The Elbow and Forearm

Topics:

Loss of Use/Amputation of the Elbow
Elbow Replacement
Elbow Limitation of Motion
Forearm Limitation of Motion
Too Much Motion or Instability
Elbow and Forearm Bones
Other Elbow and Forearm Conditions
DBQ for Elbow and Forearm Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Note: Hand and arm conditions may have higher ratings for the dominant hand. If you are right-handed, then your right hand/arm is dominant. If you are left-handed, then your left hand/arm is dominant. For the ambidextrous, the rating for the dominant hand will apply regardless of which hand is injured.

Double Note: If any forearm condition causes multiple fingers to have limited or impaired motion, then the fingers can be rated as a separate condition and combined with the forearm condition. Any combination, however, cannot total more than 70% for the dominant hand and 60% for the non-dominant hand.

 


Loss of Use/Amputation of the Elbow

Code 5205: If the elbow joint is frozen in place and cannot move at all, it is rated depending on where it is frozen. If it is frozen in flexion 50° or less, or if it is frozen so that the palm of the hand cannot be turned up or down, then it is rated 60% for the dominant arm and 50% for the non-dominant arm. If it is frozen in flexion between 50° and 70° or at an angle more than 90°, then it is rated 50% for the dominant and 40% for the non-dominant. Between 70° and 90° is rated 40% for the dominant and 30% for the non-dominant.

Code 5213: If the arm is frozen with the hand in supination or hyperpronation, it is rated 40% for the dominant arm and 30% for the non-dominant arm. If the hand is fixed in full pronation (palm pointed straight down), it is rated 30% for the dominant and 20% for the non-dominant. If the arm is stuck between 0° and 40° pronation, then it is rated 20% for either arm.

Code 5123: If the arm is amputated above the insertion of the pronator teres, then it is rated 80% for the dominant hand and 70% for the non-dominant hand.

Code 5124: If the arm is amputated below the insertion of the pronator teres, then it is rated 70% for the dominant and 60% for the non-dominant.

Code 5125: If the hand has not been amputated, but cannot be used at all, it is rated 70% for the dominant arm and 60% for the non-dominant arm.

Your condition may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

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Elbow Replacement

Code 5052: If the entire elbow joint has been replaced by a prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for VA Disability, but DoD Disability will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and/or severe pain with motion, then it is rated 50% for the dominant arm and 40% for the non-dominant. If the pain is not severe, but does limit the range of motion, then it is rated analogously (see the Analogous and Equivalent Codes page) under code 5205, 5206, 5207, or 5208 whichever best fits the condition. The minimum rating for a total elbow replacement is 30% for the dominant arm and 20% for the non-dominant arm regardless of how much motion it has.

Note: This code is only for total elbow replacements. Partial replacements are rated on any symptoms that they cause, like limited motion.

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Elbow Limitation of Motion

Code 5207: If the elbow cannot straighten the arm all the way, it is rated under this code. If the arm can only straighten to 110°, then it is rated 50% for the dominant and 40% for the non-dominant. If it can straighten to 100°, it is rated 40% for the dominant and 30% for the non-dominant. To 90°, it is rated 30% for the dominant and 20% for the non-dominant. To 75°, it is rated 20% for either arm. To 45°, it is rated 10% for either arm. Anything between 0° and 45° only warrants a 0% rating.

Code 5206: If the elbow cannot bend all the way, then it is rated under this code. If the elbow can only bend to 45°, then it is rated 50% for the dominant and 40% for the non-dominant. If it can bend to 55°, it is rated 40% for the dominant and 30% for the non-dominant. To 70°, it is rated 30% for the dominant and 20% for the non-dominant. To 90°, it is rated 20% for either arm. To 100°, it is rated 10% for either arm. If the elbow can bend to 110° or more, it is rated 0%.

Code 5208: If the elbow can only straighten 45° and only bend to 100°, then it is rated 20% for either arm.

