Neuralgia refers to a severe sharp pain occurring along the course of a nerve. All radicular groups refer to the brachial plexus. The brachial plexus is formed by the 5th, 6th, 7th, and 8th cervical roots, and 1st thoracic root which form an upper, middle, and lower trunk (see Diagnostic Code: 8710 Upper radicular group-Neuralgia, Diagnostic Code: 8711 Middle radicular group-Neuralgia, and Diagnostic Code: 8712 Lower radicular group-Neuralgia.)

In some cases, the cause of neuralgia may be unknown. Causes associated with the condition include: injury or irritation to the nerve; nerve root compression by a blood vessel; degenerative bone changes; tumors; or trauma such as penetrating missile injury. In addition, other causes 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. Factors contributing to damage include: 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 can be characterized by attacks of unilateral, sharp, stabbing, or constant burning pain. Other manifestations may include: arm, hand or supraclavicular pain; anesthesia over the shoulder; inability to raise the arm at the shoulder; decreased reflexes moderate to severe muscle weakness; atrophy of the hand, forearm, wrist and finger flexors; and edema of the injured limb. Other occurrences may include: paralysis of forearm flexion, and of abduction and internal rotation and external rotation of the arm. In addition, distal paresthesias may occur. Inability to use a normal functioning hand or complete paralysis may be evident. There may also be other signs and symptoms depending on involvement of neighboring nerves.

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 and may include: anti-inflammatory or pain medications; peripheral nerve blocks if pain medication fails; and transcutaneous electrical nerve stimulation (TENS). Physical therapy may be useful 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 ongoing 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.