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C&P Exam Prep: Radius, Impairment of
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 evaluate the nature and severity of impairment to the radius bone, including nonunion, malunion, false movement, bone substance loss, and deformity, in order to assign a disability rating under 38 CFR 4.71a, DC 5212.
What the examiner evaluates:
- Presence and location of nonunion (upper vs. lower half of radius)
- Presence of false or flail movement at the fracture site
- Extent of bone substance loss (whether 1 inch or more)
- Presence of marked deformity
- Malunion with bad alignment
- Range of motion of the elbow (flexion, extension) and forearm (pronation, supination)
- Pain on active and passive motion, at rest, and with repetitive use
- Weakness, fatigability, incoordination, and lack of endurance
- Functional loss caused by the condition
- Radiographic evidence (x-rays) documenting bone status
- Surgical history including arthroplasty or other forearm procedures
- Assistive device use (braces, splints)
- Muscle atrophy or circumferential measurement differences between extremities
The exam will include both an interview portion and a physical examination. The examiner will measure range of motion with a goniometer and perform repetitive-use testing. Bring any braces, splints, or assistive devices you use. Wear clothing that allows easy access to both arms.
Typical duration: 30-45 minutes
Elbow Flexion Range of Motion
The degree of bending at the elbow joint, normally 0 to 145 degrees.
What to expect:
Examiner will use a goniometer to measure how far you can bend your elbow. Normal endpoint is 145 degrees. You will perform this actively (you move it), passively (examiner moves it), and after 3 repetitions.
Key thresholds:
- Full 0-145 degrees — Normal; no impact from flexion alone under DC 5212
- Limited flexion (less than 145 degrees) — May support functional loss argument, particularly if associated with nonunion or malunion
Tips:
- Perform movement at YOUR comfortable maximum - do not push through severe pain
- Clearly state when pain begins during motion
- Report if end-range is different after repeating the motion three times
- Mention if your worst days are significantly more restricted than today
Pain considerations: Inform the examiner of the exact degree at which pain begins, not just the maximum degree you can reach. Pain limiting motion is a separate compensable element under DeLuca v. Brown.
Elbow Extension Range of Motion
The degree of straightening at the elbow, normal endpoint is 0 degrees (full extension).
What to expect:
Examiner measures how fully you can straighten your elbow. Any flexion contracture (inability to fully extend) will be recorded.
Key thresholds:
- Full extension to 0 degrees — Normal
- Extension limited beyond 0 degrees (flexion contracture) — Indicates functional loss; may support higher rating via analogous codes or functional impairment
Tips:
- Do not force your elbow straight if painful
- Report stiffness, snapping, or locking during extension
- Note if extension is worse in the morning or after activity
Pain considerations: Even if you can extend fully, report pain experienced during extension, as painful motion can be rated as functional loss.
Forearm Pronation Range of Motion
The ability to rotate the forearm so the palm faces downward. Normal is 0 to 80 degrees.
What to expect:
Examiner will measure how far you can rotate your forearm palm-down. This is critical under DC 5212 and related codes (DC 5213) because limitation of pronation has direct rating thresholds.
Key thresholds:
- Pronation limited beyond last quarter of arc (hand cannot approach full pronation) — 20% (major) / 20% (minor) under DC 5213
- Pronation lost beyond middle of arc — 20% (major) / 20% (minor) under DC 5213
- Complete loss of pronation (0 degrees) — Supports maximum rating consideration under related supination/pronation code
Tips:
- Measure accurately - do not compensate by rotating your shoulder
- Describe whether limitation is due to pain, mechanical block, or weakness
- Report functional tasks affected: turning a key, opening a door, using a screwdriver
Pain considerations: Report pain onset during pronation and whether pain limits you before the mechanical endpoint is reached.
Forearm Supination Range of Motion
The ability to rotate the forearm so the palm faces upward. Normal is 0 to 85 degrees.
What to expect:
Examiner will measure how far you can rotate your forearm palm-up. Limitation of supination to 30 degrees or less has a specific rating threshold.
