Trigeminal neuralgia or trigeminal neuropathy — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 84 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting trigeminal neuralgia or trigeminal neuropathy or death from trigeminal neuralgia or trigeminal neuropathy with the circumstances of a person's relevant service:

1. (1)
   having maxillary, sphenoid or frontal sinus barotrauma involving the affected trigeminal nerve, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;
2. (2)
   having one of the following traumatic injuries to the affected trigeminal nerve: (a) mechanical injury caused by compression, crush, transection or stretching; (b) chemical burn; (c) thermal burn; within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;
3. (3)
   having an injury to the affected trigeminal nerve as a result of a dental or surgical procedure or injury to the cornea as a result of surgical or laser treatment, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;
4. (4)
   undergoing one of the following procedures for the treatment of trigeminal neuralgia, involving the affected trigeminal nerve, within the 2 years before clinical onset or clinical worsening of trigeminal neuropathy: (a) fractionated stereotactic radiotherapy; (b) Gamma Knife radiosurgery; (c) microvascular decompression; (d) peripheral alcohol injection; (e) percutaneous rhizotomy, including chemical (glycerol) rhizolysis, mechanical balloon compression and radiofrequency thermocoagulation;
5. (5)
   undergoing a course of therapeutic radiation, where the affected trigeminal nerve was in the field of radiation, within the 1 year before clinical onset or clinical worsening of trigeminal neuropathy;
6. (6)
   having osteoradionecrosis of the mandible at the time of clinical onset or clinical worsening of trigeminal neuropathy;
7. (7)
   having bisphosphonate-related osteonecrosis of the jaw at the time of clinical onset or clinical worsening of trigeminal neuropathy;
8. (8)
   having vascular compression of the trigeminal nerve close to its point of entry into the brainstem, by one of the following: (a) tortuous or aberrant loop of arteries or veins; (b) haemangioma; (c) aneurysm; (d) venous sinus thrombosis; (e) arteriovenous malformation; at the time of clinical onset or clinical worsening of trigeminal neuralgia;
9. (9)
   having a mass lesion which compresses, displaces or infiltrates the affected trigeminal nerve, at the time of clinical onset or clinical worsening;

   Note: Examples of a mass lesion that can compress, displace or infiltrate the trigeminal nerve include a benign or malignant neoplasm, haematoma, abscess, granuloma, amyloidoma, cyst or benign fibro-osseous lesion.

10. (10)
    having cervical disc prolapse or cervical syringomyelia, involving the cervical spine at C4 or above, at the time of clinical onset or clinical worsening of trigeminal neuropathy;
11. (11)
    having one of the following inflammatory connective tissue diseases: (a) mixed connective tissue disease; (b) Sjögren syndrome; (c) systemic lupus erythematosus; (d) systemic sclerosis (scleroderma); at the time of clinical onset or clinical worsening;
12. (12)
    having rheumatoid arthritis or sarcoidosis at the time of clinical onset or clinical worsening of trigeminal neuropathy;
13. (13)
    having one of the following systemic vasculitides: (a) Behçet disease; (b) eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome); (c) giant cell arteritis; (d) granulomatosis with polyangiitis (Wegener granulomatosis); (e) polyarteritis nodosa; (f) Takayasu arteritis; at the time of clinical onset or clinical worsening of trigeminal neuropathy;
14. (14)
    having invasive bacterial or fungal paranasal sinusitis or viral meningoencephalitis, at the time of clinical onset or clinical worsening of trigeminal neuralgia;
15. (15)
    having one of the following infections involving the affected trigeminal nerve, at the time of clinical onset or clinical worsening of trigeminal neuropathy: (a) abscess; (b) Lyme disease (Borrelia burgdorferi infection); (c) brainstem meningitis or encephalitis; (d) herpes simplex virus infection; (e) invasive bacterial or fungal sinusitis; (f) leprosy (Mycobacterium leprae infection); (g) odontogenic infection; (h) osteomyelitis; (i) suppurative otitis media; (j) syphilis (Treponema pallidum infection);
16. (16)
    having acute herpes zoster involving the affected trigeminal nerve, within the 1 year before clinical onset or clinical worsening of trigeminal neuropathy;
17. (17)
    having infection with human immunodeficiency virus at the time of clinical onset or clinical worsening of trigeminal neuropathy;
18. (18)
    having multiple sclerosis at the time of clinical onset or clinical worsening;
19. (19)
    having Charcot-Marie-Tooth disease at the time of clinical onset or clinical worsening of trigeminal neuralgia;
20. (20)
    having a cerebrovascular accident (stroke) involving the brainstem within the 30 days before clinical onset or clinical worsening;
21. (21)
    having diabetes mellitus at the time of clinical onset or clinical worsening of trigeminal neuropathy;
22. (22)
    being treated with one of the following medications: (a) cisplatin; (b) hydroxystilbamidine isethionate (stilbamidine); (c) vincristine; for a continuous period of at least 7 days, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;
23. (23)
    inhaling, ingesting or having cutaneous contact with trichloroethylene on at least 30 occasions, within the 6 months before clinical onset or clinical worsening of trigeminal neuropathy;
24. (24)
    having an episode of acute intoxication, from inhaling, ingesting or having cutaneous contact with trichloroethylene or ethylene glycol, within the 30 days before clinical onset or clinical worsening of trigeminal neuropathy;
25. (25)
    having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 2 weeks of clinical onset of trigeminal neuralgia;

    Note: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).

26. (26)
    inability to obtain appropriate clinical management for trigeminal neuralgia before clinical worsening of trigeminal neuralgia;
27. (27)
    inability to obtain appropriate clinical management for trigeminal neuropathy before clinical worsening of trigeminal neuropathy;