Reference: 38 CFR 4.71a

Sources & Related Guides

What is the VA rating for Shortening of the Lower Extremity, the Skull, the Ribs, and the Coccyx?

Understand guidance under DC 5275 (Shortening of the Lower Extremity, a real 60/50/40/30/20/10 ladder from measured leg-length discrepancy, with its own non-combination Note disclosed as an undefined-term scope question), DC 5296 (the Skull, a real 80/50/30/10 ladder for a documented bicortical defect, with a disclosed gap for a unicortical defect), DC 5297 (the Ribs, a real 50/40/30/20/10 ladder from rib-removal count, with its two Notes and a disclosed tuberculosis-hub tension), and DC 5298 (the Coccyx, a fully computable 10/0 ladder with zero Notes), per COND-081/RSCH-088.

What is Shortening of the Lower Extremity, the Skull, the Ribs, and the Coccyx?

38 CFR 4.71a covers four standalone diagnostic codes grouped in this hub because each rates a distinct, unrelated skeletal-structural finding rather than a shared body system: DC 5275 (Shortening of the Lower Extremity), DC 5296 (the Skull), DC 5297 (the Ribs), and DC 5298 (the Coccyx). Sourced under RSCH-088. DC 5298 is fully computable with two clean tiers (10/0 percent) and zero Notes. DC 5275 computes its own real six-tier ladder (60/50/40/30/20/10 percent) from measured leg-length discrepancy. Its Note's non-combination bar against 'fracture or faulty union in the same extremity' is automated for the two textually-confirmed destinations, DC 5255 (hip/femur malunion) and DC 5262 (tibia/fibula malunion) -- this repository's cross-hub combination logic blocks combining a DC 5275 rating with either. DC 5256 (ankylosis of the knee) is deliberately excluded from that automation and remains disclosed only, since 'faulty union' is undefined and whether the bar reaches DC 5256 at all, only indirectly as a dispatch destination inside DC 5255's or DC 5262's own clauses, is a genuine open question. DC 5296 computes its own real four-tier ladder (80/50/30/10 percent) for a documented bicortical (both inner and outer table) skull defect, but discloses rather than guesses when the documented facts instead describe a unicortical defect, since the code's own title language does not resolve whether full-thickness loss is required. DC 5297 computes its own real five-tier ladder (50/40/30/20/10 percent) from a documented rib-removal count, with its own Notes disclosed as hub content: Note (1)'s bar against combining with certain pleural/lung ratings, and Note (2)'s reversing exception affirmatively requiring combination in a thoracoplasty scenario, plus a disclosed tension with the tuberculosis hub's own separately-tracked non-combination rule.

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What are you trying to understand about shortening of the lower extremity, the skull, the ribs, and the coccyx?

Overview

How VA rates leg-length shortening, skull defects, rib removal, and coccyx removal

38 CFR 4.71a covers four standalone diagnostic codes grouped in this hub because each rates a distinct, unrelated skeletal-structural finding rather than a shared body system: DC 5275 (Shortening of the Lower Extremity), DC 5296 (the Skull), DC 5297 (the Ribs), and DC 5298 (the Coccyx). Sourced under RSCH-088. DC 5298 is fully computable with two clean tiers (10/0 percent) and zero Notes. DC 5275 computes its own real six-tier ladder (60/50/40/30/20/10 percent) from measured leg-length discrepancy. Its Note's non-combination bar against 'fracture or faulty union in the same extremity' is automated for the two textually-confirmed destinations, DC 5255 (hip/femur malunion) and DC 5262 (tibia/fibula malunion) -- this repository's cross-hub combination logic blocks combining a DC 5275 rating with either. DC 5256 (ankylosis of the knee) is deliberately excluded from that automation and remains disclosed only, since 'faulty union' is undefined and whether the bar reaches DC 5256 at all, only indirectly as a dispatch destination inside DC 5255's or DC 5262's own clauses, is a genuine open question. DC 5296 computes its own real four-tier ladder (80/50/30/10 percent) for a documented bicortical (both inner and outer table) skull defect, but discloses rather than guesses when the documented facts instead describe a unicortical defect, since the code's own title language does not resolve whether full-thickness loss is required. DC 5297 computes its own real five-tier ladder (50/40/30/20/10 percent) from a documented rib-removal count, with its own Notes disclosed as hub content: Note (1)'s bar against combining with certain pleural/lung ratings, and Note (2)'s reversing exception affirmatively requiring combination in a thoracoplasty scenario, plus a disclosed tension with the tuberculosis hub's own separately-tracked non-combination rule.

