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Chronic Exertional Compartment Syndrome, often shortened to CECS, is a pressure-related muscle compartment condition. It usually shows up as pain, tightness, cramping, weakness or numbness during exertion that eases when you stop. For VA purposes, the important point is that CECS is a musculoskeletal condition of specific leg muscles, not ordinary tiredness and not a whole-body fatigue diagnosis.
Since February 7, 2021, compartment syndrome has had its own diagnostic code, DC 5331. That code has no percentage table. It tells VA to rate each affected muscle group separately and combine the results. So the record has to identify which leg, which compartment and muscle group, and which functional loss the condition produces. When the file only says "leg pain," VA may treat the condition as a generic lower-extremity complaint, or rate it at 0%.
TL;DR
- CECS is rated under 38 CFR § 4.73, DC 5331, which says to rate each affected muscle group separately and combine the ratings under § 4.25.
- In the lower leg, that usually means Muscle Group XI (DC 5311, the calf and the back and outer leg) or Muscle Group XII (DC 5312, the front of the leg). Each is rated 0, 10, 20 or 30 percent for slight, moderate, moderately severe or severe disability.
- Separate ratings are possible for each leg and each affected muscle group, but 38 CFR § 4.14 bars rating the same disability twice, and § 4.55 limits how muscle and nerve ratings combine.
- Because CECS symptoms classically stop at rest, an exam done at rest can look normal. The evidence that wins describes what happens during exertion.
- Pressure testing, operative records from a fasciotomy, duty limitations, and lay statements about exertional function all matter. Fasciotomy scars and nerve damage can be rated on their own.
Compartment syndrome VA rating criteria (DC 5331)
The rating schedule's entry for compartment syndrome is one line in the muscle injury table at 38 CFR § 4.73.
5331 Compartment syndrome: Rate each affected muscle group separately and combine in accordance with § 4.25
VA added DC 5331 in the musculoskeletal and muscle injury update that took effect February 7, 2021 (85 FR 76453). The code does the routing, and the muscle group codes set the percentages. Both lower-leg groups use the same scale.
| Level | Muscle Group XI (DC 5311) | Muscle Group XII (DC 5312) |
|---|---|---|
| Severe | 30% | 30% |
| Moderately severe | 20% | 20% |
| Moderate | 10% | 10% |
| Slight | 0% | 0% |
Muscle Group XI and Muscle Group XII
The schedule defines the two lower-leg groups by function and by muscle.
5311 Group XI. Function: Propulsion, plantar flexion of foot (1); stabilization of arch (2, 3); flexion of toes (4, 5); Flexion of knee (6). Posterior and lateral crural muscles, and muscles of the calf: (1) Triceps surae (gastrocnemius and soleus); (2) tibialis posterior; (3) peroneus longus; (4) peroneus brevis; (5) flexor hallucis longus; (6) flexor digitorum longus; (7) popliteus; (8) plantaris
5312 Group XII. Function: Dorsiflexion (1); extension of toes (2); stabilization of arch (3). Anterior muscles of the leg: (1) Tibialis anterior; (2) extensor digitorum longus; (3) extensor hallucis longus; (4) peroneus tertius
In plain terms, Muscle Group XII holds the muscles of the front (anterior) compartment, which lift the foot and toes. Muscle Group XI holds the calf and the posterior and lateral compartment muscles, which push off, point the foot, hold the arch and curl the toes. The anterior compartment is the most common site of CECS (PMID 30992340).
The medical record should do as much of that work as possible. A DBQ or specialist note that names the affected compartment, describes the functional loss, and connects the symptoms to the relevant muscle group is stronger than a general pain complaint. A claim that identifies right lower extremity CECS affecting Muscle Group XI and Muscle Group XII gives VA a much clearer rating structure than "bilateral leg CECS."
How VA picks slight, moderate, moderately severe or severe
Under 38 CFR § 4.56, the level depends on the history and the objective findings, measured against the cardinal signs and symptoms of muscle disability: "loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement." Those descriptions were written mostly for wounds, so for CECS the Board asks which level the symptoms more closely approximate.
In 2025 Board decisions I read, that produced 10 percent for each leg where the symptoms approximated moderate disability of Muscle Group XI (Board decisions A25003677 and A25014760, both raising a 0 percent rating), and 20 percent for each leg where the Board found moderately severe disability of Muscle Group XII, rated as 5331-5312 (A25053966). Those are examples of the Board's reasoning, not typical outcomes.
