Skip to main content
VA Rating Assistant

DC 5313 · 38 CFR 4.73

Muscle Group XIII Injury (Hamstrings) C&P Exam Prep

To evaluate the current severity of a service-connected or potentially service-connected injury to Muscle Group XIII (posterior thigh/hamstring muscles: biceps femoris, semitendinosus, semimembranosus), assess functional impairment, and provide the VA rater with objective findings needed to assign an accurate disability rating under 38 CFR 4.73, Diagnostic Code 5313.

Format:
Interview + Physical
Typical duration:
30-60 minutes
DBQ form:
Muscle_Injuries (Muscle_Injuries)
Examiner:
Orthopedic Surgeon, Physiatrist, or appropriate clinician

What the examiner evaluates

  • Identification and confirmation of the specific muscle group(s) injured (Group XIII: biceps femoris, semitendinosus, semimembranosus)
  • Severity classification: slight, moderate, moderately severe, or severe injury per 38 CFR 4.73
  • Presence and extent of scar characteristics (minimal, entrance/exit wound scars, ragged/depressed/adherent scars, adhesion to bone)
  • Muscle tonus, substance loss, atrophy (visible or measurable), and fascial integrity
  • Weakness and loss of power in the hamstring muscle group
  • Lowered threshold of fatigue with repetitive use
  • Pain on use or at rest with functional activities
  • Impairment of coordination and uncertainty of movement
  • Active and passive range of motion of the knee (flexion and extension) and hip
  • Manual muscle testing grades for knee flexion (primary hamstring function)
  • Functional limitations in walking, climbing, kneeling, squatting, and running
  • Presence of muscle atrophy with circumferential thigh measurements (normal vs. atrophied side)
  • Use of assistive devices (cane, crutches, walker, wheelchair, braces)
  • Flare-ups: frequency, severity, precipitating factors, and duration
  • Retained foreign bodies (shell fragments, shrapnel) via X-ray evidence if applicable
  • Impact on occupational and daily functioning
  • Any additional diagnoses or complications related to the muscle injury

The exam will be conducted in person at a VA facility, VAMC, or contracted examiner office. The examiner will review your claims file and service treatment records before or during the exam. You may be asked to change into a gown for direct physical examination of the posterior thigh. Bring all assistive devices you use regularly. If you use a brace or knee sleeve for your hamstring injury, wear or bring it. In most states you have the right to record the examination - notify the examiner at the start if you intend to do so.

Measurements and tests

Active Knee Flexion Range of Motion

What it measures: The degree to which you can actively bend your knee using hamstring muscle contraction, measured with a goniometer. Normal active knee flexion is 0-140 degrees.

What to expect: You will be asked to bend your knee as far as possible while lying prone or sitting. The examiner measures the angle achieved. This is the primary functional movement of the hamstring group. Both sides will be compared.

Critical thresholds

  • Full range (0-140-) with pain or fatigue Supports at minimum slight injury; DeLuca factors for pain/fatigue on use become critical
  • Noticeably limited flexion with weakness Supports moderate to moderately severe injury rating; document exact degree
  • Significant limitation with atrophy and loss of power Supports moderately severe to severe injury; document circumferential measurements

Tips

  • Perform the movement at your actual capacity - do not push through severe pain to appear capable
  • If you experience pain before reaching end range, say so clearly: 'I stop here because of pain in the back of my thigh'
  • If your range is worse in the morning or after prolonged sitting, mention this timing
  • Ask the examiner to test after repetitive use if your condition worsens with repeated movement
  • Report if your knee feels unstable or gives way during the test

Pain considerations: Under DeLuca v. Brown, pain on use that limits motion must be separately noted. If your active ROM is limited by pain before reaching the endpoint of structural limitation, state this explicitly. The examiner should record both the pain-free arc and the total arc achieved.

Passive Knee Flexion Range of Motion

What it measures: The degree of knee flexion achievable when the examiner moves your leg without your muscle effort, isolating structural/capsular restriction from muscle weakness.

