Musculoskeletal Overview (38 CFR 4.71a)

The musculoskeletal system is the largest system in the body. About 25% of body weight is attributed to connective tissue and bony structures, and about 50% of the body weight is attributed to muscle mass. The musculoskeletal system is closely related to the neurologic and vascular systems, and there is an interdependent relationship with the rest of the body systems. This system includes bones, joints, muscles, tendons, ligaments and bursae. The functions of the musculoskeletal system include: protection; support; locomotion; mineral storage; production and development of blood cells; and heat production. The bony structure and skeleton protect vital organs, e.g., brain, lungs and heart. The strong framework supports body structures, and body movement is made possible by muscles attached to the skeleton. Minerals are deposited and stored in bones, and the marrow in bones is responsible for the production of red and white blood cells. When muscles contract heat is produced in addition to mechanical actions.

The range of movement of a joint is termed, range of motion (ROM). Common movements performed by muscles and joints are described below:

  • Flexion/Extension-"Flexion decreases the angle between two adjacent body structures; extension increases the angle."

  • Abduction/Adduction-"Abduction is movement of a part away from the midline, either of the body or of the hand or foot. Adduction is movement toward the midline (toward the anatomical position)."

  • Lateral/Medial Rotation-"Medial rotation means torsion of the distal bone so that a point on the lateral aspect of the distal bone is moved anteriorly or medially toward the body midline. Lateral rotation is the opposite".

  • Circumduction-"A combination of flexion, abduction, extension, and adduction." (C&P Training Letter 00-05 on Muscle Injuries and Related Problems; July, 2000)

The 206 bones comprising the skeleton are categorized as follows: long bones (e.g., the thigh bone); short bones (e.g., the ankle); flat bones (e.g., the sternum); and small bones (e.g. the vertebrae). Bones are covered by a membrane called periosteum which serves in the nutrition and growth of bone, and provides for the attachment of tendons and ligaments. Nerves, blood vessels, and lymphatics are contained in the periosteum. When two or more bones are joined together, joints are formed which provide for movement of the body. The joint capsule is lubricated and protected from pressure by a membrane called the synovium. Ligaments and muscle tendons passing over a joint provide stability of the joint. Types of joints include: ball and socket (e.g., hips and shoulders); hinge (e.g., elbows and knees); condyloid (e.g., wrists); saddle (e.g., thumbs); pivot (e.g., radius and ulna); and gliding (e.g., the carpals). Associated with some joints are bursae. These structures are located at points of friction, and are filled with synovial fluid. Bursae serve as cushioning structures in movement of tendons, ligaments, and bones at the elbow, shoulder, knee, and at other joints.

General Considerations for Rating

Ratings for Multiple Losses of Extremities

Review Table II of the "Ratings for Multiple Losses of Extremities with Dictator's Rating Code and 38 CFR Citation".

Musculoskeletal

Musculoskeletal
 

Problematic Issues

  • Degenerative Joint Disease (DJD)

  • Fractures

  • Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand

Musculoskeletal Diagnostic Tests

  • Goniometer

  • Goldthwait's sign

  • Electromyogram

  • Arthrocentesis

  • Bone scan

  • Babinski's Test

  • Drawer Sign Test

  • Lachmann's Test

  • McMurray's Test

  • Patrick's Test

  • Straight Leg Rising (SLR) Test

Acute, Subacute, or Chronic Diseases

Diagnostic Code Name VA Exam Acronym
5000 Osteomyelitis, acute, subacute, or chronic Bones AOM (Acute osteomyelitis)
5001 Bone & joints, tuberculosis of, active or inactive Bones Bones & Joints,TB of
5002 Arthritis rheumatoid (atrophic) as an active process Bones or Joints RA
5003 Arthritis, degenerative (hypertrophic or osteoarthritis) Joints or Spine OSTEO, DJD
5004 Arthritis, gonorrheal Joints or Spine Arthritis GC
5005 Arthritis, pneumococcic Joints or Spine ---
5006 Arthritis, typhoid Joints or Spine ---
5007 Arthritis, syphilitic Joints or Spine ASD
5008 Arthritis, streptococcic Joints or Spine ---
5009 Arthritis, other types (specify) Joints or Spine AUD
5010 Arthritis, due to trauma, substantiated by x-ray findings Joints or Spine ---
5011 Bone, caisson disease of Bones ---
5012 Bones, new growths of, malignant Bones ---
5013 Osteoporosis, with joint manifestations Joints/Spine OPO (osteoporosis)
5014 Osteomalacia Joints/Spine OM
5015 Bones, new growths of, benign Bones ---
5016 Osteitis deformans Joints/Spine ---
5017 Gout Joints/Feet ---
5019 Bursitis Joints ---
5021 Myositis Joints ---
5023 Myositis ossificans Joints MO
5024 Tenosynovitis Joints ---
5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome) Fibromyalgia FIMY, FA

