5251 - Thigh, limitation of extension of

DBQ: Link to Index of DBQ/Exams by Disability for DC 5251 

Definition

The portion of the body lying between the hip joint and the knee refers to the thigh. Normal hip extension is at 0 degrees. The range for normal extension to hyperextension is from 0 to 30°. Limitation of extension falls short of this normal range.

Etiology

Causes of limited extension may include: muscle weakness; arthritis; spinal flexion deformity; trauma; congenital; surgery; inflammation; dislocations; or fractures.

Signs & Symptoms

Signs and symptoms may include: pain and weakness, which may prevent movement; loss of bone mass; kyphosis; crepitation; muscle deterioration; sacroiliac stiffness; or antalgic gait.

Tests

Laboratory tests will be 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

Treatment will vary according to the underlying cause of the limitation. Physical therapy; range of motion exercises; braces; surgery to restore motion through joint replacement or spinal disc removal; or medications to decrease arthritic symptoms are all useful therapies.

Residuals

If treatments are unsuccessful, the thigh is dysfunctional because of limitation of extension.

Special Considerations

  • See VAOPGCPREC 9-2004

    • On September 17, 2004, General Counsel issued a precedent opinion concerning the rating of hip conditions under two separate diagnostic codes involving limitation of motion. Specifically, General Counsel held that separate ratings for qualifying hip movements under diagnostic codes 38 CFR 4.71a, DC 5251 (extension), 38 CFR 4.71a, DC 5252) (flexion) and 38 CFR 4.71a, DC 5253 (abduction, adduction or rotation) may be assigned for a disability of the same hip.

    • Multiple hip evaluations do not, as a matter of law, violate 38 CFR 4.14.or preclude separate evaluation of a disability of the same hip  under  DC 5251, 5252, and/or 5253.

    • Evaluation of the same manifestation under multiple diagnoses is prohibited under 38 CFR 4.14.

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

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

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

  • To properly rate disability, accurate measurement of hip and thigh ranges of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of hip and thigh extension/hyperextension is indispensable.38 CFR 4.46 [Accurate measurement]

Notes

  • Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.