The Cranial Nerves

Topics:

The Cranial Nerve Rating System
The Cranial Nerves
Other Nervous Conditions
DBQ for Cranial Nerve Conditions
Principles that Apply

The Nervous System is divided over multiple pages: the Peripheral Nerves of the Upper Back and Arms, the Peripheral Nerves of the Low Back and Legs, the Cranial Nerves (this page), and Traumatic Brain Injury (TBI). Finally, all other nervous conditions can be found on The Central Nervous System page.

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Additional compensation is given by the VA for loss of use of the arms, legs and a few other body systems. If your nerve condition is severe enough that the affected body part is unable to function at all, you probably qualify. See the Special Monthly Compensation page to see if your particular condition qualifies.

The nervous system connects the brain to the rest of the body. Impulses travel up the nerves and spinal cord to the brain, and the brain then turns these impulses into ideas like pain, heat, etc. Similarly, the brain can send signals through the nerves to various parts of the body, telling it to raise the arm, point the toes, open and close the lungs to breath, etc.

The nervous system is divided into two parts: the central nervous system, and the peripheral nervous system. The central nervous system consists of the brain, the spinal cord, and the cranial nerves. The peripheral nervous system is made up of all the nerves that travel from the spinal cord to the rest of the body.

We have divided the nervous system across five different pages: the peripheral nerves are split into two categories: Nerves of the Upper Back and Arms, and Nerves of the Low Back and Legs. The Cranial Nerves are addressed on this page, and Traumatic Brain Injury (TBI) also has its own page. All other nervous conditions can be found on The Central Nervous System page.

The majority of nervous system conditions are rated on the symptoms they create. These symptoms could include mental illness (hallucinations and the like), trouble speaking, hearing, seeing, the inability to properly move the body, tremors, and more. For the VA, every symptom will be ratable, but for the DoD, since they only rate conditions that make a service member Unfit for Duty, they will only rate the symptoms that also make him unfit. Not every symptom a nerve condition causes will always be ratable for DoD Disability. If each symptom is not unfitting by itself, but the overall condition is, then only the worst symptom can be rated.

The cranial nerves protrude directly from the brain, not the spinal cord. There are twelve cranial nerves, but not all can be rated. The ratable ones include the trigeminal nerve, the facial nerve, the glossopharyngeal nerve, the vagus nerve, the spinal accessory nerve, and the hypoglossal nerve. If another cranial nerve is affected, it is rated on whatever symptoms it causes.

Note: There are a few times for these conditions that the VASRD uses vague terms like “severe.” The exact definition of terms like this is up to the opinion of the Rating Authorities, so unfortunately, we can’t really give you a more concrete definition than this. It may mean one thing to one person and something entirely different to someone else. What they are supposed to be keeping in mind when deciding ratings, however, is how much that condition affects your overall health and ability to work. If that is severely affected, then the Rating Authorities should consider it a “severe” condition. Hope that helps.

 


The Cranial Nerve Rating System

This rating system is used for rating both the Cranial Nerves and the Peripheral Nerves (the nerves on the Low Back and Upper Back pages).

There are a few basic rules/principles to follow when rating a cranial or peripheral nerve condition.

First, all nerve conditions are rated based on the loss of function of the affected body part. There are three different categories a nerve condition can be rated under: paralysis, neuritis, and neuralgia. The condition must satisfy certain terms to be rated under one of these categories. These terms are discussed below. Once it is determined which of the three categories the nerve condition falls under, it can then be rated either under that category or on limited motion, whichever gives the higher rating. It is important to note that if the nerve condition is causing the limited motion, then only one rating can be given either under a nerve code or under limited motion. If, however, the limited motion is NOT caused by the nerve condition, then it can be rated in addition to a nerve rating.

Second, when deciding which of the three categories a condition fits in, it is important to keep in mind that the actual loss of function of the body part is the main defining criteria. In other words, if the nerve leading to a muscle in the shoulder is completely paralyzed, it is not necessarily rated as completely paralyzed. If the shoulder can no longer move the arm or function at all, then it can be rated as completely paralyzed. In most cases, however, the muscles in the shoulder and arm that are not affected by the paralyzed nerve will often compensate for the loss of function, and moving the arm will still be possible. This is especially the case since the nerves rarely work alone, meaning that more than one nerve often works a single muscle. Because of this, some movements are controlled by numerous nerves and may still be able to take place if one is damaged. In cases like this, the nerve cannot be rated as completely paralyzed. We’ll work an example in a bit to help clarify this rule.