Key thresholds:
- Supination limited to 30 degrees or less — Specific threshold under DC 5213 - 20% (major) / 20% (minor)
- Complete loss of supination — Supports maximum rating consideration
Tips:
- Perform only what your arm can do comfortably without compensatory shoulder movement
- Note if carrying objects, pouring liquids, or receiving change is difficult
- Report if supination is worse after activity or on bad days
Pain considerations: Clearly distinguish between pain-limited supination and mechanically-blocked supination; both are compensable.
Bone Assessment and Deformity Examination
Physical presence of nonunion, false movement, bone loss, malunion, and deformity of the radius.
What to expect:
The examiner will palpate the radius shaft, assess for abnormal movement at the fracture site, and review any available x-rays or imaging. They will assess whether bone loss is 1 inch (2.5 cm) or more and whether marked deformity is present.
Key thresholds:
- Nonunion in lower half with false movement, with bone loss 1 inch or more and marked deformity — 40% (major) / 30% (minor)
- Nonunion in lower half with false movement, without bone loss or deformity — 30% (major) / 20% (minor)
- Nonunion in upper half — 20% (major) / 20% (minor)
- Malunion with bad alignment — 10% (major) / 10% (minor)
Tips:
- Bring all relevant x-rays, CT scans, or operative reports showing the fracture site and healing status
- If you have had a physician measure or comment on bone loss, bring that documentation
- If you experience abnormal movement or clicking at the fracture site, demonstrate and describe this to the examiner
- Describe how misalignment affects your grip, lifting, or rotation
Pain considerations: Even when a nonunion or malunion is present, also describe the pain, weakness, and functional limitations that result from the structural abnormality.
Circumferential Muscle Measurement (Atrophy Assessment)
Comparison of arm circumference between the affected and unaffected extremity to detect muscle atrophy from disuse.
What to expect:
Examiner measures the circumference of both upper extremities at the same anatomical location (typically the forearm or upper arm). A difference suggests disuse atrophy.
Key thresholds:
- Greater than 1-2 cm difference — Supports disuse atrophy finding, which is a compensable functional loss element
Tips:
- Do not flex or tense muscles during measurement
- Mention if you have been favoring the affected arm
- Note any visible difference in muscle size you have observed yourself
Pain considerations: Atrophy often results from avoiding painful use of the arm; describe the specific activities you avoid and why.
Repetitive-Use Testing (DeLuca/Correia Requirement)
Whether range of motion worsens after three repetitions of motion, simulating actual-use conditions.
What to expect:
After initial ROM measurements, the examiner will ask you to repeat each motion three times and remeasure. This is legally required under Correia v. McDonald and DeLuca v. Brown. The examiner must document any additional functional loss after repetition.
Key thresholds:
- ROM decreases after repetition — Supports higher effective disability rating by demonstrating functional loss exceeding initial measurement
- Pain, fatigue, or weakness increases after repetition — Must be documented by examiner; supports higher rating even if degrees do not change
Tips:
- Honestly report if motion becomes more painful, weaker, or more limited after repeated use
- Do not perform three repetitions faster than you would in real life
- Tell the examiner specifically: 'My range of motion is worse after repeating this motion' if applicable
- If you cannot complete three repetitions due to pain or fatigue, say so clearly
Pain considerations: Increased pain, swelling, stiffness, or weakness after repetition is legally significant. Describe it in terms of degrees of worsening if possible.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 40% | Nonunion in lower half of radius, with false movement: WITH loss of bone substance of 1 inch (2.5 cm) or more AND marked deformity - MAJOR extremity (dominant arm) |
CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, with false movement, with loss of bone substance (1 inch or more) and marked deformity - 40% major, 30% minor |
| 30% | Nonunion in lower half of radius, with false movement: WITHOUT loss of bone substance or deformity - MAJOR extremity; OR Nonunion in lower half WITH bone loss/deformity - MINOR extremity (non-dominant) |
CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, without loss of bone substance or deformity - 30% major, 20% minor |
| 20% | Nonunion in upper half of radius (major or minor); OR Nonunion in lower half without bone loss/deformity - MINOR extremity |
CFR: 38 CFR 4.71a DC 5212: Nonunion in upper half - 20% major, 20% minor |
| 10% | Malunion of radius with bad alignment (major or minor extremity) |
CFR: 38 CFR 4.71a DC 5212: Malunion with bad alignment - 10% major, 10% minor |
40% Nonunion in lower half of radius, with false movement: WITH ...
