Neuralgia refers to sharp pain occurring along the course of a nerve. This diagnostic code refers to the musculocutaneous nerve, known as the superficial peroneal nerve, which is a mixed sensory and motor nerve. This nerve is a division of the sciatic nerve and a branch of the common peroneal nerve. The musculocutaneous nerve innervates the peroneus longus muscle of the lower leg and terminates as a sensory branch supplying the dorsum of the foot.

Neuralgia may be caused by pressure on nerve trunks, faulty nerve nutrition, toxins or inflammation. The peroneal division is more easily injured as the nerve is superficial near the fibula head and susceptible to compression. Pressure injury may cause inflammation of the nerve. Some activities that may cause neuralgia are: casts that are not padded properly; severe fibula fractures; anterior compartment syndrome, and diabetic mononeuropathy.

Signs and symptoms may include: plantar flexion of the foot, sensory loss to midpoint of the lateral calf, and trophic changes in the leg and foot.

Peripheral nerve examination may include: nerve conduction studies; needle electromyography (EMG); computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; deep tendon reflexes (DTR); sensory testing; and gait examination.

Generally, the nerve in mild stretch or in compression injuries recovers spontaneously. An exception is chronic peroneal compression at the fibular head because fibrosis retards nerve regeneration. Patients should be cautioned against extended leg crossing, prolonged sitting on a toilet, or using unusual positions, such as yoga sitting. The usual treatment consists of a splint that supports the ankle and the foot, and range of motion (ROM) exercises. If the nerve does not show signs of regeneration, it may have to be explored and freed from adhesions.

Splinting, should be used as long as voluntary activity is impaired.

• 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