Elbow and forearm ratings: motion, nerves and the exam

How VA rates the elbow and forearm

38 CFR 4.71a; 4.69

VA rates how far the elbow bends (flexion), straightens (extension), and how far the forearm turns the palm down (pronation) or up (supination). Most of the schedule has two columns: major (your dominant arm) and minor. 38 CFR 4.69 says only one hand is dominant, and VA decides which from the record or the exam.

Normal motion, printed on VA’s Elbow and Forearm exam form:

• Flexion: 0 to 145 degrees
• Extension: 0
• Supination: 0 to 85
• Pronation: 0 to 80

Limited flexion (bending)

38 CFR 4.71a, DC 5206

Flexion limited to:

• 110 degrees: 0%
• 100 degrees: 10%
• 90 degrees: 20%
• 70 degrees: 30% major, 20% minor
• 55 degrees: 40% major, 30% minor
• 45 degrees: 50% major, 40% minor

Normal flexion is 145. The code starts paying at 100.

Limited extension and both limits together

38 CFR 4.71a, DC 5207 and 5208

DC 5207, extension limited to:

• 45 or 60 degrees: 10%
• 75 degrees: 20%
• 90 degrees: 30% major, 20% minor
• 100 degrees: 40% major, 30% minor
• 110 degrees: 50% major, 40% minor

DC 5208: flexion limited to 100 degrees and extension limited to 45 degrees: 20%. This is not a pronation or supination code.

Pronation and supination

38 CFR 4.71a, DC 5213

• Limited pronation, motion lost beyond the middle of the arc: 30% major, 20% minor.
• Limited pronation, motion lost beyond the last quarter of the arc, hand does not approach full pronation: 20%.
• Limited supination, to 30 degrees or less: 10%.
• Bone fusion with the hand fixed: in supination or hyperpronation, 40% major and 30% minor; in full pronation, 30% major and 20% minor; near the middle of the arc, 20%.

Ankylosis, flail elbow and the bones

38 CFR 4.71a, DC 5205 to 5212

• DC 5205, ankylosis (a fixed elbow): favorable, between 90 and 70 degrees, 40% major and 30% minor; intermediate, 50% and 40%; unfavorable, under 50 degrees or with complete loss of supination or pronation, 60% and 50%.
• DC 5209: flail joint, 60% and 50%; joint fracture with marked deformity, or an ununited fracture of the radial head, 20%.
• DC 5210: radius and ulna nonunion with a flail false joint, 50% and 40%.
• DC 5211 (ulna) and 5212 (radius): 10% to 40% depending on where the fracture is, whether it healed, and whether bone was lost.

Bursitis and tendon problems

38 CFR 4.71a, DC 5019 and 5024

• DC 5019, bursitis, and DC 5024 (tenosynovitis, tendinitis, tendinosis, tendinopathy) have no percentages of their own. The schedule says to rate them as degenerative arthritis, based on limited motion of the affected parts.
• Olecranon bursitis is under DC 5019, not DC 5003.
• Tennis elbow (lateral epicondylitis) is not named in the schedule. In three Board of Veterans’ Appeals decisions it was rated under the limitation-of-motion codes, DC 5206 in two and DC 5207 in one, not DC 5024. Painful motion and functional loss supported 10%. In one decision the Board granted 20% after a private exam estimated flexion limited to 90 degrees during flare-ups and repeated use.

Arthritis in the elbow

38 CFR 4.71a, DC 5003

• X-ray-confirmed arthritis with limited motion is rated under the motion codes above. If the limit is not compensable, VA gives 10% for each affected major joint, shown by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.
• The 10% and 20% X-ray ratings are for arthritis without limited motion, and are not combined with motion ratings.

One-year rule: arthritis is a chronic disease under 38 CFR 3.309(a). It is presumed service connected if it reached 10% within one year of separation, after 90 days or more of active service. That is not a Gulf War rule and it is not in 3.317. See the presumptive-conditions page.

Cubital tunnel and the ulnar nerve

38 CFR 4.124a, DC 8516

Rated by how much function the nerve has lost:

• Complete paralysis: 60% major, 50% minor
• Incomplete, severe: 40% and 30%
• Incomplete, moderate: 30% and 20%
• Incomplete, mild: 10%

When the involvement is wholly sensory, the rule says to rate it mild, or at most moderate. Board decisions apply DC 8516 to cubital tunnel syndrome, and they weigh sensory findings against motor findings such as grip strength.

Neuritis (38 CFR 4.123) is rated on the nerve’s scale, with a maximum of severe incomplete paralysis, or moderate if there are no organic changes. Neuralgia (4.124) is capped at moderate incomplete paralysis.

Other arm and leg nerves are on Nerve damage VA ratings.

Surgical and injury scars on the elbow

38 CFR 4.118

• DC 7801 (not head, face or neck; with soft-tissue damage): 10% for 6 to under 12 square inches, 20% for 12 to under 72, 30% for 72 to under 144, 40% for 144 or more.
• DC 7804 (unstable or painful): 10% for one or two scars, 20% for three or four, 30% for five or more, plus 10% if a scar is both.
• The 80% level is for disfigurement of the head, face or neck only.

See scar ratings.

The bilateral factor

38 CFR 4.26

If both arms have compensable disabilities, VA combines the two sides, then adds 10% of that value before combining with anything else.

Example: 20% and 10% combine to 28. Ten percent of 28 is 2.8. Added, that is 30.8, which VA carries as 31. The final conversion to the nearest 10 comes at the end.

The full method is on Why 50% + 50% Is Not 100%.

What VA’s elbow exam form asks the examiner to do

VA Elbow and Forearm exam form

• Record which hand is dominant.
• Measure active motion, and passive motion (the examiner moves the joint).
• Ask whether you can do repetitive-use testing with at least three repetitions, and whether you lose motion or function after them.
• Ask whether you have flare-ups and whether the exam is during one.
• Address pain on weight-bearing and non-weight-bearing, and ask about scars.

The form has no dedicated ulnar-nerve question. If you have numbness or tingling, say so and ask whether nerve testing was done.

See Preparing for Your C&P Exam.

What I could not verify

• The elbow, nerve and scar levels come from eCFR and Cornell’s copy of the regulations. Both are unofficial, and the official text wins over me. The nerve levels also match three Board of Veterans’ Appeals decisions.
• Which code VA uses for golfer’s elbow (medial epicondylitis). The decisions I read were about tennis elbow, and the nerve code in each case depends on the nerve involved. The Board decisions I read apply DC 8516 to cubital tunnel.
• Rating ranges for other conditions that can follow an elbow problem, such as shoulder, neck or chronic pain. I did not check them here.