Impairment of the Tibia and Fibula, and Medial Tibial Stress Syndrome
The shin bones themselves — a fracture that never knitted straight, or shin splints that never stopped.
Code 5262 covers the two long bones between the knee and the ankle, and since the February 7, 2021 revision it does two very different jobs. The first is structural failure of the bone — a fracture that healed crooked (malunion) or never healed at all (nonunion). The second is medial tibial stress syndrome, which the schedule added by name — the condition every veteran knows as shin splints, which for decades had no code of its own and was routinely denied because of it.
The Diagnostic Codes
Conditions Rated In Knee & Lower Leg
These are the codes the VA will actually stamp on a decision in this group. The code you are granted under decides which formula is used — and that decides your percentage. Tibia & Fibula is highlighted below.
DC 5257
Knee Instability — Recurrent Subluxation and Patellar Instability
The knee gives way underneath you. The ligaments no longer hold the joint where it belongs.
Read the full page
DC 5260 · 5261
Limitation of Range of Motion of the Knee — Flexion and Extension
The knee will not bend far enough, or will not straighten all the way. Both are measured in degrees on a goniometer — and each direction is its own rating on the same knee.
Read the full page
DC 5258 · 5259
Semilunar Cartilage — Dislocated Meniscus and Meniscectomy Residuals
The shock absorber in the knee is torn, displaced, or has been cut out. The joint locks, swells, and hurts.
Read the full page
DC 5003 · 5010
Degenerative and Post-Traumatic Arthritis of the Knee
The cartilage is worn through and bone is working against bone. It is stiff in the morning and it never fully goes away.
Read the full page
DC 5256
Ankylosis of the Knee
The knee is fused. It does not move at all — and the angle it is frozen at decides the rating.
Read the full page
DC 5262
Impairment of the Tibia and Fibula, and Medial Tibial Stress Syndrome
The shin bones themselves — a fracture that never knitted straight, or shin splints that never stopped.
You are reading this page
Before Anything Gets Rated
What The VA Is Actually Looking For — And What Service Connection Really Means
Before the VA ever opens the rating schedule, it asks one question: is this disability the government’s responsibility? That is what “service connection” means. It is not a diagnosis, it is not sympathy, and it is not a reward for having served. It is a legal finding that a current, diagnosed disability is linked to something that happened to you in uniform. Percentages come later. If service connection is not established, there is nothing to rate and the claim is denied — no matter how bad the tibia & fibula is.
The three elements the VA must find. All three. Every time.
These come out of Caluza v. Brown and Shedden v. Principi, and they are the checklist a rating officer works through on your file. Miss one and the claim fails on that element alone.
A current, diagnosed disability
A doctor has to have written a diagnosis in a medical record — tibia & fibula. Symptoms by themselves are not a disability the VA can rate. Saunders v. Wilkie held that pain causing functional impairment can be a disability, but you still need a clinician to document it as diagnosed and impairing. The diagnosis must exist now, during the claim period — not only years ago.
An in-service event, injury, illness or aggravation
Something in service had to have happened — an injury, an exposure, a documented sick call, or steady wear over a career. It does not have to be one dramatic moment and it does not have to be spelled out in your service treatment records: buddy statements, unit records, performance evaluations and your own competent lay testimony can establish it.
A medical nexus linking the two
A qualified medical opinion that says the current diagnosis is at least as likely as not related to the in-service event. That phrase matters: at least as likely as not means 50 percent or better. Under 38 C.F.R. §3.102, when the evidence is evenly balanced, the benefit of the doubt goes to you and the claim must be granted.
The five ways service connection is established
Most veterans only know the first one. The other routes are lower-effort paths to the same grant — and the secondary route is the one most often left on the table.
Direct — 38 C.F.R. §3.303(a)
The injury or disease began in service and never went away. The classic route: three elements, one nexus opinion.
Chronicity and continuity — §3.303(b)
A chronic condition shown in service, plus continuity of the same symptoms from separation to now, can establish the link without a formal nexus opinion. Your own testimony about symptoms you can observe is competent evidence.
Presumptive — §3.307 and §3.309
Certain chronic diseases are presumed service connected if they manifest to a compensable degree within a set window after separation. You do not have to prove causation at all.
Secondary — §3.310(a) and (b)
A disability proximately due to, or aggravated by, an already service-connected condition is itself service connected. This is how the downstream conditions tibia & fibula sets off get on the rating sheet.
Aggravation of a pre-service condition — §3.306
If you entered service with a condition and service made it permanently worse, the increase is compensable. The VA must rebut the presumption of soundness by clear and unmistakable evidence — a bar it frequently fails to meet.
VA medical care — 38 U.S.C. §1151
An additional disability caused by VA treatment, surgery, or a failure to diagnose is compensated as if it were service connected.
The bottom line — there is no way around this
No diagnosis, no rating. It has to be chronic. It has to cause impairment.
Without a diagnosis, the VA will not rate your claim.
The rating schedule is a list of diagnosed conditions and the codes attached to them. If no clinician has put a name on your condition in a medical record, there is no code to assign. Symptoms reported to a claims examiner are not a diagnosis. Get in front of a doctor and get it written down.
The condition must be chronic.
Chronic means persistent and ongoing — not something that resolved decades ago. The VA compensates a disability you carry today, which is why a documented, continuing treatment history matters more than the single worst day you ever had.
