Citation Nr: 22018002 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 15-28 391 DATE: March 27, 2022 REMANDED Entitlement to a disability rating in excess of 10 percent for visual impairment associated with left abducens palsy is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Army from October 1958 to August 1961. This case was most recently before the Board in January 2021, at which time it was remanded for additional development. The case has since returned to the Board for appellate consideration. Entitlement to a disability rating in excess of 10 percent for left abducens palsy While the issue on appeal was with the Regional Office for additional development, the Veteran was scheduled for another VA eye examination, which he underwent in January 2022. The examiner wrote that the Veteran's left abducens palsy caused diplopia when trying to gaze to the left, for which the Veteran compensated by turning his head to the left. Current symptoms consisted of "diplopia with extreme left gaze." However, the examiner later indicated that the Veteran did not have diplopia and thus did not conduct visual field testing or otherwise indicate in the examination report the areas where diplopia was present. Based on this inconsistency, the Board finds that remand is warranted to schedule the Veteran for another VA eye examination to determine the extent of any documented diplopia related to left abducens palsy. The Veteran also underwent a VA cranial nerves examination in January 2022. The examiner indicated that the Veteran's left abducens palsy affected left cranial nerve V (trigeminal), and that symptoms included moderate intermittent pain of the left upper face, eyelid, and/or forehead; moderate paresthesias and/or dysesthesias of the left upper face, eyelid, and/or forehead; mild difficulty swallowing, and mild increased salvation. Muscle strength testing showed mild paralysis of left cranial nerve VII (facial) and decreased sensation of left cranial nerve V. In her summary evaluation, the examiner determined that the Veteran had moderate incomplete paralysis of left cranial nerve V. However, the Board notes that the evidence prior to the January 2022 cranial nerves examination, including VA treatment records and multiple VA eye examination reports, noted that the Veteran's abducens palsy involved only cranial nerve VI. Under the schedule for rating diseases of the cranial nerves, disability from lesions of peripheral portions of the first, second, third, fourth, sixth, and eighth nerves will be rated under the organs of special sensein this case, visual impairment. See 38 C.F.R. § 4.124a. Given the conflicting information concerning which cranial nerves are affected by service-connected left abducens palsy, the Board finds that remand is warranted for an examination to clarify the extent of any involvement of cranial nerves other than cranial nerve VI to assist in determining whether the Veteran has residual cranial nerve involvement that would warrant a separate disability rating, in addition to the rating currently assigned for visual impairment. The matter is REMANDED for the following actions: 1. Schedule the Veteran for an examination by an optometrist or ophthalmologist to determine the current severity of his service-connected left abducens palsy. In particular, the examiner is asked to evaluate the severity of any diplopia present. The examiner must review pertinent documents in the claims file in conjunction with the examination. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 2. Schedule the Veteran for a VA cranial nerves examination to assist in determining the nature and extent of any additional cranial nerve involvement associated with left abducens palsy. All necessary tests and studies should be accomplished, and the examiner should provide a complete rationale for all conclusions reached. (Continued on the next page) In particular, the examiner is asked to identify and clarify any residuals of the Veteran's left abducens palsy, separate from vision impairment, as well as any additional residuals, including all resulting or overlapping symptomatology. For instance, the Board is mindful that the Veteran is currently service connected for vision impairment; however, it is unclear whether the mild paralysis of left cranial nerve VII (facial) and moderate incomplete paralysis of left cranial nerve V (trigeminal) results in overlapping symptomatology or distinct residuals which would potentially be compensable under an alternate diagnostic code regarding disease of the cranial nerves. Therefore, the examiner is asked to consider and discuss the report of the January 2022 VA cranial nerves examination in determining the extent of and severity of the Veteran's disability. 3. Then, readjudicate the claim. If the claim remains denied, issue a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. T. Raftery, 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.