8629 - External cutaneous nerve of thigh-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8629 

Definition

Neuritis refers to an inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. This code refers to the lateral cutaneous nerve of the thigh, a sensory nerve formed by the second and third lumbar roots. It emerges at the upper iliac spine and descends into the thigh.

Etiology

The anterior portion of the nerve is sometimes the site of meralgia paresthetica, a sensory neuritis. The course of the nerve is long and superficial, and exposed to various forms of trauma. Factors that play a bigger role than trauma in sensory neuritis include pressure of tight belts, or intermittent stretching by extensor movements of the thigh in walking. Males are more affected than females. Pelvic tumors or spinal lesions causing pain in the lateral surface of the thigh need to be excluded. Common co-morbid conditions include diabetes mellitus and centripetal obesity.

Signs & Symptoms

Tingling, burning, prickling, and sensations of pins-and-needles, with or without sensory loss, occur along the course of the nerve. The involvement is usually unilateral and, more commonly, along the anterior nerve distribution. Pain is very common.

Tests

Peripheral nerve examination may include: nerve conduction tests; computed tomography (CT) scan; magnetic resonance imaging (MRI); and sensory testing. Additional diagnostic studies may be done to rule out the presence of tumors.

Treatment

Many cases improve and clear up with the removal of tight belts and eliminating excessive walking. Sometimes symptoms disappear spontaneously. Nerve blocks can be beneficial if pain is the predominant symptom.

Residuals

Pain may be quite persistent.

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

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