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C&P Exam Prep: Seventh (Facial) Cranial Nerve, Neuritis
DBQ Overview
Interview + Physical- Form Name
- Cranial_Nerve_Conditions
- Form Code
- Cranial_Nerve_Conditions
- Page Count
- 8
- Examiner Type
- Neurologist or Physician
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of seventh (facial) cranial nerve neuritis, including motor deficits, sensory disturbances, autonomic dysfunction, and pain, in order to assign a disability rating under 38 CFR 4.124a, DC 8307. The examiner will determine the degree of incomplete or complete paralysis and associated functional impairment.
What the examiner evaluates:
- Degree of facial muscle weakness or paralysis (unilateral or bilateral)
- Ability to close eyelids completely (lagophthalmos)
- Presence and severity of facial drooping or asymmetry at rest and with movement
- Taste disturbance in the anterior two-thirds of the tongue
- Tear and saliva production abnormalities (decreased or increased lacrimation/salivation)
- Hyperacusis (sound sensitivity due to stapedius muscle involvement)
- Pain in or around the ear, face, or jaw (including constant, intermittent, or dull pain)
- Paresthesias, dysesthesias, or numbness along the facial nerve distribution
- Presence of synkinesis (abnormal involuntary co-movements)
- Difficulty speaking, chewing, or swallowing attributable to facial nerve dysfunction
- Gastrointestinal symptoms related to autonomic involvement
- Any visible disfigurement or scarring related to the condition
- Impact on occupational and daily functioning
- Results of relevant diagnostic studies (electromyography, nerve conduction velocity, MRI)
The examination is conducted in person in most cases and includes both an interview about your history and current symptoms as well as a hands-on neurological examination of facial function. You may be asked to perform facial expressions such as raising your eyebrows, smiling, puffing your cheeks, and closing your eyes tightly. The examiner will observe symmetry, strength, and completeness of movement. Bring all relevant medical records, imaging results, and nerve conduction study reports. In many states you have the right to record the examination; check your state's laws and notify the examiner before beginning.
Typical duration: 30-45 minutes
Facial Motor Function Assessment (House-Brackmann Scale or equivalent)
The degree of facial muscle weakness or paralysis affecting the forehead, eye closure, nasolabial fold, and mouth. Grades range from normal (Grade I) to complete paralysis (Grade VI).
What to expect:
The examiner will ask you to raise your eyebrows, wrinkle your forehead, close your eyes as tightly as possible, smile broadly, puff out your cheeks, and pucker your lips. They will observe and score symmetry and strength on the affected side compared to the unaffected side.
Key thresholds:
- Complete paralysis - no discernible movement on affected side — Complete paralysis rating under DC 8307 - highest rating tier
- Severe incomplete paralysis - marked loss of motor function with slight movement visible — Maximum rating for neuritis under DC 8307 per 38 CFR 4.123; neuritis is rated no higher than severe incomplete paralysis
- Moderate incomplete paralysis - obvious weakness but not disfiguring; some movement present — Mid-tier rating; maximum for neuritis without organic changes (loss of reflexes, muscle atrophy, sensory disturbances, constant pain)
- Mild incomplete paralysis - slight weakness, noticeable only on close inspection — Lower rating tier; consistent with sensory-only or minimal motor involvement
Tips:
- Perform these movements at your current maximum effort - do not exaggerate but do not hold back
- If your symptoms fluctuate, inform the examiner of your best and worst functional states
- If you experience fatigue with repeated facial movements, demonstrate this during the exam
- Note whether symptoms worsen with stress, illness, cold, or temperature changes
Pain considerations: If facial movement causes or worsens pain, clearly state this to the examiner so it is documented. Pain during function may affect the rating of functional impairment.
Eyelid Closure and Corneal Protection Test
Whether the affected eye can close completely, protecting the cornea. Incomplete closure (lagophthalmos) is a clinically significant finding that indicates moderate to severe motor involvement.
What to expect:
The examiner will observe whether your eye closes completely when you blink and when you squeeze your eye shut forcefully. They may also check for Bell's phenomenon (upward eye roll on attempted closure) as a protective mechanism.