Prosthetic Implants

Diagnostic Code Name VA Exam Acronym
5051 Shoulder replacement (prosthesis) Joints TSR (total shoulder replacement)
5052 Elbow replacement (prosthesis) Joints TER (total elbow replacement)
5053 Wrist replacement (prosthesis) Joints TWR
5054 Hip replacement (prosthesis) Joints HIREP
5055 Knee replacement (prosthesis) Joints KR, TKR
5056 Ankle replacement (prosthesis) Joints TAR

Combinations of Disabilities

Diagnostic Code Name VA Exam Acronym
5104 Anatomical loss of one hand and loss of use of one foot Amputation and Hand/Feet ---
5105 Anatomical loss of one foot and loss of use of one hand Amputation and Hand/Feet ---
5106 Anatomical loss of both hands Amputation BH (both hands)
5107 Anatomical loss of both feet Amputation BF (both feet)
5108 Anatomical loss of one hand and one foot Amputation ---
5109 Loss of use of both hands Hand, Thumb & Fingers ---
5110 Loss of use of both feet Feet BF (both feet)
5111 Loss of use of one hand and one foot Hand and Feet ---

Amputation Upper Extremity - Arm & Forearm

Diagnostic Code Category Name VA Exam Acronym
5120 Arm, Amputation of Disarticulation Amputation ---
5121 Arm, Amputation of Above insertion of deltoid Amputation AE (above elbow)
5122 Arm, Amputation of Above insertion of deltoid Amputation AE (above elbow)
5123 Forearm, Amputation of Above insertion of pronator teres Amputation BEA (below elbow)
5124 Forearm, Amputation of Below insertion of pronator teres Amputation BEA (below elbow)
5125 Forearm, Amputation of Hand, loss of use of Hand, Thumb & Fingers BEA (below elbow)

Amputation Upper Extremity - Five or Four Fingers of One Hand

Diagnostic Code Category Name VA Exam Acronym
5126 Five Digits of One Hand, Amputation of Five digits of one hand, amputation Amputation and Hand, Thumb & Fingers BEA (below elbow)
5127 Four Digits of One Hand, Amputation of Thumb, index, long and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5128 Four Digits of One Hand, Amputation of Thumb, index, long and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5129 Four Digits of One Hand, Amputation of Thumb, index, ring and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5130 Four Digits of One Hand, Amputation of Thumb, long, ring and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5131 Four Digits of One Hand, Amputation of Index, long, ring and little Amputation and Hand, Thumb & Fingers BEA (below elbow)

Amputation Upper Extremity - Three or Two Fingers of One Hand

Diagnostic Code Category Name VA Exam Acronym
5132 Three Digits of One Hand, Amputation of Thumb, index, and long Amputation and Hand, Thumb & Fingers BEA (below elbow)
5133 Three Digits of One Hand, Amputation of Thumb, index, and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5134 Three Digits of One Hand, Amputation of Thumb, index, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5135 Three Digits of One Hand, Amputation of Thumb, long, and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5136 Three Digits of One Hand, Amputation of Thumb, long, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5137 Three Digits of One Hand, Amputation of Thumb, ring, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5138 Three Digits of One Hand, Amputation of Index, long, and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5139 Three Digits of One Hand, Amputation of Index, long, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5140 Three Digits of One Hand, Amputation of Index, ring, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5141 Three Digits of One Hand, Amputation of Long, ring, and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5142 Two Digits of One Hand, Amputation of Thumb and index Amputation and Hand, Thumb & Fingers BEA (below elbow)
5143 Two Digits of One Hand, Amputation of Thumb and long Amputation and Hand, Thumb & Fingers BEA (below elbow)
5144 Two Digits of One Hand, Amputation of Thumb and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5145 Two Digits of One Hand, Amputation of Thumb and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5146 Two Digits of One Hand, Amputation of Index and long Amputation and Hand, Thumb & Fingers BEA (below elbow)
5147 Two Digits of One Hand, Amputation of Index and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5148 Two Digits of One Hand, Amputation of Index and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5149 Two Digits of One Hand, Amputation of Long and ring Amputation and Hand, Thumb & Fingers BEA (below elbow)
5150 Two Digits of One Hand, Amputation of Long and little Amputation and Hand, Thumb & Fingers BEA (below elbow)
5151 Two Digits of One Hand, Amputation of Ring and little Amputation and Hand, Thumb & Fingers BEA (below elbow)