It must cause actual impairment.
Under 38 C.F.R. §4.1 and §4.10, VA compensation exists to pay for reduction in earning capacity. A diagnosis that costs you nothing gets a zero percent rating. The function you have lost is what converts a diagnosis into a percentage.
What this means for you before you file: get the diagnosis in writing, get the treatment history documented so the chronicity is undeniable, and describe the impairment in functional terms — what you can no longer do, and what it costs you at work and at home. Everything on the rest of this page is built on top of those three things.
The Percentages
Rating Schedule — Tibia and Fibula Impairment and Medial Tibial Stress Syndrome, Diagnostic Code 5262
Reproduced verbatim from 38 CFR §4.71a as revised February 7, 2021. If your claim was pending before that date, the VA must consider both the old and the new criteria and apply whichever is more favorable to you — the old version of 5262 rated malunion directly on a slight/moderate/marked scale, which in some cases pays more.
40%
Impairment of the tibia and fibula. Nonunion of the tibia and fibula, with loose motion, requiring a brace.
—
Malunion of the tibia and fibula is evaluated under Diagnostic Codes 5256, 5257, 5260 or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.
0%
Medial tibial stress syndrome (shin splints). Treatment for less than 12 consecutive months, one or both lower extremities.
10%
Medial tibial stress syndrome. Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities.
20%
Medial tibial stress syndrome. Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity.
30%
Medial tibial stress syndrome. Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities.
Service Connection
Advice from the Advocate
The advocate's notes on causation — Tibia & Fibula
The separate arguments that decide this code: where the VA will attack, the regulation that answers it, and the evidence that closes the gap.
1Shin splints now have a code by name — the old denials are challengeable
Before February 7, 2021, medial tibial stress syndrome had no diagnostic code of its own and was regularly denied or rated by analogy at 0%. It is now expressly listed under Code 5262. If you were denied before the change, that is grounds for a supplemental claim, and where a claim was pending across the amendment date the VA must apply both criteria and use whichever is more favorable.
2The twelve-month treatment requirement is a records problem, not a medical one
The criteria hinge on treatment for no less than 12 consecutive months and on being unresponsive to orthotics or conservative care. That is proven with the treatment record, not with an examination finding. Continuous documentation — appointments, orthotics prescriptions, physical therapy notes, failed interventions — is literally the rating. A gap in the record reads as a gap in the condition.
3Shin splints in basic are in-service incurrence — §3.303(a) and §3.303(b)
Nearly every case starts in initial entry training, and the sick-call entry usually exists. 38 CFR §3.303(a) service-connects disability resulting from an in-service injury, and where the entry is thin §3.303(b) allows continuity of symptomatology. Your competent lay account of shin pain that has never resolved since basic is evidence, and under Buchanan v. Nicholson it cannot be rejected merely because the paper is sparse.
4Malunion is rated wherever it pays most — the schedule says so
The revised code directs that malunion be evaluated under 5256, 5257, 5260, 5261, 5270 or 5271, whichever results in the highest evaluation. That is a rare instruction in the schedule to affirmatively choose the most favorable code, and it is routinely ignored — a malunited tibia is rated as a mild ankle limitation when the same deformity would rate far higher through the knee codes.
5A crooked or ununited shin destroys the joints at both ends — §3.310(a)
Angular deformity in the tibia changes the mechanical axis of the whole leg, and the knee above and the ankle below take the load at the wrong angle for the rest of your life. Under 38 CFR §3.310(a), arthritis and instability developing in those joints are proximately due to the service-connected bone injury and are separately ratable — and §4.59 entitles each painful joint to at least the minimum compensable rating.
Exposure & Aggravation
How Tibia & Fibula Happens In Service — And How It Gets Worse
How veterans pick this up in uniform — Tibia & Fibula
Tibia & Fibula rarely announces itself with one dramatic moment. It is built by what service asked of your body over months and years — and once it is service-connected, it is compensated for how it keeps getting worse, not for how it started. Below is how veterans pick this up in uniform, and who is most prone to it.
- Basic training — running in boots on pavement, in formation, at someone else’s pace and stride
- Sudden increases in mileage with no build-up, repeated at every new unit
- Ruck marches on hardpan and asphalt with 60 to 100 pounds
- Tibial stress fractures treated with profile and quarters, then straight back to running
- A tibia or fibula fracture from a vehicle accident, a jump injury, or a blast
- Fractures fixed in the field or in theater and never followed up properly
- Years of impact loading on flight decks, flight lines, and concrete piers
Who is most prone to it
Every veteran who went through basic training in boots, plus infantry, airborne, military police, and anyone who ran the PT test on pavement for a full career. Fracture cases cluster in airborne, vehicle crews, and combat arms.
The Symptoms
What Tibia & Fibula Actually Feels Like
- Deep, aching pain along the inner edge of the shin bone, worse with impact
- Tenderness you can trace with a finger along several inches of the tibia
- Pain that starts early in a run or a march and does not warm out
- The lower leg looks bowed, angled, or rotated compared to the other one
- A sense of movement or give at the old fracture site
- You have worn orthotics, changed boots, and it made no lasting difference
- Swelling along the shin after activity
- Ankle or knee pain caused by the bone below or above sitting at the wrong angle
How this one is rated
For nonunion: a flat 40% where there is loose motion requiring a brace. For malunion: the schedule now directs evaluation under the knee or ankle codes — 5256, 5257, 5260, 5261, 5270 or 5271 — whichever gives the highest evaluation. For medial tibial stress syndrome: on how long you have required treatment, whether conservative care failed, whether surgery failed, and whether one leg or both are involved.
