Neuralgia refers to a severe sharp pain occurring along the course of a nerve. The circumflex nerve, known as the axillary nerve is that portion of the brachial plexus that innervates the muscles above and below the shoulder. (see Diagnostic Code: 8510 Upper radicular group-Paralysis of, and Diagnostic Code: 8513 All radicular groups-Paralysis of).

Although the cause of neuralgia may be unknown, contributing causes may 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. 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. The nerve may also be damaged by poor nutrition; toxins; inflammation; infections; iatrogenic injection injuries; metabolic injury; nerve entrapment; or fractures.

Signs and symptoms may occur at irregular intervals, and are characterized by attacks of unilateral, sharp, stabbing, or constant burning pain. Other manifestations may include: supraclavicular pain; anesthesia over the shoulder; inability to raise the arm at the shoulder; decreased reflexes; moderate to severe muscle weakness; and muscle atrophy. In addition, inability to abduct, and rotate the arm internally may be present. The presence of other signs and symptoms depend on the 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. Treatment 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 to the central nervous system (CNS), regeneration of a severely damaged nerve is less likely to occur. Frequency of attacks may vary. There may be 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. Long-term pain management may be needed. Prescribed 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