Citation Nr: 21071088 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 16-49 955 DATE: November 29, 2021 ORDER Entitlement to an increased rating higher than 30 percent for left trigeminal neuropathy is denied. FINDING OF FACT The Veteran's left trigeminal neuropathy manifested as severe, incomplete paralysis. CONCLUSION OF LAW The criteria for an evaluation higher than 30 percent for the Veteran's left trigeminal neuropathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.10, 4.27, 4.31, 4.120, 4.124a, DC 8205. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from August 1978 to July 1985. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to an increased evaluation higher than 30 percent for left neuropathy. The Veteran is currently in receipt of a 30 percent evaluation for left trigeminal neuropathy under DC 8205. Under DC 8205, a 10 percent rating is warranted for moderate incomplete paralysis of the fifth cranial nerve. A 30 percent rating is warranted for severe incomplete paralysis of the fifth cranial nerve. A 50 percent rating is warranted for complete paralysis of the fifth cranial nerve. A zero percent rating is assignable where the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. 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. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124. The Veteran underwent an examination in March 2014. The nerve affected is the cranial nerve V (trigeminal). The Veteran complained of a small patch of numbness of the left chin and muscle spasms. She had severe numbness in the left lower face, but normal muscle strength. The examiner concluded the Veteran had moderate incomplete paralysis of the left trigeminal cranial nerve. In an April 2014 statement from a treating dentist, the Veteran was noted to have no popping, clicking, or crepitus in her temporomandibular joint. She grimaced during the examination indicating pain, which appeared to be only during the closing motion on the left side. She was noted as having paresthesias. In an April 2014 statement, the Veteran reported experiencing chronic pain and numbness from her lower left jaw. In an April 2014 statement from her sister, she relayed witnessing the Veteran have difficulty opening her mouth due to pain and witness to the Veteran's complaints of numbness in her chin and jaw line. A record from Dr. M.N. in October 2016, noted the Veteran to have radiating pain to her ear, neck, and cervical regions of her head. The Veteran underwent an examination in November 2019 and was assessed as having left trigeminal neuropathy. She reported constant pain and numbness at the lower part of the left side of the face. She reported constant pain in the TMJ, which she relayed radiates to her ear, neck, and temple. There was no associated tingling. Muscle strength testing was normal. Sensory examination findings revealed decreased sensation of the left lower face. Cranial nerve V (trigeminal) summary was found to be incomplete and severe. The examiner stated the Veteran's headaches are not due to or a result of her left trigeminal neuropathy. The examiner indicated the Veteran's headaches were distinct from ear, neck, and cervical pain. VA denied service connection for headaches as a distinct issue in a November 2019 rating decision, and the Veteran did not appeal the decision. Her mother submitted a statement August 2021 stating that the Veteran continued to suffer from TMJ, and experiencing migraines and jaw clenching, which a physician attributed to her occasional use of Lortab. She stopped using the medication and still experienced the same symptoms. Her mother stated she believed the Veteran's migraines and jaw clenching are related to her TMJ. The Board notes there is no record of a medical provider attributing the use of Lortab to migraines and jaw clenching. In August 2021, a statement was received from L. J., stating he witnessed the Veteran suffer from muscle tension and headaches, and at times had to return home due to the constant pain. In September 2021, following a review of the claims file, the examiner stated ear, neck, and cervical pain is not due to or the result of the Veteran's trigeminal neuralgia. The examiner noted there is no treatment from a primary care provider or neurologist for these conditions. There is no mention of paralysis of the fifth trigeminal cranial nerve causing symptoms during treatment with Dr. M.N. Further, the memorandum from Dr. M. N. notes dental decay and TMJ joint condition. The examiner noted the fifth trigeminal cranial nerve is responsible for the sensation of the left side of the face and motor function of the muscles of mastication. The examiner found that the Veteran's ear pain has nothing to do with the fifth (trigeminal) cranial nerve. The Veteran previously stated pain radiates to her ear, which comes from a location not specified. The examiner noted the neck and cervical region pain is away from the cranial nerves sensory supply, as it is supplied by the cervical nerves. Further, the examiner found that the fifth (trigeminal) cranial nerve palsy causes a loss of sensation and motor function, not pain. Based upon a thorough review of the record, the Board concludes that the Veteran's incomplete paralysis of the right and left fifth (trigeminal) cranial nerve, has been manifested by no more than a severe degree of incomplete paralysis. To warrant an evaluation in excess of 30 percent under Diagnostic Code 8205, there must be evidence showing complete paralysis of the fifth cranial nerve and such has not been demonstrated. The November 2019 VA examiner specifically determined that the Veteran's nerve impairment was consistent with severe incomplete paralysis. Even though there are statements in support of her claim, there remains no mention of or observation by a medical provider, or otherwise, of complete paralysis of the fifth trigeminal nerve. The Veteran has not relayed that she has complete paralysis of the trigeminal nerve. There is no indication in the record, and the 2021 examiner explained there is no correlation between her ear and neck pain and her trigeminal neuralgia. Additionally, the Veteran is in receipt of service connection for TMJ. The Board appreciates the lay assertions provided by the Veteran, her mother, her sister, and other lay persons. They are competent to report the observed symptoms, but they are not competent to determine whether these symptoms are related to her service-connected left trigeminal neuropathy or are of a severity to warrant a higher rating. Neither the Veteran, nor those writing in on her behalf, have been shown to have the requisite medical expertise to make such a medical finding. The findings of the September 2021 VA examiner is the most probative evidence as to the nature and severity of her left trigeminal neuropathy. In reaching these findings, the examiner considered the Veteran's lay reports of symptoms, reviewed the medical record, and provided a detailed clinical assessment a to the severity of her disability. As such, the Veteran's left trigeminal neuropathy impairments are productive of no more than severe incomplete paralysis. Accordingly, the criteria for ratings in excess of 30 percent for severe incomplete paralysis of the right fifth (trigeminal) cranial nerve have not been met. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, Counsel 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.