Seventh (Facial) Cranial Nerve, Paralysis of C&P Exam Prep

Facial Symmetry Assessment - Voluntary Movement Testing

What it measures: The examiner observes your ability to voluntarily activate each branch of the facial nerve: forehead (temporal branch), eye closure (zygomatic branch), cheek/smile (buccal branch), lip depression (marginal mandibular branch), and neck (cervical branch). This directly maps to the rating criteria's 'relative loss of innervation of facial muscles' under DC 8207.

What to expect: The examiner will ask you to raise your eyebrows, wrinkle your forehead, close both eyes tightly, smile, show your teeth, puff out your cheeks, and frown. They will observe for weakness, asymmetry, incomplete movement, or total absence of movement on the affected side.

Pain considerations: If attempting to close the affected eye or perform facial movements causes pain, aching, or burning, clearly state this during the assessment. Pain during voluntary movement is a relevant symptom that should be documented.

Eye Closure Completeness Testing (Lagophthalmos Assessment)

What it measures: Measures whether the eye on the affected side can fully close, partially close, or cannot close at all. Incomplete eye closure (lagophthalmos) indicates zygomatic/upper facial branch involvement and creates serious corneal exposure risk. This is a critical functional finding that supports higher ratings.

What to expect: The examiner will ask you to gently and then forcefully close both eyes and will observe the gap remaining on the affected side. They may measure the gap in millimeters. They will also check Bell's phenomenon (upward eye roll with closure attempt) as a protective mechanism.

Pain considerations: Eye pain, grittiness, burning, or sensitivity to light (photophobia) from corneal exposure secondary to incomplete eye closure are significant symptoms. Describe frequency, severity on a 0-10 scale, and any emergency or unplanned ophthalmology visits.

Facial Nerve Sensory and Autonomic Assessment

What it measures: Although CN VII is primarily a motor nerve, it carries autonomic fibers (to lacrimal, submandibular, and sublingual glands) and special sensory fibers (taste, anterior two-thirds of tongue via chorda tympani). The examiner will assess taste disturbance, salivation abnormalities, tearing abnormalities, and any facial paresthesias or numbness.

What to expect: The examiner may ask you to describe taste sensation, whether you experience dry mouth, excessive drooling, crocodile tears (gustatory lacrimation), or abnormal tearing. They may lightly touch the face to assess for sensory changes, though primary sensory testing of the face tests CN V, which may also be involved.

Pain considerations: Describe any facial numbness, tingling, burning, or hypersensitivity in the distribution of the face. Even though these may overlap with CN V territory, they are relevant to the overall functional picture and should be documented.

Functional Speech, Chewing, and Swallowing Assessment

What it measures: The orbicularis oris and buccinator muscles controlled by CN VII are essential for articulating labial sounds (b, p, m, f, v), controlling food and liquid in the mouth during chewing, and preventing drooling. The examiner will assess whether facial paralysis affects these critical oral functions.

What to expect: The examiner may ask you to speak, read a sentence aloud, or describe eating difficulties. They will listen for slurred or imprecise labial consonants and observe for drooling or food spillage from the corner of the mouth.

Pain considerations: Jaw fatigue, facial muscle soreness after eating, or pain with prolonged speaking should be described. Describe how long you can eat or speak before symptoms worsen, and quantify in minutes if possible.

30%

Complete paralysis of the seventh (facial) cranial nerve. Total loss of innervation of all facial muscles on the affected side - no voluntary movement of forehead, inability to close eye (lagophthalmos), complete facial droop at rest, no ability to smile, retract lips, or wrinkle forehead. Significant functional consequences including eye exposure, inability to form oral seal, severe dysarthria, and disfigurement.

From 38 CFR: 38 CFR - 4.124a DC 8207: 'Paralysis of: Complete 30' - dependent upon complete loss of innervation of all facial muscles.

20%

Incomplete, severe paralysis of the seventh (facial) cranial nerve. Markedly reduced but not completely absent voluntary facial movement. Significant functional consequences present but some residual innervation preserved. Multiple facial muscle groups affected with severe weakness - near inability to close eye, marked facial asymmetry at rest and with movement, severe chewing or speaking difficulty.