What you are measured against
Imaging establishes union, malunion, or nonunion and the degree of angulation. Shin splints are rated on the treatment record — duration and response — not on a physical measurement.
Each One On Its Own Page
Secondary Conditions — Aggravated or Caused by a Current Service-Connected Condition
Under 38 CFR §3.310(a), a disability that is proximately due to a service-connected condition is service-connected in its own right — and under §3.310(b), so is any additional disability caused when a service-connected condition aggravates a problem you already had. Each condition below is a separate evaluation with its own diagnostic code and its own percentage. They do not fold into the tibia & fibula rating — they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.
The orthotics that did not work are your evidence
The shin-splint ratings above 0% require that the condition be unresponsive to shoe orthotics or other conservative treatment for no less than 12 consecutive months. Every insole you were prescribed, every pair of boots you changed, every course of physical therapy that failed is not a dead end — it is the proof the criteria demand. Keep all of it and put it in front of the rater.
The joints above and below pay for the crooked bone
A tibia sitting at the wrong angle changes the mechanical axis of the whole leg, so the knee above and the ankle below carry load off-center for the rest of your life. Under 38 CFR §3.310(a) the arthritis and instability that follow are proximately due to the service-connected bone injury and are separately ratable, and §4.59 entitles each painful joint to at least the minimum compensable rating. Claim the shin and the joints it is destroying.
The work it takes away — impact jobs are over
A shin that swells and screams after every mile rules out the running, rucking, standing, and climbing that physical trades depend on. Spell out what you can no longer do — the letter carrier who cannot walk the route, the mechanic who cannot stand the shift. Where the schedular rating sits below total, this functional loss is the foundation of an unemployability (TDIU) claim under 38 CFR §4.16.
Accredited Claims Agent #45147
Ready To Get This Rated Correctly?
Contingency fee — zero upfront, paid only from back pay when you win. If your rating does not increase, you owe nothing.
Knee & Lower Leg, In Detail
Knee & Lower Leg — Service Connection In Depth
Here is each claimable condition in this group on its own terms — what it is, what service did to it, and what the VA requires before it will connect it.
Knee Instability — Recurrent Subluxation and Patellar Instability
Instability is a separate rating from range of motion, and that single fact is worth thousands of dollars a year to veterans who are never told it. The VA General Counsel has confirmed that a knee with instability under Code 5257 and arthritis with limitation of motion under Codes 5003/5260/5261 can carry both ratings at once, because they compensate different functional losses and therefore do not violate the anti-pyramiding rule at 38 CFR §4.14. Most veterans are rated for one and never learn they qualified for two.
Read the full Knee Instability pageLimitation of Range of Motion of the Knee — Flexion and Extension
Range of motion in the knee is two separate measurements, and each one is its own diagnostic code. Flexion is the bend, rated under Diagnostic Code 5260; extension is the straighten, rated under Diagnostic Code 5261. Flexion tops out at 30%, extension climbs to 50%, and — this is the part veterans lose money on — 38 CFR §4.14 lets both be rated separately on the same knee, because they compensate opposite movements. Every percentage under both codes is a number on a goniometer, which means the rating is won or lost on how and when the measurement was taken. 38 CFR §4.59 requires that painful motion be treated as at least the minimum compensable rating, and DeLuca v. Brown, 8 Vet. App. 202 (1995) requires the examiner to account for additional loss during flare-ups and after repeated use. A single good-day number, taken cold and seated, is not a lawful rating picture.
Read the full Range of Motion pageSemilunar Cartilage — Dislocated Meniscus and Meniscectomy Residuals
The menisci are two crescents of fibrocartilage sitting on the tibial plateau, and they are the reason your knee survives being landed on. Once one is torn and displaced, the joint mechanically catches. The VA rates this separately from motion and separately from instability, under two codes: 5258 for a dislocated meniscus with locking, pain, and effusion, and 5259 for symptomatic residuals after the cartilage has been removed. Both are frequently swallowed into a single motion rating that pays less.
Read the full Meniscus pageDegenerative and Post-Traumatic Arthritis of the Knee
Arthritis is the knee code that quietly pays when nothing else does. Under 38 CFR §4.71a, Code 5003, degenerative arthritis established by X-ray is rated on limitation of motion — but when the limitation is noncompensable, the regulation still assigns 10 percent for each major joint affected by painful or limited motion. Code 5010 applies the same rules to traumatic arthritis. And §4.59 independently entitles an actually painful joint to the minimum compensable rating. That is three separate routes to a payment on a knee whose degrees look "normal."
Read the full Knee Arthritis pageAnkylosis of the Knee
Ankylosis is the end of the road for a joint: bony or fibrous fusion, no usable motion in any direction. It is the highest-paying knee code, running from 30% to 60%, and — counter-intuitively — the straighter the fusion, the lower the rating. A knee fused at full extension is still a leg you can stand and walk on. A knee fused at 45 degrees or more is a leg you drag. The angle is the whole rating.
