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.
Rating Criteria
| Rating | Criteria |
|---|---|
| 40% | Loss of supination and pronation where the hand is fixed in full pronation in the dominant arm |
| 30% | Loss of supination and pronation where the hand is fixed near the middle of the arc or in full pronation of non-dominant arm |
| 20% | Loss of supination and pronation where motion is limited beyond the last quarter of the arc and the hand does not approach full pronation, dominant arm |
| 10% | Limitation of pronation where motion is lost beyond the middle of the arc in 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. The rating depends on where in the rotational arc motion is lost and whether the dominant arm is affected.
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?
Yes, these are different functional impairments rated under different diagnostic codes. You can receive a rating for limited forearm rotation under DC 5213 and separate ratings for limited flexion or extension under DC 5206 and DC 5207.