evaluating knee disability general counsel precedent opinion 23-97general counsel precedent opinion...

Evaluating Knee DisabilityEvaluating Knee Disability

• General Counsel Precedent Opinion 23-97General Counsel Precedent Opinion 23-97• General Counsel Precedent Opinion 9-98General Counsel Precedent Opinion 9-98• General Counsel Precedent Opinion 9-2004General Counsel Precedent Opinion 9-2004• Fast Letter 04-22Fast Letter 04-22• Judicial Conference Call (October 7, 2004)Judicial Conference Call (October 7, 2004)

Avoidance of PyramidingAvoidance of Pyramiding

• 38 CFR 38 CFR §§4.14 states, in part – “The 4.14 states, in part – “The evaluation of the same disability evaluation of the same disability under various diagnoses is to be under various diagnoses is to be avoided.” avoided.”

Avoidance of PyramidingAvoidance of Pyramiding

• VA General Counsel has determined the VA General Counsel has determined the knee joint may be evaluated under knee joint may be evaluated under multiple diagnostic codes when there multiple diagnostic codes when there are are different manifestationsdifferent manifestations of the of the same disability. same disability.

General Counsel Opinion 23-97 – Multiple General Counsel Opinion 23-97 – Multiple Ratings for Knee DisabilityRatings for Knee Disability

• When a claimant has arthritis and When a claimant has arthritis and instability of the knee, does 38 CFR instability of the knee, does 38 CFR §4.71(a) authorize multiple ratings under §4.71(a) authorize multiple ratings under diagnostic codes 5003 and 5257?diagnostic codes 5003 and 5257?

VAOPGCVAOPGC PREC 23-97PREC 23-97

• DC 5257 provides for evaluation of DC 5257 provides for evaluation of instability of the knee without reference instability of the knee without reference to limitation of motion.to limitation of motion.

• DC 5003, on the other hand, refers to x-DC 5003, on the other hand, refers to x-ray evidence and limitation of motion. It ray evidence and limitation of motion. It does not reference instability of a joint. does not reference instability of a joint.

Rating Schedule 38 CFR Rating Schedule 38 CFR §§4.71(a)4.71(a)

• 5257: 5257: instructs that recurrent subluxation or lateral instructs that recurrent subluxation or lateral instability be rated as slight, moderate, or severe.instability be rated as slight, moderate, or severe.

• 5003 (5010): 5003 (5010): instructs that arthritis will be rated on instructs that arthritis will be rated on the basis of limitation of motion under the appropriate the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints diagnostic codes for the specific joint or joints involved. (e.g., 5003-5260) If a compensable involved. (e.g., 5003-5260) If a compensable evaluation is not warranted under the limitation of evaluation is not warranted under the limitation of motion code, a 10 percent is for application for each motion code, a 10 percent is for application for each major joint or group of minor joints affected by major joint or group of minor joints affected by limitation of motion which is confirmed by objective limitation of motion which is confirmed by objective findings of swelling, muscle spasm, or evidence of findings of swelling, muscle spasm, or evidence of painful motion.painful motion.


• Since the plain terms of DC 5257 Since the plain terms of DC 5257 and 5003 suggest that those codes and 5003 suggest that those codes apply either to different disabilities apply either to different disabilities or different manifestations of the or different manifestations of the same disability, the evaluation of same disability, the evaluation of knee dysfunction under both codes knee dysfunction under both codes would not amount to pyramiding.would not amount to pyramiding.


• HELD:HELD:–A claimant who has arthritis A claimant who has arthritis

and instability of the knee may and instability of the knee may be rated separately under be rated separately under diagnostic codes 5003 diagnostic codes 5003 (limitation of motion) and 5257 (limitation of motion) and 5257 (instability).(instability).

Additional ConsiderationsAdditional Considerations

When determining the evaluation under 5003 and other limitation When determining the evaluation under 5003 and other limitation of motion diagnostic codes (5260, 5261,etc.), consider:of motion diagnostic codes (5260, 5261,etc.), consider:

• §4.40: Functional loss.§4.40: Functional loss.

• §4.45: The joints.§4.45: The joints.

• §4.59: Painful motion. §4.59: Painful motion.

38 CFR 38 CFR §§4.404.40

• Functional loss. Disability of the musculoskeletal Functional loss. Disability of the musculoskeletal system is primarily the inability, due to damage system is primarily the inability, due to damage or infection in parts of the system, to perform the or infection in parts of the system, to perform the normal working movements of the body with normal working movements of the body with normal excursion, strength, speed, coordination normal excursion, strength, speed, coordination and endurance …. Weakness is as important as and endurance …. Weakness is as important as limitation of motion, and a part which becomes limitation of motion, and a part which becomes painful on use must be regarded as seriously painful on use must be regarded as seriously disabled.disabled.