Read the full Knee Ankylosis pageImpairment of the Tibia and Fibula, and Medial Tibial Stress Syndrome
Code 5262 covers the two long bones between the knee and the ankle, and since the February 7, 2021 revision it does two very different jobs. The first is structural failure of the bone — a fracture that healed crooked (malunion) or never healed at all (nonunion). The second is medial tibial stress syndrome, which the schedule added by name — the condition every veteran knows as shin splints, which for decades had no code of its own and was routinely denied because of it.
You are reading this page now
The C&P Exam
What To Expect At The Tibia & Fibula Exam
This is the encounter your rating is built on. The examiner has a checklist and a limited window — what follows is exactly what happens in that room, so none of it surprises you.
Clinical Section — What To Expect at the Exam
What to Expect at Your Tibia, Fibula and Shin Splint C&P Examination
Diagnostic Code 5262 — an exam won in the treatment records, not in the room
This exam splits in two. If your claim is a **fracture**, the exam is imaging and stability: is the bone united, malunited, or ununited, and is there loose motion requiring a brace. If your claim is **shin splints**, the exam is essentially a records audit — the criteria ask how many consecutive months you have been treated and whether that treatment failed. Nothing the examiner does with their hands will answer that question. Your file has to.
Condition
Tibia & Fibula — DC 5262
Governing questionnaire
VA Form 21-0960M-9, Knee and Lower Leg Conditions Disability Benefits Questionnaire
Click the form number to open the official questionnaire on VA.gov.
01In The Room
What happens during the exam
The tests and maneuvers for this condition
- X-ray of the tibia and fibula, full length
- Manual testing for loose motion at the fracture site
- Palpation along the posteromedial tibial border for a band of tenderness
- Measurement of angular deformity and any leg length discrepancy
- Goniometric measurement of both the knee and the ankle
- Gait observation and assistive device assessment
- Review of the complete treatment record for duration and failed interventions
What gets measured, and to what number
Union status
Imaging showing union, malunion with angulation measured in degrees, or nonunion with a gap.
Loose motion at the fracture site
Manual testing for movement through the bone — the specific finding the 40% criteria require.
Brace requirement
Whether a brace is needed to ambulate, and whether it is prescribed.
Duration of treatment
Number of consecutive months treated for shin splints — from the records.
Response to conservative care
Orthotics, activity modification, physical therapy — and whether they failed.
Surgical history and outcome
Fasciotomy or other surgery, and whether symptoms persisted afterward.
Laterality
One leg or both — that alone is the difference between 20% and 30% for shin splints.
Knee and ankle motion
Full goniometric measurement of both joints, required to rate a malunion at the highest code.
02Orientation
What to expect during this exam
What makes this exam different from every other C&P exam
1The twelve-month clock is the rating
For medial tibial stress syndrome, everything turns on continuous treatment for at least 12 consecutive months and documented failure of orthotics or conservative care. Assemble that record before the exam, because the examiner will not build it for you.
2Nonunion needs "loose motion" and "brace" in the report
The 40% criteria use those exact words. If the bone is ununited and you wear a brace to walk, both facts have to appear in the examination report in plain language.
3Malunion should be rated through the highest-paying joint code
Ask that the knee and the ankle both be examined and measured. The schedule requires the highest of Codes 5256, 5257, 5260, 5261, 5270 or 5271 — and the rater cannot choose the highest one if only one joint was measured.
See it before you sit in the room
03Preparation
Know your symptoms and secondary factors
What the report must actually say about tibia & fibula — dc 5262
- "I have been treated for this continuously since [month, year]."
- "Orthotics did not fix it, and neither did rest or physical therapy."
- "It is both legs" — if it is, say so clearly; it is worth a rating tier.
- "The bone moves" — if you can feel motion at the old fracture, say it in those words.
- "I have to wear this brace to walk, and it was prescribed by my doctor."
- "It started in basic training and it has never gone away."
Pain level, frequency, lost work and functional loss — how to say them
Trace the tenderness — it is a band, not a point
Medial tibial stress syndrome inflames the periosteum along several inches of the posteromedial tibia. Show the examiner you can run a finger down a long stretch of bone that all hurts — a band of tenderness is shin splints, while a single tender point suggests a stress fracture, which is a different claim under a different code. Getting this right steers the diagnosis your treatment record already supports.
Point to exactly where the tenderness starts and ends, and say it hurts the whole length, not just one spot.
"It is tender all the way down this edge of the bone — a long stretch, not one point."
Show the angle — a crooked shin is a malunion
If a fracture healed crooked, the lower leg sits bowed, angled, or rotated compared to the other side. That visible deformity is malunion, and under the revised code a malunion is rated through whichever knee or ankle code pays the most. Stand and let the examiner see both legs together — the asymmetry is objective evidence that belongs in the report in writing.
Ask the examiner to compare both legs side by side and to note any angulation or rotation in the report.
"This leg is bent compared to the other one — you can see the shin does not line up straight."
Explain the pain starts early and never warms out
Ordinary muscle soreness eases once you are moving. A stressed tibia does the opposite — the pain starts early in a run or a march and gets worse, not better, the longer you go. That pattern is what separates a bone-and-periosteum problem from a soft-tissue one, and it is exactly what the examiner needs to hear to connect your symptoms to this code.
Describe how far you get before you have to stop, and that rest is the only thing that helps.
"The pain hits early in the run and only gets worse — it never loosens up no matter how long I push."
