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C&P Exam Prep: Forearm, Limitation of Extension
DBQ Overview
Interview + Physical- Form Name
- Elbow_and_Forearm
- Form Code
- Elbow_and_Forearm
- Page Count
- 15
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To accurately document the degree of elbow/forearm extension limitation and associated functional loss for VA disability rating purposes under 38 CFR 4.71a, Diagnostic Code 5207.
What the examiner evaluates:
- Active range of motion (ROM) for elbow flexion and extension
- Passive range of motion for elbow flexion and extension
- Forearm pronation and supination active and passive ROM
- Whether pain occurs on motion and at what point in the arc
- Functional loss from pain, fatigue, weakness, and incoordination
- Additional ROM loss with repetitive use (DeLuca factors)
- Flare-up frequency, duration, and additional functional loss during flare-ups
- Presence of ankylosis, deformity, cubitus valgus/varus, or instability
- Muscle atrophy, tenderness, crepitation, and swelling
- Assistive device use
- Surgical history including total elbow arthroplasty or arthroscopic surgery
- Impact on occupational and daily functional activities
Exam is conducted in-person with physical range of motion testing using a goniometer. Weight-bearing and non-weight-bearing ROM measurements may both be recorded for the upper extremity per Correia requirements. Bring any braces or assistive devices you actually use.
Typical duration: 30-45 minutes
Active Elbow Extension ROM
How far you can straighten your elbow under your own muscle power from a fully flexed position toward 0 degrees (full extension). Normal endpoint is 0 degrees.
What to expect:
The examiner will ask you to straighten your arm as far as you can. They will measure the angle at which your arm stops extending. Report any pain immediately when it begins during the motion. If your arm cannot reach 0 degrees, that gap is your extension limitation.
Key thresholds:
- Extension limited to 110- — 50% dominant / 40% non-dominant arm
- Extension limited to 100- — 40% dominant / 30% non-dominant arm
- Extension limited to 90- — 30% dominant / 20% non-dominant arm
- Extension limited to 75- — 20% dominant / 20% non-dominant arm
- Extension limited to 60- — 10% dominant / 10% non-dominant arm
- Extension limited to 45- — 10% dominant / 10% non-dominant arm
Tips:
- Move only as far as you actually can without pushing through severe pain
- Say 'stop' or 'that's as far as I can go' so the examiner records the true endpoint
- Do not perform extra stretches or warm up before the exam - your baseline ROM matters
- If extension is also limited by pain before the mechanical endpoint, report that precisely
- Perform the motion at your typical daily pace, not faster or slower
Pain considerations: Inform the examiner of the exact degree at which pain begins during extension, the character of the pain (sharp, burning, aching), and whether pain prevents further motion. Under DeLuca v. Brown, pain on motion that limits function must be documented. The examiner should note whether painful motion causes functional loss equivalent to additional ROM limitation.
Passive Elbow Extension ROM
How far the examiner can move your elbow toward full extension when your muscles are relaxed. Per Correia v. McDonald, passive ROM must also be documented.
What to expect:
The examiner will gently straighten your arm while you relax your muscles. If passive ROM exceeds active ROM, this is clinically significant. Report pain during passive motion as well.
Key thresholds:
- Passive ROM equal to active ROM — Confirms true structural limitation rather than pain inhibition alone
- Passive ROM greater than active ROM — Suggests pain inhibition of active motion - still ratable under DeLuca
Tips:
- Relax your arm completely during passive testing
- Report any pain or discomfort during passive motion
- Do not voluntarily resist the examiner's movement
Pain considerations: Pain during passive motion supports a finding of true pathological limitation. Inform the examiner if passive motion causes the same pain as active motion.
Repetitive Use / Flare-Up ROM Testing
Whether extension ROM decreases or pain worsens after repeated use of the elbow, consistent with DeLuca v. Brown and Mitchell v. Shinseki requirements.
What to expect:
The examiner should ask about how your ROM changes during or after repetitive activity. They may ask you to perform the motion multiple times. Your ROM should be documented after repetition if it changes.
