8516 - The ulnar nerve-Paralysis of

DBQ: Link to Index of DBQ/Exams by Disability for DC 8516 

Definition

Paralysis refers to loss or impairment, either temporary or permanent, of motor or sensory function in a part. This code refers to the ulnar nerve, a sensory and motor nerve, which arises from the medial cord of the brachial plexus. (See Diagnostic Code: 8512 Lower radicular group-Paralysis of.) The ulnar nerve is susceptible to acute and chronic compression in the area of the elbow and cubital tunnel.

Etiology

Compression may cause injury and paralysis. This commonly occurs in the axilla or upper arm or both, elbow region, or at the wrist or hand. Injury from improper positioning during an anesthesia may cause compression at the elbow. Supracondylar fractures may bring about nerve dysfunction years after the injury. Nerve damage may be caused by severe penetrating wounds, dislocations, fractures, or just chronic heavy leaning on the elbows.

Signs & Symptoms

A claw hand results owing to flexion of the interphalangeal (IP) joints of the ring and little finger. Numbness, pain, and paresthesias in the fourth and fifth fingers may occur with ulnar nerve lesions. Loss of power grip and impairment of precision movements results from ulnar neuropathy. Catching a finger on a pant's pocket may be an early manifestation of fifth finger adduction. Writing becomes awkward, and holding a knife is difficult.

Tests

Examinations may include: nerve conduction tests; electromyography (EMG); computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; and deep tendon reflexes (DTR).

Treatment

Conservative therapy is usually tried for a few months. This therapy includes: avoidance of repeated elbow flexion and extension and resting on the elbows; and simple splinting in extension for lengthy periods and when sleeping. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also part of the therapy. A surgical transposition of the ulnar nerve may be done if sensory symptoms and weakness persist.

Residuals

Complications may include formation of a neuroma, recurrent scars around the nerve, and continuous pain.

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

  • Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.  38 CFR 4.123 Neuritis, cranial or peripheral.

  • 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.