Third, if the nerve affected is one that controls the eyes, ears, nose (smell), or tongue (taste), then it is not rated under a nerve code at all. Instead, the condition is rated based on the limitation of the senses. See The Eyes, The Ears, and the Taste and Smell pages for more information on rating these conditions.

Fourth, each nerve is paired, meaning that there are 2 of every nerve, one for each side of the body. For the peripheral nerves, if both are affected, then the bilateral factor is added. The bilateral factor, however, does NOT apply to any of the cranial nerves. So, if both cheeks are affected by a nerve condition, then both can be rated separately, but the additional bilateral factor is not given.

Fifth, each nerve has three different possible codes under which it could be rated:

– Paralysis of the nerve—the nerve itself, not the affected body part, cannot function at all. This can be complete paralysis or partial paralysis.
– Neuritis of the nerve—the nerve still functions, but it is swollen, irritated, and very painful. All cases of neuritis will have at least one of the following:

1.) a decreased ability to sense
2.) muscle atrophy
3.) loss of reflexes

– Neuralgia of the nerve—the nerve causes occasional or constant pain. There can also be tingling, numbness, etc.
For a condition to qualify for the next highest category, it must satisfy all the criteria. For example, a condition with severe pain but no other symptoms would still have to be considered neuralgia since the other symptoms, like muscle atrophy, that are required to call a condition neuritis aren’t present.

Sixth, each of these codes is rated based on a degree of severity.

Paralysis

Complete: This is defined for each nerve a little differently, but basically, it means that the nerve is completely paralyzed and the body part cannot function at all, like if it had been amputated.
Incomplete, severe: If the nerve is not completely paralyzed, and there are symptoms like poor blood circulation and muscle atrophy, that seriously limit the body part’s ability to function, then it is rated as severe. The condition must be very severe to be rated here.
Incomplete, moderate: If the nerve is not completely paralyzed, and there is tingling, numbness, moderate pain, or other symptoms that definitely and significantly interfere with the ability of the body part to fully function, it is rated as moderate.
Incomplete, mild: If the nerve is not completely paralyzed, and there is only tingling or mild pain in the affected body part, it is rated as mild. There could also be slight or very mild limitations in the movement of the body part, but these limitations would not really affect the overall functioning.

Neuritis

Severe: If there are all three of the main symptoms (loss of reflexes, muscle atrophy, and loss of sensation), and they seriously limit the body part’s ability to function, then it is rated as severe. The condition must be very severe to be rated here.
Moderate: If there are one or more of the main symptoms that definitely and significantly interfere with the ability of the body part to fully function, it is rated as moderate.
Mild: If there are one or more of the main symptoms, but they are mild and do not interfere significantly with the ability of the body part to function, it is rated as mild.

Neuralgia

Moderate: If there is tingling, numbness, moderate to severe pain, or other symptoms that definitely and significantly interfere with the ability of the body part to function fully, it is rated as moderate.
Mild: If there is only tingling or mild pain in the affected body part, it is rated as mild. There could also be slight or very mild limitations in the movement of the body part, but these limitations would not really affect the overall functioning.

That’s basically the entire nervous rating system. Each nerve has its own percentages for the various degrees of severity. They will all be addressed in the discussion of each cranial and peripheral nerve.

Example. A service member has damage to the trigeminal nerve that leads to his jaw. The jaw can’t open all the way, but he is able to chew soft foods. There is constant, mild pain and tingling. Tests show that the trigeminal nerve is completely paralyzed and unable to function at all. (Disclaimer: It’s rare for a nerve to be completely paralyzed with such mild symptoms, but let’s go with it for the sake of demonstrating the principles involved.) How is his condition rated?

First, we need to determine in which of the three categories the condition fits: paralysis, neuritis, or neuralgia. The tests say that the nerve is paralyzed, so that one’s easy.