Key thresholds:
- Any additional loss of ROM on repetition — Can justify rating at a higher restriction level than single-measurement ROM
- Flare-up causes additional restriction — Examiner should note estimated degrees of additional loss during flare-up
Tips:
- Proactively report if your ROM is worse after working, driving, or carrying objects
- Describe how long flare-ups last and how frequently they occur
- Quantify additional loss if possible: 'During flare-ups my arm is about 20 degrees more restricted than today'
- Mention if you had a flare-up in the days before the exam or if today is a better or worse day than average
Pain considerations: Tell the examiner whether pain during flare-ups is severe enough to prevent use of the arm entirely for a period of time.
Forearm Pronation ROM
Rotation of the forearm palm-down. Normal endpoint is 80 degrees. Separately ratable under DC 5213 if limited.
What to expect:
The examiner will ask you to rotate your forearm with elbow bent at 90 degrees, turning your palm toward the floor. Limitation may be rated separately from extension limitation.
Key thresholds:
- Pronation beyond middle of arc (beyond 40-) — Rated separately under DC 5213
- Pronation limited beyond last quarter of arc (approaching 80-) — Lower rating under DC 5213
Tips:
- Report if rotation causes pain, grinding, or clicking
- Note if pronation affects specific work or daily tasks
Pain considerations: Report pain during rotation immediately. Pronation is separately ratable from extension.
Forearm Supination ROM
Rotation of the forearm palm-up. Normal endpoint is 85 degrees. Separately ratable under DC 5213 if limited.
What to expect:
The examiner will ask you to rotate your forearm with elbow at 90 degrees, turning your palm upward toward the ceiling.
Key thresholds:
- Supination limited to 30 degrees or less — Rated separately under DC 5213
- Complete loss of supination — Maximum rating under supination criteria
Tips:
- Report if you cannot fully turn your palm upward in daily activities
- Describe how supination loss affects tasks like carrying a tray, using a screwdriver, or opening jars
Pain considerations: Report pain at any point during supination ROM testing.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 50% | Extension limited to 110 degrees - dominant arm. This represents severe limitation where the elbow can extend only about 35 degrees from full flexion (145-), leaving a very restricted functional range. |
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 110- rates 50% for dominant arm, 40% for non-dominant arm. |
| 40% | Extension limited to 100 degrees - dominant arm (30% non-dominant). Moderate-to-severe limitation leaving only 45 degrees of extension possible from full flexion. |
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 100- rates 40% dominant / 30% non-dominant. |
| 30% | Extension limited to 90 degrees - dominant arm (20% non-dominant). Arm cannot straighten beyond a 90-degree angle. |
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 90- rates 30% dominant / 20% non-dominant. |
| 20% | Extension limited to 75 degrees - rated equally at 20% for both dominant and non-dominant arm. Elbow can extend past 90 degrees but stops short of full extension by 75 degrees. |
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 75- rates 20% for both dominant and non-dominant. |
| 10% | Extension limited to 60 degrees or 45 degrees - rated at 10% for both arms. Mild-to-moderate limitation. Note: DC 5208 applies a single 20% rating if flexion is also limited to 100- with extension to 45-. |
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 60- or 45- rates 10% for both arms. If flexion limited to 100- AND extension to 45-, consider DC 5208 for a single 20% evaluation. |
50% Extension limited to 110 degrees - dominant arm. This repres ...
Extension limited to 110 degrees - dominant arm. This represents severe limitation where the elbow can extend only about 35 degrees from full flexion (145-), leaving a very restricted functional range.
Key Symptoms
- Inability to straighten arm more than approximately one-third of full extension arc
- Severe functional limitation with overhead reaching, pushing, and object manipulation
- Significant pain on attempted extension
- Daily activities requiring arm extension severely compromised
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 110- rates 50% for dominant arm, 40% for non-dominant arm.
40% Extension limited to 100 degrees - dominant arm (30% non-dom ...
Extension limited to 100 degrees - dominant arm (30% non-dominant). Moderate-to-severe limitation leaving only 45 degrees of extension possible from full flexion.
Key Symptoms
- Inability to straighten arm past a right-angle equivalent
- Difficulty with pushing, pulling, and lifting tasks
- Pain at end range of available extension
- Functional loss during sustained or repetitive arm use
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 100- rates 40% dominant / 30% non-dominant.
30% Extension limited to 90 degrees - dominant arm (20% non-domi ...