38 CFR 38 CFR §§4.454.45

• The joints. Consideration should be given to:The joints. Consideration should be given to:– Less movement than normalLess movement than normal– More movement than normalMore movement than normal– Weakened movementWeakened movement– Excess fatigabilityExcess fatigability– IncoordinationIncoordination– Pain on movement, swelling, deformity, or Pain on movement, swelling, deformity, or

atrophy of disuse. atrophy of disuse.

38 CFR 38 CFR §§4.40 Functional Loss.4.40 Functional Loss.

and and §§4.45 The Joints.4.45 The Joints.

• DeLuca v. Brown: The Court held that DeLuca v. Brown: The Court held that consideration of the provisions of 38 CFR consideration of the provisions of 38 CFR §4.40 and §4.45 when evaluating §4.40 and §4.45 when evaluating disabilities involving the joints is required.disabilities involving the joints is required.

• This was repeatedly stated in other Court This was repeatedly stated in other Court decisions prior to DeLuca; most notably: decisions prior to DeLuca; most notably: Schafrath v. Derwinski; Quarles v. Schafrath v. Derwinski; Quarles v. Derwinski; and Ferraro v. Derwinski.Derwinski; and Ferraro v. Derwinski.

38 CFR 38 CFR §§4.594.59

• Painful Motion. With any form of Painful Motion. With any form of arthritis, painful motion is an arthritis, painful motion is an important factor of disability… It is important factor of disability… It is the intention to recognize actually the intention to recognize actually painful, unstable, or malaligned painful, unstable, or malaligned joints, due to healed injury, as joints, due to healed injury, as entitled to at least the minimum entitled to at least the minimum compensable rating for the joint.compensable rating for the joint.

38 CFR §38 CFR §4.59 Painful Motion4.59 Painful Motion

• Lichtenfels v Derwinski: While there may be no Lichtenfels v Derwinski: While there may be no limitation of motion (which is usually limitation of motion (which is usually noncompensable under DC for limitation of noncompensable under DC for limitation of motion), a compensable rating may be granted motion), a compensable rating may be granted where there is painful motion. In arthritis, painful where there is painful motion. In arthritis, painful motion is an important factor of disability, which motion is an important factor of disability, which should be carefully noted and definitely related to should be carefully noted and definitely related to affected joints. It is the intention to recognize affected joints. It is the intention to recognize actually painful joints, due to healed injury, as actually painful joints, due to healed injury, as entitled to at least the minimum compensable entitled to at least the minimum compensable rating for the joint.rating for the joint.

Functional Loss and PainFunctional Loss and Pain

• Impact and severity of pain must be considered by Impact and severity of pain must be considered by applying 38 CFR §4.40, §4.45, and §4.59.applying 38 CFR §4.40, §4.45, and §4.59.

• The regulation §4.40 does not require a separate The regulation §4.40 does not require a separate rating for pain, but the impact of pain must be rating for pain, but the impact of pain must be considered in the rating. (Spurgeon V. Brown; considered in the rating. (Spurgeon V. Brown; VAOPGCPREC 9-98)VAOPGCPREC 9-98)

• Diagnostic codes, which are based on limitation of Diagnostic codes, which are based on limitation of motion, do not subsume functional loss due to pain. motion, do not subsume functional loss due to pain. (DeLuca V. Brown)(DeLuca V. Brown)

• Functional loss due to pain must be supported by Functional loss due to pain must be supported by adequate pathology, and evidence by the visible adequate pathology, and evidence by the visible behavior of the claimant. (Johnston v. Brown)behavior of the claimant. (Johnston v. Brown)

General Counsel Opinion 9-98 – Multiple General Counsel Opinion 9-98 – Multiple Ratings for Musculoskeletal Disability and Ratings for Musculoskeletal Disability and Application of 38 CFR Application of 38 CFR §§4.40, 4.40, §§ 4.45, and 4.45, and §§ 4.59 4.59

• Held:Held:– For a knee disability rated under DC 5257 to For a knee disability rated under DC 5257 to

warrant a separate rating for arthritis based warrant a separate rating for arthritis based on x-ray evidence findings and limitation of on x-ray evidence findings and limitation of motion, limitation of motion under DC 5260 or motion, limitation of motion under DC 5260 or DC 5261 need not be compensable but must DC 5261 need not be compensable but must at least meet the criteria for a zero-percent at least meet the criteria for a zero-percent rating. A separate rating for arthritis could rating. A separate rating for arthritis could also be based on X-ray findings and painful also be based on X-ray findings and painful motion under 38 CFR motion under 38 CFR §§4.59.4.59.

