- Diagnostic Code
- 5257
- CFR Section
- §4.71a — Musculoskeletal
Rating Tiers
e.g., Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (cane(s), crutch(es), walker) and bracing for ambulation | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker
e.g., (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (cane(s), crutch(es), walker) or bracing for ambulation | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker
e.g., Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (cane(s), crutch(es), walker) or bracing for ambulation | A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker
Rated Under Formula
This condition is rated using the §4.71a general rating formula.
What Raters Look For
Based on M21-1 adjudication criteria for Musculoskeletal conditions. These are the factors a VA rater evaluates when assigning a rating percentage.
M21-1 III.iv.4.A- •Range of motion measurements in degrees for each affected joint, recorded on examination
- •Pain on motion — whether pain limits motion before the normal end point is reached
- •Functional loss — specific activities the Veteran cannot perform due to the condition
- •Flare-up history: how often they occur, how severe, and how long they last (Veteran's statement counts)
- •Effects of repetitive motion (whether additional loss of motion occurs after repeated use)
- •Muscle atrophy, guarding, or tenderness noted on physical exam
- •Whether ankylosis (complete fixation) is present and in a favorable or unfavorable position
- •Imaging findings: X-ray, MRI, or CT reports noting bone/joint changes