Extension limited to 90 degrees - dominant arm (20% non-dominant). Arm cannot straighten beyond a 90-degree angle.
Key Symptoms
- Elbow locked at a right angle at maximum extension
- Significant daily functional limitation
- Pain with use
- Possible weakness on extension attempts
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 90- rates 30% dominant / 20% non-dominant.
20% Extension limited to 75 degrees - rated equally at 20% for b ...
Extension limited to 75 degrees - rated equally at 20% for both dominant and non-dominant arm. Elbow can extend past 90 degrees but stops short of full extension by 75 degrees.
Key Symptoms
- Partial extension possible but limited
- Pain and stiffness at end range
- Functional limitation with tasks requiring full arm extension
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 75- rates 20% for both dominant and non-dominant.
10% Extension limited to 60 degrees or 45 degrees - rated at 10% ...
Extension limited to 60 degrees or 45 degrees - rated at 10% for both arms. Mild-to-moderate limitation. Note: DC 5208 applies a single 20% rating if flexion is also limited to 100- with extension to 45-.
Key Symptoms
- Limited but functional range of extension
- Mild pain at extremes of motion
- Possible stiffness after rest or inactivity
- Functional impact on sustained or repetitive arm use
CFR: 38 CFR 4.71a, DC 5207: Extension limited to 60- or 45- rates 10% for both arms. If flexion limited to 100- AND extension to 45-, consider DC 5208 for a single 20% evaluation.
How to Describe Your Symptoms
Pain on Extension
How to describe:
Describe the location (lateral, medial, posterior elbow), onset during motion (at what degree), character (sharp, burning, aching, throbbing), severity on a 0-10 scale, and whether it stops you from completing full extension.
Worst-day example:
“On my worst days, I feel sharp pain on the outside of my elbow the moment I try to straighten my arm past about 90 degrees. The pain is an 8 out of 10 and forces me to stop immediately. I cannot push a door open or reach forward to grab something off a shelf without triggering this pain.”
What the examiner listens for:
Specific degree at which pain begins, whether pain limits motion before the mechanical endpoint, pain at rest vs. motion, and whether pain represents functional loss.
Understatements to avoid:
Do not say 'it's just a little stiff' if pain actually prevents you from completing the motion. Do not minimize pain by saying 'I can push through it' if doing so causes significant discomfort.
Flare-Ups
How to describe:
State how often flare-ups occur (daily, weekly, monthly), what triggers them (activity, weather, repetitive use), how long they last, how much additional ROM you lose during a flare-up, and what activities you must stop during a flare-up.
Worst-day example:
“I have flare-ups about three times per week, usually triggered by using my arm for more than 20 minutes. During a flare-up my arm becomes swollen and I can barely straighten it at all - it locks at about 120 degrees instead of the 90 degrees I can manage on a normal day. Flare-ups last 1 to 2 days and prevent me from working with my hands.”
What the examiner listens for:
The DBQ form specifically asks about flare-ups (field 302). The examiner should document frequency, duration, triggers, and estimated additional functional loss.
Understatements to avoid:
Do not fail to mention flare-ups if you experience them. Many veterans only describe their average day - the examiner needs your worst-day presentation per M21-1 guidance.
Weakness on Extension
How to describe:
Describe inability to push, lift, or extend against resistance. Note whether your arm gives out during activities, whether you drop objects, and whether you have noticed muscle thinning (atrophy) compared to the other arm.
Worst-day example:
“When I try to push something away from me or do a pushing motion, my arm feels like it will collapse. I cannot do push-ups at all and I have trouble pushing open heavy doors. My right arm looks thinner than my left arm in the upper forearm area.”
What the examiner listens for:
Weakness as a DeLuca factor that limits functional ROM even when structural ROM is preserved. Documented via DBQ fields for weakness on extension.
Understatements to avoid:
Do not say you are 'fine' with strength if you actually struggle with resistance activities. Weakness is separately documented on the DBQ and affects functional loss findings.
Fatigue and Lack of Endurance
How to describe:
Describe how quickly your arm tires during repetitive extension-based activities, how many repetitions or how many minutes of activity cause fatigue, and what happens when you continue past that point.
