NEURALGIA, CRANIAL OR PERIPHERAL

Summary

The Veteran, an Army veteran who served from September 1982 to September 1985, appeals the denial of an initial disability rating higher than 0 percent for residuals of an in-service rhinoplasty, specifically paralysis of the fifth cranial nerve. The Veteran sought an initial rating for this condition, claiming persistent numbness and pain in his nose since the surgery. The Board reviewed evidence including the Veteran's statements and non-VA treatment records from December 2010 and December 2015, which noted these symptoms. The Board also considered the Veteran's testimony from a December 2020 hearing. However, a June 2021 VA examination report could not be considered as it was not part of the record at the time of the initial rating decision. The Board applied the benefit-of-the-doubt doctrine, finding the evidence in relative equipoise regarding whether the residuals manifested as moderate incomplete paralysis. The Board defined 'moderate' as tending toward the mean or average effect and 'severe' as of a great degree, referencing the M21-1 manual for guidance. Ultimately, the Board found the evidence supported a 10 percent rating for moderate, incomplete paralysis of the fifth cranial nerve, but not a higher rating for severe or complete paralysis, as the evidence did not demonstrate such a level of impairment. Service connection for residuals of rhinoplasty with a 10 percent rating was granted.

Rationale

Evidence in relative equipoise regarding moderate incomplete paralysis of the fifth cranial nerve.; Benefit of the doubt afforded to the Veteran.; Evidence did not demonstrate severe or complete paralysis.

Full Decision Text

Citation Nr: A26034392
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 210816-179462
DATE: April 14, 2026

ORDER

Entitlement to an initial disability rating of 10 percent, but no higher, for residuals of a rhinoplasty (paralysis of the fifth cranial nerve) is granted.

FINDING OF FACT

The evidence is in relative equipoise as to whether the Veteran's rhinoplasty residuals manifested as moderate incomplete paralysis of the fifth cranial nerve during the period under consideration.

CONCLUSION OF LAW

The criteria for an initial disability rating of 10 percent, but no higher, for moderate incomplete paralysis of the fifth cranial nerve have been met.  38 U.S.C. §§ 1155; 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8405.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from September 1982 to September 1985.

The rating decision on appeal was issued in June 2021 by a Department of Veterans Affairs (VA) Regional Office, which serves as the Agency of Original Jurisdiction (AOJ).

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On March 7, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the June 2021 decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to an initial compensable disability rating for service-connected neurological residuals of a rhinoplasty.

The Veteran is seeking an initial disability rating higher than 0 percent for his service-connected residuals of a rhinoplasty (paralysis of the fifth cranial nerve).

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule).  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability.  Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran.  See 38 C.F.R. § 4.3.

The Veteran is currently assigned a noncompensable, or 0 percent, disability rating for the service-connected residuals of a rhinoplasty under 38 C.F.R. § 4.124a, Diagnostic Code 8499-8405, by analogy for neuralgia of the fifth cranial nerve.

Neuritis of this nerve is rated under Diagnostic Code 8305; neuralgia of this nerve is rated under Diagnostic Code 8405.

Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated
 in favor of the Veteran.  See 38 C.F.R. § 4.3.

The Veteran is currently assigned a noncompensable, or 0 percent, disability rating for the service-connected residuals of a rhinoplasty under 38 C.F.R. § 4.124a, Diagnostic Code 8499-8405, by analogy for neuralgia of the fifth cranial nerve.

Neuritis of this nerve is rated under Diagnostic Code 8305; neuralgia of this nerve is rated under Diagnostic Code 8405.

Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis.  The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.  38 C.F.R. § 4.123.  Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis.  38 C.F.R. § 4.124.

Pursuant to Diagnostic Code 8405, moderate, incomplete paralysis of the fifth cranial nerve warrants a 10 percent disability rating.  Severe, incomplete paralysis warrants a 30 percent disability rating.  Complete paralysis of the fifth cranial nerve warrants a 50 percent disability rating.  