What to expect: While relaxed, the examiner will gently flex your knee to its maximum comfortable range. Compare with active ROM to assess how much of any limitation is due to muscle weakness vs. joint/structural restriction.

Critical thresholds

  • Passive ROM greater than active ROM Indicates muscle weakness/fatigue is the primary limiting factor - important for hamstring injury rating
  • Passive ROM equals active ROM limitation Suggests combined structural and muscular limitation; supports higher severity rating

Tips

  • Stay relaxed and let the examiner move your leg; do not assist or resist
  • Report any pain, tightness, or pulling sensation in the posterior thigh during passive flexion
  • Mention if passive stretching triggers spasms in the hamstring

Pain considerations: Pain or tightness felt at the posterior thigh during passive flexion may indicate scar tissue, adhesions, or persistent muscle injury - report exactly where you feel it.

Manual Muscle Testing (MMT) - Knee Flexion

What it measures: The strength of hamstring muscles on a 0-5 scale: 5=normal strength against full resistance, 4=movement against some resistance, 3=movement against gravity only, 2=movement with gravity eliminated, 1=visible/palpable contraction only, 0=no contraction.

What to expect: You will be asked to flex your knee while the examiner applies resistance at the ankle/lower leg. The examiner grades the strength. Both sides are tested for comparison.

Critical thresholds

  • Grade 5/5 bilaterally Does not support significant weakness finding; focus on fatigue, pain, and functional loss
  • Grade 4/5 Supports moderate weakness; consistent with moderate injury rating
  • Grade 3/5 or below Supports moderately severe to severe injury; significant functional limitation

Tips

  • Give your honest maximum effort - the examiner needs accurate data
  • If you can only sustain maximum effort briefly before fatigue, tell the examiner: 'I feel my strength drop off quickly with repetition'
  • If one side is noticeably weaker than the other, make sure the examiner tests both
  • Report if the weakness is worse after activity or at certain times of day

Pain considerations: Pain inhibition - where pain prevents you from exerting maximum effort - should be noted. Tell the examiner if pain is what is limiting your push rather than true muscle weakness, so they can document both factors.

Thigh Circumference Measurement (Atrophy Assessment)

What it measures: Circumferential measurement of both thighs at a standardized point (typically 10-15 cm above the superior patellar pole) to detect and quantify muscle atrophy. A difference of 2 cm or more is generally considered clinically significant.

What to expect: The examiner uses a tape measure around both thighs at the same anatomical level and records the normal side and the atrophied side measurements.

Critical thresholds

  • No measurable difference Does not support atrophy finding; document other objective signs of injury
  • 1-2 cm difference Borderline atrophy; supports moderate injury; document alongside strength and functional findings
  • >2 cm difference Visible/measurable atrophy confirmed; strongly supports moderately severe or severe rating

Tips

  • Atrophy may be present even if not visually obvious - the measurement will capture it
  • If you have noticed your injured thigh looks thinner or feels weaker, point this out to the examiner
  • Long-term disuse following an old injury can result in atrophy that persists for years - mention this history

Pain considerations: Atrophy from chronic pain-related disuse is a valid and rateable finding. If you avoid using the injured leg due to pain, explain this connection to the examiner.

Active Hip Range of Motion (Extension and Flexion)

What it measures: Hip extension (hamstrings assist gluteus maximus) and hip flexion (opposing group). Limitation in hip extension may reflect hamstring scarring or tightness across the posterior thigh.

What to expect: You will be asked to move your hip in various directions. Hamstring tightness often limits straight-leg raise and hip flexion when the knee is extended (indicating hamstring length restriction).

Critical thresholds

  • Straight-leg raise limited to <60- Indicates significant hamstring tightness/scarring; supports moderate to severe injury finding
  • Hip extension limitation May support Group XIII involvement in conjunction with Group XVII (pelvic girdle) - document both

Tips

  • Report tightness, pulling, or pain in the posterior thigh during hip flexion with knee extended (straight-leg raise)
  • Distinguish pain location: back of thigh vs. low back vs. knee

Pain considerations: Posterior thigh pain during straight-leg raise is a key indicator of hamstring pathology - be specific about the location and intensity.