VAOPGCPREC 9-98VAOPGCPREC 9-98

• Held:Held:– The provisions of 38 CFR §4.40, §4.45, and The provisions of 38 CFR §4.40, §4.45, and

§4.59 must be considered in assigning an §4.59 must be considered in assigning an evaluation for degenerative arthritis or evaluation for degenerative arthritis or traumatic arthritis under DC 5003 or DC traumatic arthritis under DC 5003 or DC 5010. Rating Personnel must consider 5010. Rating Personnel must consider functional loss and clearly explain the functional loss and clearly explain the impact of pain upon the disability.impact of pain upon the disability.


• Held:Held:– If a musculoskeletal disability is rated under If a musculoskeletal disability is rated under

a specific diagnostic code that does not a specific diagnostic code that does not involve limitation of motion and another involve limitation of motion and another diagnostic code based on limitation of diagnostic code based on limitation of motion may be applicable, the latter motion may be applicable, the latter diagnostic code must be considered in light diagnostic code must be considered in light of sections §4.40, §4.45, and §4.59.of sections §4.40, §4.45, and §4.59.

ExampleExample

• Service connection is warranted for a Service connection is warranted for a veteran’s arthritis and instability of the veteran’s arthritis and instability of the right knee. Examination shows right knee. Examination shows limitation of flexion of the right knee to limitation of flexion of the right knee to 45 degrees with pain and mild instability. 45 degrees with pain and mild instability. There is no additional functional loss There is no additional functional loss with repetitive use. How should the with repetitive use. How should the veteran’s knee disability be evaluated?veteran’s knee disability be evaluated?

ExampleExample

• 5003-5260 (or 5010-5260)5003-5260 (or 5010-5260)– Arthritis of the right knee with limitation of flexionArthritis of the right knee with limitation of flexion– 10 percent (based on requirements of 5260 being 10 percent (based on requirements of 5260 being

met - no additional functional limitations above the met - no additional functional limitations above the 10 percent is shown)10 percent is shown)

• ANDAND

• 52575257– Instability of the right kneeInstability of the right knee– 10 percent10 percent

ExampleExample

• Service connection is warranted for a Service connection is warranted for a veteran’s arthritis and instability of the veteran’s arthritis and instability of the right knee. Examination shows right knee. Examination shows limitation of extension of the right knee limitation of extension of the right knee to 2 degrees with objective evidence of to 2 degrees with objective evidence of pain and mild instability. There is no pain and mild instability. There is no additional functional loss with repetitive additional functional loss with repetitive use. How should the veteran’s knee use. How should the veteran’s knee disability be evaluated?disability be evaluated?

ExampleExample

• 5261-5003 (or 5261-5010)5261-5003 (or 5261-5010)– Arthritis of the right knee with slight limitation of Arthritis of the right knee with slight limitation of

motion with pain motion with pain – 10 percent (consideration of pain under 5003 for a 10 percent (consideration of pain under 5003 for a

major joint and 4.40, 4.45, and 4.59)major joint and 4.40, 4.45, and 4.59)

ANDAND


FAQ – Q&A CommitteeFAQ – Q&A Committee

• If a veteran has ligament If a veteran has ligament instability and limited range of instability and limited range of motion, but no arthritis present, motion, but no arthritis present, can separate compensable can separate compensable evaluations be assigned under evaluations be assigned under DC 5257 and under DC 5260 DC 5257 and under DC 5260 OR 5261?OR 5261?


• Separate evaluations MAY be Separate evaluations MAY be assigned if there is instability assigned if there is instability and limitation of motion due to and limitation of motion due to disease or injury other than disease or injury other than arthritis.arthritis.


• If both lateral instability and limitation of If both lateral instability and limitation of motion are found, separate evaluations motion are found, separate evaluations would probably be warranted. would probably be warranted.

• Consideration of 38 CFR §4.40, §445, Consideration of 38 CFR §4.40, §445, and §4.59 must be considered with the and §4.59 must be considered with the diagnostic code involving the limitation diagnostic code involving the limitation of motion criteria.of motion criteria.