Key thresholds:
- Complete inability to close eye — Supports severe incomplete or complete paralysis rating; also may warrant separate eye condition rating
- Partial closure with visible sclera at rest — Supports moderate to moderately severe incomplete paralysis
Tips:
- Tell the examiner if you use eye drops, tape your eye shut at night, or wear an eye patch to protect your cornea
- Mention any history of corneal abrasion, eye irritation, or vision changes secondary to incomplete closure
- Document any secondary eye conditions that have developed as a result of incomplete eye closure
Pain considerations: Eye irritation, dryness, or pain from incomplete closure should be described in detail, including frequency and impact on daily activities such as driving, reading, or working in front of screens.
Taste Sensation Testing (Anterior Two-Thirds of Tongue)
Integrity of the chorda tympani branch of the facial nerve, which carries taste sensation from the front two-thirds of the tongue. Loss or alteration of taste is a sensory indicator of facial nerve damage.
What to expect:
The examiner may apply sweet, salty, sour, or bitter substances to the front of your tongue while your tongue is extended, asking you to identify the taste without drawing the tongue back into your mouth.
Key thresholds:
- Complete loss of taste on affected side of anterior tongue — Significant sensory finding supporting at least moderate incomplete paralysis when combined with other deficits
- Partial or altered taste (dysgeusia) — Supports sensory impairment documentation; combined with motor deficits, elevates overall severity
Tips:
- Describe any changes in taste since the onset of your condition, including foods that taste different or absent
- Note if taste disturbance is constant or intermittent
- If you have noticed a metallic, absent, or distorted taste sensation, volunteer this information
Pain considerations: Not directly applicable to taste testing, but note any pain or discomfort in the ear or jaw associated with taste changes, as these may indicate involvement of the chorda tympani and nearby structures.
Lacrimation and Salivation Assessment
Autonomic function of the facial nerve, specifically tear production (greater petrosal nerve branch) and saliva production (chorda tympani branch). Both decreased and increased production are abnormal findings.
What to expect:
The examiner will ask you about dry eye symptoms, excessive tearing, dry mouth, or drooling. They may perform a Schirmer test for tear production. The DBQ specifically captures whether you have decreased or increased salivation.
Key thresholds:
- Markedly decreased lacrimation (dry eye) — Autonomic dysfunction supporting at least moderate incomplete paralysis; risk of corneal damage increases severity
- Paradoxical lacrimation (crocodile tears/gustatory lacrimation) — Indicates aberrant nerve regeneration; supports at least moderate incomplete paralysis with synkinesis
Tips:
- Bring documentation of any ophthalmologic treatment for dry eye secondary to your facial nerve condition
- Describe your drooling or dry mouth symptoms specifically - when they occur, how disabling they are, and whether they affect eating, speaking, or sleeping
- Note if you use artificial tears, eye lubricants, or moisture chambers
Pain considerations: Dry eye can cause significant chronic ocular pain and discomfort. Describe the severity and frequency of this pain and how it limits your daily activities.
Electrodiagnostic Studies Review (EMG/Nerve Conduction Velocity)
Objective electrical evidence of facial nerve axonal loss, demyelination, or denervation of facial muscles. These studies are critical for distinguishing the degree of nerve damage and supporting the clinical examination findings.
What to expect:
The examiner will review any existing EMG or nerve conduction study results in your records. They may order new studies if none exist or if existing studies are outdated. The DBQ has dedicated fields for documenting diagnostic test results.