Functional Endurance Assessment

What it measures: How your hamstring injury affects sustained functional activities: walking distance, stair climbing, rising from seated/kneeling, and any activities requiring repetitive knee flexion.

What to expect: The examiner will ask about your functional capacity. They may observe your gait. They are assessing lowered threshold of fatigue, pain on prolonged use, and functional impairment.

Critical thresholds

  • Unable to walk >1 block without stopping due to posterior thigh pain/weakness Supports moderately severe to severe rating with functional overlay
  • Fatigue and pain after moderate activity requiring rest Supports lowered threshold of fatigue finding - key DeLuca factor

Tips

  • Describe a specific worst-day scenario: 'On my worst days, I cannot walk to my mailbox and back without the back of my thigh burning and giving out'
  • Report activities you have stopped doing entirely because of the condition
  • Describe how long you can stand, walk, or climb stairs before symptoms force you to stop

Pain considerations: Fatigue and pain that develop with use - even if not present at rest - are rateable findings under the DeLuca doctrine. Do not underreport symptoms that only appear during activity.

Rating criteria by percentage

10%

Slight: Injury with minimum disability. Minimal impairment; entrance and exit scars are small or linear; muscles are essentially intact with only slight residual symptoms.

Key symptoms

  • Minimal scars (small or linear entrance/exit wound scars)
  • Muscles essentially intact and functional
  • Slight weakness or fatigue only with extreme exertion
  • No measurable atrophy
  • No significant loss of power or coordination
  • Minimal functional limitation in daily activities

From 38 CFR: Per 38 CFR 4.73, DC 5313: Slight injury with minimum disability. Scars are minimal. No significant muscle substance loss, no atrophy, minimal residuals.

20%

Moderate: In part, entrance and exit scars are larger, indicating track of missile through muscles; some loss of muscle substance, soft flabby muscles in wound area, or some impairment of muscle tonus.

Key symptoms

  • Entrance/exit scars indicating missile track through muscle
  • Some loss of muscle substance in the posterior thigh
  • Soft or flabby muscles in the hamstring region on palpation
  • Some impairment of muscle tonus
  • Weakness and fatigue on moderate use
  • Mild but measurable functional limitation with knee flexion and ambulation

From 38 CFR: Per 38 CFR 4.73, DC 5313: Moderate injury. Scars indicate track through muscles, some muscle substance loss, soft flabby muscles, or impaired tonus in the posterior thigh.

30%

Moderately Severe: With more of the following: ragged, depressed, and adherent scars indicating wide damage to muscle groups; palpation shows loss of deep fascia or muscle substance; atrophy shown by measurement (visible or measurable); weakness, fatigue, and/or lowered endurance of affected muscle group; impairment of coordination and uncertainty of movement.

Key symptoms

  • Ragged, depressed, and adherent scars indicating wide damage to posterior thigh muscles
  • Palpation reveals loss of deep fascia or significant muscle substance loss
  • Visible or measurable atrophy of affected thigh (2+ cm circumference difference)
  • Adaptive contraction of opposing muscle group (quadriceps shortening)
  • Induration or atrophy of entire muscle following history of infection
  • Muscles swell and harden abnormally in contraction
  • Weakness and fatigue with ordinary use - not just extreme exertion
  • Impairment of coordination and uncertainty of movement when walking, climbing stairs, or squatting
  • Functional limitation: difficulty with stairs, kneeling, prolonged walking

From 38 CFR: Per 38 CFR 4.73, DC 5313: Moderately severe injury. Multiple objective findings of significant muscle damage: adherent scars, measurable atrophy, weakness, coordination impairment, lowered fatigue threshold.

40%

Severe: With extensive scar formation, muscle hernias, or if the record shows: marked loss of muscle substance (atrophy of muscle groups not in the track of the missile, from loss of nerve supply), tests of endurance or coordinated movements compared with the sound side show marked impairment of all muscle functions.