Nonunion in lower half of radius, with false movement: WITH loss of bone substance of 1 inch (2.5 cm) or more AND marked deformity - MAJOR extremity (dominant arm)
Key Symptoms
- Abnormal or false movement at nonunion site in lower radius
- Bone gap of 1 inch or greater confirmed on imaging
- Visible or palpable marked deformity of the radius
- Severe limitation of forearm rotation
- Significant pain and functional loss
- Weakness and inability to perform weight-bearing or grip tasks
CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, with false movement, with loss of bone substance (1 inch or more) and marked deformity - 40% major, 30% minor
30% Nonunion in lower half of radius, with false movement: WITHO ...
Nonunion in lower half of radius, with false movement: WITHOUT loss of bone substance or deformity - MAJOR extremity; OR Nonunion in lower half WITH bone loss/deformity - MINOR extremity (non-dominant)
Key Symptoms
- Abnormal movement at nonunion site in lower half of radius
- No significant bone gap or deformity present (for 30% major)
- Pain with motion and at rest
- Limited forearm pronation and supination
- Functional loss in gripping, rotating, lifting
CFR: 38 CFR 4.71a DC 5212: Nonunion in lower half, without loss of bone substance or deformity - 30% major, 20% minor
20% Nonunion in upper half of radius (major or minor); OR Nonuni ...
Nonunion in upper half of radius (major or minor); OR Nonunion in lower half without bone loss/deformity - MINOR extremity
Key Symptoms
- False or abnormal movement in upper radius
- Pain and functional loss of elbow and forearm
- Limitation of flexion or extension
- Reduced grip strength
- Difficulty with overhead activities or lifting
CFR: 38 CFR 4.71a DC 5212: Nonunion in upper half - 20% major, 20% minor
10% Malunion of radius with bad alignment (major or minor extrem ...
Malunion of radius with bad alignment (major or minor extremity)
Key Symptoms
- Healed fracture in a poor position (malunion) confirmed on imaging
- Visible angular or rotational deformity
- Mild to moderate limitation of motion
- Pain with use
- Some reduction in grip or forearm rotation
CFR: 38 CFR 4.71a DC 5212: Malunion with bad alignment - 10% major, 10% minor
How to Describe Your Symptoms
Pain
How to describe:
Describe pain location (e.g., middle of forearm, at fracture site, radiating to wrist or elbow), character (aching, sharp, burning), frequency (constant vs. intermittent), and what makes it worse (rotation, lifting, gripping, extended use). Rate severity on a 0-10 scale for typical days and worst days.
Worst-day example:
“On my worst days, I wake up with a constant 8/10 aching pain at the fracture site in my forearm. I cannot rotate my palm upward at all without sharp pain, and even resting my arm on a surface causes discomfort that wakes me at night.”
What the examiner listens for:
Onset of pain during specific motions, pain at rest versus with activity, pain limiting functional use, and whether pain worsens with repeated use over time.
Understatements to avoid:
Do not say 'it's not that bad' or 'I manage.' Describe the actual impact of the pain on what you can and cannot do. Do not average your pain - report your worst typical experience.
Weakness
How to describe:
Describe inability to grip objects, difficulty lifting, inability to resist forces (e.g., a jar lid, a wrench), and whether weakness is constant or develops after use. Note if the affected arm fatigues faster than the unaffected arm.
Worst-day example:
“I cannot hold a gallon of milk with my affected arm. After two or three minutes of using my forearm, my grip gives out and I drop things. My arm shakes when I try to rotate against resistance.”
What the examiner listens for:
Objective weakness on muscle testing, description of tasks that can no longer be performed, and grip or rotational strength reduction compared to contralateral side.
Understatements to avoid:
Do not say 'I'm weak but I push through it.' Quantify: how heavy an object can you hold, for how long, before you must stop.
Fatigability and Lack of Endurance
How to describe:
Explain how quickly the affected arm tires with use. Give specific examples: 'After 5 minutes of writing I have to stop,' or 'I can only carry groceries one bag at a time and must switch arms every 30 seconds.'
Worst-day example:
“On bad days, I cannot wash dishes for more than 2 minutes before my forearm becomes so fatigued and painful that I have to stop for 10 minutes before resuming. I used to work all day with my hands.”
