Long Thoracic Nerve Neuralgia — VA Disability Rating (DC 8719)
Diagnostic Code 8719 · 38 CFR §4.124
What Is It?
Neuralgia of the long thoracic nerve (DC 8719) refers to chronic nerve pain along its distribution without the structural changes seen in neuritis or paralysis. The long thoracic nerve innervates the serratus anterior muscle, which holds the shoulder blade against the rib cage. Damage causes the scapula to protrude outward, known as winged scapula. Under 38 CFR §4.124, neuralgia, characterized usually by a dull and intermittent pain of typical distribution so as to identify the nerve, is rated on the same scale as the nerve involved — here DC 8519 — with a maximum equal to moderate incomplete paralysis. DC 8519 prints incomplete paralysis as severe 20 percent, moderate 10 percent, and mild 0 percent, the same for the major and the minor arm. That puts DC 8719 at 0 and 10 percent.
Rating Criteria
| Rating | Criteria |
|---|---|
| 10% | Moderate incomplete paralysis level of DC 8519. Same rating for the major and the minor arm. Moderate is the neuralgia maximum under §4.124. |
| 0% | Mild incomplete paralysis level of DC 8519. Same rating for the major and the minor arm. |
Evidence Needed
- Medical records documenting chronic nerve pain connected to military service
- Nerve conduction studies or EMG to rule out paralysis and confirm neuralgia diagnosis
- Pain management records showing treatment with neuropathic pain medications
- Documentation of pain frequency, intensity, and functional impact
- If claiming secondary to another condition, a medical nexus opinion linking the neuralgia to your service-connected disability
C&P Exam Tips
- Describe the character of your pain — burning, shooting, aching, or electric sensations
- Explain how often the pain occurs and how it limits use of your scapula and shoulder
- Bring a log of pain episodes if you keep one
- Mention all medications tried and their effectiveness
- Describe your worst days, not just how you feel at the exam
How to File
File under DC 8719 on VA Form 21-526EZ. If claiming as secondary to a service-connected condition, identify the primary disability and explain how it causes chronic nerve pain. Include documentation of pain frequency and intensity. VA rates neuralgia on the DC 8519 scale with a maximum equal to moderate incomplete paralysis (10 percent for either arm), so document how often the pain occurs and how it limits you, and which arm is your dominant one.
Common Mistakes
The most common mistake is not filing for neuralgia as a separate condition from the underlying nerve injury or spine condition. Veterans also frequently fail to document the frequency and severity of pain episodes, which makes it difficult for the examiner to assign an appropriate rating. Ensure your diagnosis specifically names neuralgia of the long thoracic nerve rather than generic chronic pain.
Frequently Asked Questions
How is neuralgia (DC 8719) different from neuritis (DC 8619)?
Neuritis involves inflammation with objective findings like reflex loss and muscle atrophy, while neuralgia refers to nerve pain without those structural changes. Both are rated on the DC 8519 scale, but the ceilings differ: neuritis can reach the severe incomplete paralysis level (§4.123), while neuralgia stops at moderate (§4.124).
Can neuralgia be rated separately from my spine condition?
Yes. Neuralgia of a peripheral nerve can be rated separately from the spinal condition causing it, just as radiculopathy can. The spine is rated for its skeletal limitation and the nerve is rated for its neurological symptoms. File them as separate conditions on your claim.