This guide is educational only. RatingScope does not diagnose any of these conditions, does not infer measurements or findings, does not determine service connection, and does not predict a VA decision. RatingScope computes DC 5275's full 60/50/40/30/20/10 ladder from a documented measured leg-length discrepancy, DC 5296's full 80/50/30/10 ladder for a documented bicortical skull defect, DC 5297's full 50/40/30/20/10 ladder from a documented rib-removal count, and DC 5298's full 10/0 ladder from documented painful residuals. Two situations are disclosed rather than computed: (1) DC 5296 when the documented facts describe a unicortical (not clearly both-table) skull defect, a genuine unresolved threshold question in the code's own text; and (2) DC 5297's own non-combination Notes, which this hub discloses as content rather than automating as cross-hub combination logic, since their exact scope against other diagnostic codes is a genuine open question the regulation's own text does not resolve. DC 5275's non-combination bar is partially automated instead of fully disclosed: this repository's cross-hub combination logic blocks combining a DC 5275 rating with DC 5255 or DC 5262, the two textually-confirmed 'fracture or faulty union' destinations, and withholds the combined value if a veteran enters both. DC 5256 remains excluded from that automation and disclosed only, since whether DC 5275's bar reaches it -- and only indirectly -- is unresolved by the regulation's own text.

Percentage Guides

Understanding Your Percentage

Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.

60% (DC 5275, Shortening of the Lower Extremity)

Highest listed pathway

Measured lower-extremity shortening of over 4 inches (10.2 cm).

What separates the next level: A measured discrepancy of 3.5 to 4 inches reaches only the 50 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Bones, of the lower extremity, shortening of: Over 4 inches (10.2 cms.) -- 60.
Qualification explanation
Reached when the measured discrepancy between the two lower extremities, from the anterior superior iliac spine to the internal malleolus of the tibia, exceeds 4 inches.
Examples
Records document a measured leg-length discrepancy of 4.5 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records documenting the discrepancy, measured from the anterior superior iliac spine to the internal malleolus of the tibia
Functional impact examples
A measured, documented leg-length discrepancy exceeding 4 inches.
Common misconceptions
The word 'shortening' also appears as a plain-English descriptor inside DC 5255's hip/femur fracture criteria. DC 5275 is a separate diagnostic code that independently rates actual measured leg-length discrepancy -- see the dedicated disclosure on DC 5275's own non-combination bar.
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088. No pending rulemaking touches 38 CFR 4.71a's DC 5275, 5296, 5297, or 5298.

50% (DC 5275, Shortening of the Lower Extremity)

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Measured lower-extremity shortening of 3.5 to 4 inches (8.9 cm to 10.2 cm).

What separates the next level: Below 3.5 inches reaches only the 40 percent tier; over 4 inches reaches the 60 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
3½ to 4 inches (8.9 cms. to 10.2 cms.) -- 50.
Qualification explanation
Reached when the measured discrepancy falls within this range.
Examples
Records document a measured leg-length discrepancy of 3.75 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records
Functional impact examples
A measured, documented leg-length discrepancy of 3.5 to 4 inches.
Common misconceptions
This tier is measured, not estimated -- RatingScope does not infer a range from a general description like 'a few inches shorter.'
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

40% (DC 5275, Shortening of the Lower Extremity)

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Measured lower-extremity shortening of 3 to 3.5 inches (7.6 cm to 8.9 cm).

What separates the next level: Below 3 inches reaches only the 30 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
3 to 3½ inches (7.6 cms. to 8.9 cms.) -- 40.
Qualification explanation
Reached when the measured discrepancy falls within this range.
Examples
Records document a measured leg-length discrepancy of 3.2 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records
Functional impact examples
A measured, documented leg-length discrepancy of 3 to 3.5 inches.
Common misconceptions
This tier is measured, not estimated.
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

30% (DC 5275, Shortening of the Lower Extremity)

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Measured lower-extremity shortening of 2.5 to 3 inches (6.4 cm to 7.6 cm).

What separates the next level: Below 2.5 inches reaches only the 20 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
2½ to 3 inches (6.4 cms. to 7.6 cms.) -- 30.
Qualification explanation
Reached when the measured discrepancy falls within this range.
Examples
Records document a measured leg-length discrepancy of 2.75 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records
Functional impact examples
A measured, documented leg-length discrepancy of 2.5 to 3 inches.
Common misconceptions
This tier is measured, not estimated.
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

20% (DC 5275, Shortening of the Lower Extremity)

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Measured lower-extremity shortening of 2 to 2.5 inches (5.1 cm to 6.4 cm).

