8618 - Circumflex nerve-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8618 

Definition

Neuritis refers to an inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. The circumflex nerve, known as the axillary nerve is that portion of the brachial plexus that innervates the muscles above and below the shoulder. (See Diagnostic Code: 8510 Upper radicular group-Paralysis of, and Diagnostic Code: 8513 All radicular groups-Paralysis of).

Etiology

In some cases, the cause of neuritis may be unknown. Known causes may include: trauma; penetrating missile injury; shoulder injury; overextension of a joint; tumors; hemorrhage into a nerve; lesions; continuous pressure on a nerve such as carrying heavy objects supported at the shoulder; degenerative bone changes; nerve entrapment; or fractures. Contributing factors include: exposure to cold or radiation; viruses or inflammatory processes; 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 may include: supraclavicular pain; neuralgia; hyperesthesia; paresthesia; dysesthesia; anesthesia over the shoulder; inability to raise the arm at the shoulder; decreased reflexes; muscle atrophy; and moderate to severe muscle weakness. Additional manifestations may include 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 medications; antibiotics; vitamin therapy; and transcutaneous electrical nerve stimulation (TENS). 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 to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. In compression injury, complete recovery may take weeks depending on the length and severity of compression. Recovery from weakness may take several months. There may be a need for long-term pain management. An alteration of employment and daily activities would require 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.