EDUCATIONAL TOOL ONLY. Not legal or medical advice. Not affiliated with the VA.
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Long Thoracic Nerve Paralysis
✓ VERIFIED AGAINST 38 C.F.R.§ 4.124a (Neurological conditions and convulsive disorders) · reviewed 2026-05-15 · ClaimRecon Editorial Team
Long Thoracic Nerve Paralysis is rated by the U.S. Department of Veterans Affairs under DC 8519 of 38 CFR § 4.124a, DC 8519 across 4 severity tiers (0% / 10% / 20% / 30%). Service connection requires (1) a current diagnosis, (2) an in-service event, injury, or exposure, and (3) a medical nexus opinion linking the two under 38 C.F.R. § 3.303.
OVERVIEW
Paralysis of the long thoracic nerve causing winged scapula due to serratus anterior weakness.
RATING CRITERIA (4 LEVELS)
0%
Mild incomplete paralysis of the long thoracic nerve — minimal serratus anterior weakness, no winging at rest. Same 0% rating for both dominant (major) and non-dominant (minor) extremity.
10%
Moderate incomplete paralysis — visible scapular winging on wall push-up or resisted forward elevation. Same 10% rating for both extremities.
20%
Severe incomplete paralysis — same 20% rating for both extremities. OR Complete paralysis — non-dominant (minor) extremity (also 20%).
30%
Complete paralysis — dominant (major) extremity. Verbatim § 4.124a: "inability to raise arm above shoulder level, winged scapula deformity."
KEY EVIDENCE TO GATHER
-Service treatment records showing injury or complaints
-Imaging (X-ray, MRI, CT)
-Range of motion measurements
-Flare-up documentation per Sharp v. Shulkin
-Buddy statements describing limitations
-Prescription history
-Physical therapy records
-Employment impact documentation
C&P EXAM TIPS (6)
1.Do NOT stretch, warm up, or take pain medication before your exam. The VA needs your baseline limitation.
2.Report your WORST day. DeLuca v. Brown requires documentation of functional loss during flare-ups.
3.Tell the examiner about flare-ups: frequency, duration, estimated ROM loss. Sharp v. Shulkin (2017) requires estimates.
4.Request active, passive, weight-bearing, and non-weight-bearing ROM testing per Correia v. McDonald (2016).
5.If you use assistive devices (brace, cane), bring them.
6.Describe daily activity impact: work, sleep, household tasks.
SOURCES & EDITORIAL
Rating criteria text quoted verbatim from 38 C.F.R. § 4.124a (Neurological conditions and convulsive disorders). Source verified 2026-05-15 by ClaimRecon Editorial Team during a regulation-text comparison against the Cornell Law CFR mirror; eCFR.gov is the authoritative government source.
EDUCATIONAL TOOL ONLY. NOT LEGAL OR MEDICAL ADVICE.
NOT AFFILIATED WITH THE U.S. DEPARTMENT OF VETERANS AFFAIRS.
CLAIM RECON 2026