What separates the next level: Below 2 inches reaches only the 10 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
2 to 2½ inches (5.1 cms. to 6.4 cms.) -- 20.
Qualification explanation
Reached when the measured discrepancy falls within this range.
Examples
Records document a measured leg-length discrepancy of 2.25 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records
Functional impact examples
A measured, documented leg-length discrepancy of 2 to 2.5 inches.
Common misconceptions
This tier is measured, not estimated.
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

10% (DC 5275, Shortening of the Lower Extremity)

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Measured lower-extremity shortening of 1.25 to 2 inches (3.2 cm to 5.1 cm).

What separates the next level: This is DC 5275's lowest stated tier. Below 1.25 inches, the regulation names no percentage of its own -- see the dedicated disclosure.

Review CFR criteria, examples, and evidence
Official CFR language
1¼ to 2 inches (3.2 cms. to 5.1 cms.) -- 10.
Qualification explanation
Reached when the measured discrepancy falls within this range.
Examples
Records document a measured leg-length discrepancy of 1.5 inches.
Medical evidence
Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); Radiographic or clinical measurement records
Functional impact examples
A measured, documented leg-length discrepancy of 1.25 to 2 inches.
Common misconceptions
This tier is measured, not estimated.
Related topics
5275-non-combination-scope
Source context
38 CFR 4.71a; 5275; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

80% (DC 5296, the Skull)

Highest listed pathway

Loss of part of the skull, both inner and outer tables, with brain hernia.

What separates the next level: The same bicortical defect without brain hernia reaches, at most, the 50 percent tier, depending on the defect's area.

Review CFR criteria, examples, and evidence
Official CFR language
Skull, loss of part of, both inner and outer tables: With brain hernia -- 80.
Qualification explanation
Reached when a documented bicortical (both inner and outer table) skull defect is accompanied by a brain hernia.
Examples
Records document a bicortical skull defect from a craniectomy, with a documented brain hernia.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Imaging (CT or MRI) confirming both inner and outer table loss and any brain hernia; Operative or neurosurgical records
Functional impact examples
A documented bicortical skull defect with a brain hernia through the defect.
Common misconceptions
This tier applies only when the documented defect clearly involves both the inner and outer table. See the dedicated disclosure for a defect that appears to involve only one table.
Related topics
5296-bicortical-unicortical
Source context
38 CFR 4.71a; 5296; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

50% (DC 5296, the Skull)

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Loss of part of the skull, both inner and outer tables, without brain hernia, with an area larger than the size of a 50-cent piece (1.140 in² / 7.355 cm²).

What separates the next level: An intermediate area (between the 25-cent and 50-cent piece sizes) reaches only the 30 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Without brain hernia: Area larger than size of a 50-cent piece or 1.140 in² (7.355 cm²) -- 50.
Qualification explanation
Reached when a documented bicortical skull defect, without brain hernia, has an area larger than 1.140 in² (7.355 cm²).
Examples
Records document a bicortical skull defect measuring 1.5 in², without brain hernia.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Imaging confirming both inner and outer table loss and the measured defect area
Functional impact examples
A documented bicortical skull defect larger than 1.140 in², without brain hernia.
Common misconceptions
This tier applies only when the documented defect clearly involves both the inner and outer table.
Related topics
5296-bicortical-unicortical
Source context
38 CFR 4.71a; 5296; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

30% (DC 5296, the Skull)

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Loss of part of the skull, both inner and outer tables, without brain hernia, with an intermediate area.

What separates the next level: An area smaller than the 25-cent piece size reaches only the 10 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Area intermediate -- 30.
Qualification explanation
Reached when a documented bicortical skull defect, without brain hernia, has an area between the 25-cent and 50-cent piece size thresholds.
Examples
Records document a bicortical skull defect with an area between the two named thresholds, without brain hernia.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Imaging confirming both inner and outer table loss and the measured defect area
Functional impact examples
A documented bicortical skull defect of intermediate area, without brain hernia.
Common misconceptions
This tier applies only when the documented defect clearly involves both the inner and outer table.
Related topics
5296-bicortical-unicortical
Source context
38 CFR 4.71a; 5296; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

10% (DC 5296, the Skull)

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Loss of part of the skull, both inner and outer tables, without brain hernia, with an area smaller than the size of a 25-cent piece (0.716 in² / 4.619 cm²).

What separates the next level: This is DC 5296's lowest stated tier.

Review CFR criteria, examples, and evidence
Official CFR language
Area smaller than the size of a 25-cent piece or 0.716 in² (4.619 cm²) -- 10.
Qualification explanation
Reached when a documented bicortical skull defect, without brain hernia, has an area smaller than 0.716 in² (4.619 cm²).
Examples
Records document a small bicortical skull defect measuring 0.5 in², without brain hernia.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Imaging confirming both inner and outer table loss and the measured defect area
Functional impact examples
A documented small bicortical skull defect, without brain hernia.
Common misconceptions
This tier applies only when the documented defect clearly involves both the inner and outer table. DC 5296's Note directs rating intracranial complications separately.
Related topics
5296-bicortical-unicortical
Source context
38 CFR 4.71a; 5296; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

50% (DC 5297, the Ribs)

Highest listed pathway

Removal of more than six ribs.