Key symptoms

  • Extensive scar formation throughout posterior thigh
  • Muscle hernias present
  • Marked loss of muscle substance (significant visible atrophy)
  • Atrophy of muscle groups beyond the direct injury track (neurogenic atrophy)
  • Tests of endurance show marked impairment compared to unaffected side
  • Coordinated movements severely impaired compared to sound side
  • Loss of power: grade 3/5 or below on manual muscle testing for knee flexion
  • Significant functional limitation: cannot climb stairs, cannot perform activities requiring knee flexion under load
  • Adhesion of scar to underlying bone (femur)
  • Requiring assistive devices (cane, crutches) for ambulation
  • Severe flare-ups that incapacitate for extended periods

From 38 CFR: Per 38 CFR 4.73, DC 5313: Severe injury. Extensive scarring, muscle hernias, marked atrophy beyond missile track, tests of endurance and coordination show marked impairment vs. sound side. Maximum schedular rating under DC 5313.

Describing your symptoms accurately

Pain - Location, Quality, and Triggers

How to describe it: Describe pain as precisely as possible: location (posterior thigh, behind the knee, ischial tuberosity), quality (burning, aching, sharp, pulling), triggers (walking, climbing stairs, bending knee under load, prolonged sitting, getting up from chair), and severity on a consistent 0-10 scale. Distinguish resting pain from activity-induced pain.

Example: On my worst days, the back of my right thigh burns at a 7/10 from the moment I get out of bed. Walking to the bathroom causes a sharp pulling pain that forces me to limp. I cannot bend my knee enough to go down stairs without gripping the railing and going one step at a time. I have to take ibuprofen and lie down within 30 minutes of any activity.

Examiner listens for: The examiner is listening for whether pain is present at rest or only on use, whether it is proportionate to the injury, whether it limits functional activities, and whether it correlates with objective findings like atrophy or scar tissue.

Avoid: Do not say 'it's not that bad' or 'I can manage.' Do not describe your best days as typical. Do not minimize pain by saying 'I take Advil and it's fine' without explaining how often you need medication and what you still cannot do even with medication.

Weakness and Loss of Power

How to describe it: Describe functional manifestations of weakness: inability to climb stairs without a rail, difficulty rising from low chairs or the floor, leg giving way when going down inclines, inability to run or jog, dropping objects or stumbling due to knee buckling. Connect weakness to specific daily activities.

Example: My hamstring feels completely dead on bad days. I have fallen twice this year because my knee buckled going down stairs. I cannot get up off the floor without pulling myself up on furniture. I had to stop my job that required climbing ladders because my right leg is too unreliable.

Examiner listens for: The examiner is assessing whether weakness is functional - meaning it actually limits what you can do - and whether it matches the objective manual muscle test findings. Descriptions that correlate with exam findings are most credible.

Avoid: Do not demonstrate that you can do something during the exam that you cannot do in real life, then fail to explain the discrepancy. If you can do a task during the exam due to adrenaline or because it is only a short effort, say: 'I can do this briefly but I could not sustain this for normal daily activities.'

Fatigue and Lowered Endurance Threshold

How to describe it: Explain how quickly your hamstring fatigues compared to before the injury and compared to your other leg. Provide specific distances, durations, or repetitions: 'After walking half a block, the back of my thigh begins to burn and feel heavy and I have to stop and rest for 5-10 minutes before continuing.' Describe what happens with repetitive use - does it get worse?

Example: Even on an average day, I cannot walk more than one block without stopping. The muscle in the back of my thigh starts burning and trembling, and by the second block it feels like the muscle is going to cramp and lock up. I used to walk 3-4 miles without issue before my injury. Now I plan all errands around benches or places I can sit.

Examiner listens for: The examiner is listening for whether fatigue develops with ordinary use (not just maximal exertion), how quickly it develops, and whether it resolves with rest or persists. This directly supports the 'lowered threshold of fatigue' criterion that distinguishes moderate from moderately severe ratings.

Avoid: Do not say 'I get a little tired.' Be specific about how much activity triggers fatigue, how long recovery takes, and how this compares to your pre-injury baseline or your unaffected leg.

