A peripheral nerves compensation and pension examination is short, often twenty to thirty minutes, and much of the percentage is decided by findings recorded in that window. Knowing what is being measured makes it far more likely the report reflects your actual condition.
The examiner works through the questions on the peripheral nerves questionnaire. The exam is not a treatment visit and the examiner is not there to diagnose anything new; the purpose is to document findings for the rater.
What the examiner tests
The worksheet is a checklist, and each line below turns into a finding the rater uses:
- Symptoms by extremity - constant pain, intermittent pain, paresthesias or tingling, and numbness, each graded none, mild, moderate, or severe
- Manual muscle strength testing graded 0 to 5 at the elbow, wrist, fingers, hip, knee, ankle, and toes
- Deep tendon reflexes at the biceps, triceps, brachioradialis, knee, and ankle, graded from absent to hyperactive
- Sensory testing by dermatome for light touch in the shoulder, forearm, hand, thigh, lower leg, ankle, and toes
- Muscle atrophy, including circumference measurements of the affected and unaffected limb when atrophy is present
- Trophic changes such as loss of hair, shiny skin, or nail changes
- Gait and whether an assistive device is used
- Which nerves are affected, the severity of incomplete paralysis for each, and whether the findings are wholly sensory
Answer for the whole picture, not the best moment
Nerve symptoms fluctuate. Morning numbness may have eased by an afternoon appointment, and the medication you took to get through the drive may be masking the burning. If your foot drags by evening, if you have fallen, if you drop cups, or if you cannot feel the pedals, say so plainly.
The rating is meant to reflect the disability over time. Describing only the moment of the exam is the most common reason a report understates a condition, the same point our hip C&P exam guide and shoulder C&P exam guide make about joint exams.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service or an already service-connected disability.
The dominant hand question
For upper extremity nerves, the examiner records which hand is dominant, because 38 CFR 4.69 sets higher percentages for the major extremity. This is a one-word entry that changes the outcome, so make sure it is recorded correctly.
Bring the objective findings with you
If you have had an EMG, a nerve conduction study, or an MRI showing nerve root compression, make sure those results are in the VA record before the exam. The examiner can only consider what is available.
Our nerve claim evidence guide lists what belongs in the file, and the VA claim exam page explains the process from the VA's side.
After the exam
You can request a copy of the examination report. If it records findings you know are wrong - a reflex marked normal that was never tested, a hand marked non-dominant, an atrophy question left blank - those errors can be raised, and a detailed statement or a treating provider's records can address them.
Understanding what the decision actually said comes first. Our guide on why VA claims get denied walks through reading the decision letter, and free accredited assistance is available through a Veterans Service Officer.