Eleventh (spinal accessory, external branch) cranial nerve paralysis — VA Diagnostic Code 8211

The Diseases of the Cranial Nerves block says: Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor. The eleventh nerve is not in the special-sense list. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just. 38 CFR § 4.14 says the evaluation of the same disability under various diagnoses is to be avoided, and that the evaluation of the same manifestation under different diagnoses is to be avoided.

38 CFR § 4.123 says: “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. See nerve involved for diagnostic code number and rating. 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.” On this scale, severe incomplete paralysis is 20. Moderate is 10. There is no moderately severe line. The sciatic clause is a different nerve. DC 8311 prints “Neuritis.” and no percentage. 38 CFR § 4.124 says: “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. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve.” The tic douloureux sentence is not this nerve. DC 8411 prints “Neuralgia.” and no percentage. Moderate on this scale is 10.

The 2026-10-01 text of 38 CFR § 3.309 does not contain “spinal accessory,” “sternomastoid,” or “8211.” This page does not add DC 8211 to a presumptive row.

Source: 38 CFR § 4.124a, Diagnostic Code 8211, eCFR full-text XML for 2026-10-01. The source note prints 29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005; 73 FR 54705, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 76 FR 78824, Dec. 20, 2011; 79 FR 2100, Jan. 13, 2014.