What the examiner listens for:
Evidence that functional capability degrades significantly with sustained or repeated use - this is the core of the DeLuca doctrine and must be captured in the DBQ.
Understatements to avoid:
Do not say 'I get tired sometimes.' Provide specific time estimates, describe what happens when you push through fatigue, and clarify that this is different from before your injury.
Incoordination
How to describe:
Describe difficulty with fine motor tasks: buttoning a shirt, turning a key, catching objects, pouring liquids, using tools. Note any tremor, unsteadiness, or loss of precise control in the affected arm.
Worst-day example:
“I spill drinks when I try to pour because I cannot control the rotation of my forearm smoothly. I miss the keyhole when trying to unlock doors. I cannot thread a needle or handle small screws.”
What the examiner listens for:
Loss of smooth, coordinated movement in the forearm and hand that was not present before the injury, particularly in tasks requiring rotation or fine control.
Understatements to avoid:
Do not minimize coordination problems as 'clumsiness.' Describe specific tasks that have become unreliable and any injuries or accidents that have resulted.
Flare-Ups
How to describe:
Describe what triggers a flare (weather, activity, stress, overuse), how long flare-ups last, how severe they are, how often they occur, and what you must do when they occur (rest, ice, medication).
Worst-day example:
“When I do any heavy lifting or repeated twisting motions, my forearm swells, the pain spikes to 9/10, and I cannot use the arm for 2-3 days. This happens at least twice a month. During a flare I cannot drive, cook, or care for myself properly.”
What the examiner listens for:
Frequency, severity, duration, and triggers of flare-ups. The examiner is required to document flare-up impact and must note if range of motion would be further reduced during a flare.
Understatements to avoid:
Do not say 'I just rest until it gets better.' Quantify rest duration, activity restrictions during flares, and whether you have sought medical treatment for flares.
False Movement and Deformity
How to describe:
If you have nonunion with false movement, describe the sensation: abnormal bending or movement at the fracture site, a sense of the bone shifting, clicking, or instability in the forearm when you try to use it.
Worst-day example:
“When I try to rotate my forearm or apply any torque, I can feel the fracture site flex abnormally. It feels unstable, like the bone is not solid. I avoid any activity that loads the forearm because I fear re-injury.”
What the examiner listens for:
Palpable or observable false movement at the fracture site, instability during forearm rotation, and patient-reported sensation of nonunion.
Understatements to avoid:
Do not say 'it feels weird sometimes.' Be specific: describe when it happens, what the movement feels like, and what you are unable to do because of it.
Common Mistakes to Avoid
Presenting at your best - dressing up, masking pain, performing at full capacity
C&P exams are not job interviews. The examiner is rating your actual disability level. If you perform better than typical, your rating may not reflect your true functional loss.
Instead: Come as you are on a typical or moderately bad day. If you are having a particularly good day, tell the examiner: 'Today is actually better than usual. On a typical day I am more limited.'
Impact: All levels - can result in underrating across the board
Not demonstrating or describing false movement at the fracture site
Under DC 5212, the distinction between nonunion WITH false movement versus simple nonunion is directly tied to rating percentage. False movement must be observed or described to qualify for higher ratings.
Instead: If you have nonunion with false movement, ask the examiner to specifically assess for it. Describe the abnormal sensation and demonstrate the instability if possible.
Impact: Difference between 20% (nonunion upper half) and 30-40% (nonunion lower half with false movement)
Not bringing imaging or operative reports showing bone loss measurement
The 40% rating requires bone substance loss of 1 inch (2.5 cm) or more. Without radiographic or surgical documentation, the examiner cannot confirm this threshold.
Instead: Obtain and bring all x-rays, CT scans, operative reports, and any physician notes documenting the size of any bone defect. Request copies from your treating providers before the exam.
Impact: Difference between 30% and 40% (major extremity)
Failing to distinguish dominant (major) from non-dominant (minor) arm
DC 5212 has separate ratings for major and minor extremity. Dominant arm consistently receives the higher percentage at each level. Misidentifying which arm is dominant can cost you a rating tier.
Instead: Clearly state which arm is your dominant arm at the beginning of the exam and confirm this is reflected in the DBQ.