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Forearm Limitation of Motion

The forearm can twist to rotate the palm of the hand upward or downward.

Code 5213: If the arm is limited in its twisting motion, then it is rated under this code. If the arm cannot turn the hand with the palm up more than 30°, then it is rated 10% for either arm. If the arm cannot turn the hand with the palm down more than 0°, then it is rated 30% for the dominant arm and 20% non-dominant arm. If it can turn it palm down more than 40°, then it is rated 20% for either arm.

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Too Much Motion or Instability

Code 5209: If there is too much or unreliable motion in the elbow (“flail joint”), then it is rated 60% for the dominant and 50% for the non-dominant.

Code 5210: If either the radius or ulna bone has been broken, did not heal, and thus causes extraneous and unreliable motion in the arm, then it is rated 50% for the dominant and 40% for the non-dominant.

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Elbow and Forearm Bones

Code 5211: The majority of conditions of the ulna bone are rated under this code. If the upper half of the ulna bone in the forearm is broken through, did not heal, and is causing extra motion in the arm, then it is either rated under this code or 5210. If the extra motion of the arm is significant, then it is coded 5210. If it is fairly limited and insignificant, it is rated here.

If it has bone loss of 1 inch or more and is very deformed, it is rated 40% for the dominant arm and non-dominant arm. If it does not have bone loss or deformity, then it is rated 30% for the dominant arm and 20% for the non-dominant arm. If the ulna is broken through in the lower half and does not heal, it is rated 20% for either arm. If the ulna is broken and has healed, but is not aligned properly, then it is rated 10% for either arm.

Code 5212: The majority of conditions of the radius bone are rated under this code. If the lower half of the radius bone in the forearm is broken through, did not heal, and is causing extra motion in the arm, then it is rated under this code or 5210. If the extra motion of the arm is significant, then it is coded 5210. If the extra motion of the arm is fairly limited and insignificant, it is rated here.

If it has bone loss of 1 inch or more and is very deformed, it is rated 40% for the dominant arm and 30% for the non-dominant. If it does not have bone loss or deformity, then it is rated 30% for the dominant arm and 20% for the non-dominant arm. If the radius is broken through in the upper half and does not heal, it is rated 20% for either arm. If the radius is broken and has healed, but is not aligned properly, then it is rated 10% for either arm.

Code 5209: If there is a fracture in the elbow joint that causes the forearm to angle too far in toward the body or too far out to the side when it is hanging straight down, then it is rated 20% for either arm.

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Other Elbow and Forearm Conditions

Diseases that affect the elbow and forearm can be found on the Diseases of the Musculoskeletal System page and cancer in the elbow and forearm can be found on the Cancer and Tumors of the Musculoskeletal System page. All other elbow and forearm injuries or conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQ for Elbow and Forearm Conditions

Here is the Disability Benefits Questionnaire (DBQ) used for elbow and forearm conditions: Elbow and Forearm DBQ.

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Principles that Apply

The Amputation Rule: Dominant arm: Any ratings for the elbow and forearm cannot be combined to be more than 80% for above the insertion of the pronator teres and 70% for below the insertion of the pronator teres. Non-dominant: Any ratings for the elbow and forearm cannot be combined to be more than 70% for above the insertion of the pronator teres and 60% for below the insertion of the pronator teres.

Painful Motion: If pain is present with motion, then the minimum rating must be given.

Special Monthly Compensation: If your condition makes it impossible to grasp things with your fingers or hold things in your hand, you may qualify for the VA’s Special Monthly Compensation. You may also qualify if your arm has been amputated.

The Joints: When rating arthritis, the elbow is considered a major joint.

Pyramiding: A single condition can only be rated once! However, if a nerve condition exists that is additional to the elbow or arm condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified physician in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. All ranges of motion should be measured with a goniometer. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.


Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For muscle conditions, see The Forearm and Hand Muscles page.

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