Analogous codes for CECS
Before DC 5331 existed, VA rated compartment syndrome by analogy, and analogous codes still turn up in appeals, even in ratings made after the new code took effect. Board decisions show a 1996 rating under 5399-5312, an analogous muscle injury of the front of the leg (A25032804), and a May 2021 rating under 5299-5271, limited ankle motion by analogy (A25007184). If your rating sits under an analogous code, ask whether rating each affected muscle group under DC 5331 would come out higher.
Separate ratings for each leg and the pyramiding rule
CECS often affects both legs, and one leg may involve more than one compartment. DC 5331 says to rate each affected muscle group separately, and when both legs are rated at 10 percent or more, the bilateral factor in 38 CFR § 4.26 adds 10 percent of their combined value. That does not mean VA must assign a separate rating for every label in the file.
The key rule is 38 CFR § 4.14. VA cannot compensate the same manifestation twice. If two claimed muscle groups produce the same functional loss in the same extremity, VA may treat the picture as one disability. If the evidence shows different extremities or distinct functions, such as propulsion impairment and dorsiflexion impairment, separate ratings become more plausible.
Muscle ratings also follow 38 CFR § 4.55. Section 4.55(a) bars combining a muscle injury rating with a peripheral nerve rating for the same body part unless the two affect entirely different functions. In one 2025 appeal, VA replaced separate 10 percent muscle and nerve ratings for each leg with a single 20 percent rating per leg under that rule, and the Board found no basis for more (A25053966). Muscle Group XI and Muscle Group XII both act on the ankle, and § 4.55(d) says the combined rating for muscle groups acting on the same unankylosed joint must be lower than the rating for unfavorable ankylosis of that joint.
Fasciotomy residuals are a separate question. A painful or unstable scar can be rated under the skin schedule, and nerve damage from the condition or the surgery can be rated under a nerve code when it affects a different function. In one 2025 decision, a veteran held 10 percent for the fasciotomy scars under DC 7804 and a separate 20 percent for superficial peroneal neuropathy tied to the compartment syndrome (Board decision 25007687). See the scars and peripheral neuropathy pages for those ratings.
How to prove CECS is service connected
CECS is diagnosed from a careful history, exclusion of other causes of exercise-induced leg pain, and compartment pressure testing (PMID 27013413, PMID 36368837). That is why pressure testing is often the cleanest evidence: it objectively documents compartment pressure before or after exertion. Operative records matter too if a fasciotomy was performed.
For service connection, the strongest records show the symptoms starting during training or duty. Evidence that helps includes the items below.
- Compartment pressure testing results.
- Profiles, duty restrictions, running limitations, or fitness-test failures during service.
- Orthopedics, sports medicine, neurology, vascular, or physical therapy notes.
- Operative notes for any fasciotomy, plus post-surgery residuals such as scars, weakness, numbness, recurrence, or incomplete relief.
- Lay statements describing what happens during exertion and how long symptoms take to resolve.
When CECS affects both legs or multiple compartments, frame the claim so the anatomy is visible: right lower extremity CECS, Muscle Group XI; right lower extremity CECS, Muscle Group XII; and the same for the left leg. Those labels are not a guarantee of separate ratings. They make sure VA looks at the right anatomy, the right DBQ sections, and the right functional losses.
CECS can also anchor secondary claims. In one 2025 decision, the Board remanded knee claims argued as secondary to service-connected compartment syndrome because the examiner addressed only causation, not whether the CECS made the knees worse (A25017292). An opinion on a secondary condition has to answer both.
The CECS C&P exam
CECS exams in the Board decisions I read used either the Muscle Injuries DBQ or the knee and lower leg conditions DBQ. The knee and lower leg exam asks about CECS directly; Board decisions quote examiners stating whether a veteran has had "shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment" (Board decision 25000070).
The trap is timing. CECS symptoms classically appear during exertion and disappear when the activity stops (PMID 32473344), so an exam at rest can find nothing. In one 2025 appeal, the Muscle Injuries DBQ recorded no signs of muscle disability while the veteran reported calf pain after walking more than a mile; the Board remanded for a new exam that asks about pain, weakness or other symptoms with activity (A25007184). Before the exam, write down how far you can run, march or walk before symptoms start, what they feel like, and how long they take to fade, and bring statements from people who have seen you stop.