What separates the next level: Removal of exactly five or six ribs reaches only the 40 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Ribs, removal of: More than six -- 50.
Qualification explanation
Reached when the documented rib-removal count exceeds six.
Examples
Records document removal of eight ribs.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the number of ribs removed or resected
Functional impact examples
Documented surgical removal of more than six ribs.
Common misconceptions
DC 5297's own Notes disclose a bar against combining with certain pleural/lung ratings, and a reversing exception for thoracoplasty -- see the dedicated disclosure.
Related topics
5297-notes-tuberculosis-tension
Source context
38 CFR 4.71a; 5297; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

40% (DC 5297, the Ribs)

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Removal of five or six ribs.

What separates the next level: Removal of three or four ribs reaches only the 30 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Five or six -- 40.
Qualification explanation
Reached when the documented rib-removal count is five or six.
Examples
Records document removal of six ribs.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the number of ribs removed
Functional impact examples
Documented surgical removal of five or six ribs.
Common misconceptions
See DC 5297's Notes disclosure for the pleural/lung combination bar and thoracoplasty exception.
Related topics
5297-notes-tuberculosis-tension
Source context
38 CFR 4.71a; 5297; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

30% (DC 5297, the Ribs)

Next: [object Object]

Removal of three or four ribs.

What separates the next level: Removal of two ribs reaches only the 20 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Three or four -- 30.
Qualification explanation
Reached when the documented rib-removal count is three or four.
Examples
Records document removal of three ribs.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the number of ribs removed
Functional impact examples
Documented surgical removal of three or four ribs.
Common misconceptions
See DC 5297's Notes disclosure for the pleural/lung combination bar and thoracoplasty exception.
Related topics
5297-notes-tuberculosis-tension
Source context
38 CFR 4.71a; 5297; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

20% (DC 5297, the Ribs)

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Removal of two ribs.

What separates the next level: Removal of one rib, or resection (without full removal) of two or more ribs without regeneration, reaches only the 10 percent tier.

Review CFR criteria, examples, and evidence
Official CFR language
Two -- 20.
Qualification explanation
Reached when the documented rib-removal count is exactly two.
Examples
Records document removal of two ribs.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the number of ribs removed
Functional impact examples
Documented surgical removal of two ribs.
Common misconceptions
See DC 5297's Notes disclosure for the pleural/lung combination bar and thoracoplasty exception.
Related topics
5297-notes-tuberculosis-tension
Source context
38 CFR 4.71a; 5297; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

10% (DC 5297, the Ribs)

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Removal of one rib, or resection of two or more ribs without regeneration.

What separates the next level: This is DC 5297's lowest stated tier.

Review CFR criteria, examples, and evidence
Official CFR language
One or resection of two or more ribs without regeneration -- 10.
Qualification explanation
Reached when the documented finding is removal of exactly one rib, or resection (short of removal) of two or more ribs without bone regeneration.
Examples
Records document removal of one rib.; Records document resection of three ribs, with no regeneration documented.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the specific procedure and any regeneration findings
Functional impact examples
Documented surgical removal of one rib, or resection of two or more ribs without regeneration.
Common misconceptions
See DC 5297's Notes disclosure for the pleural/lung combination bar and thoracoplasty exception.
Related topics
5297-notes-tuberculosis-tension
Source context
38 CFR 4.71a; 5297; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

10% (DC 5298, the Coccyx)

Highest listed pathway

Removal of the coccyx, partial or complete, with painful residuals.

What separates the next level: The same removal without painful residuals reaches 0 percent.

Review CFR criteria, examples, and evidence
Official CFR language
Coccyx, removal of: Partial or complete, with painful residuals -- 10.
Qualification explanation
Reached when coccyx removal, partial or complete, is documented along with painful residuals.
Examples
Records document partial coccyx removal with documented ongoing pain.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the extent of removal; Records documenting painful residuals
Functional impact examples
Documented coccyx removal with ongoing painful residuals.
Common misconceptions
DC 5298 carries zero Notes -- it is the cleanest of this hub's four codes, with no disclosed ambiguity.
Related topics
Not yet populated
Source context
38 CFR 4.71a; 5298; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

0% (DC 5298, the Coccyx)

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Removal of the coccyx, partial or complete, without painful residuals.

