Reasonable Hypothesis [1] | 77 of 2015 |
Balance of Probabilities [2] | 78 of 2015 |
SOP Bulletin 184 [3]
There are two SOPs concerning the trigeminal (5th cranial) nerve, being trigeminal neuralgia and trigeminal neuropathy. The trigeminal nerve provides sensation to the face, the top of the head, gums and anterior tongue, and motor function to the muscles of mastication (chewing).
Trigeminal neuralgia is a paroxysmal facial pain disorder in the trigeminal nerve sensory distribution which is precipitated by various innocuous stimuli and the paroxysms are of short duration and are separated in time by asymptomatic intervals.
Trigeminal neuropathy is a disease or injury of the trigeminal nerve or ganglion which involves loss of function of the trigeminal nerve, with objective signs as well as symptoms.
There are other facial pain syndromes that are not covered by either SOP.
To confirm the diagnosis a report from a specialist neurologist is required.
* another SOP applies - the SOP has the same name unless otherwise specified
# non-SOP condition
The clinical onset is the earliest time prior to the confirmation of the disease, that the pathognomonic set of symptoms could be documented.
A clinical worsening in an episodic disorder such as trigeminal neuralgia is not simply triggering an episode of pain, but would require that the whole episodic pain pattern is worse in intensity, and or increased in frequency and for aggravation (as opposed to aggravation of signs and symptoms) that this clinical worsening is permanent.
If it is thought that there is a clinical worsening, it is recommended that an expert opinion be sought from a neurologist to evaluate whether the clinical worsening was out of keeping with the natural history of the underlying pathology.
Bajwa et al (2014)[i] [4] states “the course of TN [trigeminal neuralgia] is variable” and “Episodes may last weeks or months, followed by pain-free intervals”, “Recurrence is common..” and “Most often, the condition tends to wax and wane in severity and frequency of pain exacerbations” and “however, there are no pure natural history studies of TN, most likely because the severity of the pain leads to intervention.”
[i] [5] Bajwa, Z., Ho, C. and Khan, S. 2014, ‘Trigeminal neuralgia’, UpToDate, September 3rd, http://www.uptodate.com/contents/trigeminal-neural... [6]
Place holder node for Rulebase for trigeminal neuralgia
Trigeminal neuralgia - Cerebral malaria Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8156]
8606 [8] there is some evidence that cerebral malaria may be a factor in the development of the condition under consideration.
8194 [8] the veteran has suffered from cerebral malaria at some time.
8195 [9] the veteran suffered from cerebral malaria prior to the clinical onset of trigeminal neuralgia. [10]
8196 — the veteran has established the causal connection between the cerebral malaria and operational service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8196]
8197 — the cerebral malaria is causally related to operational service. [11]
Trigeminal neuralgia - Connective tissue disease Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8154]
8603 [12] there is some evidence that a connective tissue disease may be a factor in the development of the condition under consideration.
8184 — the veteran has suffered from a connective tissue disease at some time.
6563 [13] the veteran has had scleroderma at some time.
or
8615 [14] the veteran has had Sjogren's syndrome at some time.
or
2576 [15] the veteran has had systemic lupus erythematosus at some time. or
or
8617 [17] the veteran has had mixed connective tissue disease at some time.
8186 [18] the veteran suffered from the identified illness or injury, a connective tissue disease, prior to the clinical onset of trigeminal neuralgia. [19]
8187 — the veteran has established the causal connection between the identified illness or injury, a connective tissue disease, and operational service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8187]
8188 — the identified illness or injury, a connective tissue disease, is causally related to operational service. [20]
Trigeminal neuralgia - Inability to obtain appropriate clinical management for trigeminal neuralgia Factor
Last reviewed for CCPS 10 March 1995.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [8158]
8204 [22] the clinical onset of the veteran's trigeminal neuralgia occurred after the end of the veteran's last period of VEA service. the veteran's trigeminal neuralgia permanently worsened. the veteran was unable to obtain appropriate clinical management for trigeminal neuralgia at some time.
8207 [25] the inability to obtain appropriate clinical management for trigeminal neuralgia contributed to the clinical worsening of the veteran's trigeminal neuralgia. 8209 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for trigeminal neuralgia and VEA service for the clinical worsening of trigeminal neuralgia. 8210 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for trigeminal neuralgia and operational service for the clinical worsening of trigeminal neuralgia. or 8211 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for trigeminal neuralgia and eligible service for the clinical worsening of trigeminal neuralgia. Clinical worsening and operational service [8210] or 8218 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for trigeminal neuralgia is causally related to operational service. [30] [31] Clinical worsening and eligible service [8211] or 8219 — the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for trigeminal neuralgia is causally related to eligible service. [30] [31]
Trigeminal neuralgia - Leprosy with cranial nerve involvement Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8157]
8607 [38] there is some evidence that leprosy with trigeminal nerve involvement may be a factor in the development of the condition under consideration.