Worst-day example:
“After about 10 minutes of working with my arm extended - like typing, driving, or using tools - my elbow becomes fatigued and begins aching. I have to stop and rest for at least 20 minutes. If I push through, the pain escalates dramatically and I am essentially unable to use the arm for the rest of the day.”
What the examiner listens for:
Fatigability that reduces effective ROM on repetitive use - a core DeLuca factor. DBQ has separate checkboxes for fatigability.
Understatements to avoid:
Do not omit fatigue symptoms because they seem less dramatic than pain. Fatigability is an independent basis for functional loss under DeLuca.
Incoordination
How to describe:
Describe any trembling, jerky motion, inability to control the speed or direction of elbow extension, or difficulty with fine motor tasks that require a stable extended arm position.
Worst-day example:
“When I try to slowly lower something heavy with my arm extending outward, my elbow shakes and I cannot control the movement smoothly. I have dropped items because my arm gave out unexpectedly during extension.”
What the examiner listens for:
Incoordination as a DeLuca factor, documented separately on the DBQ. Can contribute to functional loss findings even with preserved ROM.
Understatements to avoid:
Do not overlook coordination problems if you have them. Veterans often fail to mention this symptom because they attribute it to general weakness rather than a distinct finding.
Functional Impact on Daily Activities and Work
How to describe:
Describe specific activities you cannot do or can only do with difficulty or pain: reaching overhead, pushing open doors, carrying objects with arm extended, driving, typing, using tools, self-care tasks. Quantify how much time you lose and what accommodations you make.
Worst-day example:
“I can no longer perform my previous job duties which required me to extend my arm repeatedly while handling equipment. At home, I cannot fully straighten my arm to wash dishes, I avoid driving long distances because holding the steering wheel aggravates my elbow, and I need help with tasks like carrying grocery bags or putting items on high shelves. On bad days I need a brace.”
What the examiner listens for:
Specific functional limitations tied to extension loss. The DBQ asks about functional impact (field 822) and the examiner documents occupational effects.
Understatements to avoid:
Do not give vague answers like 'it limits what I can do.' Be specific about named activities, frequency, duration, and the workarounds or assistance you require.
Common Mistakes to Avoid
Performing warm-up exercises or stretching before the exam to reduce stiffness
This artificially improves your ROM measurement and may not reflect your true daily functional capacity
Instead: Arrive at the exam in your normal daily condition. If you are stiffer in the morning, schedule a morning exam if possible. Your typical baseline ROM is what matters.
Impact: Can cause underrating by 1-2 rating levels if ROM appears better than actual daily function
Pushing through pain to achieve a better ROM measurement
VA rates the degree of extension where pain begins to limit function, not just the mechanical endpoint. Forcing through pain misrepresents your condition.
Instead: Stop the motion when pain meaningfully limits you and tell the examiner 'I can physically push further but it causes significant pain at this point.' The examiner should document painful motion.
Impact: Can cause significant underrating across all levels
Failing to report flare-up history because you are not in a flare-up on the day of the exam
The DBQ specifically asks about flare-ups and the M21-1 requires the examiner to address additional functional loss during flare-ups based on your reported history
Instead: Proactively state: 'I want to note that today is not my worst day. I experience flare-ups [frequency] that increase my limitation to approximately [degrees]. During flare-ups I cannot [specific activities].'
Impact: Can result in rating based only on exam-day ROM rather than worst-day functional capacity
Not mentioning all DeLuca factors (pain, weakness, fatigue, incoordination) separately
The DBQ has separate checkboxes and fields for each factor. If you only mention pain, the other factors may not be documented, resulting in an incomplete functional loss assessment.
Instead: Before the exam, prepare a written summary of each DeLuca factor and how it affects your extension. Mention each one explicitly during the interview portion.
Impact: Affects functional loss determination at all rating levels
Underreporting the impact on your dominant arm
DC 5207 assigns different ratings for dominant vs. non-dominant arm. The dominant arm receives a higher percentage at several thresholds.
Instead: Clearly state your dominant hand at the start of the exam. If the affected arm is your dominant arm, ensure this is documented on the DBQ.
Impact: Can affect rating by 10% at the 100- and 110- thresholds
Not mentioning assistive devices or braces you use
Use of braces or assistive devices is documented on the DBQ and supports the severity of your functional limitation
Instead: Bring any brace, splint, or other device you use. Tell the examiner when and why you use it and how much it helps or does not help.
