Evidence Checklist: Thoracic Outlet Syndrome

Vascular studies (duplex ultrasound, CTA, MRA) confirming neurovascular compressionCritical

Imaging studies documenting subclavian artery or vein compression with positional maneuvers. Required for arterial or venous TOS; neurogenic TOS may have normal vascular imaging.

EMG/nerve conduction study documenting lower brachial plexus involvementCritical

Electrodiagnostic testing documenting C8-T1 nerve root or lower trunk brachial plexus involvement with reduced ulnar and medial antebrachial cutaneous sensory amplitudes.

Nexus opinion linking TOS to service (at least as likely as not)Critical

Medical opinion connecting TOS to in-service cervical rib, repetitive overhead military duties, rucksack or load-bearing shoulder straps, or direct trauma to the shoulder/neck area.

Chest X-ray or CT showing cervical rib or scalene anomaly

Imaging documenting a cervical rib, elongated C7 transverse process, or fibromuscular band that compresses the neurovascular bundle.

Treatment records (physical therapy, first rib resection, scalenectomy)

Records of physical therapy, scalene injections, or surgical decompression (first rib resection, cervical rib removal, scalenectomy) with functional outcomes.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Peripheral Nerves ConditionsCritical

VA standardized form capturing brachial plexus and peripheral nerve deficits from TOS.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.