Next, we need to determine the severity of the paralysis. We know that it cannot be rated as completely paralyzed even though the nerve is completely paralyzed, since the jaw can still move and function okay. This means that the other nerves that affect the same muscles as the trigeminal nerve are compensating for the damage. The definition of severe for paralysis requires severe symptoms like muscle atrophy which are clearly not seen in this case. Similarly, the definition of mild paralysis is too mild for this case since the range of motion is fairly limited. So, the best category for our condition would be moderate paralysis: “the nerve is not completely paralyzed, and there is tingling, numbness, moderate pain, or other symptoms that definitely and significantly interfere with the ability of the body part to fully function.” Yep.

Now that we have determined the severity of paralysis, we can find the proper rating under the trigeminal nerve section. The code for this condition is 8205, and the rating under moderate paralysis is 10%.

Alright, so we know that the nerve rating for this condition under code 8205 is 10%. Now we need to determine what his condition would rate for limited motion of the jaw (mandible). Underneath each of the ratings for the individual nerves below is a section that gives the codes the limited motions for that nerve, if there are any. Many of the cranial nerves do not have corresponding limited motion codes. In this case, limited motion of the jaw is rated under code 9902. This code rates limited motion of the mandible at 50%.

Since 50% under limited motion is far more than the 10% given under the nerve code, this condition would be rated on limited motion. The final code would look like this: 8205-9902. The first four-digit code defines the condition as a paralyzed trigeminal nerve. The second four-digit code tells us that the condition was rated under limited motion of the mandible.

That’s it. Just remember to figure out which nerve category and severity the condition best fits and then find the rating for limited motion. Choose the highest rating.

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The Cranial Nerves

The Trigeminal Nerve
The Facial Nerve
The Glossopharyngeal Nerve
The Vagus Nerve
The Spinal Accessory Nerve
The Hypoglossal Nerve

 


The Trigeminal Nerve (a.k.a. fifth cranial nerve or fifth nerve) extends from the brain to the face and jaw muscles. It divides into the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. Any condition of these nerves is rated here. The trigeminal nerve provides feeling to the skin of the face, and controls the biting and chewing motions.

A condition of the trigeminal nerve is rated under one of the following codes with the corresponding ratings.

Code 8205: Paralysis of the trigeminal nerve. Complete paralysis: If the jaw is unable to move at all and the skin of the face has lost all sensation, it is rated 50%. Incomplete, severe paralysis is rated 30%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8305: Neuritis of the trigeminal nerve. If the condition causes severe symptoms, it is rated 30%. If it causes moderate symptoms, it is rated 10%. There is no rating given for mild neuritis.

Code 8405: Neuralgia of the trigeminal nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

Limited motion of the jawbone (mandible) is rated under code 9902.

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The Facial Nerve (a.k.a. seventh cranial nerve) extends from the brain to the face and mouth. It is responsible for moving the facial muscles that are used to make facial expressions, and it helps in tasting.

A condition of the facial nerve is rated under one of the following codes with the corresponding ratings.

Code 8207: Paralysis of the facial nerve. Complete paralysis: If the face cannot make facial expressions, and the ability to taste is decreased, it is rated 30%. Incomplete, severe paralysis is rated 20%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8307: Neuritis of the facial nerve. If the condition causes severe symptoms, it is rated 20%. If it causes moderate symptoms, it is rated 10%. No rating is given for mild neuritis.

Code 8407: Neuralgia of the facial nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

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The Glossopharyngeal Nerve (a.k.a. ninth cranial nerve) extends from the brain to the ears, throat, and tongue. It provides feeling to the throat and tonsils, helps sense tastes, and controls the movements of swallowing.

A condition of the glossopharyngeal nerve is rated under one of the following codes with the corresponding ratings.

Code 8209: Paralysis of the glossopharyngeal nerve. Complete paralysis: If it is difficult or impossible to swallow, it is rated 30%. Incomplete, severe paralysis is rated 20%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8309: Neuritis of the glossopharyngeal nerve. If the condition causes severe symptoms, it is rated 20%. If it causes moderate symptoms, it is rated 10%. No rating is given for a mild condition.