Amputation Upper Extremity - Single Finger

Diagnostic Code Category Name VA Exam Acronym
5152 Single Finger Index finger, amputation of Amputation and Hand, Thumb & Fingers BEA (below elbow)
5153 Single Finger Thumb, amputation of Amputation and Hand, Thumb & Fingers BEA (below elbow)
5154 Single Finger Long finger, amputation of Amputation and Hand, Thumb & Fingers BEA (below elbow)
5155 Single Finger Ring finger, amputation of Amputation and Hand, Thumb & Fingers BEA (below elbow)
5156 Single Finger Little finger, amputation of Amputation and Hand, Thumb & Fingers BEA (below elbow)

Amputation Lower Extremity - Thigh & Leg

Diagnostic Code Category Name VA Exam Acronym
5160 Thigh, Amputation of Disarticulation, with loss of extrinsic pelvic girdle muscles Amputation LLA (lower limb amputation), AKA
5161 Thigh, Amputation of Upper third, one-third of the distance from perineum to knee joint measured from perineum Amputation LLA (lower limb amputation), AKA
5162 Thigh, Amputation of Middle or lower thirds Amputation LLA (lower limb amputation), AKA
5163 Leg, Amputation of With defective stump, thigh, amputation recommended Amputation LLA (lower limb amputation), AKA
5164 Leg, Amputation of Amputation not improvable by prosthesis controlled by natural knee action Amputation LLA (lower limb amputation), BKA
5165 Leg, Amputation of At a lower level permitting prosthesis Amputation LLA (lower limb amputation), BKA
5166 Leg, Amputation of Forefoot, amputation proximal to metatarsal bones (more than one-half of metatarsal loss) Amputation BKA
5167 Leg, Amputation of Foot, loss of use of Feet ---
5170 Leg, Amputation of Toes, all, amputation of, without metatarsal loss Amputation ---
5171 Leg, Amputation of Toe, great, amputation of Amputation ---
5172 Leg, Amputation of Toes, other than great, amputation of, with removal of metatarsal head Amputation ---
5173 Leg, Amputation of Toes, three or four, amputation of, without metatarsal involvement Amputation ---

Upper Extremity - Shoulder, Arm, Elbow, Forearm & Wrist

Diagnostic Code Category Name VA Exam Acronym
5200 The Shoulder & Arm Scapulohumeral articulation, ankylosis of Joints ---
5201 The Shoulder & Arm Arm, limitation of motion of Joints Limited ROM (range of motion)
5202 The Shoulder & Arm Humerus, other impairment of Joints ---
5203 The Shoulder & Arm Clavicle or scapula, impairment of Joints ---
5205 The Elbow & Forearm Elbow, ankylosis of Joints ---
5206 The Elbow & Forearm Forearm, limitation of flexion of Joints Limited ROM (range of motion)
5207 The Elbow & Forearm Forearm, limitation of extension of Joints ---
5208 The Elbow & Forearm Forearm, flexion limited to 100 degrees and extension to 45 degrees Joints ---
5209 The Elbow & Forearm Elbow, other impairment of flail joint Joints ---
5210 The Elbow & Forearm Radius and ulna, nonunion of, with flail false joint Joints ---
5211 The Elbow & Forearm Ulna, impairment of Joints ---
5212 The Elbow & Forearm Radius, impairment of Joints ---
5213 The Elbow & Forearm Supination and pronation, impairment of Joints ---
5214 The Wrist Wrist, ankylosis of Joints ---
5215 The Wrist Wrist, limitation of motion of Joints Limited ROM (range of motion)

