Sixth Cranial Nerve Paralysis

DC 8209Neurological38 CFR 4.124a, DC 8209

Paralysis of the sixth cranial nerve (abducens nerve), which controls outward eye movement, causing the eye to turn inward and resulting in double vision. Rated based on the degree of nerve paralysis.

Rating Levels

You have complete paralysis of the sixth cranial nerve. The affected eye cannot move outward at all, resulting in constant inward turning of the eye and persistent double vision.

What the VA looks for

Complete inability to move the affected eye outward (abduct)
Constant inward turning of the eye (esotropia)
Persistent diplopia documented by Goldmann or diplopia field testing
Neurological examination confirming complete sixth nerve paralysis
Significant impact on visual function and daily activities

Common Pitfalls

⚠Not documenting diplopia (double vision) with a Goldmann visual field test or diplopia field testing — this objective evidence is critical for establishing the severity of your condition.
⚠Not connecting to TBI, head trauma, or stroke that may have caused the nerve damage — a clear nexus between the service event and nerve paralysis is essential.
⚠If both eyes are affected, file for each separately — bilateral sixth nerve palsy is rated independently for each eye.
⚠Consider whether a higher rating is available through visual impairment codes if visual acuity or field loss is significant — the VA should rate under whichever code provides the highest evaluation.

Related DBQ Forms

DBQ Cranial Nerves Diseases and Peripheral Nerves Diseases
DBQ Eye Conditions

View evidence checklist →See secondary conditions →

Condition Rating Guides

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

Rating Levels

You have complete paralysis of the sixth cranial nerve. The affected eye cannot move outward at all, resulting in constant inward turning of the eye and persistent double vision.

What the VA looks for

Complete inability to move the affected eye outward (abduct)
Constant inward turning of the eye (esotropia)
Persistent diplopia documented by Goldmann or diplopia field testing
Neurological examination confirming complete sixth nerve paralysis
Significant impact on visual function and daily activities

Common Pitfalls

⚠Not documenting diplopia (double vision) with a Goldmann visual field test or diplopia field testing — this objective evidence is critical for establishing the severity of your condition.

⚠Not connecting to TBI, head trauma, or stroke that may have caused the nerve damage — a clear nexus between the service event and nerve paralysis is essential.

⚠If both eyes are affected, file for each separately — bilateral sixth nerve palsy is rated independently for each eye.

⚠Consider whether a higher rating is available through visual impairment codes if visual acuity or field loss is significant — the VA should rate under whichever code provides the highest evaluation.