Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The most common form of paralysis of the VIIth cranial nerve is Bell's palsy. The VIIth cranial nerve is one of twelve pairs of nerves connected with the brain, which moves facial expression muscles, provides sensory input for taste in the anterior two-thirds of the tongue, and innervates the tear and salivary glands.

In most cases, the cause may be unknown. Manifestations of identified causes include tumors or lesions of the nerve or nerve root, or tumors of the temporal bone. Other causes include: surgery; infections; inflammatory processes such as herpes zoster; immune or viral disease; Lyme disease; trauma; sarcoidosis; leprosy; or certain syndromes such as Guillain-Barre.

Signs and symptoms may depend on the location of the lesion along the nerve. These manifestations may include: facial edema; drooping of the corners of the mouth; eyelids may remain open; the lower eyelid may sag; and tearing may be abnormal. Saliva may dribble from the corners of the mouth. In addition, there may be a sense of heaviness or numbness of the face; muscle weakness; contractures; pain behind the ear; loss of taste; sensitivity to loud sounds; or synkinesis.

Diagnostic measures may include: a complete history; physical and neurological examinations; sensory and motor tests; blood studies; spinal tap; computed tomography (CT) scan; magnetic resonance imaging (MRI); and electromyography (EMG).

Treatment may be directed to the specific underlying cause and symptoms. There may be need for eye protection during sleep, muscle massage, or a splint for the lower face to prevent drooping. Glucocorticosteroids may be given, and, in some cases, surgery may be needed.

In some cases where facial paralysis has been prolonged and where recovery of motor function is incomplete, there may be contractures of the facial muscles. Recovery from Bell's palsy may be prolonged, and there may be residual partial paralysis (regeneration of the nerve may be incomplete). Hemifacial spasm may develop in the future (see Diagnostic Code: 8103 Tic, convulsive).

• 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).

Notes

• Dependent upon relative loss of innervation of facial muscles.

• 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.