What separates the next level: This is DC 5298's lowest tier, explicitly stated in the regulation's own text (unlike DC 5275, which names no 0 percent tier of its own).

Review CFR criteria, examples, and evidence
Official CFR language
Without painful residuals -- 0.
Qualification explanation
Reached when coccyx removal is documented without painful residuals.
Examples
Records document coccyx removal with no residual pain documented.
Medical evidence
Bones and Other Skeletal Conditions DBQ; Operative reports documenting the extent of removal
Functional impact examples
Documented coccyx removal without painful residuals.
Common misconceptions
A 0 percent rating still reflects a service-connected finding; it is not the same as no rating at all.
Related topics
Not yet populated
Source context
38 CFR 4.71a; 5298; Current DC 5275/5296/5297/5298 educational pathway, per RSCH-088.

Learn

Understand the details behind the criteria

Use these short guides to connect published terms with the records and observations that may clarify them.

DC 5275's non-combination bar: automated for two confirmed pairs, disclosed where DC 5256's reach is unresolved

DC 5275's own Note bars combining a leg-length-shortening rating with other ratings for 'fracture or faulty union in the same extremity.' 'Faulty union' appears exactly once in all of 38 CFR 4.71a and is undefined there, but two destination codes use terms close enough to confirm textually: DC 5255 (hip/femur) uses 'malunion' and 'nonunion,' and DC 5262 (tibia/fibula) uses 'malunion,' 'nonunion,' and 'false joint.' RatingScope's cross-hub combination logic now blocks combining a DC 5275 rating with either. A third candidate, DC 5256 (ankylosis of the knee), is deliberately left out of that automation and disclosed instead, since its own text carries none of those terms and its only connection to DC 5275 is indirect.

  • DC 5275's Note, verbatim, in full: "Measure both lower extremities from anterior superior spine of the ilium to the internal malleolus of the tibia. Not to be combined with other ratings for fracture or faulty union in the same extremity."
  • This repository's own Non-Combination Rule Register (docs/NON_COMBINATION_RULE_REGISTER.md, section 6.6) documents the same finding after a dedicated verification pass (RSCH-088): 'faulty union' itself appears exactly once in all of 38 CFR 4.71a and is undefined there, while DC 5255 (hip/femur) uses 'malunion' and 'nonunion,' and DC 5262 (tibia/fibula) uses 'malunion,' 'nonunion,' and 'false joint' -- none of them the exact phrase DC 5275's own Note uses, but close enough in kind and confirmed as the register's own textually-supported reading to automate.
  • RatingScope's cross-hub combination logic (lib/combined-ratings/non-combination-rules.ts, rule id dc-5275-fracture-malunion) blocks combining a DC 5275 rating with a DC 5255 or DC 5262 rating: if a veteran enters both in the combined-ratings calculator, the combined value is withheld rather than silently computed, the same as this repository's other confirmed non-combination pairs.
  • A related, distinct question remains genuinely open and is NOT automated: DC 5256 (ankylosis of the knee) contains no fracture, malunion, nonunion, or false-joint language of its own at all, and is reached only indirectly, as a dispatch destination named inside DC 5255's or DC 5262's own 'malunion of' clause -- not directly by DC 5275's Note. Whether DC 5275's bar reaches DC 5256 at all, and if so only through that indirect path, is unresolved by the regulation's own text, so combining DC 5275 with DC 5256 is not blocked here -- disclosed as an open question rather than assumed either way.

Records to review: Records documenting any separate fracture, malunion, nonunion, or false-joint finding in the same extremity, for a claims representative's own manual review.

DC 5296's bicortical/unicortical gap, and a TBI cross-reference

DC 5296 rates 'loss of part of, both inner and outer tables' of the skull. Its title language creates a genuine unresolved question for a documented unicortical (single-table) defect: does the code require full-thickness (both-table) loss to apply at all, or would a significant single-table defect also be described by this language? RatingScope computes nothing for a unicortical fact pattern and discloses the gap instead, the same category of open threshold question already disclosed for DC 6817 in the Pulmonary Vascular Disease hub.

