5205 - Elbow, ankylosis of

DBQ: Link to Index of DBQ/Exams by Disability for DC 5205 

Definition

Ankylosis is the immobilization or stiffness of a joint. In this case, the elbow is involved.

Etiology

The condition may result from disease, trauma, surgery, contractures, or, in some instances, it may be congenital.

Signs & Symptoms

Ankylosis in the elbow area would result in immobility of the joint. Normal ROM for elbow flexion is 0 to 145 degrees. However, additional signs and symptoms may be present due to the underlying cause or associative conditions.

Tests

Tests to determine the presence of ankylosis may include: inspection of the joint; palpation; measurements of range of motion (ROM); evaluation of the ligaments for stability; muscle-strength testing; sensory testing; and radiology studies.

Treatment

Treatments related to the condition may include: physical therapy, maintenance of the joint in a functional position, and orthopedic intervention. If the ankylosis was surgically created, the joint is kept immobilized in correct body alignment for 6 to 12 weeks until the bone is healed. Medications and other therapies may be instituted to treat associative conditions that contribute to the process (e.g., arthritis).

Residuals

  • Wasting away at the site of the joint may occur due to decreased activity. The possibility of long-term physical therapy exists.

  • When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for an SC disability. 

Special Considerations

  • The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still applies and should be considered with existing evaluations (38 CFR 3.951(a)).

  • Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the table in the M21-1 for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each. 

  • Impairments of the elbow, forearm, and wrist will be assigned separate disability evaluations.  The motions of these joints are all viewed as clinically separate and distinct.  Assign separate evaluations for impairment under the following DCs:

  • 38 CFR 4.59 may be applied separately to the elbow, the forearm, and the wrist to result in potentially three separate evaluations for painful motion when the evidence otherwise supports such a finding.  However, 38 CFR 4.59 may only be applied once to the elbow and may not be separately applied to both elbow flexion and elbow extension.

  • When examination or other evidence denotes pain present in the joint or periarticular region but does not delineate the specific motions in which pain is present and there is a potential for a separate evaluation under 38 CFR 4.59, obtain a medical opinion to determine which motions are painful. When the examiner cannot delineate which motions are associated with pain, resolve doubt in favor of the Veteran, per 38 CFR 4.3, and consider painful motion to be present in the separate plane such as to allow assignment of the separate minimum compensable evaluation under 38 CFR 4.59.

  • It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations.

Notes

  • In all the forearm and wrist injuries, codes 5205 through 5213, multiple impaired finger movements due to tendon tie-up, muscle or nerve injury, are to be separately rated and combined not to exceed rating for loss of use of hand. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]