NEURALGIA OF THE FIFTH (TRIGEMINAL) CRANIAL NERVE

Summary

The veteran, who served from August 2005 to September 2006, appeals the denial of an increased rating for left trigeminal neuralgia and the denial of service connection for secondary conditions. The veteran sought an increased rating for left trigeminal neuralgia, currently rated at 10 percent. The Board reviewed the November 2024 VA examination report, which detailed severe incomplete paralysis of the trigeminal nerve, including constant severe facial pain, paresthesias, numbness, difficulty chewing, swallowing, speaking, increased salivation, gastrointestinal symptoms, blurred vision, dizziness, and sleep disturbance. The Board found this examination to be competent and probative, concluding that the veteran's symptoms more nearly approximated the criteria for a 30 percent rating, thus granting an increased rating to 30 percent. The Board found that the evidence did not support a higher rating as complete paralysis was not indicated. Additionally, the Board granted service connection for blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment as secondary to the service-connected trigeminal neuralgia, citing Morgan v. Wilkie and Bailey v. Wilkie, which allow for secondary claims when residual complications are reasonably raised by the record. The Board found these secondary conditions were clearly present and attributable to the primary condition, warranting secondary service connection.

Rationale

November 2024 VA examination report afforded significant probative weight; Symptoms included severe incomplete paralysis, moderate constant pain, severe intermittent pain, moderate dull pain, severe paresthesias/dyesthesias, severe numbness, difficulty chewing, swallowing, speaking, increased salivation, GI symptoms, blurred vision, dizziness, sleep disturbance, and severe left side muscle loss.; Evidence in approximate balance supports 30 percent rating

Full Decision Text

Citation Nr: A26027493
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 250313-523981
DATE: March 26, 2026

ORDER

Entitlement to an increased rating of 30 percent, but no higher, for left trigeminal neuralgia is granted.

Entitlement to service connection for blurred vision, secondary to left trigeminal neuralgia, is granted.

Entitlement to service connection for dizziness, secondary to left trigeminal neuralgia, is granted.

Entitlement to service connection for nausea/gastrointestinal symptoms, secondary to left trigeminal neuralgia, is granted.

Entitlement to service connection for sleep impairment, secondary to left trigeminal neuralgia, is granted.

FINDINGS OF FACT

1. The severity of the Veteran's left trigeminal neuralgia has more nearly approximated severe incomplete paralysis of the left trigeminal (5th) cranial nerve, but the evidence is persuasively against a finding of complete paralysis of the left trigeminal (5th) cranial nerve.

2. The Veteran experiences additional disabilities, to include blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment, due to left trigeminal neuralgia that is not contemplated by the rating criteria under 38 C.F.R. § 4.124a, Diagnostic Code 8205.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an increased rating of 30 percent, but no higher, for left trigeminal neuralgia have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§  4.1, 4.3, 4.124a, Diagnostic Code 8205.

2. The criteria for service connection for blurred vision, secondary to left trigeminal neuralgia, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. The criteria for service connection for dizziness, secondary to left trigeminal neuralgia, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for service connection for nausea/gastrointestinal symptoms, secondary to left trigeminal neuralgia, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

5. The criteria for service connection for sleep impairment, secondary to left trigeminal neuralgia, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active military service from August 2005 to September 2006.

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). Here, the February 2025 rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ), denied the Veteran's claim to an increased rating in excess of 10 percent for trigeminal neuralgia. The February 2025 rating decision constitutes an initial decision; therefore, the AMA applies. 

The Veteran appealed the decision by submitting a March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)). The Veteran elected the Direct Review docket. As a result, the Board may only consider the evidence of record at the time of the February 2025 rating decision on appeal.

Analysis

1. Entitlement to an increased 30 percent rating, but no higher, for left trigeminal neuralgia is granted.

The Veteran seeks an increased rating for his trigeminal neuralgia. The Veteran is in receipt of 10 percent ratings pursuant to Diagnostic Code 8205 which addresses neuralgia of the fifth (trigeminal) cranial nerve. See 38 C.F.R. § 4.124(a).

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R
 record at the time of the February 2025 rating decision on appeal.

