VA Disability Rating for Supination and Pronation Impairment
Diagnostic Code 5213 · 38 CFR §4.71a
What Is It?
Supination and pronation are the rotational movements of your forearm. Supination turns your palm upward, like holding a bowl of soup. Pronation turns your palm downward, like typing on a keyboard. These movements depend on the radius bone rotating around the ulna. When this rotation is impaired by fracture residuals, arthritis, or bone deformity, many daily tasks become difficult, including using tools, turning keys, eating with utensils, and typing. Veterans commonly lose forearm rotation from forearm fractures, elbow injuries, or wrist trauma sustained during service. 38 CFR 4.71a divides DC 5213 into three parts. Loss of supination and pronation through bone fusion is rated by the position the hand is fixed in: in supination or hyperpronation, 40 percent in the major arm and 30 in the minor; in full pronation, 30 and 20; near the middle of the arc or in moderate pronation, 20 in either arm. Limitation of pronation is rated 30 percent in the major arm and 20 in the minor when motion is lost beyond the middle of the arc, and 20 in either arm when motion is lost beyond the last quarter of the arc and the hand does not approach full pronation. Limitation of supination to 30 degrees or less is 10 percent in either arm. There is no 0 percent row.
Rating Criteria
| Rating | Criteria |
|---|---|
| 40% | Loss of supination and pronation (bone fusion), the hand fixed in supination or hyperpronation — major (dominant) arm. |
| 30% | Loss of supination and pronation (bone fusion), the hand fixed in supination or hyperpronation — minor (non-dominant) arm. Also: bone fusion with the hand fixed in full pronation — major (dominant) arm. Also: limitation of pronation, motion lost beyond the middle of the arc — major (dominant) arm. |
| 20% | Bone fusion with the hand fixed in full pronation — minor (non-dominant) arm. Also: limitation of pronation, motion lost beyond the middle of the arc — minor (non-dominant) arm. Also, in either arm: bone fusion with the hand fixed near the middle of the arc or in moderate pronation; or limitation of pronation with motion lost beyond the last quarter of the arc, the hand not approaching full pronation. |
| 10% | Limitation of supination to 30 degrees or less — either arm. |
Evidence Needed
- Goniometer measurements of forearm supination and pronation
- Medical records linking the rotational loss to a service-connected condition
- Imaging of the forearm showing structural causes
- Documentation of dominant arm
- Functional assessment showing tasks affected by rotational loss
C&P Exam Tips
- Make sure the examiner measures both supination and pronation separately
- Demonstrate difficulty with tasks requiring forearm rotation like using a screwdriver
- Describe how the limitation affects your daily activities and work
- Confirm your dominant arm is documented
- Show the position your hand is fixed in if rotation is severely limited
How to File
File under DC 5213 for impaired forearm rotation. Include goniometer measurements of both supination and pronation. If the forearm bones have fused, have the record state the position the hand is fixed in — supination or hyperpronation, full pronation, or near the middle of the arc or moderate pronation — because that position sets the rating. If motion remains, the rating depends on how much of the pronation arc is lost, or on whether supination is limited to 30 degrees or less. Several levels also differ by whether the dominant arm is affected, so make sure your dominant arm is documented.
Common Mistakes
- Not having forearm rotation measured separately from wrist motion.
- Failing to describe the practical impact of losing the ability to turn the palm up or down.
- Not specifying dominant arm.
- Missing forearm rotation testing during the C&P exam entirely.
Frequently Asked Questions
What daily tasks require forearm rotation?
Almost everything you do with your hands involves some forearm rotation: eating with a fork or spoon, opening doorknobs, typing, using tools, turning a steering wheel, and receiving change at a store. Loss of rotation is more functionally limiting than many people realize.
Can I get rated for rotation loss and elbow flexion limitation separately?
Often, yes. Limited forearm rotation (DC 5213) and limited elbow flexion (DC 5206) or extension (DC 5207) are listed under different codes and can be rated separately and combined under 38 CFR 4.25, so long as the ratings do not evaluate the same disability twice (38 CFR 4.14). One place to watch for overlap: unfavorable ankylosis of the elbow under DC 5205 includes "complete loss of supination or pronation" in its own criteria.
Are finger problems from the same forearm injury rated separately?
The schedule provides for it. A Note to the forearm and wrist codes, 5205 through 5213, states that multiple impaired finger movements due to tendon tie-up, muscle or nerve injury are to be separately rated and combined, not to exceed the rating for loss of use of the hand.