8620 - Sciatic nerve-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8620 

Definition

Neuritis refers to inflammation of a nerve accompanied by pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. Sciatica is a term that describes the pain that occurs along the course of the sciatic nerve.

Etiology

In most patients, the cause of the condition is usually a ruptured intervertebral disc (see Diagnostic Code: 5243 Intervertebral disc syndrome). However, pain in the back that extends to the posterior surface of the leg could be associated with disease processes in the pelvis or lower spine, such as arthritis (see Diagnostic Code: 5003 Arthritis, degenerative).

Signs & Symptoms

Manifestations of the condition include pain that worsens by movement and sometimes by the Valsalva maneuver, coughing, laughing, or straining during defecation. Paresthesias may be present, and deep tendon reflexes (DTR) may be depressed or lost. In addition, with lumbosacral herniation, straight-leg raises, knee flexion, hip abduction, ankle dorsiflexion, plantar flexion, and all toe movements may result in back or leg pain. Muscles supplied by the damaged root may become weak, atrophied, and flaccid, and may show a contraction or twitching motion. Finally, compression at the end of the spinal cord (cauda equina) may result in urinary problems. The pain of sciatica varies from discomfort to being incapacitating. Any movement that stretches the nerve is painful.

Tests

Diagnostic tests most likely include: lumbosacral, hip, pelvic and sacroiliac x-rays; cerebrospinal fluid (CSF) examination; computed tomography (CT) scan; magnetic resonance imaging (MRI); electromyography (EMG); angiography; muscle-strength testing; and reflex testing.

Treatment

Essentially, treatment is aimed at the underlying cause. Therapy measures may include: use of crutches; a back brace; heat; a walker; physical therapy; analgesics; and electrical stimulation. Sciatica associated with arthritis may be treated by bedrest for a few weeks.

Residuals

The course of sciatica depends on the underlying disorder. In many patients, the symptoms last for weeks to months and disappear, only to recur within months or even years later.

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.