Flare-Ups

How to describe it: Describe flare-ups as distinct episodes of worsening: frequency (how many per month), duration (hours to days), triggers (weather, overactivity, sitting or standing too long), severity during the flare versus baseline, and what you cannot do during a flare. Explain whether they are predictable or unpredictable.

Example: I have severe flare-ups about twice a month, usually triggered by anything more than 20 minutes of walking or any activity involving bending and squatting. During a flare, the back of my thigh swells, the muscle cramps involuntarily, and the pain reaches 9/10. I cannot walk more than a few steps and I need to ice my thigh and stay in bed for 1-3 days until it settles down.

Examiner listens for: The examiner needs to document flare-up characteristics to apply DeLuca factors. They are listening for whether flares represent a meaningful addition to baseline disability - particularly any additional functional loss during flares.

Avoid: Do not say 'I have some bad days sometimes.' Give numbers: frequency, duration, severity scale, and specific functional losses. If flares are unpredictable and affect your ability to maintain employment, state this explicitly.

Impairment of Coordination and Uncertainty of Movement

How to describe it: Describe situations where you are uncertain whether your leg will support you: fear of falling on uneven terrain, difficulty judging how much to bend your knee, involuntary movement or trembling of the posterior thigh, difficulty with precise movements like stepping over curbs, and any compensatory changes in your gait.

Example: I never know when my leg is going to give out. I hold the wall when I walk down the hall at home. I stopped hiking and going to crowded places because any unexpected movement - stepping off a curb, someone bumping me - can make my knee buckle. My physical therapist told me my gait pattern has completely changed because I cannot trust my right hamstring.

Examiner listens for: The examiner is looking for whether coordination impairment and movement uncertainty are present as separate, rateable findings beyond simple weakness. These are specifically listed criteria at the moderately severe level under 38 CFR 4.73.

Avoid: Do not frame this only as 'my leg is weak.' The specific language of 'impairment of coordination' and 'uncertainty of movement' are enumerated criteria - use these terms or describe exactly what they mean for you functionally.

Scars and Physical Changes to the Muscle

How to describe it: Describe any visible scars, their size and texture, whether they are raised, depressed, adherent (stuck to underlying tissue), or affect movement. Describe whether palpation of the scar or posterior thigh is painful. Note any lumps, muscle herniations, or areas where the muscle feels absent or abnormal.

Example: The scar on the back of my thigh is about 4 inches long, deeply indented, and sticks to the muscle underneath so that when I try to flex my knee I can feel it pull. There is a divot where muscle tissue is clearly missing. The area around the scar is hypersensitive and painful when touched or when clothing rubs against it.

Examiner listens for: The examiner is identifying scar characteristics that correspond to the rating levels: minimal scars vs. scars indicating missile track vs. ragged/depressed/adherent scars indicating wide damage vs. bone adhesion. Be accurate and detailed.

Avoid: Do not downplay scars as 'just a scar.' The type and characteristics of scars are the primary objective determinants of the injury severity level under 38 CFR 4.73. Point the examiner to all scars related to the injury, including surgical scars.

Common mistakes to avoid

Describing only your best or average days during the exam

Why: VA raters must rate the condition at its worst typical presentation. If you describe your best days, your rating will reflect a milder condition than you actually have.

Do this instead: Per M21-1 guidance, describe your worst typical days. Lead with: 'Today is actually a relatively good day for me - let me describe what my bad days look like.' Then give specific worst-day examples for all symptoms.

Impact: All levels - this mistake can reduce a rating by one full severity level (e.g., moderately severe to moderate)

Performing movements during the exam that you cannot sustain in daily life

Why: A brief exam demonstration may not capture fatigue, pain, or functional loss that develops with sustained or repeated activity. The examiner may document only what they observe during the brief exam.

Do this instead: After performing any movement, state: 'I can do that once during an exam but in daily life, after doing that 2-3 times I cannot continue due to burning pain and fatigue in my hamstring.' Ask the examiner to document the effect of repetitive use.