Key thresholds:
- Absent or severely reduced facial nerve conduction — Objective support for severe incomplete or complete paralysis rating
- Reduced amplitude with preserved conduction velocity — Axonal loss pattern supporting moderate to severe incomplete paralysis
- Normal electrodiagnostic studies — May limit rating to mild or moderate based on sensory-only impairment guidelines
Tips:
- Bring copies of all prior EMG and nerve conduction studies to the examination
- If studies were performed at diagnosis or during acute phase, mention that current function may differ from initial test results
- Ask your treating neurologist to document any electrodiagnostic findings in a current treatment note before the exam
Pain considerations: EMG testing itself can be uncomfortable. If you experienced significant pain or difficulty during prior electrodiagnostic studies, this context may be relevant to your overall pain profile.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Complete paralysis of the seventh cranial nerve. No discernible voluntary movement of any facial muscles on the affected side. This rating level is not achievable under neuritis (DC 8307) per 38 CFR 4.123; neuritis is capped at the severe incomplete paralysis level. |
CFR: Under 38 CFR 4.124a, complete paralysis represents the absolute maximum evaluation for the facial nerve. For neuritis (DC 8307), this rating is not assignable; neuritis is capped at severe incomplete paralysis per 38 CFR 4.123. |
| 80% | Severe incomplete paralysis - the maximum rating assignable for neuritis under DC 8307 per 38 CFR 4.123. Marked loss of function with only slight movement detectable, organic changes present (loss of reflexes, muscle atrophy, constant pain, sensory disturbances). |
CFR: 38 CFR 4.123 specifies that neuritis characterized by organic changes (loss of reflexes, muscle atrophy, sensory disturbances, constant pain) is rated on the scale provided for injury of the nerve, with the maximum being severe incomplete paralysis. This is the ceiling for DC 8307. |
| 60% | Moderately severe incomplete paralysis. Significant loss of motor function, obvious facial weakness and asymmetry, but some voluntary movement preserved. Multiple organic changes present. (Note: This level is applicable to the general paralysis schedule; for neuritis, the cap is severe incomplete paralysis.) |
CFR: This evaluation level reflects substantial motor and sensory impairment. Multiple organic changes (reflex loss, sensory disturbance, pain, atrophy) are expected. For neuritis without all organic changes specified in 38 CFR 4.123, moderate is the maximum assignable rating. |
| 40% | Moderate incomplete paralysis. Obvious weakness but not disfiguring; some voluntary movement present in all muscle groups, though clearly reduced. This is the maximum evaluation for neuritis not characterized by the organic changes referenced in 38 CFR 4.123. |
CFR: Per M21-1 guidance, moderate is the maximum rating for neuritis not characterized by organic changes (38 CFR 4.123). The moderate level is also the maximum for sensory-only impairment in the most significant and disabling cases. |
| 20% | Mild incomplete paralysis. Slight weakness noticeable only on close inspection or with specific facial movements. Sensory symptoms may be present but are recurrent rather than constant and affect a limited distribution. |
CFR: Per M21-1 guidance, the mild evaluation is appropriate when sensory symptoms are recurrent but not continuous, graded as lower medical impairment, and affecting a smaller area in the nerve distribution. Sensory-only impairment is rated mild or at most moderate per 38 CFR 4.124a. |
100% Complete paralysis of the seventh cranial nerve. No discerni ...
Complete paralysis of the seventh cranial nerve. No discernible voluntary movement of any facial muscles on the affected side. This rating level is not achievable under neuritis (DC 8307) per 38 CFR 4.123; neuritis is capped at the severe incomplete paralysis level.
Key Symptoms
- Total absence of voluntary facial movement on affected side
- Complete inability to close eyelid
- Complete loss of forehead wrinkling and nasolabial fold
- Total loss of taste on anterior two-thirds of tongue
- Complete loss of salivation and lacrimation on affected side
- Severe speech and chewing difficulty
CFR: Under 38 CFR 4.124a, complete paralysis represents the absolute maximum evaluation for the facial nerve. For neuritis (DC 8307), this rating is not assignable; neuritis is capped at severe incomplete paralysis per 38 CFR 4.123.
80% Severe incomplete paralysis - the maximum rating assignable ...
Severe incomplete paralysis - the maximum rating assignable for neuritis under DC 8307 per 38 CFR 4.123. Marked loss of function with only slight movement detectable, organic changes present (loss of reflexes, muscle atrophy, constant pain, sensory disturbances).
