Brain and nervous system: migraine, TBI, seizures and the exam

How VA rates brain and nervous system conditions

38 CFR 4.124a

This part of the schedule covers diseases of the brain and spinal cord, migraine, traumatic brain injury, seizures and the cranial nerves. For these conditions, the schedule says disability may be rated from 10 to 100 percent in proportion to the impairment of motor, sensory or mental function. VA is told to look especially at loss of use of a limb, speech problems, vision, gait, tremors and similar effects, and to rate partial loss of use of a limb by comparison with the mild, moderate, severe or complete paralysis of peripheral nerves.

Nerves of the arms and legs, sciatica and neuropathy are on nerve damage VA ratings. Mental disorders are on mental health ratings explained.

Migraine headaches

38 CFR 4.124a, DC 8100

• 50%: very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability.
• 30%: characteristic prostrating attacks occurring on average once a month over the last several months.
• 10%: characteristic prostrating attacks averaging one in two months over the last several months.
• 0%: less frequent attacks.

VA’s exam form defines prostrating as causing extreme exhaustion, powerlessness, debilitation or incapacitation, and asks how often prostrating attacks and completely prostrating and prolonged attacks happen: less often, once in two months, once a month, or more than once a month.

Traumatic brain injury (TBI)

38 CFR 4.124a, DC 8045

TBI residuals fall into three areas: cognitive, emotional or behavioral, and physical. Each is evaluated its own way:

• Cognitive and subjective symptoms are rated on a table of 10 facets: memory, attention, concentration and executive functions; judgment; social interaction; orientation; motor activity; visual spatial orientation; subjective symptoms; neurobehavioral effects; communication; and consciousness.
• Each facet has a level from 0 to 3, and some have a highest level called total. If any facet is total, the rating is 100%. Otherwise the rating follows the highest facet: level 0 is 0%, level 1 is 10%, level 2 is 40%, level 3 is 70%.
• Emotional and behavioral problems are rated under the mental disorders schedule when a mental disorder is diagnosed. Without a diagnosis, they are rated on the table.
• Physical problems are rated separately under the code that fits: motor and sensory problems, vision, hearing loss and tinnitus, loss of smell and taste, seizures, balance and gait, speech, neurogenic bladder or bowel, cranial nerves, autonomic and endocrine problems. A distinct diagnosis such as migraine or Meniere’s disease is rated under its own code, even if based on symptoms.

The regulation says the same signs and symptoms cannot support more than one rating. The table result counts as one condition when combined with other ratings. The words mild, moderate and severe in medical records describe the injury at the time it happened and do not set the rating. VA must also consider special monthly compensation. Related pages: tinnitus, ear conditions and vertigo.

Epilepsy and seizure disorders

38 CFR 4.124a, DC 8910 to 8914

Grand mal (8910) uses the major-seizure scale. Petit mal (8911), Jacksonian and focal motor or sensory (8912) and diencephalic (8913) use the minor-seizure scale, or the predominating type if both occur. Psychomotor epilepsy (8914) is rated as major or minor depending on whether it involves automatic states or generalized convulsions with unconsciousness. The levels:

• 100%: averaging at least one major seizure per month over the last year.
• 80%: averaging at least one major seizure in three months over the last year; or more than 10 minor seizures weekly.
• 60%: averaging at least one major seizure in four months over the last year; or 9 to 10 minor seizures per week.
• 40%: at least one major seizure in the last six months or two in the last year; or averaging 5 to 8 minor seizures weekly.
• 20%: at least one major seizure in the last two years; or at least two minor seizures in the last six months.
• 10%: a confirmed diagnosis of epilepsy with a history of seizures.

When continuous medication is needed for control, the minimum is 10%, and that rating is not combined with another rating for epilepsy. A major seizure is a generalized tonic-clonic convulsion with unconsciousness. Narcolepsy (8108) is rated as petit mal epilepsy.

