Neuralgia refers to severe, sharp pain occurring along the course of a nerve. This diagnostic code refers to the external cutaneous nerve of the thigh, a sensory nerve formed by the 2nd and 3rd lumbar roots. It emerges from the iliac spine and descends into the thigh.

Neuralgia may be caused by pressure on the nerve trunks, faulty nerve nutrition, toxins, or inflammation. The course of the nerve is long and superficial, and exposed to various forms of trauma. Factors that play a bigger role than trauma in sensory neuralgia include pressure of tight belts or intermittent nerve stretching by extensor movements of the thigh in walking. Men are more affected than women. Pelvic tumors or spinal lesions may play a role and need to be excluded. Common co-morbid conditions include diabetes mellitus and centripetal obesity.

Tingling, burning, prickling, and sensations of pins-and-needles, with or without sensory loss, occur along the course of the nerve. The involvement is usually unilateral and more commonly along the anterior nerve distribution. Pain is very common.

Peripheral nerve examination may include: nerve conduction tests; computed tomography (CT) scan; magnetic resonance imaging (MRI); and sensory testing. Additional diagnostic studies may be done to rule out the presence of tumors.

Many cases improve and clear up with the removal of tight belts and eliminating excessive walking. Sometimes symptoms disappear spontaneously. Nerve blocks can be beneficial if pain is the predominant symptom.

Pain may be quite persistent. Sometimes, it is necessary to split the fascia lata and surgically correct the angulation of the nerve to stop the pain.

• 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.

• 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.