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Exams during flare up?

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Cobra4v

Question

A friend of mine who is a fellow Vet were talking about the C&P process. Like me he has a lot of inflammation issues in his shoulders. I told him how the examiner asked me if I was having a flare up when she examined my knee. We both became curious if that has any effect on a rating.

 

So if a veteran is experiencing a flare up during a C&P exam. Does the assigned rater take that into consideration and rate it at less of a percentage based on the restriction of movement due to a flare up? Or do they rate it as scheduled no matter what?

 

 

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I actually was referencing the CFR but that is a good find.

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§4.40   Functional loss.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 

 
 

 

§4.45   The joints.

As regards the joints the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: 

(a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.). 

(b) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.). 

(c) Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.). 

(d) Excess fatigability. 

(e) Incoordination, impaired ability to execute skilled movements smoothly. 

(f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

 

§4.59   Painful motion.

With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.

These are some of the references 

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The Knee and Leg

    Rating
5256   Knee, ankylosis of:  
Extremely unfavorable, in flexion at an angle of 45° or more 60
In flexion between 20° and 45° 50
In flexion between 10° and 20° 40
Favorable angle in full extension, or in slight flexion between 0° and 10° 30
5257   Knee, other impairment of:  
Recurrent subluxation or lateral instability:  
Severe 30
Moderate 20
Slight 10
5258   Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint 20
5259   Cartilage, semilunar, removal of, symptomatic 10
5260   Leg, limitation of flexion of:  
Flexion limited to 15° 30
Flexion limited to 30° 20
Flexion limited to 45° 10
Flexion limited to 60° 0
5261   Leg, limitation of extension of:  
Extension limited to 45° 50
Extension limited to 30° 40
Extension limited to 20° 30
Extension limited to 15° 20
Extension limited to 10° 10
Extension limited to 5° 0
5262   Tibia and fibula, impairment of:  
Nonunion of, with loose motion, requiring brace 40
Malunion of:  
With marked knee or ankle disability 30
With moderate knee or ankle disability 20
With slight knee or ankle disability 10
5263   Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) 10
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