Impact: Moderate to Moderately Severe transition - repetitive use symptoms are key at this level

Failing to report all DeLuca factors: fatigue, weakness, pain on use, incoordination

Why: DeLuca v. Brown requires examiners to consider pain, fatigue, weakness, and incoordination during flare-ups and with repetitive use. If you do not report these, the examiner has no basis to document them.

Do this instead: For every movement tested, proactively report: (1) pain - where and how much, (2) whether you could sustain this effort, (3) whether your strength drops off with repetition, and (4) any uncertainty or coordination issues.

Impact: All levels - DeLuca factors can bridge the gap between adjacent rating levels

Not mentioning flare-ups that represent a higher level of disability

Why: If your baseline is moderate but your flares are severely debilitating, the rating should account for the average disability over time including flares. Failing to describe flares means only baseline is rated.

Do this instead: Describe flare-up frequency, duration, triggers, and functional impact. Give specific examples: 'During flares, I am bedridden for 2 days and cannot walk to the bathroom without assistance.' If the examiner does not ask, volunteer this information.

Impact: Moderate to Moderately Severe and Moderately Severe to Severe transitions

Not disclosing use of assistive devices or compensatory strategies

Why: Using a cane, brace, or avoiding stairs altogether is objective evidence of functional severity. Hiding these adaptations makes your condition appear less severe than it is.

Do this instead: Tell the examiner every device you use and why: 'I use a knee brace on my right leg every day to prevent buckling. I use a cane on bad days. I have not been able to climb stairs without a railing for 3 years.' Bring devices to the exam.

Impact: Moderately Severe to Severe - assistive device use supports higher functional impairment

Failing to connect symptoms to specific Group XIII muscles

Why: The examiner must identify Muscle Group XIII (hamstrings: biceps femoris, semitendinosus, semimembranosus) as the affected group. If symptoms are described vaguely ('my leg hurts'), the examiner may not correctly identify or document the affected muscle group.

Do this instead: Be anatomically specific: 'My pain and weakness are in the back of my thigh - I understand this is the hamstring area.' Point to the posterior thigh and ischial region. Reference knee flexion weakness specifically as the primary functional loss.

Impact: All levels - incorrect or missing muscle group identification can affect service connection and rating

Not mentioning all related symptoms like atrophy, induration, or adaptive changes in other muscle groups

Why: The VA rates based on all objective findings present. Atrophy, adaptive contraction of the quadriceps, and palpable changes in muscle texture are separate criteria that cumulatively determine severity level.

Do this instead: Tell the examiner if your thigh looks visibly thinner on the injured side, if the muscle feels different in texture (hard, lumpy, absent), and if you notice your quadriceps or other muscles working harder to compensate. Point out the atrophied area.

Impact: Moderate to Moderately Severe transition - atrophy and adaptive contraction are moderately severe criteria

Prep checklist

  • critical

    Compile your complete symptom history with specific examples

    Write down: (1) When your symptoms started and how they have progressed, (2) Your three worst-day experiences in the past 6 months, (3) Every activity you can no longer do or do with significant difficulty, (4) How the condition affects sleep, work, and social activities. Bring this written summary to the exam.

    before exam

  • critical

    Gather all relevant medical records not already in your VA file

    Collect: private orthopedic records, physical therapy notes, imaging reports (MRI, X-ray showing muscle changes or retained fragments), surgical records, emergency room records, and any documentation of assistive device prescriptions. Bring copies to the exam.

    before exam

  • critical

    Document your current medications for hamstring injury

    List all medications: name, dose, frequency, and what symptom they treat. Include OTC medications like NSAIDs. Note if medications cause side effects that further limit your function. This shows ongoing treatment need and severity.

    before exam

  • critical

    Identify and document all assistive devices you use

    List every device: knee braces, compression sleeves, canes, crutches, wheelchairs, shower chairs, grab bars. Note whether these were prescribed by a physician and what function they serve. Bring all portable devices to the exam.

    before exam

  • critical

    Review your service records for the injury event

    Identify: the exact date and circumstances of the injury (combat wound, training injury, MVA), any in-service treatment records, any line-of-duty determinations, and service treatment records documenting the hamstring injury. Know your own story before the exam.