Say the words "the bone moves" if you feel give
The 40% nonunion rating turns on loose motion requiring a brace. If you can feel movement or give at an old fracture site, that is the single most valuable thing you can report — it is the finding that opens the highest rating in this code. Do not soften it or call it "weakness"; describe the actual sensation of the bone shifting.
Tell the examiner exactly where you feel the movement and whether you wear a brace because of it.
"I can feel the bone move at the old break — that is why I wear the brace to walk."
Secondary conditions to raise in the same appointment
The orthotics that did not work are your evidence
The shin-splint ratings above 0% require that the condition be unresponsive to shoe orthotics or other conservative treatment for no less than 12 consecutive months. Every insole you were prescribed, every pair of boots you changed, every course of physical therapy that failed is not a dead end — it is the proof the criteria demand. Keep all of it and put it in front of the rater.
The joints above and below pay for the crooked bone
A tibia sitting at the wrong angle changes the mechanical axis of the whole leg, so the knee above and the ankle below carry load off-center for the rest of your life. Under 38 CFR §3.310(a) the arthritis and instability that follow are proximately due to the service-connected bone injury and are separately ratable, and §4.59 entitles each painful joint to at least the minimum compensable rating. Claim the shin and the joints it is destroying.
The work it takes away — impact jobs are over
A shin that swells and screams after every mile rules out the running, rucking, standing, and climbing that physical trades depend on. Spell out what you can no longer do — the letter carrier who cannot walk the route, the mechanic who cannot stand the shift. Where the schedular rating sits below total, this functional loss is the foundation of an unemployability (TDIU) claim under 38 CFR §4.16.
How to prepare for this specific exam
- Assemble a continuous treatment timeline covering at least 12 consecutive months.
- Bring every orthotic prescription and every note saying a treatment failed.
- Bring full-length imaging of the tibia and fibula, not just the knee or ankle.
- Bring the operative report if you had surgery, and note what symptoms remained.
- Bring the brace and its prescription documentation.
- Ask that both the knee and the ankle be examined if you have a malunion.
04The Protocol
What procedures are required during the exam
These are not courtesies. Each comes out of the regulation or out of binding case law. Take this list in with you and tick them off as they happen.
01Palpation along the posteromedial tibial border
38 C.F.R. §4.71a
The examiner runs fingertips down the inner-rear edge of the shin bone to map the tenderness. A band several inches long documents medial tibial stress syndrome; a single exquisitely tender point points instead to a stress fracture. This hands-on finding, paired with your treatment record, is what fixes the diagnosis in the report.
The length and location of the tenderness is what distinguishes shin splints from a stress fracture — and the two are rated under different criteria. An exam that records only "tenderness" without describing the band leaves the rater guessing.
02Standing alignment and angulation assessment
38 C.F.R. §4.71a
With you standing and bearing weight, the examiner assesses the alignment of the lower leg — any bowing, angulation, or rotation from a malunion, and any leg-length difference. A deformity that is invisible on the exam table often shows plainly under load, and it is the finding that drives a malunion to the higher knee or ankle codes.
Malunion is rated through whichever of Codes 5256, 5257, 5260, 5261, 5270 or 5271 pays the most — but the rater cannot apply that instruction if the angulation was never measured and both joints were never examined.
03Loose-motion and brace-requirement check
38 C.F.R. §4.71a
The examiner tests for movement through the bone at an old fracture site and documents whether a brace is required to walk. Those two findings — loose motion and a prescribed brace — are the exact words the 40% nonunion criteria use. If both are true, they must appear in the report in plain language, not implied.
The 40% rating lives or dies on the phrases "loose motion" and "requiring a brace." A report that describes the bone as merely "weak" or "unstable" without those words hands the rater an excuse to rate it lower.
04Full-length imaging — union, malunion, or nonunion
38 C.F.R. §4.71a
The examiner confirms current full-length tibia and fibula films are in the file and reads them for the one distinction the code turns on: solid union, malunion with the angulation measured in degrees, or nonunion with a visible gap and false joint. Code 5262 rates entirely on this finding, and the malunion tiers cannot be applied unless the angle is actually measured off the film.
The difference between a token rating and 40% is what the imaging shows and whether the angulation was measured. Films described as "old fracture, healed" without reading for malunion or nonunion close off the higher tiers before the exam even ends.
05Range of motion at the knee and ankle above and below
38 C.F.R. §4.71a
Because malunion is rated through whichever of the knee or ankle codes pays most, the examiner must measure goniometric range of motion at both the knee and the ankle on the injured side. A deformed shaft throws off the joints at each end, and those measurements are what let the rater apply Codes 5260, 5261, 5270 or 5271 — the instruction the 5262 malunion criteria expressly require.
A malunion rated under a single joint code, with the other joint never measured, is the most common way this diagnosis is undervalued. Both joints must be on the page for the "highest evaluation" instruction to work in your favor.
05The Standard
What makes an exam adequate
Read your exam report against these. An exam that fails the standard is legally inadequate, and an inadequate exam is something you challenge rather than accept.
The range of motion has to be MEASURED, not estimated
38 CFR §4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. An examiner who eyeballs your bend and writes a number has not complied with the regulation. This is the most common defect in a spine exam and it is the easiest one to spot from the chair.
Joints must be tested in every required condition
Under Correia v. McDonald, a joint examination for pain must, wherever possible, record active motion, passive motion, motion in weight-bearing and motion in non-weight-bearing — and where relevant, the range of the opposite undamaged joint. An exam that records one set of numbers and stops is incomplete on its face, and that incompleteness is grounds to challenge it.