Upper Extremity Ankylosis - Multiple or Single Digits

Diagnostic Code Category Name VA Exam Acronym
5216 Multiple Digits: Unfavorable Ankylosis Five digits of one hand, unfavorable ankylosis of Hand, Thumb & Fingers ---
5217 Multiple Digits: Unfavorable Ankylosis Four digits of one hand, unfavorable ankylosis of Hand ---
5218 Multiple Digits: Unfavorable Ankylosis Three digits of one hand, unfavorable ankylosis of Hand ---
5219 Multiple Digits: Unfavorable Ankylosis Two digits of one hand, unfavorable ankylosis of Hand ---
5220 Multiple Digits: Favorable Ankylosis Five digits of one hand, favorable ankylosis of Hand ---
5221 Multiple Digits: Favorable Ankylosis Four digits of one hand, favorable ankylosis of Hand ---
5222 Multiple Digits: Favorable Ankylosis Three digits of one hand, favorable ankylosis of Hand ---
5223 Multiple Digits: Favorable Ankylosis Two digits of one hand, favorable ankylosis of Hand ---
5224 Multiple Digits: Favorable Ankylosis Thumb, ankylosis of Hand ---
5225 Multiple Digits: Favorable Ankylosis Index finger, ankylosis of Hand ---
5226 Multiple Digits: Favorable Ankylosis Long finger, ankylosis of Hand ---
5227 Multiple Digits: Favorable Ankylosis Ring or little finger, ankylosis of Hand ---

Upper Extremity - Limitation of Motion of Individual Digits

Diagnostic Code Category Name VA Exam Acronym
5228 Limitation of Motion of Individual Digits Thumb, limitation of motion Hand Limited ROM (range of motion)
5229 Index or long finger, limitation of motion Thumb, limitation of motion Hand Limited ROM (range of motion)
5230 Limitation of Motion of Individual Digits Ring or little finger, limitation of motion Hand Limited ROM (range of motion)

Lower Extremity - The Spine

Diagnostic Code Category Name VA Exam Acronym
5235 The Spine Vertebral fracture or dislocation Spine FX (fracture)
5236 The Spine Sacroiliac injury and weakness Spine SI (sacroiliac injury)
5237 The Spine Lumbosacral or cervical strain Spine LS (lumbosacral)
5238 The Spine Spinal stenosis Spine SS
5239 The Spine Spondylolisthesis or segmental instability Spine ---
5240 The Spine Ankylosing spondylitis Spine AKS
5241 The Spine Spinal fusion Spine SPFU
5242 The Spine Degenerative arthritis of the spine (see also Diagnostic Code 5003) Spine ---
5243 The Spine Intervertebral disc syndrome Spine IVDS

Lower Extremity - The Hip & Thigh

Diagnostic Code Category Name VA Exam Acronym
5250 The Spine Hip, ankylosis of Joints ---
5251 The Spine Thigh, limitation of extension of Joints ---
5252 The Spine Thigh, limitation of flexion of Joints ---
5253 The Spine Thigh, impairment of Joints ---
5254 The Spine Hip, flail joint Joints ---
5255 The Spine Femur, impairment of Joints ---

Lower Extremity - The Knee & Leg

Diagnostic Code Category Name VA Exam Acronym
5256 The Knee & Leg Knee, ankylosis of Joints ---
5257 The Knee & Leg Knee, other impairment of Joints ACL Insufficiency
5258 The Knee & Leg Cartilage, semilunar, dislocated, with frequent episodes of locking, pain, and effusion into the joint Joints MMT
5259 The Knee & Leg Cartilage, semilunar, removal of, symptomatic Joints ---
5260 The Knee & Leg Leg, limitation of flexion of Joints ---
5261 The Knee & Leg Leg, limitation of extension of Joints ---
5262 The Knee & Leg Tibia and fibula, impairment of Joints ---
5263 The Knee & Leg Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) Joints ---

Lower Extremity - The Ankle

Diagnostic Code Category Name VA Exam Acronym
5270 The Ankle Ankle, ankylosis of Joints ---
5271 The Ankle Ankle, limited motion of Joints ---
5272 The Ankle Subastragalar or tarsal joint, ankylosis of Joints ---
5273 The Ankle Os calcis or astragalus, malunion of Joints ---
5274 The Ankle Astragalectomy Joints ---

Lower Extremity - Shortening of

Diagnostic Code Category Name VA Exam Acronym
5275 --- Bones, of the lower extremity, shortening of Bones ---