  • DC 5296's own text, verbatim, in full: "Skull, loss of part of, both inner and outer tables: With brain hernia -- 80. Without brain hernia: Area larger than size of a 50-cent piece or 1.140 in² (7.355 cm²) -- 50. Area intermediate -- 30. Area smaller than the size of a 25-cent piece or 0.716 in² (4.619 cm²) -- 10. Note: Rate separately for intracranial complications."
  • For a documented bicortical (both inner and outer table) skull-defect finding, RatingScope computes the applicable tier normally from the stated area or brain-hernia facts -- this is the code's own clearly-stated core case.
  • For a documented unicortical (for example, outer-table-only) defect, or any finding not clearly described as involving both tables, RatingScope computes nothing. The code's title language is genuinely ambiguous between a strict anatomical description (both tables must be involved) and a threshold that a significant single-table defect might also satisfy in substance -- the regulation's own text does not resolve which reading applies, and guessing either reading would produce a different outcome for the same real fact pattern. This is disclosed, never computed, matching DC 6817's own disclosed 60 percent ambiguity in the Pulmonary Vascular Disease and Bacterial Lung Infections hub.
  • A related but textually distinct cross-reference: the TBI (Traumatic Brain Injury) hub's own physical-dysfunction-dispatch disclosure notes that a skull or cranial-bone defect is a clinically common physical residual of the same head trauma that produces TBI facet-table findings, while confirming that neither DC 8045's text nor DC 5296's text cross-references the other. This hub repeats that same cross-reference here: a documented skull defect may be worth reviewing alongside a TBI claim, but no textual link exists between the two codes, and this hub does not compute anything across them.

Records to review: Imaging (CT or MRI) clearly documenting whether the skull defect involves the inner table, the outer table, or both; Operative or neurosurgical records describing the defect's extent.

DC 5297's two Notes, and a disclosed tension with the tuberculosis non-combination rule

DC 5297 carries two Notes: Note (1) bars combining a rib-removal rating with certain pleural/lung ratings; Note (2) reverses that bar in a thoracoplasty scenario, affirmatively requiring combination with lung-collapse, lobectomy, pneumonectomy, or graduated tuberculosis ratings. This creates an apparent, unresolved tension with the tuberculosis hub's own separately-tracked, already-disclosed inactive-tuberculosis non-combination bar under 38 CFR 4.96(a).

  • DC 5297's Note (1), verbatim, in full (preserving the source text's own spelling): "The rating for rib resection or removal is not to be applied with ratings for purrulent pleurisy, lobectomy, pneumonectomy or injuries of pleural cavity." This spelling ('purrulent,' two r's) is confirmed as it appears in the actual regulatory text across two independent sourcing channels, not a RatingScope typo -- quoted here exactly as written, without correction.
  • DC 5297's Note (2), verbatim, in full: "However, rib resection will be considered as rib removal in thoracoplasty performed for collapse therapy or to accomplish obliteration of space and will be combined with the rating for lung collapse, or with the rating for lobectomy, pneumonectomy or the graduated ratings for pulmonary tuberculosis."
  • RatingScope computes DC 5297's own five-tier ladder normally from a documented rib-removal count -- this is the code's own clean, unambiguous core case. Both Notes are disclosed here as hub content, not automated into this repository's cross-hub combination logic (lib/combined-ratings/non-combination-rules.ts): Note (1)'s bar the same way DC 5275's non-combination bar is disclosed rather than automated, and Note (2)'s reversing exception because it affirmatively requires a combination this repository does not compute across hubs.
  • A specific, disclosed tension: 38 CFR 4.96(a) (the musculoskeletal and respiratory schedules' own bar against combining ratings within DC 6600-6817 and 6822-6847 with each other) already governs the live tuberculosis hub's own inactive-tuberculosis disclosure. DC 5297 Note (2) sits in the musculoskeletal section (38 CFR 4.71a) and affirmatively requires combining a rib-resection rating with 'the graduated ratings for pulmonary tuberculosis' in the thoracoplasty scenario -- a combination instruction that, on its face, sits in tension with 4.96(a)'s own separate bar. Musculoskeletal and respiratory are different schedule sections, and DC 5297 itself is not one of the DC numbers 4.96(a)'s own text lists, so this likely is not a live conflict -- but 'likely isn't' is not the same as resolved. Neither section's own text states how the two interact, and RatingScope does not pick a side: this is disclosed as an unresolved regulatory-text question, not something RatingScope has decided.

Records to review: Operative reports documenting whether a rib procedure was performed as thoracoplasty for collapse therapy; Records documenting any separate pleurisy, lobectomy, pneumonectomy, pleural-cavity-injury, lung-collapse, or pulmonary tuberculosis rating in place.

No pending rulemaking found for DC 5275, 5296, 5297, or 5298

A direct check of the Federal Register and this repository's own tracked pending-rule list found no pending amendment touching these four diagnostic codes.

  • RIN 2900-AQ72 (ENT/Audiology and Respiratory), RIN 2900-AQ73 (Neurological Conditions), RIN 2900-AQ82 (Mental Disorders), and RIN 2900-AS40 (Heart Conditions), this repository's highest-priority tracked pending rules, are each scoped to CFR sections other than the specific DC 5275/5296/5297/5298 rows within 38 CFR 4.71a.
  • This hub is built on the current, in-force regulatory text sourced under RSCH-088, and will be updated in a future work order if and when any amendment to these specific diagnostic codes is proposed or finalized.