8198 [38] the veteran has had leprosy with trigeminal nerve involvement at some time.
8200 [39] the leprosy involved the trigeminal nerve prior to the clinical onset of trigeminal neuralgia. [40]
8201 — the veteran has established the causal connection between the leprosy with trigeminal nerve involvement and operational service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8201]
8202 — the leprosy is causally related to operational service. [41]
Trigeminal neuralgia - Multiple sclerosis Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8151]
8600 [42] there is some evidence that multiple sclerosis may be a factor in the development of the condition under consideration.
8159 [42] the veteran has multiple sclerosis.
8160 [43] the veteran had multiple sclerosis prior to the clinical onset of trigeminal neuralgia. [44]
8161 — the veteran has established the causal connection between the multiple sclerosis and VEA service for the clinical onset of trigeminal neuralgia.
8164 — the veteran has established the causal connection between the multiple sclerosis and operational service for the clinical onset of trigeminal neuralgia.
or
8165 — the veteran has established the causal connection between the multiple sclerosis and eligible service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8164]
8166 — the multiple sclerosis is causally related to operational service. [45] [46]
Clinical onset and eligible service [8165]
8167 — the multiple sclerosis is causally related to eligible service. [47] [46]
Trigeminal neuralgia - Paget's disease of the skull Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8155]
8605 [48] there is some evidence that Paget's disease of the skull may be a factor in the development of the condition under consideration.
8189 [48] the veteran has had Paget's disease of the skull at some time. the veteran suffered from Paget's disease of the skull prior to the clinical onset of trigeminal neuralgia. [50]
8191 — the veteran has established the causal connection between the Paget's disease of the skull and VEA service for the clinical onset of trigeminal neuralgia.
8192 — the veteran has established the causal connection between the Paget's disease of the skull and operational service for the clinical onset of trigeminal neuralgia.
or
8193 — the veteran has established the causal connection between the Paget's disease of the skull and eligible service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8192]
5699 — the Paget's disease of bone is causally related to operational service. [51] [52]
Clinical onset and eligible service [8193]
5700 — the Paget's disease of bone is causally related to eligible service. [53] [52]
Trigeminal neuralgia - Tumour affecting the trigeminal nerve Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8152]
8601 [54] there is some evidence that a tumour affecting the trigeminal nerve may be a factor in the development of the condition under consideration.
8168 [54] the veteran has suffered from a tumour affecting the trigeminal nerve at some time.
8169 — tumour means an abnormal growth, and includes benign and malignant lesions. [Default true]
8170 [55] the veteran suffered from the identified illness or injury, a tumour affecting the trigeminal nerve, prior to the clinical onset of trigeminal neuralgia. [56]
8171 — the veteran has established the causal connection between the identified illness or injury, a tumour affecting the trigeminal nerve, and VEA service for the clinical onset of trigeminal neuralgia.
8172 — the veteran has established the causal connection between the identified illness or injury, a tumour affecting the trigeminal nerve, and operational service for the clinical onset of trigeminal neuralgia.
or
8173 — the veteran has established the causal connection between the identified illness or injury, a tumour affecting the trigeminal nerve, and eligible service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8172]
8174 — the identified illness or injury, a tumour affecting the trigeminal nerve, is causally related to operational service. [57] [58]
Clinical onset and eligible service [8173]
8175 — the identified illness or injury, a tumour affecting the trigeminal nerve, is causally related to eligible service. [59] [58]
Trigeminal neuralgia - Vascular anomaly affecting the trigeminal nerve Factor
Last reviewed for CCPS 10 March 1995.
Preliminary questions [8153]
8602 [60] there is some evidence that a vascular anomaly affecting the trigeminal nerve may be a factor in the development of the condition under consideration.
8176 [60] the veteran has a vascular anomaly affecting the trigeminal nerve.
8178 [61] the trigeminal nerve was affected by the vascular anomaly prior to the clinical onset of trigeminal neuralgia. [62]
8177 — the vascular anomaly affecting the trigeminal nerve is an illness or injury which is identifiable. [Default true]
8179 — the veteran has established the causal connection between the identified illness or injury, a vascular anomaly affecting the trigeminal nerve, and VEA service for the clinical onset of trigeminal neuralgia.
8180 — the veteran has established the causal connection between the identified illness or injury, a vascular anomaly affecting the trigeminal nerve, and operational service for the clinical onset of trigeminal neuralgia.
or
8181 — the veteran has established the causal connection between the identified illness or injury, a vascular anomaly affecting the trigeminal nerve, and eligible service for the clinical onset of trigeminal neuralgia.