From 38 CFR: 38 CFR - 4.124a DC 8207: 'Paralysis of: Incomplete, severe 20' - markedly impaired innervation of facial muscles with near-complete functional loss.

10%

Incomplete, moderate paralysis of the seventh (facial) cranial nerve. Partial loss of innervation of facial muscles with noticeable but not severe functional impairment. Some voluntary movement preserved in most muscle groups but with measurable weakness and asymmetry. Symptoms are present and functionally limiting but less debilitating than severe incomplete paralysis. Also the minimum rating under DC 5325 if mastication is affected to any extent.

From 38 CFR: 38 CFR - 4.124a DC 8207: 'Paralysis of: Incomplete, moderate 10' - partial loss of innervation of facial muscles. Also DC 5325 minimum 10% when mastication is affected to any extent.

Facial Movement and Muscle Weakness

How to describe it: Describe which specific facial movements you cannot perform or can only perform weakly. Be specific: 'I cannot raise my left eyebrow at all,' 'I can only partially close my left eye and it remains open about a centimeter even when I try my hardest,' 'When I smile my face only moves on the right side.' Describe the degree of asymmetry others notice and how you perceive it in the mirror.

Example: On my worst days, I cannot close my left eye at all even pressing my finger to my lid, my entire left side of my face is completely drooped with no movement, I drool uncontrollably, and I cannot form words that begin with B, P, or M clearly enough for anyone to understand me on the phone.

Examiner listens for: The examiner wants to know which muscle groups are affected, how severely, and whether the weakness is partial (incomplete paralysis) or total (complete paralysis). They are specifically mapping your symptoms to the 'relative loss of innervation of facial muscles' language in DC 8207.

Avoid: Do not say 'my face is a little weak' - specify which movements are absent or reduced. Do not say 'it's mostly fine' if you have compensated over time. Describe your actual functional deficits, not how well you have adapted.

Eye Closure and Corneal Protection

How to describe it: Specify whether you can fully close your eye, and if not, how large the gap remains in millimeters if known. Describe your eye protection routine: 'I use lubricating eye drops every hour,' 'I tape my eye shut every night with medical tape,' 'I wear an eye patch or moisture chamber glasses.' Describe any corneal problems, eye infections, or emergency eye care visits.

Example: On bad days my eye is so dry and painful from exposure that I cannot focus on reading or working on a computer for more than 10 minutes. The burning sensation wakes me up at night even with tape on my eye. I had to go to the emergency room twice for corneal abrasions because my eye dried out while I slept.

Examiner listens for: The examiner is assessing whether lagophthalmos is present and whether it constitutes a severe or complete functional deficit. The inability to protect the cornea is a serious and ratable consequence of CN VII paralysis that substantiates higher rating levels.

Avoid: Do not minimize eye symptoms as 'just dryness.' Corneal exposure from incomplete eye closure is a direct and serious complication of facial nerve paralysis. Describe every eye care measure you take and every symptom you experience.

Pain - Facial, Ear, and Periorbital

How to describe it: Classify your pain as the DBQ does: constant pain that is at times excruciating, intermittent pain, or dull ongoing pain. Give a 0-10 severity rating for your average day and your worst day. Describe the location precisely: behind the ear (mastoid), across the cheek, around the eye socket, or radiating. Describe triggers and duration of pain episodes.

Example: On my worst days I have a constant burning and stabbing pain rating a 9 out of 10 that starts behind my left ear and radiates across my entire left face. It lasts all day regardless of what I take for it. Even wind touching my face or a light breeze triggers severe pain that leaves me unable to work or concentrate.

Examiner listens for: The examiner will document which pain checkbox applies - constant/excruciating, intermittent, or dull - and the specific location and severity. These pain characteristics directly map to DBQ fields that influence the overall disability picture the rater uses alongside the motor findings.

Avoid: Do not say 'I just take Tylenol for it.' Describe the actual severity and functional impact of your pain. If pain keeps you from sleeping, working, socializing, or performing activities of daily living, state this specifically and quantify it.

