Skip to main content

Evidence checklist

Restless Legs Syndrome

DC 8699-862038 CFR § 4.124aNeurological

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 3 collected
Polysomnography or actigraphy documenting periodic limb movements

An overnight sleep study documenting periodic limb movements in sleep (PLMS) index, which correlates with RLS severity and supports the diagnosis.

Private provider · independent opinion
Neurologist evaluation diagnosing RLS using IRLSSG criteriaCritical

A neurologist's evaluation confirming RLS diagnosis using the International Restless Legs Syndrome Study Group (IRLSSG) criteria: urge to move, worse at rest, worse in evening/night, relieved by movement.

Private provider · independent opinion
Nexus opinion linking RLS to service or service-connected conditionCritical

Medical opinion connecting RLS to in-service iron deficiency, peripheral neuropathy, kidney disease, or a service-connected condition that causes secondary RLS.

Private provider · independent opinion
02

Treatment records

0 of 1 collected
Treatment records (dopamine agonists, gabapentin, iron supplementation)

Records of medication trials, response to treatment, and ongoing management documenting the chronic nature of the condition.

VA or private records · written request
03

Lay statements

0 of 3 collected
Symptom diary documenting severity and sleep disruptionCritical

A personal log documenting nightly RLS symptom severity (using the IRLS rating scale or descriptively), duration, and resulting sleep loss. Supports functional impact for rating purposes.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
04

Benefits questionnaire

0 of 1 collected
Completed DBQ Central Nervous System and Neuromuscular DiseasesCritical

VA standardized form for nervous system conditions capturing symptom severity and functional impact.

Provider-completed · VA DBQ formHow to get this →
05

Service records

0 of 1 collected
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180

What you mark here is saved in this browser, on this device only — not to an account. Changing the target rating shows different items, but never loses what you have already marked.