Flare-ups have to be addressed, not dodged
Under Sharp v. Shulkin, when a veteran describes flare-ups, the examiner is obligated to estimate the additional loss of motion during a flare based on all the available evidence — including your own account of it. "I cannot opine without resorting to mere speculation" is not automatically acceptable; the examiner has to have actually sought the information first and explained why an estimate is impossible.
Repetitive use and functional loss must be factored in
Sections 4.40 and 4.45, and the DeLuca line of cases, require that pain, weakness, fatigability, incoordination and lack of endurance after repeated use be considered — and expressed in additional degrees of lost motion where that is feasible. Your rating is supposed to reflect what you can do on the fifth repetition and on a bad day, not just the first careful bend of the morning.
Neurological findings must be separately documented
Note (1) to the General Rating Formula requires that any associated objective neurologic abnormality be evaluated separately under an appropriate diagnostic code. If your leg symptoms were mentioned in the narrative but never tested and never assigned, the exam did not do what the schedule requires of it.
The examiner must review the record when the question requires it
Where a medical opinion on cause, aggravation or a secondary relationship was requested, the examiner is expected to review the relevant evidence and give a reasoned explanation. A bare conclusion — "less likely than not related to service" with no reasoning attached — carries little weight, and an opinion with no rationale is challengeable.
The examiner has to be qualified for the body system
The VA may use its own clinicians or a contract vendor. Either way, the examiner is expected to have the competence to evaluate the system being examined. If a spinal exam with a neurological component was performed by someone who never tested a reflex, that is a problem worth raising.
The exam has to be CURRENT
A rating is supposed to reflect your condition now. An exam performed before a documented worsening, or years before the decision, may not support the current evaluation — and you can request a new one on that basis.
06Afterward
What happens after your exam is complete
The examiner writes the report and submits it, it is reviewed for completeness, and only then does the claim move toward a rating decision. Here is what actually controls the clock.
The examiner writes and submits the report
Days 1–5 after the exam
The examiner compiles the history, the physical findings, the measurements and any testing into the questionnaire, adds any requested medical opinion, and submits it. Contract vendors typically have a turnaround requirement measured in days, not weeks.
Nothing about your claim moves while this is happening, and nothing you do speeds it up. What matters is that the report is written from notes taken in the room — which is exactly why what you said, and how the examiner recorded it, is already locked in by the time you get to your car. Request your copy now rather than later.
Quality review — and the request for clarification
Days 3–30
The report is reviewed for completeness. If it is internally inconsistent, missing a required field or missing the opinion the VA asked for, it goes back for correction or a second opinion. This is the single most common cause of a claim appearing to stall after the exam.
Understand what a finished exam actually means: it means the appointment happened, not that your claim is ready for a decision. If the reviewer finds a blank range-of-motion field, an opinion that does not answer the question that was asked, or findings that contradict each other, the file goes back out for more information. That is a normal quality control step, not a rejection of your claim, and it is not a sign that you did something wrong — but it does add weeks, and it is the reason so much of what you read online sounds like the system is broken.
Your status tracker moves backward — and it is usually not bad news
Any time after the exam
The online tracker shows eight steps. Veterans watch it reach step 7 or 8, then find it back at step 3 or 4 a week later. That regression almost always means one thing: the file went back for additional information, most often a returned or clarified exam.
This is the number one thing veterans panic about, and it is misread constantly. The tracker is not a countdown — it is a location marker. When the VA decides it needs one more piece of evidence, a corrected exam, a clarifying medical opinion or an outstanding record, the claim is routed back to the evidence gathering step and the bar redraws itself where the file physically is. It does not mean a denial. It does not mean your case was thrown out or restarted. It does not erase anything already in the file, and it does not change your effective date. What it does mean is that something in the record was not good enough to decide on yet — which is worth knowing, because if the weak link is the exam, this is the window where a corrective statement or a private opinion from your own doctor does the most good.
Evidence gathering closes
Varies
Before anyone rates your claim, the file has to be built. This is the stretch where the Regional Office pulls together everything the decision will rest on: your service treatment records, your VA medical records, any federal records, the C&P exam report, and any private records it has requested on your behalf. The claim sits here until the VA is satisfied the record is complete enough to decide — which is exactly why a status tracker can appear to stall or slide backward at this step. You are not powerless while it sits here. Anything you put into the file yourself lands the day you send it, and every relevant record you add now is one less thing the rater can later say was missing.
A VA request to a private provider is a letter that may or may not be answered, and the VA will wait on it for weeks before moving on — sometimes without ever getting a response. A record you walk in yourself, or upload through your claim, is in the file the day you send it. So do not sit and wait to be asked. If you know a treatment record, an imaging report, a surgical note or a buddy statement exists and it matters, send it now, with a VA Form 21-4138 statement that explains in plain words what the document is and what it shows. This is also the window where a corrective statement or a private medical opinion from your own doctor does the most good — before the rater has locked in a decision, not after. Once the evidence gathering step closes, the file goes to a rating specialist, and your chance to shape the record cheaply and quickly closes with it.