Records to review: .

Evidence

Evidence that may clarify the published criteria

Surgical, orthopedic, and imaging records

Records confirming a measured leg-length discrepancy, a skull-defect finding with its table involvement and area, a rib-removal count and procedure type, or a coccyx-removal finding with or without painful residuals.

Only the records relevant to the specific diagnostic code documented are needed.

Radiographic and clinical measurement records

Supports the specific measurements distinguishing DC 5275's six tiers and DC 5296's four tiers.

Only relevant to the specific diagnosis documented.

Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9) and Bones and Other Skeletal Conditions DBQ

VA's examination forms for these conditions -- DC 5275 by the Knee and Lower Leg Conditions DBQ, and DC 5296/5297/5298 together by the Bones and Other Skeletal Conditions DBQ. Both confirmed fully aligned with these four diagnostic codes' text, no discrepancy found.

A DBQ is one common evidence source, not the only way to document these findings.

DBQ

What a skeletal-structural examination commonly documents

VA publishes the Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9), confirmed aligned with DC 5275's own measurement and criteria, and the Bones and Other Skeletal Conditions DBQ, confirmed aligned with DC 5296, DC 5297, and DC 5298's own criteria -- no discrepancy found for any of the four codes beyond the disclosures in this hub's learning topics. RatingScope reads whatever is documented; it does not infer undocumented findings, including whether a skull defect involves one table or both.

  • Measured leg-length discrepancy (DC 5275), from the anterior superior iliac spine to the internal malleolus of the tibia
  • Skull-defect table involvement (both inner and outer tables, or one table only), area, and any brain hernia (DC 5296)
  • Number of ribs removed or resected, and whether the procedure was thoracoplasty for collapse therapy (DC 5297)
  • Extent of coccyx removal and whether painful residuals are present (DC 5298)

Terminology

Plain-English terms

Shortening of the Lower Extremity (DC 5275)

A rating based on how much shorter one leg is measured to be than the other, using a specific measurement method.

Determines which of DC 5275's six tiers applies. The regulation names no tier below 1.25 inches.

Knee and Lower Leg Conditions DBQ (VA Form 21-0960M-9); 5275-non-combination-scope

The Skull (DC 5296)

A rating for a skull defect from bone loss, based on its size and whether the brain protrudes through it.

Requires a documented bicortical (both-table) defect to compute a tier; a unicortical defect is a disclosed, unresolved gap.

Bones and Other Skeletal Conditions DBQ; 5296-bicortical-unicortical

The Ribs (DC 5297)

A rating based on how many ribs have been surgically removed.

DC 5297's own Notes are disclosed, not automated: a bar against certain combinations, reversed by an affirmative combination requirement in a thoracoplasty scenario.

Bones and Other Skeletal Conditions DBQ; 5297-notes-tuberculosis-tension

The Coccyx (DC 5298)

A rating for surgical removal of the tailbone, based on whether pain persists afterward.

DC 5298 carries zero Notes and is fully computable with no disclosed ambiguity.

Bones and Other Skeletal Conditions DBQ

TDIU

Even if the schedular rating for these skeletal-structural conditions does not reach 100 percent, TDIU may still provide a pathway to compensation at the 100 percent rate, based on unemployability from this and/or other service-connected disabilities combined.

A lower schedular percentage does not by itself foreclose TDIU eligibility -- this hub computes only the schedular percentage for these specific conditions and does not determine TDIU eligibility.

Employment history; vocational impact documentation; occupational impairment

Common Questions

Questions veterans commonly ask

How does VA rate shortening of the lower extremity?

DC 5275 rates measured leg-length discrepancy on a six-tier scale, from 10 percent (1.25 to 2 inches) up to 60 percent (over 4 inches), measured from the anterior superior iliac spine to the internal malleolus of the tibia. The regulation names no percentage of its own below 1.25 inches.

What is DC 5275's non-combination bar, and what does it cover?

DC 5275's Note bars combining its rating with other ratings for 'fracture or faulty union in the same extremity.' 'Faulty union' is undefined anywhere in 38 CFR 4.71a, and the plausible destination codes use different terms ('malunion,' 'nonunion,' 'false joint'). RatingScope discloses this scope question rather than assuming an answer, and does not automate this bar as cross-hub combination logic.

How does VA rate a skull defect?

DC 5296 rates loss of part of the skull involving both the inner and outer tables, from 10 percent (a small area) up to 80 percent (with brain hernia). A documented single-table (unicortical) defect is a disclosed, unresolved gap in the code's own text -- RatingScope does not compute a tier for it.