Impact: Supports higher ratings and overall disability picture
Forgetting to address both flexion and extension as potentially separate ratable conditions
DC 5206 (limitation of flexion) and DC 5207 (limitation of extension) are separately ratable. If you have both, failing to mention flexion limitation means a separate compensable rating may be missed.
Instead: Describe any limitation of bending the elbow (flexion) as well as straightening it (extension). Note if DC 5208 may apply if both flexion to 100- and extension to 45- are present.
Impact: Missing a separate flexion rating can mean a loss of 10-50% additional compensation
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request that your C&P examination be recorded (audio or video) in most states. Check your state's recording consent laws and notify the examiner at the start of the appointment.
- You have the right to review your C&P examination report once it is completed. Request a copy through your MyHealtheVet account, the VA FOIA process, or your VSO.
- You have the right to submit a personal statement (lay statement or buddy statement) documenting your symptoms, functional limitations, and flare-ups. This statement becomes part of your claims file and must be considered by the rating adjudicator.
- You have the right to request a supplemental or new C&P examination if the original exam is found to be inadequate - for example, if DeLuca factors were not addressed, passive ROM was not tested per Correia, or flare-ups were not discussed.
- You have the right to have a Veterans Service Officer (VSO), claims agent, or attorney represent you in your VA claim at no cost for VSO representation.
- You have the right to have the benefit of the doubt applied in your favor when the evidence is in approximate balance (38 CFR 3.102).
- You have the right to appeal any rating decision, including the C&P exam findings, through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals pathways under the Appeals Modernization Act.
- Per M21-1 and VA policy, the examiner is required to document your worst-day functional presentation, not just the findings on the exam day. If the examiner only recorded exam-day ROM without asking about flare-ups or repetitive use, this is a deficiency you can challenge.
- You are not required to accept the examiner's characterization of your symptoms. If the report misrepresents what you said or observed, you can submit a written rebuttal.
- Under Correia v. McDonald, the examiner is required to test both active and passive ROM. If only active ROM was tested, the examination may be considered inadequate.
Related Conditions
- Forearm, Limitation of Flexion Separately ratable condition under DC 5206. Flexion and extension limitations are evaluated independently under M21 1 guidance. If flexion is limited to 100 and extension to 45 , DC 5208 may apply instead for a combined single rating.
- Forearm, Flexion Limited to 100- and Extension to 45- DC 5208 provides a single 20% evaluation when both flexion is limited to 100 and extension to 45 are present simultaneously. Consider whether DC 5207 alone or DC 5208 combined yields the higher overall rating.
- Elbow, Ankylosis of If the elbow is fused (ankylosed) rather than limited in motion, DC 5205 applies instead of DC 5207. Ankylosis at a favorable angle rates differently than limitation of motion.
- Impairment of Supination and Pronation of the Forearm Forearm rotation (pronation/supination) is separate and distinct from elbow flexion/extension and can be separately rated under DC 5213. M21 1 confirms these are non duplicative disabilities warranting independent evaluations.
- Arthritis, Post-Traumatic (Elbow) Post traumatic arthritis of the elbow is often the underlying diagnosis driving extension limitation. DC 5010 may be used as the diagnostic basis (e.g., 5010 5207) when the extension limitation results from arthritis following an injury.
- Dislocation of the Elbow Elbow dislocation history may be the precipitating cause of extension limitation. Document any prior dislocation events in your history as they establish the nexus between service and current limitation.
- Total Elbow Arthroplasty If you have had a total elbow joint replacement, DC 5054 provides a minimum 100% rating for one year post surgery, after which the residual limitation is rated under the appropriate motion limitation code. Ensure surgical history is fully documented on the DBQ.
- Lateral Epicondylitis (Tennis Elbow) Lateral epicondylitis can cause or contribute to extension limitation and is documented on the elbow/forearm DBQ. It may be rated analogously under a motion limitation code or under DC 5024 (tenosynovitis).
- Heterotopic Ossification Heterotopic ossification around the elbow joint is a documented cause of extension limitation, particularly following trauma or surgery. It is listed as a diagnosis option on the DBQ and should be identified if present on imaging.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.