Eating, Chewing, and Swallowing Difficulties

How to describe it: Describe specific foods you can no longer eat or avoid due to the facial paralysis (tough meats, hard vegetables, soups/liquids that spill). Describe whether food accumulates in your cheek (a sign of buccinator weakness). Explain if you drool during meals or if food falls out of your mouth. Describe any swallowing difficulties and whether you have choked or aspirated liquids.

Example: On bad days I cannot eat anything that requires a proper lip seal or significant chewing. I stick to soft pureed foods because I cannot control food in my left cheek - it just collects there. When I try to eat soup or drink water I spill it down my chin. Meals that used to take 15 minutes now take 45 minutes and leave me exhausted. I have lost weight because eating is so difficult and embarrassing.

Examiner listens for: The examiner is documenting whether difficulty chewing (mastication) is present at any level. Under DC 5325, even any interference with mastication supports a minimum 10% rating. Swallowing difficulty suggests involvement beyond pure motor paralysis and adds to the functional picture.

Avoid: Do not say 'I manage okay' if you have changed your diet, eat more slowly, or avoid certain foods. Adaptations and diet modifications due to your condition are evidence of functional impairment, not evidence that your condition is under control.

Speech Difficulties

How to describe it: Describe which sounds or words are difficult - labial consonants (B, P, M, F, V, W) are typically most affected. Describe how often others ask you to repeat yourself, whether you avoid phone calls or speaking in groups, and whether your speech difficulty has affected your work or social life. Rate severity on your average day versus your worst day.

Example: On my worst days people cannot understand me over the phone at all. I have to spell out words or ask someone else to make calls for me. I have stopped attending meetings at work and avoid speaking in public because I am embarrassed and frequently misunderstood. My supervisor has noticed the change in my speech.

Examiner listens for: The examiner will listen to your natural speech during the interview. Mention speech difficulty proactively even if the examiner does not specifically test it. Describe the practical impact - avoiding social situations, job tasks, or communication because of speech impairment.

Avoid: Do not avoid mentioning speech difficulty because it seems minor compared to the eye or motor symptoms. Dysarthria from CN VII paralysis is documented on the DBQ and contributes to the functional impairment picture.

Salivation, Taste, and Autonomic Symptoms

How to describe it: Describe whether your saliva production has changed: 'My mouth is extremely dry and I cannot eat dry foods without large amounts of water,' or 'I drool uncontrollably, especially when my attention is elsewhere or during sleep.' For taste, describe whether foods taste different, absent, or distorted on one side of your tongue. For tearing, describe whether your eye is constantly dry or whether you experience excessive tearing while eating.

Example: My taste on the left side of my tongue has been gone since the paralysis began. I cannot taste sweet or salty on that side at all. Additionally, when I eat, my left eye tears up uncontrollably - my doctor called it crocodile tears. This is embarrassing in social situations and I have stopped eating in public.

Examiner listens for: The examiner is checking for involvement of the chorda tympani (taste, submandibular gland secretion) and the greater petrosal nerve (lacrimal gland). These autonomic and special sensory findings indicate the level and completeness of the nerve lesion.

Avoid: Do not assume taste or tearing symptoms are unrelated or unimportant. These are direct functions of CN VII and their impairment substantiates the completeness of the nerve lesion, which supports higher rating levels.

Disfigurement and Psychosocial Impact

How to describe it: Describe the visible facial asymmetry and its impact on your daily social life, employment, and mental health. Be specific: 'I no longer make eye contact with people because of my facial droop,' 'I have stopped attending family events or social gatherings,' 'I was passed over for a promotion because of my appearance,' 'I have developed depression and social anxiety secondary to the disfigurement.'

Example: On bad days I cannot look in the mirror without severe distress. I have canceled social plans, avoided family photos, and stopped going to my place of worship because of the stares I receive. I have begun wearing masks even outside of required situations to hide my face. I have sought counseling for depression directly caused by the change in my appearance.

Examiner listens for: The DBQ specifically asks about scars and disfigurement. Disfigurement from facial nerve paralysis may be separately ratable under DC 7800. The examiner documents these findings, and the rater may assign additional ratings for disfigurement if separate and distinct.

Avoid: Do not understate the emotional and social impact of a visible facial deformity. The VA recognizes disfigurement as independently ratable. If you have sought mental health treatment for depression or anxiety related to your facial condition, mention this and provide records.