What if my skull defect only affects one table, not both?

DC 5296's title language ('both inner and outer tables') does not clearly resolve whether a significant single-table (unicortical) defect also qualifies. RatingScope discloses this as a genuine unresolved threshold question rather than guessing either reading.

How does VA rate rib removal?

DC 5297 rates the number of ribs removed, from 10 percent (one rib, or resection of two or more without regeneration) up to 50 percent (more than six ribs).

Does rib removal combine with lung or pleural ratings?

DC 5297's Note (1) bars combining with certain pleural/lung ratings (purulent pleurisy, lobectomy, pneumonectomy, or pleural-cavity injury). Note (2) reverses that bar in a thoracoplasty-for-collapse-therapy scenario, affirmatively requiring combination with lung-collapse, lobectomy, pneumonectomy, or graduated tuberculosis ratings. RatingScope discloses both Notes as hub content and also discloses an apparent, unresolved tension between Note (2)'s affirmative combination requirement and the tuberculosis hub's own separately-disclosed 4.96(a) non-combination bar.

How does VA rate coccyx removal?

DC 5298 rates coccyx removal at 10 percent with painful residuals, or 0 percent without. This code carries zero Notes and no disclosed ambiguity.

Is a rule change coming?

No pending VA rulemaking touching DC 5275, 5296, 5297, or 5298 was found in a direct Federal Register check, and this section is outside the scope of this repository's tracked pending rulemakings (RIN 2900-AQ72, AQ73, AQ82, and AS40).

If my schedular rating for these conditions is below 100%, can I still be compensated at the 100% rate?

Possibly, through TDIU (Total Disability rating based on Individual Unemployability, 38 CFR 4.16) -- a separate pathway to 100 percent compensation based on unemployability, from this and/or other service-connected disabilities combined, independent of whether the schedular rating itself reaches 100 percent. This hub computes only the schedular percentage and does not determine TDIU eligibility.

Preparation

What to have nearby

  • Confirmed diagnosis

    Determines which of the four independent DC 5275/5296/5297/5298 pathways applies.

  • Measured leg-length discrepancy, if applicable

    The single load-bearing fact for DC 5275's six-tier ladder.

  • Skull-defect table involvement (both tables or one), area, and brain hernia status, if applicable

    Determines whether DC 5296 computes a tier or discloses the bicortical/unicortical gap.

  • Number of ribs removed or resected, and thoracoplasty status, if applicable

    Determines DC 5297's applicable tier and whether the thoracoplasty exception is relevant.

  • Whether painful residuals are documented after coccyx removal, if applicable

    Determines DC 5298's 10 percent versus 0 percent tier.

Ready when you are

Compare documented shortening, skull, rib, or coccyx findings

RatingScope computes DC 5275's full ladder from a documented measured leg-length discrepancy, DC 5296's full ladder for a documented bicortical skull defect, DC 5297's full ladder from a documented rib-removal count, and DC 5298's full ladder from documented painful residuals. DC 5296 for a documented unicortical (single-table) defect is disclosed rather than computed. DC 5275's and DC 5297's own non-combination Notes are disclosed as hub content, not automated. Do not upload records or enter Social Security numbers, claim numbers, full dates of birth, or other sensitive identifiers. RatingScope does not infer missing findings.

Informational guidance only. RatingScope does not predict, decide, or guarantee VA outcomes.

Compare my leg-length, skull, rib, or coccyx records

Learn More

Continue Understanding

Claims Process: exam preparation

General claim-exam preparation guidance, not specific to this condition.

Open resource

Claims Process: evidence checklist

General evidence-gathering guidance, not specific to this condition.

Open resource

38 CFR 4.71a - Schedule of ratings, musculoskeletal system

Official eCFR source for DC 5275, 5296, 5297, and 5298's published text.

Open resource

VA Knee and Lower Leg Conditions Disability Benefits Questionnaire

Official VA form index.

Open resource

38 CFR 4.16 - Total disability ratings for compensation based on unemployability (TDIU)

Official source for TDIU, a separate pathway to 100 percent compensation based on unemployability, independent of the schedular percentage. This hub does not determine TDIU eligibility.

Open resource

Secondary conditions

Conditions commonly connected to Shortening of the Lower Extremity, the Skull, the Ribs, and the Coccyx

No commonly documented secondary connections are tracked for Shortening of the Lower Extremity, the Skull, the Ribs, and the Coccyx yet.

Keep going

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Percentage Guide

See what each percentage level means for your condition, then use the whole-person calculator to combine more than one rating.

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Evidence Categories

Understand common evidence categories and what they can clarify without treating them as a checklist.

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