Key Symptoms
- Severe facial asymmetry at rest and with movement
- Inability or near-inability to close eyelid completely
- Severe weakness of all facial muscle groups
- Constant, at times excruciating pain in facial nerve distribution
- Significant muscle atrophy of facial muscles
- Loss of reflexes (corneal reflex, stapedius reflex)
- Significant sensory disturbances including numbness and paresthesias
- Markedly decreased or absent salivation and/or lacrimation
- Severe difficulty chewing, speaking, or swallowing
CFR: 38 CFR 4.123 specifies that neuritis characterized by organic changes (loss of reflexes, muscle atrophy, sensory disturbances, constant pain) is rated on the scale provided for injury of the nerve, with the maximum being severe incomplete paralysis. This is the ceiling for DC 8307.
60% Moderately severe incomplete paralysis. Significant loss of ...
Moderately severe incomplete paralysis. Significant loss of motor function, obvious facial weakness and asymmetry, but some voluntary movement preserved. Multiple organic changes present. (Note: This level is applicable to the general paralysis schedule; for neuritis, the cap is severe incomplete paralysis.)
Key Symptoms
- Obvious facial weakness and asymmetry clearly visible to observer
- Partial eyelid closure with effort
- Significant forehead and nasolabial fold weakness
- Intermittent or constant pain of moderate to severe intensity
- Paresthesias and numbness in facial distribution
- Moderately decreased salivation or lacrimation
- Hyperacusis affecting daily function
- Moderate difficulty chewing and speaking
CFR: This evaluation level reflects substantial motor and sensory impairment. Multiple organic changes (reflex loss, sensory disturbance, pain, atrophy) are expected. For neuritis without all organic changes specified in 38 CFR 4.123, moderate is the maximum assignable rating.
40% Moderate incomplete paralysis. Obvious weakness but not disf ...
Moderate incomplete paralysis. Obvious weakness but not disfiguring; some voluntary movement present in all muscle groups, though clearly reduced. This is the maximum evaluation for neuritis not characterized by the organic changes referenced in 38 CFR 4.123.
Key Symptoms
- Noticeable but not severe facial asymmetry
- Weakness of eye closure but able to close with effort
- Reduced forehead wrinkling on affected side
- Diminished smile and nasolabial fold depth
- Intermittent dull pain or discomfort in facial distribution
- Some sensory disturbance without complete numbness
- Mildly decreased salivation or lacrimation
- Mild difficulty chewing or speaking
CFR: Per M21-1 guidance, moderate is the maximum rating for neuritis not characterized by organic changes (38 CFR 4.123). The moderate level is also the maximum for sensory-only impairment in the most significant and disabling cases.
20% Mild incomplete paralysis. Slight weakness noticeable only o ...
Mild incomplete paralysis. Slight weakness noticeable only on close inspection or with specific facial movements. Sensory symptoms may be present but are recurrent rather than constant and affect a limited distribution.
Key Symptoms
- Slight facial asymmetry visible only during specific movements or expressions
- Minor weakness of eye closure (fully closes with effort)
- Slight reduction in forehead or smile movement
- Recurrent but not continuous sensory symptoms (tingling, numbness)
- Mild or intermittent pain
- No significant muscle atrophy
CFR: Per M21-1 guidance, the mild evaluation is appropriate when sensory symptoms are recurrent but not continuous, graded as lower medical impairment, and affecting a smaller area in the nerve distribution. Sensory-only impairment is rated mild or at most moderate per 38 CFR 4.124a.
How to Describe Your Symptoms
Facial Muscle Weakness and Motor Deficit
How to describe:
Describe which specific facial movements are affected, how severely, and how this has changed over time. Use concrete functional examples: 'I cannot fully close my left eye, which causes constant dryness and irritation.' 'When I try to smile, only one side of my face moves.' 'My left cheek droops and I bite the inside of my cheek when chewing.' Focus on your current worst-day function, not your best day.
Worst-day example:
“On my worst days, my entire left side of my face is completely limp. I cannot close my eye at all and must tape it shut to sleep. I cannot form a full smile, whistle, or blow out candles. My speech is slurred because I cannot control my lips properly, and food and liquid escape from the corner of my mouth when I eat.”
What the examiner listens for:
Specific muscle group involvement, degree of functional limitation, whether deficits are improving or worsening, whether weakness is constant or fluctuating, impact on eating, speaking, sleeping, and personal appearance.
