VA Disability Rating for Long Thoracic Nerve Paralysis
Diagnostic Code 8519 · 38 CFR §4.124a
What Is It?
The long thoracic nerve controls the serratus anterior muscle, which holds your shoulder blade flat against your rib cage. When this nerve is damaged, your shoulder blade wings outward from your back, a condition known as winged scapula. This makes it difficult to push things, reach overhead, or lift your arm fully. Veterans may develop this from carrying heavy packs with improperly fitted straps, repetitive overhead activities, direct blows to the shoulder area, or surgical injuries during service.
Rating Criteria
| Rating | Criteria |
|---|---|
| 30% | Complete paralysis in the major (dominant) arm: inability to raise the arm above shoulder level, winged scapula deformity. |
| 20% | Complete paralysis in the minor (non-dominant) arm, or severe incomplete paralysis in either arm. Severe is the same 20 percent for the major and the minor arm. |
| 10% | Moderate incomplete paralysis. Same rating for the major and the minor arm. |
| 0% | Mild incomplete paralysis. Same rating for the major and the minor arm. |
Evidence Needed
- Medical records documenting long thoracic nerve injury connected to service
- Photographs showing winged scapula when pushing against a wall
- Electromyography results confirming serratus anterior denervation
- Range of motion testing for overhead arm elevation
- Documentation of which side is affected and whether it is the dominant arm
C&P Exam Tips
- Ask the examiner to observe your shoulder blade while you push against a wall with both hands
- Demonstrate difficulty reaching overhead
- Show how the scapula wings out during forward arm elevation
- Describe activities that worsen the winging or cause shoulder pain
- Explain how the condition limits pushing, lifting, and reaching tasks
How to File
File under DC 8519 for long thoracic nerve paralysis. Photographs of your winged scapula are particularly persuasive evidence. Include nerve testing results and explain how the injury occurred during service, such as from carrying heavy loads or direct shoulder trauma. 38 CFR 4.124a prints complete paralysis at 30 percent for the major arm and 20 for the minor; severe incomplete paralysis is 20 percent, moderate 10 percent, and mild 0 percent for either arm. A Note under DC 8519 says the rating is not to be combined with lost motion above shoulder level.
Common Mistakes
- Not providing photographs that clearly show the scapular winging.
- Having the condition diagnosed as a shoulder problem rather than a nerve condition.
- Not performing the wall push test during the C&P exam to demonstrate winging.
- Failing to connect the nerve injury to specific service activities like rucksack carrying.
Frequently Asked Questions
Can winged scapula heal on its own?
Some cases of long thoracic nerve palsy do recover over one to two years, particularly if caused by a stretch injury. However, many cases become chronic. For VA rating purposes, document your condition at its current state and request a re-evaluation if it worsens.
Is scapular winging always caused by long thoracic nerve damage?
No, other conditions can cause scapular winging, including damage to the spinal accessory nerve or the dorsal scapular nerve. The specific pattern of winging and nerve testing results help identify which nerve is involved, and different nerves have different diagnostic codes.