ExampleExample

• Service connection is warranted for a Service connection is warranted for a veteran’s patellofemoral pain syndrome status veteran’s patellofemoral pain syndrome status post ACL repair and instability of the right post ACL repair and instability of the right knee. Examination shows limitation of flexion knee. Examination shows limitation of flexion of the right knee to 112 degrees with objective of the right knee to 112 degrees with objective evidence of pain and mild instability. There is evidence of pain and mild instability. There is no additional functional loss with repetitive no additional functional loss with repetitive use. How should the veteran’s knee disability use. How should the veteran’s knee disability be evaluated?be evaluated?

ExampleExample

• 5260 5260 – Patellofemoral pain syndrome of the right Patellofemoral pain syndrome of the right

knee with limitation of flexionknee with limitation of flexion– 10 percent (considering §4.40, §4.45, and 10 percent (considering §4.40, §4.45, and

§4.59)§4.59)ANDAND


Rating Limitation of Flexion and Extension Rating Limitation of Flexion and Extension of the Legof the Leg

• General Counsel Opinion 9-2004General Counsel Opinion 9-2004– Held: Separate ratings under DC 5260 (limitation Held: Separate ratings under DC 5260 (limitation

of flexion) and DC 5261 (limitation of extension) of flexion) and DC 5261 (limitation of extension) may be assigned for disability of the same joint.may be assigned for disability of the same joint.

• Fast Letter 04-22 Fast Letter 04-22 – Where a veteran meets the requirements for a 0 Where a veteran meets the requirements for a 0

percent or higher evaluation under DC 5260 and percent or higher evaluation under DC 5260 and under DC 5261, an evaluation under each under DC 5261, an evaluation under each diagnostic code may be assigned. diagnostic code may be assigned.

Rating Limitation of Flexion and Extension Rating Limitation of Flexion and Extension of the Legof the Leg

• Do not consider evaluating a knee joint Do not consider evaluating a knee joint under both diagnostic codes 5260 and under both diagnostic codes 5260 and 5261 unless the actual limitation of 5261 unless the actual limitation of motion of the knee meets the schedular motion of the knee meets the schedular requirements for at least a requirements for at least a noncompensable evaluation.noncompensable evaluation.

STAR ErrorSTAR Error• RD dtd 6/29/09 cont a 10% eval under DC RD dtd 6/29/09 cont a 10% eval under DC

5260 based on LOM of flexion to 90 degrees 5260 based on LOM of flexion to 90 degrees & painful motion. However, RD dtd 9/30/08 & painful motion. However, RD dtd 9/30/08 assigned a sep 10% eval under DC 5261 assigned a sep 10% eval under DC 5261 based on LOM of ext to 10 degrees. Multiple based on LOM of ext to 10 degrees. Multiple evaluations under multiple dcs for a single evaluations under multiple dcs for a single knee is not warranted unless the requirements knee is not warranted unless the requirements for a 0% or higher eval is met. DC 5260 for a 0% or higher eval is met. DC 5260 requires LOM on flexion to 60 degrees for a requires LOM on flexion to 60 degrees for a sep eval. Sep 10% eval not warranted. Chg in sep eval. Sep 10% eval not warranted. Chg in combined eval eff 11/21/08. VAOGCPREC 9-combined eval eff 11/21/08. VAOGCPREC 9-98;38CFR4.14;FL 04-22;38CFR3.105(a)98;38CFR4.14;FL 04-22;38CFR3.105(a)

STAR ErrorSTAR Error

• RD dtd 12-5-08 incorrectly states RD dtd 12-5-08 incorrectly states extension is normal for the right knee. extension is normal for the right knee. VAE indicates extension limited to 10 VAE indicates extension limited to 10 degrees. Because flexion does not degrees. Because flexion does not meet the 0% criteria, separate eval for meet the 0% criteria, separate eval for flexion and extension are not warranted. flexion and extension are not warranted. VAOPGCPREC 9-04 and M21-1MR VAOPGCPREC 9-04 and M21-1MR III.iv.6.C.11.aIII.iv.6.C.11.a


• The rating fails to explain the basis of the 10% The rating fails to explain the basis of the 10% evaluation as required per M21-1 MR evaluation as required per M21-1 MR III.iv.6.C.11.a.& c. The rating cited 10% criteria III.iv.6.C.11.a.& c. The rating cited 10% criteria under 38 CFR 4.71a DCs 5259, 5260, & 5261 - under 38 CFR 4.71a DCs 5259, 5260, & 5261 - all of which are not applicable as there is no all of which are not applicable as there is no semilunar cartilage removal, flexion is not 45 semilunar cartilage removal, flexion is not 45 degrees or less, & extension is not less 10 degrees or less, & extension is not less 10 degrees. The rating appears to note the dx of degrees. The rating appears to note the dx of knee strain is being rated analogous to knee strain is being rated analogous to cartilage removal which is not in compliance cartilage removal which is not in compliance with 38 CFR 4.20.with 38 CFR 4.20.


