8615 - The median nerve-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8615 

Definition

Neuritis refers to an inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. The 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 this nerve include: forearm pronation; hand flexion; thumb flexion, index finger flexion and middle finger flexion; and opposition of the thumb.

Etiology

In some cases, the cause related to neuritis of the median nerve may be unknown. Causes associated with the condition include: lacerations; blunt trauma; gunshot wounds; hemorrhage into the nerve; fractures of the elbow or forearm; dislocation of the radius; degenerative bone changes such as arthritis; changes in tendons and connective tissue of the wrist; compression of the nerve such as from watchbands, or tourniquets; and rifle-sling palsy. Other etiologic factors may include: entrapment; prolonged elbow extension; repeated strenuous muscle activity; tumors; ganglia; exposure to cold or radiation; viruses; inflammatory conditions; systemic malignancy; leprosy; metabolic diseases such as diabetes mellitus or alcoholism; collagen blood disorders; toxic agents; certain medications; nutritional deficiencies; and genetics.

Signs & Symptoms

Signs and symptoms may vary depending on the form of neuritis and the location of the lesion along the nerve. Manifestations of the condition may include: neuralgia; hyperesthesia; paresthesia; dysesthesia; hypoesthesia; and demyelination. In addition, there may also be symptoms of nerve entrapment such as 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; atrophy of thenar eminence muscles; small areas of sensory loss; causalgia; paresthesias; and vasomotor disturbances.

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. In some cases, there may be no specific treatment. Treatment may otherwise include: wrist splints; passive range of motion (ROM) exercises; anti-inflammatory or pain medications; transcutaneous electrical nerve stimulation (TENS); antibiotics; vitamin therapy; or, in some cases, surgery may be needed when recovery is poor or weakness progresses.

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 also 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.