Code 8409: Neuralgia of the glossopharyngeal nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

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The Vagus Nerve (a.k.a. tenth cranial nerve or pneumogastric nerve) is an extremely important nerve. It connects the brain with all the internal organs in the chest and abdomen. This nerve reports to the brain on the state of the internal organs and how well they are functioning. It does not directly control the internal organs, but just acts mostly as a way for them to communicate with the brain. In addition, it controls the muscles used for speaking and swallowing and is responsible for lowering the heart rate. Damage to the vagus nerve often results in high heart rate (tachycardia) and high blood pressure.

A condition of the vagus nerve is rated under one of the following codes with the corresponding ratings.

Code 8210: Paralysis of the vagus nerve. Complete paralysis: If there is difficulty swallowing and speaking or if the heart or other internal organs are severely affected (uncontrollable high blood pressure, very high heart rate, etc.), it is rated 50%. Incomplete, severe paralysis is rated 30%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8310: Neuritis of the vagus nerve. If the condition causes severe symptoms, it is rated 30%. If it causes moderate symptoms, it is rated 10%. No rating is given for mild neuritis.

Code 8410: Neuralgia of the vagus nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

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The Spinal Accessory Nerve (a.k.a. eleventh cranial nerve or accessory nerve) is a branch of the accessory nerve. The root of the accessory nerve starts in both the brain and the spinal cord. The brain branch joins the vagus nerve, and so is rated as the vagus nerve. Only the spinal branch of the accessory nerve is rated here. This branch extends from the brain to the neck and shoulders. It controls the motions of shrugging the shoulders, rotating the head, and tilting the head front-to-back and side-to-side.

Code 8211: Paralysis of the spinal accessory nerve. Complete paralysis: If the shoulders are unable to shrug and the neck is unable to move at all, it is rated 30%. Incomplete, severe paralysis is rated 20%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8311: Neuritis of the spinal accessory nerve. If the condition causes severe symptoms, it is rated 20%. If it causes moderate symptoms, it is rated 10%. No rating is given for a mild condition.

Code 8411: Neuralgia of the spinal accessory nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

Code 8104: Paramyoclonus multiplex is a condition where the spinal accessory nerve causes the muscles in the neck, shoulders, and upper body to spasm regularly. If it is severe, it is rated 60%. Moderate is rated 10%, and mild is rated 0%.

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The Hypoglossal Nerve (a.k.a. twelfth cranial nerve) extends from the brain to the tongue. It controls all the movements of the tongue in speech, eating, and swallowing.

A condition of the hypoglossal nerve is rated under one of the following codes with the corresponding ratings.

Code 8212: Paralysis of the hypoglossal nerve. Complete paralysis: If the tongue is unable to move at all, it is rated 50%. Incomplete, severe paralysis is rated 30%. Incomplete, moderate paralysis is rated 10%. There is no rating for mild paralysis.

Code 8312: Neuritis of the hypoglossal nerve. If the condition causes severe symptoms, it is rated 30%. If it causes moderate symptoms, it is rated 10%. No rating is given for a mild condition.

Code 8412: Neuralgia of the hypoglossal nerve. Neuralgia cannot be rated higher than moderate, even if it is considered severe. If the condition is moderate, it is rated 10%. There is no rating given for a mild condition.

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Other Nervous Conditions

Make sure to check the other Nervous System pages for your condition. If your condition cannot be found, then it is rated analogously (see the Analogous and Equivalent Codes page) with the nervous system code that best defines the condition. The bottom-line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQ for Cranial Nerve Conditions

Here is the Disability Benefits Questionnaire (DBQ) used for cranial nerve conditions: Cranial Nerve Conditions DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if a mental disorder or another condition exists that is additional to the nervous condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in the area will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical car (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.


For mental and psychiatric conditions, please see the Mental Disorders page. For conditions of the peripheral nerves, see the Nerves of the Upper Back and Arms and the Nerves of the Low Back and Legs pages. For TBI, see the Traumatic Brain Injury (TBI) page. For all other nervous system conditions, see The Central Nervous System page.

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