Clinical onset and operational service [8180]
8182 — the identified illness or injury, a vascular anomaly affecting the trigeminal nerve, is causally related to operational service. [63] [64]
Clinical onset and eligible service [8181]
8183 — the identified illness or injury, a vascular anomaly affecting the trigeminal nerve, is causally related to eligible service. [65] [64]
Links
[1] http://www.rma.gov.au/SOP/15/077.pdf
[2] http://www.rma.gov.au/SOP/15/078.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20184.pdf
[4] http://awsp76.main.dva/#_edn1
[5] http://awsp76.main.dva/#_ednref1
[6] http://www.uptodate.com/contents/trigeminal-neuralgia?source=search_result&search=trigeminal+neuralgia&selectedTitle=1%7E150
[7] https://clik.dva.gov.au/user/login?destination=comment/reply/64200%23comment-form
[8] https://clik.dva.gov.au/standard-commentary-56
[9] clikpopup://CCPS/Cerebral malaria predates onset of trigeminal neuralgia
[10] clikpopup://CCPS/reject8195No
[11] clikpopup://CCPS/reject8197No
[12] https://clik.dva.gov.au/ccpsf002rc-3
[13] https://clik.dva.gov.au/ccpsj002rc-4
[14] https://clik.dva.gov.au/ccpsj002rc-6
[15] https://clik.dva.gov.au/ccpsf001rc-0
[16] clikpopup://CCPS/reject2576No
[17] https://clik.dva.gov.au/standard-commentary-61
[18] clikpopup://CCPS/Connective tissue disease predates onset of trigeminal neuralgia
[19] clikpopup://CCPS/reject8186No
[20] clikpopup://CCPS/reject8188No
[21] https://clik.dva.gov.au/ccpsother-31
[22] https://clik.dva.gov.au/screening
[23] clikpopup://CCPS/Reject/OnsetAfterService
[24] clikpopup://CCPS/Reject/NoPermanentWorsening
[25] clikpopup://CCPS/Trigeminal neuralgia/ACM - contributed to worsening
[26] clikpopup://CCPS/ACM/NoContribution
[27] clikpopup://CCPS/ACM/NotOpService
[28] clikpopup://CCPS/ACM/NotOperDuties
[29] clikpopup://CCPS/rejectwilful
[30] clikpopup://CCPS/ACM/NoIllness
[31] clikpopup://CCPS/reject8218,8219No
[32] clikpopup://CCPS/Trigeminal neuralgia/ACM - onset prior to operational service
[33] clikpopup://CCPS/ACM/OnsetFailOper
[34] clikpopup://CCPS/ACM/NotEligService
[35] clikpopup://CCPS/ACM/NotEligDuties
[36] clikpopup://CCPS/Trigeminal neuralgia/ACM - onset prior to eligible service
[37] clikpopup://CCPS/ACM/OnsetFailElig
[38] https://clik.dva.gov.au/ccpsf002rc-0
[39] clikpopup://CCPS/Leprosy involving the trigeminal nerve prior to onset of trigeminal neuralgia
[40] clikpopup://CCPS/reject8200No
[41] clikpopup://CCPS/reject8202No
[42] https://clik.dva.gov.au/ccpsf027rc-1
[43] clikpopup://CCPS/Multiple sclerosis predates onset of trigeminal neuralgia
[44] clikpopup://CCPS/reject8160No
[45] clikpopup://CCPS/reject8166No
[46] clikpopup://CCPS/reject8166,8167No
[47] clikpopup://CCPS/reject8167No
[48] https://clik.dva.gov.au/ccpsf002rc-2
[49] clikpopup://CCPS/reject8189No
[50] clikpopup://CCPS/reject8190No
[51] clikpopup://CCPS/reject5699No
[52] clikpopup://CCPS/reject5699,5700No
[53] clikpopup://CCPS/reject5700No
[54] https://clik.dva.gov.au/ccpsf002rc
[55] clikpopup://CCPS/Tumour affecting the trigeminal nerve predates onset of trigeminal neuralgia
[56] clikpopup://CCPS/reject8170No
[57] clikpopup://CCPS/reject8174No
[58] clikpopup://CCPS/reject8174,8175No
[59] clikpopup://CCPS/reject8175No
[60] https://clik.dva.gov.au/ccpsf002rc-10
[61] clikpopup://CCPS/Vascular anomaly affected the trigeminal nerve before onset of trigeminal neuralgia
[62] clikpopup://CCPS/reject8178No
[63] clikpopup://CCPS/reject8182No
[64] clikpopup://CCPS/reject8182,8183No
[65] clikpopup://CCPS/reject8183No