Understatements to avoid:
Do not say 'it's getting better' if you still have significant symptoms on bad days. Do not minimize the emotional and social impact of visible facial disfigurement. Do not fail to mention that your function varies - the VA rates based on the full picture including your worst days.
Pain - Constant, Intermittent, or Dull
How to describe:
The DBQ specifically captures three pain types: constant pain (at times excruciating), intermittent pain, and dull pain. Describe which type applies to you, where the pain is located (ear, jaw, face, behind eye), how severe it is on a 0-10 scale on a typical day and on your worst day, how long episodes last, and what triggers or worsens the pain.
Worst-day example:
“On my worst days, I have a deep, burning, constant pain starting behind my right ear that radiates across my entire right cheek and jaw. The pain reaches 8 or 9 out of 10 and makes it impossible to concentrate at work, eat comfortably, or sleep. Cold weather, stress, and fatigue reliably trigger these severe episodes.”
What the examiner listens for:
Pain type (constant vs. intermittent vs. dull), location in the nerve distribution, severity, triggers, how pain affects sleep, work, and daily activities, and whether pain is accompanied by other organic changes.
Understatements to avoid:
Do not report only your average pain level. State your worst-day pain clearly. Do not omit pain that exists behind the ear or in the jaw - this is characteristic of facial nerve neuritis and is clinically significant.
Sensory Disturbances (Numbness, Paresthesias, Dysesthesias)
How to describe:
Describe exactly where you feel numbness, tingling, burning, or abnormal sensations on your face, including whether these sensations are constant or come and go. Specify the affected region (forehead, cheek, around the eye, ear, chin, inside the mouth) and how severely these sensations interfere with your daily life.
Worst-day example:
“On my worst days, the entire left side of my face from my ear to my chin feels like it is simultaneously numb and burning, as if someone pressed a hot and cold object against my skin at the same time. This makes shaving, washing my face, wearing glasses, and eating very uncomfortable. It also makes it hard to tell if food is too hot before I put it in my mouth.”
What the examiner listens for:
Location and distribution of sensory changes within the facial nerve territory, whether sensory symptoms are the only deficit or are combined with motor changes, continuity of symptoms, and impact on safety and daily function.
Understatements to avoid:
Do not fail to mention if you have accidentally burned yourself or bitten your cheek because you could not feel properly. Do not describe sensory symptoms as just 'tingling' - use precise language about burning, electrical sensations, coldness, or hypersensitivity to touch.
Autonomic Symptoms (Salivation, Lacrimation, Gastrointestinal)
How to describe:
The DBQ specifically captures changes in salivation (increased or decreased), difficulty swallowing, and gastrointestinal symptoms. Describe whether you have a dry mouth, excessive drooling, dry eye, excessive tearing, or crocodile tears (tearing while eating). Explain how these symptoms affect your daily life.
Worst-day example:
“On my worst days, my affected eye is so dry that it is painful and red all day, and I have to use artificial tear drops every hour. I also drool involuntarily from the left side of my mouth, especially when eating or speaking, which is embarrassing in social and professional settings. I have developed crocodile tears - I cry from my affected eye when eating, which is distressing and disabling.”
What the examiner listens for:
Evidence of chorda tympani, greater petrosal nerve, or vagal involvement through salivation and lacrimation changes; whether these symptoms are accompanied by functional consequences such as corneal damage, dehydration, or social impairment.
Understatements to avoid:
Do not omit drooling or dry eye symptoms because they seem minor. These are documented DBQ fields that directly reflect the degree of nerve damage. Do not underestimate the social and occupational impact of visible drooling.
Functional Impact on Speech, Chewing, and Swallowing
How to describe:
Describe specifically how your facial nerve condition affects your ability to speak clearly, chew food on both sides, and swallow. Note whether you avoid certain foods, have changed your diet, or need extra time to eat. Describe any incidents where food or liquid escaped your mouth unexpectedly.
Worst-day example:
“On my worst days, my speech is noticeably slurred and people ask me to repeat myself frequently. I can only chew on one side of my mouth, which causes jaw pain and limits what I can eat. I have stopped eating in public because food falls out of my mouth uncontrollably. I sometimes choke on liquids because I cannot fully seal my lips around a cup.”