Diseases with fixed or minimum ratings

38 CFR 4.124a, DC 8000 to 8025

• Amyotrophic lateral sclerosis (8017) and bulbar palsy (8005): 100%. VA must consider special monthly compensation for ALS.
• Parkinson’s disease (8004), multiple sclerosis (8018), myasthenia gravis (8025), progressive muscular atrophy (8023) and syringomyelia (8024): a minimum of 30%, with higher ratings possible on the effects.
• Brain or spinal cord cancer (8002, 8021): 100%, continuing for two years after treatment ends. If residuals have stabilized, it is then rated on the neurological residuals, with a minimum of 30%.
• Benign brain or spinal cord growth (8003, 8022): a minimum of 60%, then residuals with a minimum of 10%.
• Stroke or bleeding in the brain (8007 to 8009): 100% for six months, then residuals with a minimum of 10%. Hematomyelia (8012) is the same.
• Active infections of the brain or its coverings (encephalitis 8000, polio 8011, meningitis 8019, brain abscess 8020): 100% while active, then residuals with a minimum of 10%.
• Myelitis (8010): a minimum of 10%.

The schedule requires that there be ascertainable residuals for the minimum ratings under codes 8000 to 8025. It says subjective residuals, such as headaches, dizziness and fatigability, are accepted when consistent with the disease and not more likely due to another disease. When a rating above the minimum is given, the codes used as the basis must be cited. Hereditary and other related diseases are rated by the effects on motor, sensory and mental function.

Tics, chorea, narcolepsy and cerebral arteriosclerosis

38 CFR 4.124a, DC 8046, 8103 to 8108

• Convulsive tic (8103): 30% severe, 10% moderate, 0% mild, depending on frequency, severity and muscle groups involved.
• Paramyoclonus multiplex (8104): severe cases are rated 60%.
• Sydenham’s chorea (8105): 100% pronounced and progressive; 80% severe; 50% moderately severe; 30% moderate; 10% mild. Huntington’s chorea (8106) and acquired athetosis (8107) are rated the same way.
• Cerebral arteriosclerosis (8046): purely neurological effects such as hemiplegia are rated under the matching code. Purely subjective complaints such as headache, dizziness, tinnitus, insomnia and irritability are rated 10% and no more, and that 10% is not combined with another rating for arteriosclerosis.

The cranial nerves

38 CFR 4.124a, DC 8205 to 8412

Ratings are for one side. When both sides are affected, the ratings are combined without the bilateral factor. Lesions of the first, second, third, fourth, sixth and eighth cranial nerves are rated under the organs of special sense. The levels for the others, for paralysis (neuritis and neuralgia use the same scale):

• Fifth (trigeminal, 8205): complete 50%, incomplete severe 30%, incomplete moderate 10%. Tic douloureux may be rated according to severity, up to complete paralysis.
• Seventh (facial, 8207): complete 30%, severe 20%, moderate 10%.
• Ninth (glossopharyngeal, 8209): complete 30%, severe 20%, moderate 10%.
• Tenth (vagus, 8210): complete 50%, severe 30%, moderate 10%.
• Eleventh (spinal accessory, 8211): complete 30%, severe 20%, moderate 10%.
• Twelfth (hypoglossal, 8212): complete 50%, severe 30%, moderate 10%.

What VA’s neurological exam forms cover

VA Headaches DBQ (updated 2024-07-09), Seizure Disorders DBQ (updated 2024-07-31)

• Headaches form: diagnosis (migraine, tension, cluster or other), continuous medication, pain and associated symptoms such as nausea and light sensitivity, typical duration, whether there are characteristic prostrating attacks and completely prostrating and prolonged attacks, with frequency, scars and functional impact on work.
• Seizure form: seizure types, continuous medication, whether a seizure was witnessed, findings during seizures, the number and frequency of minor and major seizures over the past six months, one year and two years, associated brain syndromes, testing (MRI, CT, EEG and others) and functional impact.
• Other forms: VA also has public exam forms for Parkinson’s disease, multiple sclerosis, ALS, narcolepsy, cranial nerve conditions, and central nervous system and neuromuscular diseases. The TBI exam forms are listed as not available for public use.

See Preparing for Your C&P Exam.

What I could not verify

• The rating levels come from the eCFR text of 38 CFR 4.124a (current as of October 16, 2026). eCFR is unofficial, and the official text wins over me.
• I checked the exam forms through a text reader of VA’s PDFs, not line by line. The forms themselves are the authority. I did not read the Parkinson’s, multiple sclerosis, ALS, narcolepsy, cranial nerve or central nervous system forms.
• I did not restate the preface rules for epilepsy in 38 CFR 4.121 and 4.122, or every detail of the TBI table. Read the regulation for the exact words of each facet level.
• I did not cover the peripheral nerve ratings, which are on the nerve damage page, or the mental disorders ratings, which are on the mental health page.
• I did not research presumptive conditions for neurological diseases. See presumptive conditions by era.