Analysis

1. Entitlement to an increased 30 percent rating, but no higher, for left trigeminal neuralgia is granted.

The Veteran seeks an increased rating for his trigeminal neuralgia. The Veteran is in receipt of 10 percent ratings pursuant to Diagnostic Code 8205 which addresses neuralgia of the fifth (trigeminal) cranial nerve. See 38 C.F.R. § 4.124(a).

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

Under 38 C.F.R. § 4.124(a), Diagnostic Code 8205, a 10 percent disability rating is assigned where the evidence shows incomplete moderate paralysis of the trigeminal nerve. A 30 percent disability rating is appropriate for disabilities marked by incomplete severe paralysis of the trigeminal nerve. A 50 percent disability rating is warranted where the evidence shows that there has been complete paralysis of the trigeminal nerve. The terms "moderate," and "severe" are not defined in the rating schedule, and the Board must evaluate the evidence of record and reach a decision that is equitable and just. See 38 C.F.R. § 4.6.

According to Merriam-Webster's Dictionary, "mild" means not very severe, "moderate" means limited in scope or effect, and "severe" means very painful or harmful or of a great degree. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary. Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. 

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration.

Turning to the evidence of record, the November 2024 VA examiner concluded that the Veteran's left trigeminal neuralgia is manifested by severe incomplete paralysis due to symptoms of moderate constant pain, severe intermittent pain on the left side of the upper face, mid face, and lower face. Further, moderate dull pain, on the left side of the upper face, mid face, lower face and side of mouth/throat. Severe paresthesias and/or dyesthesias on the left side of upper face, and mild on the left side of the mid face, lower face, and side of mouth/throat. There was severe numbness on the left side, upper face. The Veteran had severe difficulty chewing, swallowing, speaking, and severe difficulty with increased salivation, gastrointestinal symptoms, and other symptoms that include blurred vision, dizziness, and sleep disturbance. There was severe left side muscle loss. The facial sensation was absent. The VA examiner explained that the impact of the Veteran's condition is that he experiences sudden, severe, recurrent facial pain with nausea and vomiting that impair daily function. The chronic and severe nature of the pain causes emotional distress and anxiety, further affecting the overall quality of life. The severe pain led to social isolation and reduced participation in daily life.

Upon review, the Board affords significant
 lower face, and side of mouth/throat. There was severe numbness on the left side, upper face. The Veteran had severe difficulty chewing, swallowing, speaking, and severe difficulty with increased salivation, gastrointestinal symptoms, and other symptoms that include blurred vision, dizziness, and sleep disturbance. There was severe left side muscle loss. The facial sensation was absent. The VA examiner explained that the impact of the Veteran's condition is that he experiences sudden, severe, recurrent facial pain with nausea and vomiting that impair daily function. The chronic and severe nature of the pain causes emotional distress and anxiety, further affecting the overall quality of life. The severe pain led to social isolation and reduced participation in daily life.

Upon review, the Board affords significant probative weight to the competent medical evidence of the November 2024 VA examination report. Here, the Board finds that the November 2024 VA examination report is based on a review of the claims file, consideration of the Veteran's statements, and examination of the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Based on the facts described above, the Board finds that an increased rating of 30 percent rating, but no higher, for left trigeminal neuralgia is warranted. The severity of the Veteran's left trigeminal neuralgia more nearly approximates the criteria for severe, incomplete paralysis of the trigeminal nerve. In this regard, the November 2024 VA examination report shows that the Veteran's left neuralgia of the trigeminal nerve has resulted in severe incomplete paralysis. As noted above, the VA examiner noted additional symptoms that include severe difficulty chewing, swallowing, speaking, and severe difficulty with increased salivation, gastrointestinal symptoms, and other symptoms that include blurred vision, dizziness, and sleep disturbance. Accordingly, as the evidence is in approximate balance, the Board finds that the Veteran's symptoms more nearly approximates the criteria for a 30 percent rating. 