The Note to Diagnostic Code 8205 for paralysis of the fifth cranial nerve explains that the level of disability is dependent upon the relative degree of sensory manifestation or motor loss.

Diagnostic Code 8405 does not define the terms "moderate" or "severe."  If the applicable rating criteria include subjective terms of degree, the Board must define those terms.  See Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018).  The Merriam-Webster Dictionary defines moderate as "tending toward the mean or average amount or dimension" or "limited in scope or effect" and severe as "of a great degree."  See MERRIAM-WEBSTER.COM, https//www.merriam-webster.com/dictionary (last visited April 6, 2026).

VA's Adjudication Procedures Manual (M21-1) also offers a discussion on evaluating the severity of neurological disorders.  Although the Board is not bound by the M21-1, the standards provided in the M21-1 are "relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims," which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision.  Healey v. McDonough, 33 Vet. App. 312 (2021); Overton v. Wilkie, 30 Vet. App. 257 (2018).

The Board finds the section that provides guidance on evaluating completely sensory peripheral nerve impairment to be instructive. Per the M21-1, the mild level of evaluation would be more reasonably assigned when sensory symptoms are recurrent but not continuous, assigned lower medical grade reflecting less impairment, or affecting a smaller are in the nerve distribution.  The moderate level of evaluation should be reserved for the most significant and disabling cases of sensory-only involvement.  These are cases where the symptoms are continuous, assigned a higher medical grade reflecting greater impairment, or affecting a larger area in the nerve distribution.  See M21-1, § V.iii.12.A.2.b.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

After conducting a holistic analysis, the Board concludes the evidence is at least in balance as to whether the Veteran's rhinoplasty residuals manifested as moderate incomplete paralysis of the fifth cranial nerve during the period under consideration.  Therefore, an initial 10 percent disability rating, but no higher, is warranted.

In
 the evidence is in relative equipoise, the veteran prevails.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

After conducting a holistic analysis, the Board concludes the evidence is at least in balance as to whether the Veteran's rhinoplasty residuals manifested as moderate incomplete paralysis of the fifth cranial nerve during the period under consideration.  Therefore, an initial 10 percent disability rating, but no higher, is warranted.

In his December 2010 claim for service connection and in numerous other statements, the Veteran reported his nose was numb and sore as a result of an in-service rhinoplasty.

VA treatment records also show the Veteran regularly reported experiencing nose numbness and discomfort as a result of the surgery during the period under consideration.

A December 2015 non-VA treatment record notes the Veteran complained of numbness and pain on the tip and sides of his nose.  The treating physician noted that he explained to the Veteran the numbness and pain were secondary to the rhinoplasty.

The Veteran testified during a December 2020 Board hearing that the left and right sides of his nose had been numb and painful since his in-service rhinoplasty.

The Veteran was provided a VA cranial nerves examination in June 2021, but the Board cannot consider the examination report as evidence because it was not of record when the June 2021 rating decision was issued. 

After considering the above and affording the Veteran the benefit of the doubt, the Board finds the Veteran's rhinoplasty residuals manifested as moderate incomplete paralysis of the fifth cranial nerve with constant numbness and pain during the period under consideration.  The Board finds the constant or continuous nature of the Veteran's numbness and pain amounts to moderate, incomplete paralysis of the fifth cranial nerve.  See M21-1, § V.iii.12.A.2.b.

However, there was no evidence determinative of severe incomplete paralysis or complete paralysis during the period under consideration to warrant a disability rating in excess of 10 percent.  The Veteran's statements and treatment records do not indicate a severe level of numbness or pain or the involvement of non-sensory impairment. 

In sum, the Board finds the evidence is in relative equipoise as to Veteran's rhinoplasty residuals manifested as moderate incomplete paralysis of the fifth cranial nerve throughout the period on appeal.  Resolving reasonable doubt in the Veteran's favor, the criteria for an initial disability rating of 10 percent, but no higher, have been met. 

 

William Skowronski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Fields, Ashley N.

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.