Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The lower radicular group refers to the VIIIth cervical root and 1st thoracic root which consists of motor and sensory pathways. This lower group represents one of three trunks forming the brachial plexus.

Paralysis of these nerves may be caused by damage to the nerve fibers, cell body, or myelin sheath. Causes of damage may include: trauma; penetrating missile injury; shoulder injury; overextension of a joint; brachial neuritis; carrying heavy objects supported at the shoulder; and iatrogenic injection injuries. Other causes include: metabolic injury; infection; and compression of the nerve from degenerative bone changes, nerve nerve entrapment, fractures, inflammation, or tumors.

Signs and symptoms may include those manifestations similar to median and ulnar nerve lesions, and thoracic outlet syndrome. (See Diagnostic Code: 8515 The median nerve-Paralysis of, and Diagnostic Code: 8516 The ulnar nerve-Paralysis of.) There may be weakness and wasting of the muscles of the hand, forearm, wrist, and finger flexors. Other manifestations may include: numbness; paresthesias; and pain in the shoulder, arm or hand. Other evidence may include: vascular symptoms such as swelling, blanched fingers, and an aching, cold and cyanotic arm. Raynaud's disease may be rarely present.

Diagnostic measures may include: a complete history; physical and neurological examinations; motor, sensory, reflex, strength and resistance tests; blood studies; spinal tap; evoked responses; electromyography (EMG); x-ray; computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Treatments may include management of the underlying disorder. Other measures may include: splints; physical therapy; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); or, in some cases, surgery may be needed.

Regeneration may depend on the degree of axonal injury and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Recovery from weakness may take several months. Recovery may range from return to complete function to permanent dysfunction of the arm or hand. Long-term physical therapy may be needed. There may be injuries to other distal peripheral nerves. Pain may be provoked when carrying heavy items in the hand. There may be alteration of employment and daily activities requiring counseling intervention.

• If the Veteran is a former prisoner of war and was interned or detained for not less than 30 days, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR §3.309(c) Disease subject to presumptive service connection].

• If the Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.309(e). Disease subject to presumptive service connection.

• Consider potential entitlement to special monthly compensation for loss of use of hand or foot when assigning the higher evaluations under particular Diagnostic Codes (e.g., Diagnostic Code 8510 through 8515, 8520, and 8521).

• POW presumptive provisions apply to peripheral neuropathy except where directly related to infectious causes.