8515 - The median nerve-Paralysis of

DBQ: Link to Index of DBQ/Exams by Disability for DC 8515 

Definition

Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. This code refers to the median nerve, a motor and sensory nerve arising from the 6th, 7th, and 8th cervical, and first thoracic roots. Movements controlled by the nerve include: forearm pronation; hand flexion; thumb flexion, index finger flexion and middle finger flexion and opposition of the thumb.

Etiology

Paralysis may be caused by damage to the nerve fibers, cell body, or myelin sheath. This damage may be caused by factors including: gunshot wounds; lacerations; blunt trauma; nerve compression related to the use of watchbands and tourniquets; rifle sling palsy; prolonged elbow extension; elbow or forearm fractures; and chronic compression of fibro-osseous tunnels. Other related causes include: degenerative bone changes such as arthritis; changes in tendons and connective tissue of the wrists; tumors; ganglia; inflammatory conditions; and damage from repeated strenuous muscle activity. Partial injury of the median nerve is more common than complete injury.

Signs & Symptoms

Signs and symptoms may be those of nerve entrapment. These manifestations include: carpal tunnel syndrome; loss of forearm pronation; weakness of wrist and first and second finger flexion; paralysis of thumb abduction and opposition; inability to grip; and atrophy of thenar eminence muscles. Small areas of sensory loss; causalgia; paresthesias; and vasomotor disturbances may also occur.

Tests

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

Treatment

Treatments may include management of the underlying disorder; splints; passive range of motion (ROM) exercises; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); or, in some cases, surgery may be needed.

Residuals

Regeneration of the nerve may depend on the degree 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. There may be little to no sensory loss with partial nerve injury. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Partial movement of the wrist and fingers may occur with use of unparalyzed muscles. There may be a need for long-term pain management. There may be alteration of employment and daily activities requiring counseling intervention.

Special Considerations

  • 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).

  • This disability 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(a)

Notes

  • With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves] 38 CFR 4.124a Schedule of ratings—neurological conditions and convulsive disorders.”