Autonomic Neuropathy

DC 8599Neurological38 CFR 4.124a, DC 8599

Damage to the nerves that control automatic body functions like blood pressure, heart rate, digestion, and sweating. The VA rates autonomic neuropathy by analogy because there is no specific diagnostic code for it. It is commonly secondary to diabetes.

Rating Levels

You have severe autonomic neuropathy. You have frequent fainting episodes, severe digestive problems, and difficulty staying upright, making it very hard to work or perform daily activities.

What the VA looks for

Frequent syncopal episodes documented
Severe gastrointestinal dysfunction (severe gastroparesis, malnutrition risk)
Inability to maintain upright position for sustained periods
Tilt table test showing severe autonomic failure
Multiple medications with incomplete symptom control
Significant occupational impairment documented

Common Pitfalls

⚠Not getting autonomic function testing (tilt table test, QSART, thermoregulatory sweat test) — these tests objectively measure the severity of your autonomic dysfunction and are the strongest evidence for your rating.
⚠Not documenting the connection to a service-connected condition — autonomic neuropathy is most commonly secondary to diabetes. If your diabetes is service-connected, file autonomic neuropathy as secondary.
⚠Not tracking blood pressure readings in different positions (lying down, sitting, standing) — documented drops in blood pressure when you change position directly support orthostatic hypotension claims.
⚠Not reporting all affected body systems — autonomic neuropathy can affect the heart, digestive system, bladder, and sweat glands. Each affected system may support a higher rating or separate claims.
⚠Not documenting fainting episodes with witness statements — syncopal episodes often happen without warning. Buddy statements from family, friends, or coworkers who have seen you faint are critical evidence.

Related DBQ Forms

DBQ Peripheral Nerves Conditions

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

Rating Levels

You have severe autonomic neuropathy. You have frequent fainting episodes, severe digestive problems, and difficulty staying upright, making it very hard to work or perform daily activities.

What the VA looks for

Frequent syncopal episodes documented
Severe gastrointestinal dysfunction (severe gastroparesis, malnutrition risk)
Inability to maintain upright position for sustained periods
Tilt table test showing severe autonomic failure
Multiple medications with incomplete symptom control
Significant occupational impairment documented

Common Pitfalls

⚠Not getting autonomic function testing (tilt table test, QSART, thermoregulatory sweat test) — these tests objectively measure the severity of your autonomic dysfunction and are the strongest evidence for your rating.

⚠Not documenting the connection to a service-connected condition — autonomic neuropathy is most commonly secondary to diabetes. If your diabetes is service-connected, file autonomic neuropathy as secondary.

⚠Not tracking blood pressure readings in different positions (lying down, sitting, standing) — documented drops in blood pressure when you change position directly support orthostatic hypotension claims.

⚠Not reporting all affected body systems — autonomic neuropathy can affect the heart, digestive system, bladder, and sweat glands. Each affected system may support a higher rating or separate claims.

⚠Not documenting fainting episodes with witness statements — syncopal episodes often happen without warning. Buddy statements from family, friends, or coworkers who have seen you faint are critical evidence.