• The rating incorrectly assigned 2 The rating incorrectly assigned 2 compensable evaluations based on R knee compensable evaluations based on R knee flexion & extension. The veteran does not flexion & extension. The veteran does not meet the noncompensable criteria under 38 meet the noncompensable criteria under 38 CFR 4.71 DC 5260. 38 CFR 4.59 does not CFR 4.71 DC 5260. 38 CFR 4.59 does not apply regarding a separate evaluation in this apply regarding a separate evaluation in this case as R knee LOM warrants compensation case as R knee LOM warrants compensation under DC 5261. under DC 5261.


• RD assigned a 10% evaluation for RT knee flx under RD assigned a 10% evaluation for RT knee flx under DC 5260 for painful motion (PM). 10% evaluations DC 5260 for painful motion (PM). 10% evaluations were properly assigned for ext based on LOM (DC were properly assigned for ext based on LOM (DC 5261) & instability (DC 5257). A 10% evaluation is 5261) & instability (DC 5257). A 10% evaluation is warranted for PM under DC 5260 or 5261 where no warranted for PM under DC 5260 or 5261 where no compensable LOM is demonstrated per the Schedule. compensable LOM is demonstrated per the Schedule. Since a 10% evaluation was assigned for ext, a Since a 10% evaluation was assigned for ext, a separate compensable evaluation is not warranted for separate compensable evaluation is not warranted for flx unless it meets DC 5260 criteria. REF: 38CFR flx unless it meets DC 5260 criteria. REF: 38CFR 4.59; 4.71a DC 5260 & 5261; FL 04-22; 4.59; 4.71a DC 5260 & 5261; FL 04-22; VAOPGCPREC 9-2004VAOPGCPREC 9-2004

VAOPGCPREC 9-2004 - VAOPGCPREC 9-2004 - ExamplesExamples

Range of motion is 0 degrees of extension Range of motion is 0 degrees of extension and 30 degrees of flexion. and 30 degrees of flexion.

Question:Question:

Can you grant two separate evaluations?Can you grant two separate evaluations?


• Answer:Answer:– No, two separate evaluations are not No, two separate evaluations are not

warranted. warranted. – 20 percent under DC 5260, limitation of 20 percent under DC 5260, limitation of

flexion, would be grantedflexion, would be granted– A disability rating under DC 5261 would not A disability rating under DC 5261 would not

be in order as extension is not limited to 5 be in order as extension is not limited to 5 degrees.degrees.


Range of motion is 30 degrees of Range of motion is 30 degrees of extension and 90 degrees of flexion. extension and 90 degrees of flexion.

Question:Question:



• Answer:Answer:– No, two separate evaluations are not No, two separate evaluations are not


extension, would be grantedextension, would be granted– A disability rating under DC 5260 would not A disability rating under DC 5260 would not

be in order as flexion is not limited to 60 be in order as flexion is not limited to 60 degrees.degrees.


Range of motion is 15 degrees of Range of motion is 15 degrees of extension and 45 degrees of flexion. extension and 45 degrees of flexion.

Question:Question:



• Answer:Answer:– Yes, two separate evaluations are Yes, two separate evaluations are


flexion, would be grantedflexion, would be granted– 20 percent under DC 5261, limitation of 20 percent under DC 5261, limitation of

extensionextension

Rating Limitation of Flexion and Extension of Rating Limitation of Flexion and Extension of the Leg and Consideration of 38 CFR the Leg and Consideration of 38 CFR §§4.40, 4.40, §§4.45, and 4.45, and §§4.594.59

• If you can grant evaluations under both extension and If you can grant evaluations under both extension and flexion:flexion:– Consideration of the provisions of 38 CFR §4.40,Consideration of the provisions of 38 CFR §4.40,

§4.45, and §4.59 must be considered. Where knee §4.45, and §4.59 must be considered. Where knee motion is actually impeded by pain, fatigability, motion is actually impeded by pain, fatigability, weakness, etc., the evaluation assigned based on weakness, etc., the evaluation assigned based on limitation of motion must consider the level at which limitation of motion must consider the level at which motion is limited. motion is limited.

