Evidence Checklist: Bell's Palsy (Facial Nerve Paralysis)

Cranial nerve examination documenting facial nerve palsy severityCritical

A neurologist's or otolaryngologist's examination using the House-Brackmann grading scale to document facial weakness severity from Grade I (normal) to Grade VI (complete paralysis).

Nexus opinion linking Bell's palsy to service (at least as likely as not)Critical

Medical opinion connecting Bell's palsy to in-service cold/wet exposure, viral infection during service, or stress-related immune suppression during deployment.

Facial nerve EMG/electroneurography (ENoG)

Electrodiagnostic testing measuring facial nerve degeneration percentage and assessing prognosis. Useful for documenting severity and incomplete recovery.

MRI with gadolinium (facial nerve enhancement)

MRI showing gadolinium enhancement of the facial nerve at the geniculate ganglion, confirming Bell's palsy and ruling out structural causes.

Treatment records (steroids, antivirals, eye protection)

Records of prednisone and antiviral treatment, physical therapy for facial retraining, and records of eye complications (exposure keratopathy) from incomplete eye closure.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Cranial Nerve ConditionsCritical

VA standardized form for DC 8207 (facial nerve) capturing the degree of facial paralysis, synkinesis, and functional impact.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.