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VA General Counsel Precedent Opinions |
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PREC 09-98 Multiple Ratings for Musculoskeletal Disability and Applicability of 38 C.F.R. §§ 4.40, 4.45, and 4.59
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PREC 09-98 Multiple Ratings for Musculoskeletal Disability and Applicability of 38 C.F.R. §§ 4.40, 4.45, and 4.59 Citation: Vet. Aff. Op. Gen. Couns. Prec. 9-98, VAOPGCPREC 9-98, 1998 QUESTIONS PRESENTED: 1. When a knee disorder is rated under Diagnostic Code (DC) 5257 (instability of the knee), must the claimant have compensable limitation of motion under DC 5260 or DC 5261 in order to obtain a separate rating for arthritis? 2. Must 38 C.F.R. §§ 4.40, 4.45, and 4.59 be considered when assigning an evaluation for degenerative or traumatic arthritis under DC 5003 or DC 5010, and if so, how? 3. When a disability is rated under a specific diagnostic code that does not appear to involve limitation of motion, must 38 C.F.R. §§ 4.40, 4.45, and 4.59 be considered to determine the applicability of another diagnostic code that does involve limitation of motion? 4. What determines whether a particular diagnostic code is predicated on loss of range of motion so that sections 4.40 and 4.45 apply? 5. Are DC 5259 (removal of the semilunar cartilage) and DC 5284 (foot injuries) based on loss of range of motion, requiring consideration of sections 4.40 and 4.45? HELD: 1. For a knee disability rated under DC 5257 to warrant a separate rating for arthritis based on X-ray findings and limitation of motion, limitation of motion under DC 5260 or DC 5261 need not be compensable but must at least meet the criteria for a zero-percent rating. A separate rating for arthritis could also be based on X-ray findings and painful motion under 38 C.F.R. § 4.59. 2. The provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 must be considered in assigning an evaluation for degenera-tive or traumatic arthritis under DC 5003 or DC 5010. Rating personnel must consider functional loss and clearly explain the impact of pain upon the disability. 3. If a musculoskeletal disability is rated under a specific diagnostic code that does not involve limitation of motion and another diagnostic code based on limitation of motion may be applicable, the latter diagnostic code must be considered in light of sections 4.40, 4.45, and 4.59. 4. The medical nature of the particular disability to be rated under a given diagnostic code determines whether the diagnostic code is predicated on loss of range of motion. Reference should be made to appropriate medical authorities. 5. DC 5259 requires consideration of sections 4.40 and 4.45 because removal of the semilunar cartilage may result in complications producing loss of motion. Depending on the nature of the foot injury, DC 5284 may involve limitation of motion and therefore require consideration under sections 4.40 and 4.45.
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