Which ROM is used for Compensation

[pminme]

I’m being rated on both knees.  I know ROM is involved in rating the case, but which ROM do they use?  Initial, after 3, or flare up?  

[MrStryker]

On 11/18/2018 at 2:35 AM, pminme said:

I’m being rated on both knees.  I know ROM is involved in rating the case, but which ROM do they use?  Initial, after 3, or flare up?  

Limitation of Motion of the Knee

Code 5261: If the knee is not frozen, but is limited in extension and cannot straighten all the way, then it is rated under this code. If the leg can only straighten to within 45° of being completely straight, then it is rated 50%. If it can straighten to 30°, it is rated 40%. To 20°, it is rated 30%. To 15°, it is rated 20%, To 10°, it is rated 10%, and to 5°, it is rated 0%.

Code 5260: If the knee can straighten, but cannot bend all the way, then it is rated under this code. If the knee can only bend to 15°, then it is rated 30%. If it can bend to 30°, it is rated 20%. To 45°, it is rated 10%, and anything 60° or more is rated 0%.

Now if the knee can move, but cannot either bend all the way or straighten all the way, then it can be rated TWICE—once under code 5261, and once under this code 5260.

[MrStryker]

The logical answer is the range of motion  (ROM) will be measured during the C&P exam. I think you would need to make a trip to the emergency room during flare ups in order to document rom.

[Tbird]

Here's an article that might be helpful

[pminme]

I understand when it will be used;  my question was which ROM measurement is used for the actual determination.  There are three different ROM measurements the C&P takes:  resting, after use, and when in extreme flair up.  Which does the evaluator use for their determination?

[broncovet]

The VA is NOT a unified body.  Your examiner can use either of the 3 you listed, or make up his own.  Im having a "senior" moment and cant remember the case right now, but there is a well known cavc case where "pain" has to be considered.  In other words, this suggest the rom measurement should be taken when you first experience pain in bending the appendage, not the max the physical therapist can get in spite of your pain.  

As far as "flare ups", sometimes the examiner will opine if he thinks you are in flare up, and document it accordingly.  Remember, tho, we have to show continuity of symptoms..if it hurt for a while then goes away that is considered an "acute" condition.  The VA rates us on "chronic" conditions, that is, while the pain may wax and wane, it pretty much limits our ability to work.  You wont get paid for a sprained ankle that heals up, but only if this sprained ankle leaves "residuals" such as degenerative arthirits or other chronic symptoms.  

[MrStryker]

This may help.

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014194/M21-1-Part-III-Subpart-iv-Chapter-4-Section-A-Musculoskeletal-Conditions?query=range of motion

 

In DeLuca v. Brown, 8 Vet.App. 202 (1995), the CAVC held that in examinations of musculoskeletal disabilities, the examiner must be asked to give an opinion on whether pain could significantly limit functional ability during flare-ups or with repeated use over a period of time.   This information must be portrayed in terms of the degree of additional ROM lost due to pain on use or during flare-ups.

Edited January 15, 2019 by MrStryker
Added DeLuca v. Brown