050432, A25006020, 23037021)
• A negative VA opinion lost weight when it answered only whether the nerve problem began in service, not whether the neck caused it, or when it assumed there was no current diagnosis. (2 of 15 decisions read, few decisions; e.g. A25003631, A24021660)

Common reasons in denied cases

• Secondary service connection was denied because the neck condition itself was not service connected, so there was nothing to be secondary to. (7 of 16 decisions read; e.g. 24004683, A24003306, A23015432)
• The Board found no current radiculopathy or neuropathy, for example exams showing no nerve deficit or records where the veteran denied arm symptoms. (6 of 16 decisions read; e.g. A25003577, 23029854, A21006087)
• The nerve problem was attributed to another source, such as carpal tunnel at the wrist or ulnar nerve overuse, or the symptoms were already covered by an existing rating. (4 of 16 decisions read; e.g. 22055101, A21007092, 21036468)

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Radiculopathy / peripheral neuropathy secondary to cancer (other)

Secondary (caused or worsened by a service-connected condition)

75.8% granted of 33 decided cases (margin of error 59.0–87.2%). 25 granted, 8 denied, 35 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or treating doctor, often an oncologist, linked the neuropathy to the service-connected cancer or its treatment, usually with no medical opinion to the contrary. (8 of 13 decisions read; e.g. 21026423, A24047169, A24009637)
• Most grants tied the neuropathy to chemotherapy or other drugs used to treat the cancer, including opinions that the treatment caused or worsened existing neuropathy. (7 of 13 decisions read; e.g. 22015047, 21049301, A24050737)
• Credible statements from the veteran or family that numbness or pain began after cancer treatment supported the grant. (2 of 13 decisions read, few decisions; e.g. A24069230, 22000810)

Common reasons in denied cases

• The Board denied when there was no competent medical evidence linking the neuropathy to the service-connected cancer. (2 of 3 decisions read, few decisions; e.g. A24011588, 22053333)

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Radiculopathy / peripheral neuropathy secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

Small sample: 22 decided cases, too few for a reliable percentage. 14 granted, 8 denied, 17 sent back to VA (remanded, not decided), 5 dismissed.

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Radiculopathy / peripheral neuropathy secondary to arthritis

Secondary (caused or worsened by a service-connected condition)

Small sample: 18 decided cases, too few for a reliable percentage. 9 granted, 9 denied, 13 sent back to VA (remanded, not decided), 1 dismissed.

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Radiculopathy / peripheral neuropathy secondary to knee

Secondary (caused or worsened by a service-connected condition)

Small sample: 17 decided cases, too few for a reliable percentage. 2 granted, 15 denied, 35 sent back to VA (remanded, not decided), 0 dismissed.

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Radiculopathy / peripheral neuropathy secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

Small sample: 13 decided cases, too few for a reliable percentage. 1 granted, 12 denied, 22 sent back to VA (remanded, not decided), 2 dismissed.

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Radiculopathy / peripheral neuropathy secondary to shoulder

Secondary (caused or worsened by a service-connected condition)

Small sample: 12 decided cases, too few for a reliable percentage. 2 granted, 10 denied, 14 sent back to VA (remanded, not decided), 0 dismissed.

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Radiculopathy / peripheral neuropathy secondary to prostate cancer

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 8 granted, 2 denied, 3 sent back to VA (remanded, not decided), 0 dismissed.

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