8518 - Circumflex nerve-Paralysis of

DBQ: Link to Index of DBQ/Exams by Disability for DC 8518 

Definition

Paralysis refers to a temporary or permanent loss or impairment of motor or sensory function in a part. The circumflex, or axillary nerve, is that portion of the brachial plexus that innervates the muscles above and beneath the shoulder. (See Diagnostic Code: 8510 Upper radicular group-Paralysis of, and Diagnostic Code: 8513 All radicular groups-Paralysis of)

Etiology

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

Signs & Symptoms

Manifestations may include: partial sensory loss to the outer arm and forearm; inability to raise the arm at the shoulder; decreased reflexes; pain; moderate to severe muscle weakness; and muscle atrophy. Additional manifestations may include: an inability to abduct, and rotate the arm internally. The presence of other signs and symptoms depend on the involvement of neighboring nerves.

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. Treatment measures include: splints; physical therapy; anti-inflammatory or pain medication; or transcutaneous electrical nerve stimulation (TENS). In some cases, surgery may be needed.

Residuals

Regeneration may depend on the degree of axonal injury and site of injury. The closer the injury to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Recovery may range from complete function to permanent dysfunction. Actions of the deltoid and teres minor muscles may mask injury to the suprascapular nerve. There may be severe limitations in shoulder and elbow joint mobility, from lack of use and a potential for contractures to develop. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Intensive rehabilitation may be delayed for certain injuries. 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

  • 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.