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. Extension is the movement by which two elements of any jointed part are drawn away from each other. Limitation of motion refers to a point or line beyond which motion is restricted, and movement cannot or may not progress normally (i.e., range of motion of joints). In this case, the joint of flexion and extension for the forearm is the elbow.

Causes of limitation of flexion and extension of the forearm may include diseases of the joint, the structures adjacent to the joint, or both. Trauma or infection may also limit range of motion. Problems associated with the tendon of the long head of the biceps or with the flexor muscles may limit flexion. A loose body in the joint may also contribute to limitation of its extension.

Signs and symptoms suggestive of musculoskeletal involvement, that could limit flexion of the forearm or extension of the forearm may include: joint pain; swelling; stiffness; deformity; immobility; muscle aches; weakness; and decreased range of motion (normal ROM for flexion of the forearm is 0 to 145° degrees, and normal ROM for elbow extension is 145° to 0 degrees).

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

Physical therapy, as well as anti-inflammatory medications, may be used to treat the specific underlying cause. Orthotics may be provided to support the joint and associated structures. In some cases of advanced joint disease, surgery may be necessary.

• 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. 

• 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.

• If elbow flexion is limited to 100 degrees and elbow extension is limited to 45 degrees, assign a single 20-percent disability evaluation under 38 CFR 4.71a, DC 5208.

• 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 4.71a [Schedule of ratings-musculoskeletal system]