Evidence Checklist: Sixth Cranial Nerve Paralysis

Neuro-ophthalmology evaluation documenting lateral rectus weakness and diplopiaCritical

A neuro-ophthalmologist's evaluation documenting horizontal diplopia, esotropia, failure of abduction of the affected eye, and degree of lateral gaze limitation. The VA rates based on severity of diplopia and visual field loss.

MRI brain/orbit with gadoliniumCritical

MRI to evaluate the sixth nerve course from pons to cavernous sinus to orbit, looking for compressive, demyelinating, or ischemic causes.

Nexus opinion linking sixth nerve palsy to service (at least as likely as not)Critical

Medical opinion connecting sixth cranial nerve palsy to in-service TBI, elevated intracranial pressure, skull base fracture, or meningitis during service.

Prism cover test and ocular motility measurement

Quantified ocular deviation measurement in prism diopters across the gaze field, documenting the extent of muscle paresis for rating purposes.

Treatment records (prism glasses, patching, strabismus surgery)

Records of Fresnel prism correction, occlusion patching for diplopia, or botulinum toxin injection and strabismus surgery.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Cranial Nerve ConditionsCritical

VA standardized form for DC 8209 (sixth cranial nerve) capturing diplopia severity, visual field limitation, and functional impact.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.