Why VA denies CECS claims
Across 264 decided Board rulings on chronic exertional compartment syndrome from 2021 to 2026, 27.7% were granted, 32.6% denied and 39.8% remanded. A ruling is one issue the Board decided in one decision; one decision often rules on several issues. That grant rate is 3.0 percentage points above the 24.7 percent across all decided Board rulings. When the Board sent CECS claims back, an inadequate VA exam or opinion was the most common reason; the Board section below shows why the Board sent these claims back and how CECS appeals have gone since 1992.
Too few CECS claims were denied for a reliable breakdown of denial reasons, so the list below is a set of evidence checks, not a ranking of Board denials.
Vague diagnosis. The record says "shin splints" or "leg pain" without pressure testing or a specialist diagnosis. Shin splints are a different condition, rated under DC 5262 (see shin splints).
Exam at rest only. The examiner records a normal exam and never asks what happens with exertion, so the rating stays at 0 percent.
No muscle group named. The file never connects the symptoms to Muscle Group XI or XII, so the rater has nothing to measure against § 4.56.
Overlapping ratings. Muscle, nerve and joint ratings claimed for the same function run into §§ 4.14 and 4.55.
No in-service record. Symptoms that began in training were never documented, and no lay statement fills the gap.
Questions veterans ask about compartment syndrome
Is there a VA diagnostic code for compartment syndrome?
Yes. DC 5331 in 38 CFR § 4.73 covers compartment syndrome. It has no percentages of its own and tells VA to rate each affected muscle group separately and combine them.
What is the VA rating for compartment syndrome in the lower leg?
Each affected lower-leg muscle group, Muscle Group XI or XII, rates 0, 10, 20 or 30 percent for slight, moderate, moderately severe or severe disability. The level depends on the cardinal signs in § 4.56, such as weakness, fatigue-pain and a lowered threshold of fatigue.
Can I get separate ratings for compartment syndrome in both legs?
Yes. Each leg is rated on its own, and when both legs are rated at 10 percent or more, the bilateral factor in § 4.26 adds 10 percent of their combined value. Two muscle groups in the same leg can also be rated separately when they affect different functions, within the § 4.55 limits.
Is CECS the same as shin splints for VA?
No. Shin splints (medial tibial stress syndrome) are rated under DC 5262. CECS is a compartment pressure condition rated through DC 5331 and the muscle group codes.
Can I get a VA rating for fasciotomy scars?
Yes, if the scars meet the skin criteria, for example a painful or unstable scar under DC 7804. Nerve damage from the surgery can also be rated when it affects a different function than the muscle rating.
Bottom Line
CECS has had its own code since February 2021, but DC 5331 only sends the rating to the muscle groups. The percentage comes from how severe the disability of each affected group is, usually Muscle Group XI or XII, at 0 to 30 percent per group, combined across groups and legs. The claims that do well name the leg, the compartment and the muscle group, prove the diagnosis with pressure testing, and show what happens during exertion rather than at rest.
Methodology and Limitations
- Data source: 38 CFR § 4.73 (DCs 5311, 5312 and 5331), §§ 4.14, 4.25, 4.26, 4.55 and 4.56, DCs 5262 and 5271 in § 4.71a, and DC 7804 in § 4.118, checked against the eCFR text in October 2026; the 2021 muscle injury update at 85 FR 76453. Board examples are from 2025 Board decisions cited by number. Medical statements are from PubMed abstracts (PMIDs 27013413, 30992340, 32473344, 36368837).
- Sample size: Board figures come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds, 511,036 decisions containing 1,378,030 rulings. That includes 264 decided Board rulings on chronic exertional compartment syndrome (284 rulings in all, counting dismissed and withdrawn issues). The Board section on this page breaks these down by remand reason and era; those figures are computed from the data, not typed here.
- Limitations: The § 4.56 severity levels are applied case by case, and the Board decisions cited here are examples, not predictions of individual outcomes. BVA-level patterns reflect cases that appealed; most CECS claims resolve at the regional office level. Claim Raven is data analysis, not legal, medical, or VA-accredited advice.