Bulbar palsy is a worsening neurological condition characterized by progressive paralysis.

The paralysis is caused by deterioration of the nuclear cells of the lower cranial nerves. The cause of the deterioration is unknown.

The condition is characterized by progressive muscular weakness, stiffness, and variable wasting of affected muscles without sensory changes. Chewing, swallowing and talking become increasingly difficult. There is dysphagia, and respiratory complications occur as the condition progresses. Other manifestations may include: drooping of the palate; depressed gag reflex; pooling of the saliva in the pharynx; a weak cough; and a tremulous tongue.

The diagnosis is based on the age of onset of the condition (usually during middle or late adult life), and the progressive generalized motor involvement without sensory abnormalities. Diagnostic measures may include a biopsy of the muscles and electromyography (EMG) studies.

There is no specific treatment. Physical therapy is a part of the treatment, and a gastrostomy may be required for feeding. Antianxiety medications may be given to reduce spasms and anticonvulsants to decrease cramps. An anticholinergic may be given to reduce production of saliva. A tracheostomy may be necessary if respiratory muscles are affected.

Residuals will include progressive muscle paralysis, difficulty in breathing and swallowing, and, eventually, respiratory complications.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC)

• It is required for the minimum ratings for residuals under diagnostic codes 8000-8025, that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses.

• Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating disability from the conditions in the preceding sentence refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.  38 CFR 4.120

• With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves” 38 CFR 4.124a