Lower Extremity - The Foot

Diagnostic Code Category Name VA Exam Acronym
5269 The Foot Plantar Fasciitis Feet PF
5276 The Foot Flatfoot, acquired Feet FF
5277 The Foot Weak foot, bilateral Feet ---
5278 The Foot Claw foot (pes cavus), acquired Feet ---
5279 The Foot Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral Feet ---
5280 The Foot Hallux valgus, unilateral Feet HAVA, HV
5281 The Foot Hallux rigidus, unilateral, severe Feet HR
5282 The Foot Hammer toe Feet ---
5283 The Foot Tarsal, or metatarsal bones, malunion of, or nonunion of Feet TA, MERAR
5284 The Foot Foot injuries, other Feet ---

Other

Diagnostic Code Category Name VA Exam Acronym
5296 --- Skull, loss of part of, both inner and outer tables Brain & Spinal Cord ---
5297 --- Ribs, removal of Bones ---
5298 --- Coccyx, removal of Spine ---

Analogous

Diagnostic Code Name
5099-5003 Arthralgia
5099-5021 Muscular dystrophy
5099-5021 Myofasciitis
5099-5021 Disease, Pellegrini-Stieda
5099-5260 Chondromalacia patella
5299-5015 Ganglia (ganglion cysts)
5299-5024 Epicondylitis (lateral or medial)
5299-5203 Fracture, clavicle
5299-5203 Rotator cuff tear
5299-5215 Fracture, wrist
5299-5230 Dupuytren's contracture
5299-5239 Kyphosis, dorsal
5299-5239 Scoliosis, dorsal
5299-5257 Hypotonia, ligaments, knees
5299-5257 Patellectomy
5299-5261 Patellofemoral syndrome/retropatellar
5299-5262 Disease, Osgood-Schlatter's
5299-5262 Fracture, knee
5299-5263 Varus deformity, knee (genu varum/bowlegs)
5299-5278 Fusion, toes
5299-5297 Fracture, ribs
6599-5015 Osteoma, frontal sinus

Historical

Old Diagnostic Code Name New Diagnostic Code
5002 Multi-joint Arthritis (except post-traumatic and gout)  5002 - Name and Rating Criteria Changed
5009 Other specified forms of arthropathy (excluding gout)  5009 - Name and Rating Criteria Changed
5018 Hydraarthrosis, intermittent: Removed Effective February 7, 2021
5020 Synovitis Removed Effective February 7, 2021
5022 Periostitis Removed Effective February 7, 2021
5054 Hip, resurfacing or replacement (prosthesis) 5054 - Name and Rating Criteria Changed
5055 Knee, resurfacing or replacement (prosthesis) 5055 - Name and Rating Criteria Changed
5120 Complete amputation, upper extremity 5120 - Name and Rating Criteria Changed
5160 Disarticulation, with loss of extrinsic pelvic girdle muscles 5160 - Name and Rating Criteria Changed
5201 Arm, limitation of motion of: 5201 - Rating Criteria Changed
5202 Humerus, other impairment of: 5202 - Rating Criteria Changed
5255 Femur, impairment of: 5255 - Rating Criteria Changed
5257 Knee, other impairment of: 5257 - Rating Criteria Changed
5262 Tibia and fibula, impairment of: 5262 - Rating Criteria Changed
5271 Ankle, limited motion of: 5271 - Rating Criteria Changed
5285 Vertebra, fracture of, residuals 5235 - Rating Criteria Changed
5286 Spine, complete bony fixation (ankylosis) of 5237 - Rating Criteria Changed
5287 Spine, ankylosis of, cervical 5241/5238 - Rating Criteria Changed
5288 Spine, ankylosis of, dorsal 5241/5238 - Rating Criteria Changed
5289 Spine, ankylosis of, lumbar 5241/5238 - Rating Criteria Changed
5290 Spine, limitation of motion of, cervical 5237 - Rating Criteria Changed
5291 Spine, limitation of motion of, dorsal 5237 - Rating Criteria Changed
5292 Spine, limitation of motion of, lumbar 5237 - Rating Criteria Changed
5293 Intervertebral disc syndrome 5242/5243 - Rating Criteria Changed
5295 Lumbosacral strain 5237 - Rating Criteria Changed