Impact: All levels - minor arm rates 0-10% lower at each tier
Not describing functional loss beyond structural findings
The rating criteria for DC 5212 are based on structural bone status, but functional loss from pain, weakness, and limited motion can support the examiner documenting additional impairment and may support secondary or analogous codes.
Instead: After describing the structural issue, describe every functional task you cannot do: turning a screwdriver, lifting groceries, driving, performing self-care. This supports both the primary rating and any supplemental functional loss documentation.
Impact: All levels - functional loss documentation affects total rating picture
Not reporting worsening after repetitive use
Under DeLuca v. Brown and Correia v. McDonald, the examiner must document whether ROM or functional ability worsens after repetition. If you do not report this and the examiner does not ask, it may be omitted from the DBQ, weakening your claim.
Instead: After each ROM measurement, proactively tell the examiner: 'My motion worsens after repeated use. By the third repetition, I feel more pain and my range decreases.' If the examiner does not perform repetitive-use testing, note this to your VSO.
Impact: All levels - critical for ensuring DeLuca compliance in the DBQ
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 bring a representative, advocate, or support person to the C&P exam. They may not answer questions for you but can be present for moral support.
- You have the right to request that the examination be conducted in person (not via telehealth) if you believe an in-person physical evaluation is necessary for an adequate assessment of your condition.
- You have the right to record your C&P examination in most states. Check applicable state recording consent laws before the exam and notify the examiner at the start if you intend to record.
- You have the right to submit your own independent medical opinion (IMO) from a private physician before or after the C&P exam. A private nexus opinion or severity opinion can supplement or rebut the VA examiner's findings.
- You have the right to a copy of the completed Disability Benefits Questionnaire (DBQ) through a Freedom of Information Act (FOIA) request or through your VSO's access to the claims file.
- You have the right to request a new or additional C&P examination if the initial exam is found to be inadequate (e.g., examiner failed to perform repetitive-use testing, failed to assess false movement, or provided a conclusory opinion without supporting rationale).
- You have the right to submit lay statements (buddy statements, personal statements) attesting to your observable symptoms, functional limitations, and how the condition affects your daily life. These are considered evidence under 38 CFR 3.303.
- Under the PACT Act and AMA, you have the right to choose from three review lanes after a rating decision: Supplemental Claim, Higher-Level Review, or Board of Veterans Appeals appeal, each with different evidentiary rules.
- You have the right to submit medical literature, peer-reviewed research, or treatises supporting your claim under 38 CFR 3.303(c) and related provisions.
- You have the right to request that VA obtain any outstanding federal records (e.g., service treatment records, VA treatment records) that are relevant to your claim before the rating decision is made.
Related Conditions
- Radius and Ulna, Nonunion of, with Flail False Joint DC 5210 applies when both the radius AND ulna have nonunion with a flail/false joint, rated at 50% major / 40% minor higher than DC 5212 alone. If both bones are affected, this code may produce a more favorable rating.
- Supination and Pronation, Impairment of DC 5213 rates limitation of forearm rotation (pronation and supination) independently. If rotation is significantly limited due to radius impairment, DC 5213 may rate the rotational component separately or as the governing code if more favorable.
- Ulna, Impairment of DC for ulna impairment (5213 analogous) covers nonunion and malunion of the ulna. Often claimed alongside DC 5212 when both bones of the forearm are injured.
- Elbow Dislocation Radial head or elbow dislocations associated with radius fractures may be separately ratable under DC 5209 (elbow dislocation) if residuals are present.
- Post-Traumatic Arthritis, Elbow Long standing radius nonunion or malunion can lead to post traumatic arthritis in the elbow or wrist joints, which may be separately ratable under DC 5010 (arthritis due to trauma) or DC 5003 (degenerative arthritis).
- Limitation of Flexion, Elbow If elbow flexion is significantly limited as a result of radius impairment, DC 5206 (limitation of flexion of the elbow) may apply as an alternative or analogous rating code if more favorable.
- Peripheral Nerve Conditions - Radial Nerve Radius fractures or nonunion can cause direct injury to or entrapment of the radial nerve, potentially producing separately ratable peripheral nerve involvement under DC 8514 (radial nerve paralysis).
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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.