What the examiner listens for:
Objective speech abnormalities audible during the exam, reports of dietary restriction or avoidance, evidence of aspiration risk from swallowing difficulty, and social isolation or occupational limitation from communication deficits.
Understatements to avoid:
Do not say 'I manage fine' if you have significantly changed your diet or eating habits. Do not omit that you have had choking episodes or been embarrassed in social eating situations. These are significant quality-of-life impairments relevant to your rating.
Psychological and Social Impact
How to describe:
Facial disfigurement, even when partial, has well-documented psychological consequences including depression, anxiety, social withdrawal, and occupational impact. Accurately describe how the visible symptoms of your condition affect your self-esteem, social interactions, and work performance.
Worst-day example:
“On my worst days, I avoid all social situations because the drooping and asymmetry of my face makes me extremely self-conscious. I have reduced my social activities significantly, avoid photographs, and have experienced depressive episodes related directly to my visible facial symptoms. My employer has noted changes in my client-facing performance.”
What the examiner listens for:
Secondary mental health conditions (depression, anxiety, social phobia) that may be separately ratable as secondary conditions; impact on occupational functioning; degree to which the visible nature of the condition impairs social integration.
Understatements to avoid:
Do not hide the emotional impact of your condition. VA raters consider functional impact holistically. If you have sought or been recommended mental health treatment related to your facial nerve condition, disclose this.
Common Mistakes to Avoid
Reporting only average or 'good day' symptoms
M21-1 guidance and VA rating practice instruct examiners to consider the full range of a condition's severity, including worst-day presentations. If you describe only your best or average function, the examiner may document a severity level that does not reflect your actual disability.
Instead: Explicitly state: 'On my worst days, which occur [frequency], my symptoms are...' and describe the full impact. Bring a personal symptom journal or buddy statement documenting worst-day function if available.
Impact: Can result in mild or moderate rating when moderate or severe is warranted
Failing to document all organic changes required for a higher neuritis rating
Under 38 CFR 4.123, neuritis rated above the moderate level must be characterized by organic changes: loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. If you have these findings but do not clearly communicate them, the examiner may not document them, capping your rating at moderate.
Instead: Before the exam, confirm with your treating neurologist that your records document any reflex changes, muscle atrophy, sensory disturbances, and constant pain. Verbally confirm these findings to the examiner at the start of the interview.
Impact: Determines eligibility for ratings above moderate (40%) - critical for severe (80%) rating
Not mentioning taste, salivation, and lacrimation changes
These autonomic and special sensory symptoms directly map to specific DBQ checkbox fields and reflect the extent of facial nerve branch involvement. Veterans often do not mention them because they seem minor or unrelated.
Instead: Proactively report any changes in taste, dry eye, excessive tearing, dry mouth, or drooling. Use the specific DBQ language: 'I have decreased salivation,' 'I have increased tearing,' 'I have lost taste on the front of my tongue on the affected side.'
Impact: Moderate to severe incomplete paralysis ratings
Describing pain only in terms of severity without specifying type and location
The DBQ captures three distinct pain types (constant/excruciating, intermittent, dull) as separate checkboxes. If you only say 'I have pain,' the examiner may only check one box or none. The type of pain directly affects how organic the neuritis is considered.
Instead: Describe your pain using the three categories: Is it constant? Is it intermittent? Is it dull? Specify location (ear, jaw, face, eye) and severity (0-10 scale). State explicitly that pain is 'in the distribution of the facial nerve.'
Impact: Differentiates between moderate (without organic changes) and severe (with organic changes including constant pain) ratings
Not bringing prior EMG, nerve conduction, or imaging results
The DBQ includes dedicated fields for diagnostic test results. Objective electrodiagnostic evidence of axonal loss or denervation strongly supports higher severity ratings and validates the clinical findings on examination.
Instead: Gather all prior EMG, nerve conduction velocity, brainstem auditory evoked potential, and MRI/CT imaging reports. Bring physical copies and ensure they are in your claims file. Ask your neurologist to write a current note summarizing these findings.