Next, the Board finds that an increased rating higher than 30 percent is not warranted as the evidence of record does not reflect, nor otherwise suggest, the Veteran's left neuralgia of the trigeminal nerve more closely approximates complete paralysis of the trigeminal nerve. The evidence of record reflects that the Veteran's symptoms of left neuralgia of the trigeminal nerve have, at most, been manifested by moderate constant pain, severe intermittent pain, moderate dull pain, severe paresthesias and/or dyesthesias, and severe numbness. Notably, the November 2024 VA examiner did not conclude that the Veteran experienced complete paralysis for his disability. The Board acknowledges that the November 2024 examination reflects that the Veteran experiences decreased sensation to light touch for facial sensation which may indicate the presence of complete paralysis. However, the VA examiner considered this and opined that the Veteran's left trigeminal neuralgia is not manifested by complete paralysis. Further, the Veteran's medical records do not reflect that the Veteran experiences complete paralysis. Thus, neither complete paralysis nor its approximation is indicated. As such, the Board finds that an increased rating higher than 30 percent are not warranted for left and trigeminal neuralgia.

In summary, the Board finds that an increased rating of 30 percent, but no higher, for the Veteran's left trigeminal neuralgia is warranted. To the extent that the Veteran contends entitlement to higher ratings, the most probative evidence of record persuasively weighs against the claims, the benefit-of-the-doubt doctrine does not apply, and any further increased rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

2. Entitlement to service connection for blurred vision, secondary to left trigeminal neuralgia, is granted.

3. Entitlement to service connection for dizziness, secondary to left trigeminal neuralgia, is granted.

4. Entitlement to service connection for nausea/gastrointestinal symptoms, secondary to left trigeminal neuralgia, is granted.

5. Entitlement to service connection for sleep impairment, secondary to left trigeminal neuralgia, is granted.

In addition to the impairment discussed above, the Board notes the Veteran's November 2024 VA examiner noted several symptoms that result in functional impairment in earning capacity that are not contemplated by the rating criteria under 38 C.F.R. § 4.124a, Diagnostic Code 8205.  More specifically, these additional disabilities include blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment - other symptoms related to pain, numbness, paresthesias and/or dysesthesias, loss of muscle strength, and associated movement of face
, secondary to left trigeminal neuralgia, is granted.

5. Entitlement to service connection for sleep impairment, secondary to left trigeminal neuralgia, is granted.

In addition to the impairment discussed above, the Board notes the Veteran's November 2024 VA examiner noted several symptoms that result in functional impairment in earning capacity that are not contemplated by the rating criteria under 38 C.F.R. § 4.124a, Diagnostic Code 8205.  More specifically, these additional disabilities include blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment - other symptoms related to pain, numbness, paresthesias and/or dysesthesias, loss of muscle strength, and associated movement of face and jaw are contemplated by the rating assigned under Diagnostic Code 8205.

In Morgan v. Wilkie, 31 Vet. App. 162 (2019), the United States Court of Appeals for Veterans Claims (Court) address this scenario and held VA must ensure it exhausts all schedular alternatives, to include secondary service connection, before resorting to the last resort of an extra-schedular referral to compensate a claimant for functional impairment not contemplated by the applicable rating criteria.  The Court expanded upon this notion in Bailey v. Wilkie, 33 Vet. App. 188 (2021) and held that, pursuant to 38 C.F.R. § 3.155(d)(2), it is not necessary for a claimant to file a formal secondary service connection claim for additional complications related to a service-connected disability when such residual complications are reasonably raised by the record during the rating period for the primary disability.

In accordance with this case law, the Board finds secondary service connection is warranted for disabilities manifest by blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment.  The November 2024 VA examiner's report establishes this impairment is clearly present in the Veteran's case and attributable to his service-connected left trigeminal neuralgia.  This impairment is only contemplated by the criteria under 38 C.F.R. § 4.124a to the extent that the regulation indicates such impairment should be rated "referring to the appropriate bodily system of the schedule."  As a result, when reasonable doubt is resolved in the Veteran's favor, the Board finds secondary service connection for blurred vision, dizziness, nausea/gastrointestinal symptoms, and sleep impairment is warranted in accordance with the holdings in Morgan and Bailey, as well as authorized under the provisions of 38 C.F.R. § 4.124a.  To this extent, the Veteran's appeal is also granted.

 

M. HYLAND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Ivan Franklin.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.