The leg includes the femur, tibia, fibula, and patella. Extension is the movement that brings the members of a limb into or toward a straight position. Limitation of motion refers to a point or line beyond which motion is restricted, and cannot or may not progress normally (i.e., range of motion of joints). Full extension is to 0 degree, straight leg.

Limited extension of the leg may result from diseases of the joints of the knee; contractures; fractures; tumors; fluid in the joint spaces; trauma; infection; muscle weakness; strains or sprains; shin splints; blood clot in a vein; disorders present at birth; overuse of the muscles and supporting structures; or inflammation of the tendons.

Manifestations of the condition may include: pain; crepitus; shortening of the leg; flexion contracture; limping; muscle weakness or decreased range of motion. (Normal ROM for knee extension is from 140° to 0° degrees.)

Tests may include: physical examination, and range of motion testing. Laboratory tests are based on the underlying disease or condition. X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) are used for diagnosis. Other diagnostic studies that may be used in evaluating limitation of extension include: electromyography (EMG); goniometer ; bone scans; and nerve conduction tests.

Treatment will vary according to the underlying cause of the limitation. Treatments may include: physical therapy; range of motion exercises; braces; surgery to restore motion through joint replacement; or medications to decrease arthritic symptoms or inflammation.

Depending on the degree of limitation in normal range of motion, there may be impaired physical mobility, and limited activities of daily living (ADL).

• To properly rate disability, accurate measurement of range of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of leg flexion is indispensable. 38 CFR §4.46 [Accurate measurement]

• See VAOPGCPREC 9-2004

  • On September 17, 2004, General Counsel issued a precedent opinion concerning the rating of knee conditions under two separate diagnostic codes involving limitation of motion. Specifically, General Counsel held that separate ratings under diagnostic code 5260 (leg, limitation of flexion) and diagnostic code 5261 (leg, limitation of extension) may be assigned for a disability of the same knee. This letter provides guidance to implement this opinion.

  • Where a veteran meets the requirements for a 0% or higher evaluation under diagnostic code 5260 (limitation of flexion) and under diagnostic code 5261 (limitation of extension), an evaluation under each diagnostic code may be assigned.

  • You must ensure that all knee examinations record range of motion findings in both flexion and extension, in accordance with the Disability Examination Worksheets.

  • Although it is permissible to assign multiple evaluations under multiple diagnostic codes for a single knee, you must always abide by the amputation rule (38 CFR § 4.68).

  • As always, when evaluating knee function, the provisions of 38 CFR § 4.40, 4.45, and 4.59 must be considered.

  • Where knee motion is actually impeded by pain, fatigability, weakness, etc., the evaluation assigned based on limitation of motion must consider the level at which motion is limited. For example, if, on examination, a Veteran has full range of knee motion, but on repetitive motion, the knee is actually limited to 10 degrees extension and 45 degrees flexion due to fatigue, a 10% evaluation would be warranted under diagnostic code 5260 and a separate 10% evaluation would be warranted under diagnostic code 5261.

• None.