Neuralgia refers to a severe sharp pain occurring along the course of a nerve. The lower radicular group refers to the 8th cervical root and 1st thoracic root which consists of motor and sensory pathways. This lower group is one of three trunks forming the brachial plexus.

In some cases, the cause of neuralgia may be unknown. Causes related to the condition include: injury or irritation to the nerve; nerve root compression by a blood vessel, degenerative bone changes, and tumors; or trauma such as penetrating missile injury. Other causes may include: shoulder injury; overextension of a joint; brachial neuritis; carrying heavy objects supported at the shoulder; viral infections; and chronic degenerative diseases such as multiple sclerosis. Damage to the nerves may be caused by factors including: poor nutrition to the nerve; toxins; inflammation; infections; iatrogenic injection injuries; metabolic injury; nerve entrapment; or fractures.

Signs and symptoms may occur at irregular intervals and be characterized by attacks of unilateral, sharp, stabbing, or constant burning pain. Manifestations may include: anesthesia over the shoulder; metabolic neuropathies; demyelination; inability to raise the arm at the shoulder; and weakness and wasting of the muscles of the hand, forearm, wrist and finger flexors. Evidence of numbness, paresthesias, and pain in the shoulder, arm, or hand may also be present. In addition, there may be vascular symptoms such as swelling, blanched fingers, and an aching, cold and cyanotic arm. Raynaud's disease may rarely be present.

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 may depend on the underlying cause. Other measures may include: anti-inflammatory or pain medications; peripheral nerve blocks if pain medication fails; transcutaneous electrical nerve stimulation (TENS); or physical therapy for certain types of neuralgia. Surgical resection may be necessary when medical therapy fails.

Regeneration of the nerve may depend on the degree and site of injury. The closer the injury is to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Frequency of attacks may vary with periods of long remissions. However, remission periods may decrease with age. Continuous bouts may be incapacitating and may alter activities of daily living (ADL) and employment. These changes may require counseling intervention. There may be a need for long-term pain management. Medications may warrant on-going liver and blood studies. The potential for paralysis of the nerve exists.

• 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.

•  POW presumptive provisions apply to peripheral neuropathy except where directly related to infectious causes.