– Judicial Review Conference Call dated October 7, Judicial Review Conference Call dated October 7, 2004 clarified that the medical examination report 2004 clarified that the medical examination report must show the additional limitation of motion caused must show the additional limitation of motion caused by pain, fatigability, or weakness (actual range of by pain, fatigability, or weakness (actual range of motion). motion).

ExampleExample

• Full range of motion is shown on Full range of motion is shown on examination, but on repetitive use, examination, but on repetitive use, extension is limited to 10 degrees and extension is limited to 10 degrees and flexion is limited to 45 degrees due to flexion is limited to 45 degrees due to fatigue.fatigue.

• Question:Question:• Can you grant two separate Can you grant two separate

evaluations?evaluations?

ExampleExample

• Yes, two separate evaluations are Yes, two separate evaluations are warrantedwarranted

• 10 percent under DC 5260, limitation of 10 percent under DC 5260, limitation of flexion, would be grantedflexion, would be granted

• 10 percent under DC 5261, limitation of 10 percent under DC 5261, limitation of extension, would be grantedextension, would be granted


• Where joint motion is not limited, but Where joint motion is not limited, but there is objective evidence of pain on there is objective evidence of pain on motion, whether in flexion, extension, or motion, whether in flexion, extension, or both, only one compensable evaluation both, only one compensable evaluation would be warranted under EITHER would be warranted under EITHER diagnostic code 5260 OR 5261. diagnostic code 5260 OR 5261.

ExampleExample

• Full range of motion is shown on Full range of motion is shown on examination, but on repetitive use, examination, but on repetitive use, objective evidence of pain is shown with objective evidence of pain is shown with extension and with flexion at end-points extension and with flexion at end-points of movementof movement

• Question:Question:• Can you grant two separate Can you grant two separate

evaluations?evaluations?

ExampleExample

• No, two separate evaluation are not No, two separate evaluation are not warranted.warranted.

• Either a 10 percent evaluation could be Either a 10 percent evaluation could be assigned under 5260 or 5261. assigned under 5260 or 5261.


• If there is compensable limitation of flexion If there is compensable limitation of flexion and extension and there is objective evidence and extension and there is objective evidence of pain on motion, but such pain does not of pain on motion, but such pain does not actually impede motion consider elevating one actually impede motion consider elevating one of the compensable evaluations, if it is of the compensable evaluations, if it is determined that the painful motion results in determined that the painful motion results in additional disability beyond that reflected in additional disability beyond that reflected in the measured limitation of motion. To elevate the measured limitation of motion. To elevate both evaluations based on painful motion both evaluations based on painful motion would constitute pyramiding.would constitute pyramiding.

ExampleExample

• Range of motion is 10 degrees of extension Range of motion is 10 degrees of extension and 45 degrees of flexion. The examiner and 45 degrees of flexion. The examiner stated that there is additional functional loss stated that there is additional functional loss due to pain, incoordination, impaired ability to due to pain, incoordination, impaired ability to execute skill movements smoothly, and execute skill movements smoothly, and fatigability fatigability

• Question:Question:• Can you grant two separate evaluations?Can you grant two separate evaluations?

ExampleExample

• Yes, two separate evaluations are warrantedYes, two separate evaluations are warranted• 10 percent under DC 5260, limitation of 10 percent under DC 5260, limitation of

flexion, would be grantedflexion, would be granted• 10 percent under DC 5261, limitation of 10 percent under DC 5261, limitation of

extension, would be grantedextension, would be granted• Consideration would be given to elevating Consideration would be given to elevating

ONE of the evaluations to 20 percent, if it was ONE of the evaluations to 20 percent, if it was determined that additional disability is present determined that additional disability is present beyond that reflected in the measured beyond that reflected in the measured limitation of motion.limitation of motion.

Evaluating Knee DisabilityEvaluating Knee Disability

• There is a possibility that a single knee There is a possibility that a single knee could be evaluated under three DC could be evaluated under three DC codes. codes.

• If,If,– There is objective evidence of instabilityThere is objective evidence of instability– Flexion is limited to at least 60 degreesFlexion is limited to at least 60 degrees– Extension is limited to at least 5 degreesExtension is limited to at least 5 degrees

• Then, three evaluations would be Then, three evaluations would be warranted.warranted.

Questions??Questions??

evaluating knee disability general counsel precedent opinion 23-97general counsel precedent opinion...

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