Accessory Nerve Paralysis (Cranial Nerve XI)

DC 8211Neurological38 CFR 4.124a, DC 8211

Damage to the eleventh cranial nerve (spinal accessory nerve), which controls the trapezius and sternocleidomastoid muscles. Causes shoulder droop, difficulty raising your arm above your head, and trouble turning your head. Often results from neck surgery, trauma, or tumors.

How the VA rates this condition

The VA rates this condition based on how much it affects your ability to work and carry out daily activities. The examiner will focus on the functional limitations your condition causes, not just the diagnosis itself.

Diagnostic code

DC 8211

Rating range

10% – 30%

Rating levels

Rating criteria are defined in 38 CFR 4.124a, DC 8211. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

Complete paralysis — you have total loss of trapezius and sternocleidomastoid function on the affected side with inability to shrug your shoulder or turn your head.

What the VA looks for

Complete loss of trapezius function
Complete inability to shrug shoulder
Severe scapular winging
Significant shoulder pain due to instability
Complete loss of sternocleidomastoid function

Common Pitfalls

⚠Not documenting the cause of nerve damage — the spinal accessory nerve can be injured during neck surgeries (lymph node biopsies, tumor removal), combat injuries, or physical trauma. Link the injury to your service clearly.
⚠Not filing for secondary shoulder conditions — accessory nerve damage causes chronic shoulder instability and pain that can lead to secondary conditions like frozen shoulder or rotator cuff problems.
⚠Failing to get EMG/nerve conduction studies — objective testing is important to confirm the nerve damage and distinguish accessory nerve paralysis from other causes of shoulder weakness.
⚠Not documenting occupational impact — difficulty lifting, reaching overhead, and carrying loads are significant functional limitations for many jobs. Describe specific work tasks you cannot perform.

Related DBQ Forms

DBQ Cranial Nerves Diseases

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

Accessory Nerve Paralysis (Cranial Nerve XI)

How the VA rates this condition

Diagnostic code

DC 8211

Rating range

10% – 30%

Rating levels

Rating Levels

Complete paralysis — you have total loss of trapezius and sternocleidomastoid function on the affected side with inability to shrug your shoulder or turn your head.

What the VA looks for

Complete loss of trapezius function
Complete inability to shrug shoulder
Severe scapular winging
Significant shoulder pain due to instability
Complete loss of sternocleidomastoid function

Common Pitfalls

⚠Not documenting the cause of nerve damage — the spinal accessory nerve can be injured during neck surgeries (lymph node biopsies, tumor removal), combat injuries, or physical trauma. Link the injury to your service clearly.

⚠Not filing for secondary shoulder conditions — accessory nerve damage causes chronic shoulder instability and pain that can lead to secondary conditions like frozen shoulder or rotator cuff problems.

⚠Failing to get EMG/nerve conduction studies — objective testing is important to confirm the nerve damage and distinguish accessory nerve paralysis from other causes of shoulder weakness.

⚠Not documenting occupational impact — difficulty lifting, reaching overhead, and carrying loads are significant functional limitations for many jobs. Describe specific work tasks you cannot perform.