5262 - Tibia and fibula, impairment of

DBQ: Link to Index of DBQ/Exams by Disability for DC 5262 

Definition

The tibia is the inner and larger bone of the leg below the knee known as the shin bone. It articulates with the femur and head of the fibula, and with the talus. The fibula is the outer and smaller bone of the leg. The fibula articulates with the proximal end of the tibia, and joins the tibia at the distal end. Impairment refers to any loss or abnormal change related to structure or function. The impairment involves the tibia and fibula.

Etiology

Impairment may be caused by fractures, trauma, knee hyperextension, or hyperflexion injuries to the knee. These injuries may include ligament or meniscus injury, or rupture of a tendon or muscle. Bone or joint disease; tumors; infections; conditions of the nervous system; and overuse syndromes, as well as, disease of the veins may contribute to impairment.

Signs & Symptoms

Signs and symptoms may include: pain; swelling; hemarthrosis; bruising; compartment syndrome; decreased weight bearing; loss of function; gait abnormalities such as limping; deformity such as leg-length discrepancy; decreased range of motion; and deterioration.

Tests

Tests may include: physical examination; x-ray; computed tomography (CT) scan; arthrogram; a goniometer to measure range of motion; or bone scan.

Treatment

Treatment may be surgical or non-surgical. Immobilization, traction, orthotics, medication, and physical therapy may also be part of a conservative treatment schedule.

Residuals

Depending on the related cause of the condition, there may be residual neuropathy, abnormal gait, decreased range of motion, or functional impairment. The potential for malunion or nonunion of a fracture exists.

Special Considerations

  • 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)).

  • Shin splints can be evaluated based on impairment of the tibia and fibula including nonunion, malunioin, or medial tibial stress syndrome (MTSS) or based on pain associated with shin splints.

  • For evaluating impairment of the tibia and fibula including nonunion, malunion (evaluated under the corresponding knee or ankle codes based on associated impairment), or MTSS. Evaluations based on MTSS are based on conservative treatment, i.e., rest, ice, elevation, medication, compression socks, and/or massage.

  • MTSS, or shin splints, is a type of joint or periarticular pathology which is a requirement for application of 38 CFR 4.59, for assignment of the minimum compensable evaluation under 38 CFR 4.71a, DC 5262 when painful motion is shown and shin splints are otherwise noncompensable.

  • The minimum compensable evaluation is warranted when painful motion due to shin splints occurs in nearby affected joints such as the ankle or knee or when shin pain or other similar pain occurs with motion.  However, when a separate knee or ankle disability exists and has been compensably evaluated, do not assign a compensable evaluation under 38 CFR 4.59 for shin splints causing painful motion in an already-compensable SC knee or ankle joint.

  • Shin splints without pain that is not associated with motion, such as pain on palpation, are noncompensable under 38 CFR 4.59.

  • Federal Register that updated the musculoskeletal schedule per 85 FR 76453.

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.