Neuralgia refers to severe, sharp pain occurring along the course of a nerve. This code refers to the obturator nerve which is a mixed sensory and motor nerve that originates the 2nd lumbar spinal root. This nerve innervates the muscles at the upper thigh. Sensation is transmitted from a small area on the inner surface of the thigh and knee joint.

Neuralgia is caused by pressure on the nerve trunks, faulty nerve nutrition, toxins, or inflammation. Pelvic tumors or obturator hernias may be possible causes of pressure and subsequent neuritis.

Manifestations include a constant burning pain. In addition, autonomic trophic changes represented by a reddened, glossy skin, nail and hair abnormalities, and sensitivity to cold are likely to be present. The ability to adduct the leg will depend on the degree of injury. Chronic and intense pain may cause insomnia, anxiety, or depression.

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

Pain treatment is a priority. Often, tricyclic antidepressants are very effective in terms of the burning and aching sensation, and also assist with sleeping difficulties. Occasionally, nerve blocks provide some pain relief. Other useful therapies include: physical therapy; foot brace; electrical stimulation; ultrasound; analgesics; and massage.

If a surgical sympathectomy, or other destructive procedure is to be undertaken for pain relief, then a multidisciplinary review is recommended first to assess physiologic, physical and behavioral factors pertaining to the patient.

• 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.