Neuralgia refers to a severe sharp pain occurring along the course of a nerve. This code refers to the median nerve, a motor and sensory nerve arising form the 6th, 7th, and 8th cervical, and first thoracic roots. Movements controlled by this nerve include: forearm pronation; hand flexion; thumb flexion, index finger flexion and middle finger flexion and opposition of the thumb.

The exact cause of neuralgia of the median nerve is unknown. Attributing causes include: injury or irritation to the nerve; lacerations; compression of the nerve such as from watchbands and tourniquets; rifle sling palsy; prolonged elbow extension; elbow or forearm fractures; and chronic compression of fibro-osseous tunnels. Other related causes include: degenerative bone changes such as arthritis; changes in the tendons and connective tissue of the wrists; tumors; ganglia; or damage from trauma due to penetrating missile injury. Other etiologic factors may include: overextension of a joint; brachial neuritis; viral infections; and chronic degenerative diseases such as multiple sclerosis. Nerve damage can also be related to conditions 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 may be characterized by attacks of unilateral, sharp, stabbing, or constant burning pain. Other symptoms may include: metabolic neuropathies; demyelination; symptoms of nerve entrapment such as carpal tunnel syndrome; loss of forearm pronation; weakness of wrist and first and second finger flexion; paralysis of thumb abduction and opposition; inability to grip; and atrophy of thenar eminence muscles. Small areas of sensory loss; causalgia; paresthesias; and vasomotor disturbances may also occur.

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: wrist splints; 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, and may require counseling intervention. Painful paresthesias, dysesthesias, or neuromas of the wrist may develop. Long-term management of pain may be needed. 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.

• 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)

• Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See nerve involved for diagnostic code number and rating. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve.  38 CFR 4.124 Neuralgia, 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.