8617 - Musculocutaneous nerve-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8617 

Definition

Neuritis refers to an inflammation of a nerve accompanied by pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. This code refers to the musculocutaneous nerve, a sensory and motor nerve which arises from the brachial plexus that innervates the muscles of the upper arm. The musculocutaneous nerve is the main branch of the upper trunk of the brachial plexus. The sensory nerve innervation is to the forearm.

Etiology

Injury to this nerve is usually involved in brachial plexus injury. The causes of the injury to the brachial plexus roots may include: gunshots; cuts; or compression from tumors or aneurysms; falls; or dislocations of the shoulder resulting in brachial neuritis. Carrying heavy weights supported only at the elbow crease may be a possible factor in the development of neuritis and neuralgia. In addition, a misplaced antecubital injection, cause nerve injury.

Signs & Symptoms

Signs and symptoms of the condition may include: muscle atrophy; pain; weak elbow flexion; and impaired sensation along the radial border of the forearm.

Tests

Electrophysiologic studies are used to distinguish between spinal nerve root causes and musculocutaneous nerve dysfunction. Spinal taps and myelography may be performed. Other studies may include: computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; deep tendon reflexes (DTR); and sensory testing.

Treatment

Satisfactory results are usually obtained with conservative treatment. Such measures include: physical therapy; splints; anti-inflammatory and analgesic medications; and transcutaneous electrical nerve stimulation (TENS). Surgical intervention to repair a severed nerve is a possibility.

Residuals

Damage to the musculocutaneous nerve alone rarely occurs. It usually involves components of the brachial plexus. Recovery may take several months and could range from return to complete function to permanent dysfunction. Alteration in activities of daily living (ADL) and employment may require counseling.

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.