Long Thoracic Nerve Palsy (Winged Scapula)

DC 8519Neurological38 CFR 4.124a, DC 8519

Damage to the long thoracic nerve, which controls the serratus anterior muscle that holds the shoulder blade flat against the chest. When this nerve is injured, the shoulder blade sticks out (winging), causing shoulder weakness and difficulty raising the arm.

How the VA rates this condition

The VA rates this condition based on how much it affects your ability to work and carry out daily activities. The examiner will focus on the functional limitations your condition causes, not just the diagnosis itself.

Diagnostic code

DC 8519

Rating range

0% – 30%

Rating levels

Rating criteria are defined in 38 CFR 4.124a, DC 8519. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

You have severe long thoracic nerve palsy with prominent scapular winging and significant shoulder dysfunction. You cannot raise your arm fully overhead and have marked weakness.

What the VA looks for

Prominent scapular winging clearly visible
Severe serratus anterior weakness or complete paralysis
Unable to fully raise arm overhead
Compensatory rotator cuff strain or secondary shoulder pathology
EMG/NCS confirming severe denervation or complete paralysis

Common Pitfalls

⚠Not getting an EMG and nerve conduction study specifically testing the long thoracic nerve and serratus anterior — this is the definitive test to confirm the diagnosis and severity.
⚠Not documenting the in-service cause — common military causes include heavy pack carrying, repetitive overhead work, traumatic shoulder injuries, and chest wall trauma. The nexus between the nerve injury and service must be established.
⚠Failing to claim secondary shoulder conditions — chronic scapular winging causes compensatory rotator cuff strain, shoulder impingement, and adhesive capsulitis that can each be rated separately.
⚠Not having the examiner observe winging during forward arm elevation — scapular winging may only be obvious during active wall push-ups or forward flexion, and the examiner must specifically test for it.

Related DBQ Forms

DBQ Peripheral Nerves

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

Long Thoracic Nerve Palsy (Winged Scapula)

How the VA rates this condition

Diagnostic code

DC 8519

Rating range

0% – 30%

Rating levels

Rating Levels

You have severe long thoracic nerve palsy with prominent scapular winging and significant shoulder dysfunction. You cannot raise your arm fully overhead and have marked weakness.

What the VA looks for

Prominent scapular winging clearly visible
Severe serratus anterior weakness or complete paralysis
Unable to fully raise arm overhead
Compensatory rotator cuff strain or secondary shoulder pathology
EMG/NCS confirming severe denervation or complete paralysis

Common Pitfalls

⚠Not getting an EMG and nerve conduction study specifically testing the long thoracic nerve and serratus anterior — this is the definitive test to confirm the diagnosis and severity.

⚠Not documenting the in-service cause — common military causes include heavy pack carrying, repetitive overhead work, traumatic shoulder injuries, and chest wall trauma. The nexus between the nerve injury and service must be established.

⚠Failing to claim secondary shoulder conditions — chronic scapular winging causes compensatory rotator cuff strain, shoulder impingement, and adhesive capsulitis that can each be rated separately.

⚠Not having the examiner observe winging during forward arm elevation — scapular winging may only be obvious during active wall push-ups or forward flexion, and the examiner must specifically test for it.