Trigeminal neuralgia, facial nerve palsy and disorders of cranial nerves IX to XII are documented for VA disability claims on this 8-page questionnaire. The clinician maps pain, numbness and paresthesias by facial zone and side, rates chewing, swallowing and speech difficulty, tests motor strength and facial sensation, then grades each nerve as unaffected, incompletely or completely paralyzed. VA uses that grading when it assigns the rating.
The Veteran's treating or examining clinician completes every section and signs the Section XI examiner's certification with NPI, license and specialty. No part is completed by the Veteran.
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Cranial Nerves Diseases Disability Benefits Questionnaire
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Yes. Cranial nerve V (trigeminal) is one of the nerves this form evaluates. The examiner records constant, intermittent or dull pain, paresthesias and numbness for the upper, mid and lower face on each side, tests jaw-clench strength and facial light-touch sensation, and then grades the degree of paralysis.
No. The cranial nerves form sends cranial nerve VIII problems to the Hearing Loss and Tinnitus questionnaire, but VA lists that DBQ among those not available for public use, explaining that federal regulations or specialized training limit who can complete it.