    before exam

  • recommended

    Learn the anatomy and muscle group identification for your claim

    Know that Muscle Group XIII = posterior thigh hamstrings: biceps femoris, semitendinosus, and semimembranosus. Their primary function is knee flexion and hip extension. Be able to point to the posterior thigh as the location of your injury.

    before exam

  • recommended

    Check your state's recording law and prepare to record the exam

    Veterans have the right to record C&P examinations in most states. Research your state's consent requirements (one-party vs. two-party). Bring a smartphone or recording device. Notify the examiner at the start of the exam that you are recording. A recording protects your rights if the exam report is inaccurate.

    before exam

  • recommended

    Write a personal statement (buddy statement / 21-4138) describing your worst-day symptoms

    Submit a personal statement to your claims file before the exam documenting: your typical bad day, your worst flare-up, activities you can no longer perform, impact on employment, and the progression of your condition over time. This creates a written record the examiner should review.

    before exam

  • recommended

    Consider obtaining a buddy statement from someone who witnesses your disability

    A spouse, caregiver, or coworker can document what they have observed: how you walk, activities you cannot do, flare-ups they have witnessed, and how the condition has changed you. Submit VA Form 21-4138 to your claims file before the exam.

    before exam

  • critical

    Do NOT engage in unusually strenuous activity in the days before the exam

    Do not try to 'push through' extra activity before the exam to prove capability, nor should you rest more than normal to appear more functional. Arrive at the exam representing your actual typical baseline. Wear or bring your usual assistive devices.

    before exam

  • critical

    Arrive wearing or carrying your usual assistive devices

    Bring your knee brace, cane, or any other device you use regularly. The examiner should see you using what you actually use. Do not leave assistive devices at home to appear more capable.

    day of

  • recommended

    Dress for easy examination access to the posterior thigh

    Wear shorts or loose-fitting pants that allow easy access to both thighs for measurement, palpation, and visual assessment. You may be asked to change into a gown.

    day of

  • recommended

    Arrive early and note your symptoms during the waiting period

    If your symptoms are worse after sitting in the waiting room for an extended time, or if getting up to walk to the exam room causes pain, tell the examiner. Prolonged sitting often exacerbates hamstring symptoms - this is clinically relevant data.

    day of

  • critical

    Do not take extra pain medication before the exam to mask symptoms

    Take your usual medications at your usual time. Do not take extra medication to get through the exam - this will mask your true functional level and result in an inaccurate (lower) rating. If you are in extra pain the day of the exam, tell the examiner.

    day of

  • critical

    Begin with a clear, structured statement of your condition

    When the examiner asks about your condition, open with: 'I have an injury to my right/left hamstring muscles from [service event]. My main problems are [pain/weakness/fatigue/atrophy]. On my worst days, which happen about [X] times per month, [describe specific worst-day scenario].' This sets the framework before physical testing begins.

    during exam

  • critical

    Verbalize pain and effort level during every movement test

    Do not perform movements silently. For each test, say: 'I feel pulling/burning/pain in the back of my thigh at [location] rated [X]/10.' After testing, add: 'I would not be able to repeat that movement more than [X] times before the pain/fatigue forces me to stop.'

    during exam

  • critical

    Report the effect of repetitive use, not just single-test performance

    After any strength or ROM test, explicitly state: 'I can do that once under exam conditions, but with repetitive use throughout the day, my strength drops significantly, and the pain and fatigue become severe.' Ask the examiner to document DeLuca factors.

    during exam

  • critical

    Point out all scars, atrophy, and physical changes to the examiner

    Actively direct the examiner to: all scars in the posterior thigh region (including surgical scars), areas where muscle mass appears or feels absent, any adhesions you can feel when you flex your knee, and the visible size difference between your two thighs if present.

    during exam

  • critical

    Report all functional limitations proactively if not asked

    If the examiner does not ask about daily function, volunteeer it: 'I should also mention that this injury prevents me from [climbing stairs, kneeling, running, prolonged walking, performing my job duties, etc.].' Do not wait to be asked about every limitation.