Rating decision and promulgation
Typically several weeks after the last piece of evidence lands
This is the stage where your evidence finally becomes a number. A rating specialist — not the examiner, and not a doctor — takes everything in the file and applies the rating schedule to it: the exam findings, your range-of-motion measurements, your lay statements, your private records and any medical opinions. They assign a diagnostic code to each condition, pull a percentage from the schedule, set your effective date, and either grant, deny or defer each issue. The decision is then reviewed and authorized — promulgation is simply the VA’s word for making it official — and the decision letter and code sheet are generated and mailed. Where an award is made, payment follows the effective date rules, and back pay is calculated to that date.
Read the code sheet, not just the percentage. It names the diagnostic code used, the exact measurements relied on and the effective date assigned — and that is where most mistakes live. This is a human being reading a file under a production quota, and the two things that go wrong most often are a rater using the pre-repetition range-of-motion numbers instead of the worst-case figures §4.59 and §4.40 require, and a claimed condition being decided on a thin record or quietly left out. Check whether painful motion was accounted for, whether your radiculopathy was rated separately under Note (1) or folded into the spine rating, and whether every condition you claimed was actually addressed. A decision you do not read is a decision you cannot challenge — and the deadline to challenge it starts the day the letter is dated, not the day you understand it.
C&P examination is the decision letter
The day it lands in your mailbox
The envelope holds two different documents: the narrative decision letter, and the code sheet. Together they are the single most important piece of paper in your claim, because every deadline, every appeal option and every dollar of back pay is set by what is printed on them — not by what you were told at the exam.
Most veterans read one thing on that letter: the percentage. Then they either celebrate it or get angry at it, and file it in a drawer. That is the mistake. The percentage is the conclusion; the reasons section is the reasoning, and the reasoning is what you attack. It tells you which diagnostic code the rater used, which range-of-motion figures they relied on and which they ignored, whether painful motion under §4.59 was accounted for, whether your neurological findings were rated separately under Note (1) or folded into the spine rating, which conditions were decided, which were deferred, and which were never addressed at all. It also assigns your effective date, which controls back pay. A rating that looks low is very often not a disagreement about how bad your neck is — it is a rater who used the pre-repetition numbers, or missed the radiculopathy, or rated one side and not both. You cannot see any of that from the percentage. Do not go by the percentage alone, and do not decode it by yourself if you are not sure what you are looking at — have someone who reads these for a living read it with you before the clock runs out. You have one year from the date on that letter to file a Higher-Level Review (VA Form 20-0996), a Supplemental Claim (VA Form 20-0995) or a Board appeal, and the deadline runs from the date printed on the letter, not the date you opened it. Bring it to this office and we will go through it line by line, at no cost, and tell you plainly whether it is right.
What normal looks like: 30 to 60 days for a simple claim, longer for a complex one
After your exam you should expect some kind of notification from the VA — a decision, a request for more information, or a notice that another exam has been scheduled. For a straightforward, single-issue claim that often lands within 30 to 60 days. But 30 to 60 days is a rough guide, not a rule, and it is not a ceiling. A claim with several conditions, a toxic-exposure or presumptive question, a returned exam, or missing records routinely takes 90 days or more, and that alone does not mean anything is wrong — the more moving parts your case has, the longer the VA takes to work it. Inside the window that is normal for a case like yours, silence is expected and there is nothing to fix, and a tracker that jumps backward is normal too.
What matters is not a fixed number of days — it is whether the claim is still moving and whether you can get a straight answer about where it is. Once you are well past what is normal for a case like yours and the VA either goes silent or cannot tell you what the claim is waiting on, stop waiting. That is usually where the real trouble hides — an exam that came back twice, a records request that was never answered, a claimed condition that got dropped, or a file sitting in the wrong queue. Call the VA at 800-827-1000, ask specifically what the claim is waiting on and who it is assigned to, and write down the answer. If you cannot get a straight answer, or the answer tells you the exam is the problem, that is the moment to bring it to this office rather than sitting on it for another three months. Problems raised early get fixed inside the claim. Problems discovered in a denial letter get fixed on appeal, and that costs you a year.
Other things that control the clock
Six things decide how long you wait, and none of them are visible from the tracker alone.
The average is a moving number
Check it at the source, not second-hand
The VA publishes an average days-to-complete figure for disability claims that moves month to month; check the current number on the VA’s own claim status page rather than relying on any second-hand figure. In practice, most veterans see a decision somewhere between roughly three and eight months from the date the claim was filed, with the exam usually falling in the middle of that window.
The exam is not the last step
Three stages still sit in front of you
The exam is not the last step. The clock does not start at the exam and it does not stop there either — the claim still has to clear evidence gathering, the rating decision and authorization.
A returned exam is the invisible delay
The reason a tracker slides backward
A returned or clarified exam is the most common invisible delay, and it is why a tracker can slide backward. Expect some contact from the VA within 30 to 60 days of the exam. Past 60 days with nothing at all, call and ask specifically what the claim is waiting on.
30 to 60 days is a guide, not a deadline
A complex case can take 90 days or more
Thirty to sixty days is a rough average for a simple, single-issue claim — not a hard rule and not a ceiling. A claim with several conditions, a presumptive or toxic-exposure question, a returned exam, or missing records can easily take 90 days or more, and that alone does not mean anything is wrong. Watch whether the claim is still moving, not the calendar. Only when it stalls well past what is normal for a case like yours, and no one can tell you what it is waiting on, should you stop waiting — call 800-827-1000 and ask what the claim is waiting on and who it is assigned to.
