The radius is the outer shorter bone of the forearm. The ulna is the inner and larger bone of the forearm between the wrist and the elbow. Nonunion refers to failure to unite. In this case, nonunion is of the radius and ulna bones. Flail false joint is a pseudoarthrosis joint with excessive mobility. In this case, it refers to the elbow joint; the joint between the upper arm and forearm.

Nonunion of the bones may be caused by failure of fractured bones to heal completely; prolonged, untreated nonunion of the bones; excess motion from inadequate immobilization; dislocation of the elbow; infection of the bone; loosening of the prosthetic joint; loss of bone mass; or direct trauma.

There may be pain; restricted motion; deformity; shortening of the limb; soft tissue injury; swelling; decreased circulation to the forearm; and instability.

Tests may include: general physical examination and nerve and muscle function examinations; laboratory studies; and radiology studies such as, x-ray, magnetic resonance imaging (MRI), bone scan, or computed tomography (CT) scan. A goniometer to measure range of motion may be used.

Surgical intervention is the treatment of choice for nonunion of a false flail joint. Other treatments may include: elbow arthroplasty; splinting; casting; traction; bone graft; range of motion exercises; and medication to treat infection or pain.

Outcomes of function and motion may depend on the length of time the nonunion existed. Osteomyelitis may develop. The need for physical therapy may be ongoing.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply 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]

• 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.

• 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]