    during exam

  • critical

    Describe your flare-ups in detail

    Tell the examiner: frequency (X times per month), duration (X days), worst symptoms during a flare (specific functional losses), triggers (activity level, weather, specific movements), and recovery time. If you are currently in a flare or just coming out of one, say so.

    during exam

  • recommended

    Mention all conditions that are secondary to or caused by the hamstring injury

    Describe any secondary conditions: knee instability, hip problems from compensatory gait, low back pain from altered mechanics, sleep disruption from pain, depression or anxiety from chronic pain or disability. These may support secondary service connection claims.

    during exam

  • critical

    Correct any inaccurate statements the examiner makes during the interview

    If the examiner summarizes something incorrectly (e.g., 'so you have occasional mild pain'), politely but firmly correct it: 'I want to make sure the record is accurate - my pain is daily and severe on bad days, not occasional and mild.' You have the right to accurate documentation.

    during exam

  • critical

    Write down everything you remember about the exam immediately after

    As soon as you leave, write down: what the examiner tested, what findings they noted aloud, any statements that seemed inaccurate, whether they performed all measurements (bilateral thigh circumference, goniometer ROM), and the approximate duration. This documentation is critical if you need to challenge an inadequate exam.

    after exam

  • critical

    Request a copy of the completed DBQ through your VSO or MyHealtheVet

    You are entitled to a copy of the completed DBQ. Review it for accuracy. Check whether all your reported symptoms are documented, whether the severity classification matches what you described, and whether all DBQ fields relevant to your severity level were completed.

    after exam

  • recommended

    File a notice of disagreement if the exam report is inadequate or inaccurate

    If the completed DBQ omits symptoms you reported, contains factual errors, fails to address DeLuca factors, or was conducted without a proper physical examination, you can challenge the exam as inadequate. Contact your VSO or accredited claims agent promptly.

    after exam

  • recommended

    Continue documenting your symptoms in a daily symptom journal

    Keep an ongoing log of daily symptoms, flare-ups, functional limitations, and medical appointments. This creates a contemporaneous record that supports future rating increases or appeals. Note dates, pain levels, and specific activities affected.

    after exam

Your rights during a C&P exam

  • You have the right to have the examination conducted by a qualified clinician (typically an Orthopedic Surgeon, Physiatrist, or appropriately trained clinician) - if the examiner does not have relevant expertise in musculoskeletal conditions, you may request a different examiner.
  • You have the right to record the C&P examination in most states - notify the examiner at the start of the session and confirm your state's consent requirements beforehand.
  • You have the right to accurate and complete documentation - if the examiner does not test something relevant to your condition (e.g., bilateral thigh measurements, repetitive-use effects), you may request they do so and note the omission if they refuse.
  • You have the right to review the completed DBQ - request a copy through your VSO, MyHealtheVet, or by filing a FOIA/Privacy Act request; review it for accuracy against what you reported.
  • You have the right to challenge an inadequate examination - if the DBQ is incomplete, contradicts your records, omits DeLuca factors, or was conducted without a proper physical examination, you can file a notice of disagreement or request a new examination.
  • You have the right to submit additional evidence (personal statements, buddy statements, private medical opinions) to supplement the C&P exam findings - this evidence must be considered by VA raters.
  • Under the PACT Act and existing VA regulations, VA must consider all lay evidence - including your own testimony about your symptoms - as competent evidence of your condition's severity.
  • You have the right to a fully reasoned rating decision that explains how the VA evaluated your evidence - if the decision does not explain why it rejected medical or lay evidence, this is grounds for appeal.
  • Under 38 CFR 3.102 (benefit of the doubt), when there is an approximate balance of positive and negative evidence, the question must be resolved in your favor - ensure all positive evidence is in your file before a rating decision is made.
  • You have the right to free representation by an accredited VSO, claims agent, or attorney at no charge until after a final BVA decision - use this resource to review your claim before and after the C&P exam.

Related conditions

Get a personalized prep packet

This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

Get personalized prep

This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.