Range of Motion VA For C&P Exams

Range of Motion (ROM) is defined as the ability of a joint to complete and go through its full spectrum of movement. It is utilized by the VA under 38 CFR 4.71 to rate orthopedic disabilities.^1,2 ROM determines the health of a joint and the ability of the muscles around the joint to function optimally. Their functional capacities may be lowered or diminished if ROM is limited at a joint (such as the back, neck, knees, and shoulders).^1,2 This impacts your ability to carry out activities of daily living (ADL), duties at work, and any sports or hobbies you may partake in.^1,2

If you have experienced a musculoskeletal injury during your service, and you apply for service connection, your ROM will be assessed to determine whether the condition is related to service and how severe the impairment is.^1,2

This article will address the VA’s C&P exam when done to assess a veteran’s range of motion, and, thus the potential rating.

Compensation and Pension (C&P) Exam

A range of motion VA C&P exam is foundational to the claims review process and allows a VA physician (or nurse practitioner) to examine your affected joint. It also includes questions about your time in service so that service connection can be established, along with the severity of your condition.^1,2

Who Orders a C&P Exam?

A Rating Veteran Service Representative (RVSR) orders the Range of Motion VA C&P Exam. The RVSR’s role is to review disability claims and determine if your claim should be awarded disability benefits.^1,2 A C&P exam is ordered if the RVSR finds that further data or missing information is needed to make the decision, such as lab reports, a nexus opinion, or test results.^1,2 While the C&P exam is performed by a VA clinician, partner, or contractor, it does not replace a complete physical, nor will you receive a diagnosis, medication, or any form of treatment due to its completion.^1,2 It is utilized to clarify and fill in the needed information by the RVSR to decide on your disability claim.^1,2

In our experience, VA examiners often perform as gatekeepers to weed out the claims that VA does not think warrant either service connection or a higher rating. Although these exams are done under the umbrella of the VA’s duty to assist, they could also be viewed as exams that VA may use to generate evidence against your claim. As such, obtaining a copy of any VA C&P exam report after completion is important so that you can refute it with a rebuttal opinion from your medical expert.

What Does a Range of Motion VA C&P Exam Entail?

At the C&P exam, the VA practitioner will check the ROM for your affected joint using a goniometer. This is an instrument used to measure precise angles.^2,3 In this case, it would be used to measure the precise degrees of motion that you experience around a joint. Each joint in the human body has a certain optimal range of motion.³ For example, your knee at full flexion should be at 140 degrees, and full extension should be at 0 degrees.²

Range of Motion VA C&P Exam for Knees

Essentially, if you are being assessed for knee pain, you will be asked to flex your knee (this is where the joint angle at the knee shortens such that you are bringing your heel to your sits bones/gluteal muscles).² The practitioner can then use the goniometer to measure your joint angle once you come to a stopping point or what is called end of range of motion.^2,3 Similarly, you will be asked to extend your knee (increase the joint angle at the knee such that you bring your toes away from your body like you are kicking out or taking a step).² The practitioner will use a goniometer to see how far out you can extend your knee.^2,3

When being asked to move your impacted joint, it is important to stop as soon as you feel pain or cannot go any further. Do not force it if you cannot go to 140 degrees of flexion or bring your foot back towards your sitting bones. The VA Practitioner will take the measurement using the goniometer at the point where you stop or express pain. That is how your ROM at the knee joint would be scored.^1,2 Based on the score and VA ratings for the ROM for the knee, your eligibility will be determined.^1,2

Other Commonly Impacted Joints

The back, neck, and shoulders are commonly impacted joints. This is due to their highly flexible nature and their role in human movement.^2,4,5 The back can perform forward flexion (bend towards your knees), extension (move backward towards your heels), lateral flexion (go towards your left or right knee), and rotation.²

The neck is capable of similar directional movements as the back: flexion, extension, lateral flexion (to left and right), and rotation.^2,4 The shoulders are one of the most flexible joints in the body. They can also perform flexion and extension, abduction (bringing the should away from the body), adduction (bringing the shoulder towards the body), lateral or external rotation (opening the arms as if to hug, with the elbows at the rib cage), medial or internal rotation (closing the arms such that you would be hugging yourself, with the elbows at the rib cage).^2,5

Since these are frequently used joints and have various directions in which they can move, their ROM tends to be impacted by musculoskeletal injuries. If you are experiencing pain or lowered functioning in any of these joints, it is important to seek medical attention.^2,4

Results: Favorable or Unfavorable

Upon completing the exam, the VA Examiner will determine the severity of your condition based on the verbal and physical exam and provide an opinion. The VA Practitioner would say that your injury at the impacted joint is:^1,2

• Favorable: This means the practitioner agrees that your injury is service-connected or that the symptoms equate to a high or higher rating if service connected.
• Unfavorable: This means that the practitioner is not in agreement that your injury is service-connected or that the symptoms do not warrant a compensatory or higher rating.

A favorable result will help ensure you receive the most accurate rating.^1,2

Whenever the range of motion for a joint is being examined in connection with a VA disability claim, it is important to let the examiner know the point at which pain begins. For example, you may be able to forcibly move your joint over the full range of motion but experience severe pain halfway through the range of motion. It is important to tell the examiner when the pain begins. You should be considered limited from the point pain begins.

In addition, your range of motion can also be affected by multiple repetitions or joint use. Make sure the VA examiner tests your range of motion after multiple repetitions to ensure that the impacts of repetitive motion and fatigue can accurately be measured.

References:

1. National Archives and Records Administration, Code of Federal Regulations. (2022, November 15). Title 38 Chapter I Part 4 Subpart B – Disability Ratings, Musculoskeletal System.
2. National Archives and Records Administration, Code of Federal Regulations. (2022, November 15). Title 38 Chapter I Part 4 Subpart B – The Musculoskeletal System § 4.71, Measurement of Ankylosis and Joint Motion.
3. Gandbhir, V.N., Cunha, B. (2022, July 30). Goniometer. In: StatPearls, National Library of Medicine, National Center for Biotechnology Information. Treasure Island (FL): StatPearls Publishing.
4. Gang, E. (2022, August 11). The Neck’s Normal Range of Motion.
5. Gang, E. (2022, June 9). Range of Motion for the Shoulder. Disability Info Blog.