Watch your status yourself — in one of three places
Weekly, not daily
Check your own status in one of three places: your VA.gov claim status page, the VA Health and Benefits mobile app, or by calling 800-827-1000. Check it weekly, not daily. And understand exactly what a status check can tell you: if a decision is posted in your account, it is live; if it is not posted, it is not ready. That is the whole rule. This is not something your representative or your attorney can speed up — we see the same thing you see, at the same time, and calling us to ask does not move it. Calling the VA to ask for an update does not move it either. Watch it yourself, weekly, and the moment a decision posts, bring it to us.
Your decision letter arrives — read it, then start the appeal clock
What to do the day it lands in your mailbox
The decision letter is the finish line of the claim and the starting line of the appeal — and the moment it arrives, a one-year clock starts running. Read it the same day. Find the combined rating, the percentage assigned to each condition, and the effective date, because the effective date controls how far back your back pay reaches. Then request a copy of your C&P exam report so you can see whether the rater used your real range-of-motion numbers or ignored the radiculopathy. If any part of the decision is wrong — a low rating, a denied condition, or a bad effective date — you have three appeal lanes, and you must choose one within one year of the date printed on the letter: a **Higher-Level Review (VA Form 20-0996)**, where a senior reviewer re-decides on the same evidence; a **Supplemental Claim (VA Form 20-0995)**, when you have new and relevant evidence such as a private DBQ or your own range-of-motion exam; or a **Board Appeal (VA Form 10182)** to a Veterans Law Judge. Miss that one-year deadline and the decision becomes final. You can still file again later, but you lose the original effective date — and that lost time is lost back pay you never get back. Bring the letter to this office before the year runs out and we will read it with you, line by line, at no cost.
07Remedy
How to report a bad exam
Where this exam goes wrong
Two traps live in this code. For shin splints, a claim is denied because the record shows scattered visits over the years rather than the **12 consecutive months** the criteria demand — the condition is real, the paperwork is not continuous. For fractures, a malunion gets rated at a token percentage under a single ankle code because nobody measured the knee, when the schedule expressly requires **whichever code results in the highest evaluation**. Both are file-building failures, and both are fixable before the exam rather than after the denial.
Write it down the moment you get to your car
Date, start time, end time, the examiner’s name and credentials, the vendor, every test that was performed, and every test that was not. A contemporaneous note written the same day is evidence. A memory reconstructed four months later is not.
Get the exam report and the questionnaire
Request a copy through VA.gov, through a written request to the Regional Office, or by calling 800-827-1000. You cannot challenge what you have not read. Compare it line by line against what actually happened in the room.
Name the defect specifically, with the citation
Never write "the exam was unfair." Write "no goniometer was used, contrary to 38 CFR §4.46" or "flare-ups were reported and not addressed, contrary to Sharp v. Shulkin" or "repetitive use testing was not performed, contrary to 38 CFR §4.40 and DeLuca." A specific, citable defect is what forces action.
Submit a statement asking for a new examination
VA Form 21-4138, Statement in Support of Claim, filed through VA.gov or mailed to the Evidence Intake Center. State the defect, cite the authority, and request a new or supplemental examination. Do this BEFORE the decision if the claim is still open — it is far easier than undoing a decision afterward.
Report examiner conduct separately
If the problem is behavior rather than methodology — you were rushed out, dismissed, never touched, or treated with hostility — file a complaint with the VA facility’s Patient Advocate, or with the vendor directly for a contract exam, and copy the Regional Office. Conduct complaints and adequacy challenges are two different tracks and you can run both.
If a decision has already issued, pick the right lane
A Higher-Level Review (VA Form 20-0996) argues the VA erred on the evidence it had — the right vehicle when the exam was inadequate on its face. A Supplemental Claim (VA Form 20-0995) is the vehicle when you are adding new and relevant evidence, such as your own private range-of-motion examination or a completed DBQ from your treating provider.
Put your own measurements on the table
A private examination with full goniometric measurements, or a DBQ completed by your own provider, creates a conflict in the evidence that the VA has to resolve — and under 38 CFR §3.102 reasonable doubt is resolved in your favor.
End of clinical section
Tibia & Fibula — DC 5262
See It Before You Sit In The Room
Nonunion of Fractures — Causes and Treatment
Dr. Nabil Ebraheim
Medial Tibial Stress Syndrome (Shin Splints)
Physiotutors
The Questions Veterans Actually Ask
Tibia & Fibula Claims — Frequently Asked Questions
Straight answers to the questions that decide tibia & fibula claims — the ratings, the separate evaluations, and the exam mistakes that cost veterans money.
Tibia & Fibula is evaluated under DC 5262. The scale runs across 6 rating levels, and the highest is 40%, which the VA assigns for: Impairment of the tibia and fibula. Nonunion of the tibia and fibula, with loose motion, requiring a brace. Where your evaluation actually lands depends on how your exam and records document those criteria — not on how bad the condition feels on an average day.
Every condition in Knee & Lower Leg
Three Ways to Put an Accredited Agent on Your Case
No fee unless you win. An accredited agent #45147 personally reviews every request — we respond within 48 hours.
Book a Free Consultation
Pick a time to talk through your VA claim with our team — no pressure, no obligation.
Hire Us · File VA Form 21-22a
Appoint us as your accredited representative and get registered as a client so we can act on your behalf.
Call an Accredited Agent
Speak to a real person on our team right now.
702-992-4883