8621 - External popliteal nerve (common peroneal)-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8621 

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 diagnostic code refers to the external popliteal nerve, a mixed sensory and motor nerve that innervates the extensor muscles of the ankle and toes, and the abductor muscles of the foot. Sensation is transmitted from the outer side of the leg, the front lower third, the instep, and the dorsal surface of the four inner toes.

Etiology

Because of the superficial position of the nerve, it may be easily injured. Pressure against hard objects while sleeping, or unconsciousness from anesthesia or alcohol may lead to injury, neuritis, and paralysis. Prolonged squatting or maintaining crossed knees may be other causes of injury. Damage to the nerve may occur from wounds in the region of the knee or in the sciatic nerve trunk in the thigh. Compression of the nerve from tumors or cysts at the head of the fibula may produce foot drop and burning pain along the lateral side of the leg.

Signs & Symptoms

Common peroneal nerve neuritis may result in paralysis with foot drop and inversion of the ankle. The ankle cannot dorsiflex, the toes cannot straighten or extend, and the foot cannot evert. During walking, the gait is characterized by slapping of the foot on the floor and hyperflexion of the knee. Trophic changes in muscle size of the leg, and vasomotor disturbances of swelling and local cyanosis may be present. Sensory loss and pain occurs in an area that is less in size than the distribution of the nerve.

Tests

Peripheral nerve examination may include: nerve conduction tests; electromyography (EMG); computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; deep tendon reflexes (DTR); sensory testing; and gait examination.

Treatment

Generally, the treatment consists of physiotherapy and use of a foot brace. An exception is chronic peroneal compression at the fibular head because fibrosis retards nerve regeneration. Patients should avoid extended leg crossing, prolonged sitting on a toilet, or using unusual positions, such as yoga sitting. The usual treatment consists of a splint that supports the ankle and the foot, and range of motion (ROM) exercises. If the nerve does not show signs of regeneration, it may have to be explored and freed from adhesions. Other therapies that may be used include electrical stimulation, ultrasound, analgesics, and massage. If a ganglion cyst is the cause of pain, then relief of symptoms may be obtained by excision of the cyst.

Residuals

Pressure neuritis may be temporary or permanent depending on the amount and time of exposure to injury.

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.