Forearm refers to the portion of the arm that lies between the elbow and the wrist. Flexion refers to bending or decreasing an angle between joint-forming bones. In this case, the joint of flexion for the forearm is the elbow. Limitation of motion refers to a point or line beyond which motion is restricted, and movement cannot progress normally (i.e., range of motion of joints).

Causes of limitation of the flexion of the forearm may include: diseases of the joint, the structures adjacent to the joint, or both; and problems associated with the tendon of the long head of the biceps or with the flexor muscles. Trauma or infection may also limit range of motion.

Signs and symptoms suggestive of musculoskeletal involvement, associated with limitation of flexion of the forearm may include: joint pain; swelling; stiffness; deformity; immobility; muscle aches; weakness and decreased range of motion. (Normal ROM for forearm flexion is 0 to 145 ° degrees.)

To determine limited flexion of the forearm, tests involving range of motion of the elbow joint may be done. These may include: inspection; passive range of movement (passive flexion); and isometric resistance (resisted flexion, pronation and supination). A goniometer may be used to measure limitations of range of motion. Radiology studies may also be indicated. Laboratory tests may be ordered to confirm a diagnosis.

Various physical therapies, as well as anti-inflammatory medications, may be used to treat the specific underlying cause.

• There may be impaired physical mobility and limited activities of daily living (ADL)

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for an SC disability. 

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still applies and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of shoulder and arm ranges of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of motion in shoulder and arm in flexion, elevation, abduction, external rotation, and internal rotation is indispensable. 38 CFR 4.46 [Accurate measurement]

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the table in the M21-1 for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each. 

• Impairments of the elbow, forearm, and wrist will be assigned separate disability evaluations.  The motions of these joints are all viewed as clinically separate and distinct.  Assign separate evaluations for impairment under the following DCs:

  • elbow: flexion under  or extension under 38 CFR 4.71a, DC 5206 or extension under 38 CFR 4.71a, DC 5207

  • forearm supination and pronation under 38 CFR 4.71a, DC 5213, and

  • wrist flexion or ankylosis under 38 CFR 4.71a, DC 5214 or 38 CFR 4.71a, DC 5215

• 38 CFR 4.59 may be applied separately to the elbow, the forearm, and the wrist to result in potentially three separate evaluations for painful motion when the evidence otherwise supports such a finding.  However, 38 CFR 4.59 may only be applied once to the elbow and may not be separately applied to both elbow flexion and elbow extension.

• When examination or other evidence denotes pain present in the joint or periarticular region but does not delineate the specific motions in which pain is present and there is a potential for a separate evaluation under 38 CFR 4.59, obtain a medical opinion to determine which motions are painful. When the examiner cannot delineate which motions are associated with pain, resolve doubt in favor of the Veteran, per 38 CFR 4.3, and consider painful motion to be present in the separate plane such as to allow assignment of the separate minimum compensable evaluation under 38 CFR 4.59.

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations.

• In all the forearm and wrist injuries, codes 5205 through 5213, multiple impaired finger movements due to tendon tie-up, muscle or nerve injury, are to be separately rated and combined not to exceed rating for loss of use of hand. 38 CFR 4.71 (a) [Schedule of ratings-musculoskeletal system]