Impact: All rating levels - objective evidence is required to support severe ratings
Downplaying disfigurement and social/psychological impact
The DBQ captures scars or disfigurement separately, and functional impact is a documented field. Facial nerve palsy frequently causes visible disfigurement with significant quality-of-life and occupational consequences that veterans minimize out of stoicism.
Instead: Accurately describe visible asymmetry, drooping, and how it affects your work, social life, and mental health. If you have pursued or need mental health treatment related to your condition, disclose this as it may support a secondary psychiatric condition claim.
Impact: Functional impact fields support higher severity documentation across all rating levels
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to a thorough and complete C&P examination that adequately assesses all aspects of your facial nerve condition, including motor, sensory, autonomic, and pain components.
- You have the right to receive a copy of the completed DBQ examination report. Request this through your VSO or VA representative after the exam.
- In many states, you have the right to audio or video record your C&P examination under single-party consent laws. Verify your state's law before the appointment and notify the examiner if you choose to record.
- You have the right to bring a representative, advocate, family member, or caregiver to the examination.
- You have the right to submit your own medical evidence, including private physician opinions, buddy statements, and symptom diaries, to supplement the C&P examination findings.
- If you believe the C&P examination was inadequate - too brief, incomplete, or conducted by an unqualified examiner - you have the right to request a new examination by filing a supplemental claim or appeal.
- You have the right to a rating that reflects your worst-day symptom presentation, not just your best-day or average function. The VA is required to consider the full range of your disability.
- You have the right to have all service-connected secondary conditions (such as eye conditions, depression, or anxiety secondary to facial nerve palsy) considered for separate ratings.
- You have the right to be treated with respect and dignity during the examination. If you feel the examiner was dismissive, rushed, or failed to adequately evaluate your condition, document this and discuss options with your VSO.
- You have the right to benefits of the doubt: when there is an approximate balance of positive and negative evidence, the VA must resolve the doubt in your favor (38 CFR 3.102).
Related Conditions
- Bell's Palsy (Seventh Cranial Nerve Paralysis) Bell's palsy is the most common cause of facial nerve paralysis and is rated under the same diagnostic codes as facial nerve neuritis. If your condition has resolved from neuritis to residual paralysis, a different DC under 38 CFR 4.124a may apply.
- Eighth Cranial Nerve (Vestibulocochlear) Conditions The facial nerve (CN VII) travels through the internal auditory canal alongside the vestibulocochlear nerve (CN VIII). Conditions affecting one often affect the other. Hearing loss and vestibular dysfunction may be separately ratable secondary conditions.
- Dry Eye / Keratoconjunctivitis Sicca Incomplete eyelid closure (lagophthalmos) from facial nerve palsy causes chronic corneal exposure, dry eye syndrome, and risk of corneal ulcers. This may be separately ratable as a secondary service connected eye condition.
- Major Depressive Disorder / Adjustment Disorder Visible facial disfigurement from facial nerve palsy is associated with depression, anxiety, and social phobia. These psychiatric conditions may be ratable as secondary to the service connected facial nerve condition.
- Herpes Zoster Oticus (Ramsay Hunt Syndrome) Ramsay Hunt Syndrome is a herpes zoster infection of the geniculate ganglion that causes facial nerve palsy along with ear pain and vesicles. If your facial nerve condition resulted from this syndrome, it may involve multiple cranial nerve claims.
- Acoustic Neuroma / Vestibular Schwannoma Tumors of the cerebellopontine angle frequently damage the facial nerve. If your facial nerve neuritis is associated with acoustic neuroma or its surgical treatment, multiple conditions and additional DCs may be applicable.
- Temporomandibular Joint Disorder (TMJ) Facial nerve dysfunction causing abnormal chewing mechanics or jaw muscle weakness may contribute to or worsen temporomandibular joint disorder, which may be separately ratable as a secondary condition.
- Neuralgia, Facial Nerve (DC 8207) Facial nerve neuralgia (DC 8207) is evaluated separately from neuritis (DC 8307). Neuralgia is characterized by dull, intermittent pain and is rated at the moderate level maximum. If your condition presents primarily as neuralgia, DC 8207 may be the appropriate code.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.