VA Disability Rating for Ulna Impairment
Diagnostic Code 5211 · 38 CFR §4.71a
What Is It?
DC 5211 covers impairments of the ulna bone, which is the larger of the two forearm bones on the pinky finger side. Impairments include nonunion of the ulna where a fracture fails to heal, and malunion where it heals in a poor position. Veterans may develop ulna impairments from forearm fractures during training, falls, vehicle accidents, or direct blows to the forearm during service. 38 CFR 4.71a rates DC 5211 on where the bone failed to unite and what that left. Nonunion in the upper half, with false movement, is rated 40 percent in the major arm and 30 in the minor arm when there is loss of bone substance (1 inch (2.5 cm) or more) and marked deformity, and 30 and 20 when there is no loss of bone substance or deformity. Nonunion in the lower half is 20 percent in either arm, and malunion with bad alignment is 10 percent in either arm. There is no 0 percent row.
Rating Criteria
| Rating | Criteria |
|---|---|
| 40% | Nonunion in upper half, with false movement, with loss of bone substance (1 inch (2.5 cm) or more) and marked deformity — major (dominant) arm. |
| 30% | Nonunion in upper half, with false movement, with loss of bone substance (1 inch (2.5 cm) or more) and marked deformity — minor (non-dominant) arm. Also: nonunion in upper half, with false movement, without loss of bone substance or deformity — major (dominant) arm. |
| 20% | Nonunion in upper half, with false movement, without loss of bone substance or deformity — minor (non-dominant) arm. Also: nonunion in lower half — either arm. |
| 10% | Malunion of the ulna, with bad alignment — either arm. |
Evidence Needed
- Imaging showing ulna nonunion or malunion
- Medical records from the original fracture during service
- Physical exam documenting instability or false movement
- Range of motion testing of the elbow and wrist
- Documentation of dominant arm
C&P Exam Tips
- Show the examiner imaging documenting the ulna impairment
- Demonstrate any false movement at the nonunion site
- Describe how the impairment affects your ability to grip, lift, and rotate the forearm
- Point out any visible deformity in the forearm
- Document your dominant arm
How to File
File under DC 5211 for ulna impairment. Specify whether the impairment is nonunion or malunion, and in which half of the bone. For nonunion in the upper half, have the record show false movement and whether there is loss of bone substance of 1 inch (2.5 cm) or more with marked deformity, since those findings separate the 40 and 30 percent levels from the 30 and 20. Include imaging and indicate your dominant arm: the upper-half nonunion figures differ by arm, while nonunion in the lower half (20 percent) and malunion (10 percent) are the same for either arm.
Common Mistakes
- Not specifying which half of the ulna is affected.
- Failing to document false movement at the nonunion site.
- Not noting dominant arm status.
- Missing associated ulnar nerve damage from the fracture.
Frequently Asked Questions
Why does location on the ulna matter?
The schedule rates the two halves differently. Nonunion in the upper half, with false movement, is rated 40 or 30 percent in the major arm and 30 or 20 in the minor arm, depending on whether there is loss of bone substance (1 inch (2.5 cm) or more) and marked deformity. Nonunion in the lower half is 20 percent in either arm. Anatomically, the upper half of the ulna forms part of the elbow joint, while the lower half sits toward the wrist.
What is false movement?
False movement means there is abnormal motion at the fracture site because the bone ends are not connected. The forearm bends or shifts where it should be rigid. This is a sign of nonunion and indicates significant structural failure.
Is there a 0 percent rating under DC 5211?
No. DC 5211 prints 40, 30, 20 and 10 percent and nothing lower. The lowest figure, 10 percent, is for malunion of the ulna with bad alignment, in either arm.