As a part of the assessment conducted in accordance with , 8 Vet.App. 202 (1995), the medical evidence must clearly indicate the exact degree of movement at which pain limits motion in the affected joint, and include the findings of at least three repetitions of ROM. Per , 25 Vet.App. 32 (2011),when pain is associated with movement, an examiner must opine or the medical evidence must show whether pain could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time, and if there is functional impairment found during flare-ups or with repeated use over a period of time, the examiner must provide, if feasible, the degree of additional LOM due to pain on use or during flare-ups. If the examiner is unable to provide any of the above findings, he Important: or she must indicate that he/she cannot determine, without resort to mere speculation, whether any of these factors cause additional functional loss, and provide the rationale for this opinion. Per 23 Vet.App. 382 (2010), the VA may only accept a medical Note: , that an opinion would be speculative if examiner’s conclusion the examiner has explained the basis for such an opinion, identifying what facts cannot be determined, or the basis for the opinion is otherwise apparent in of the VA’s review evidence. For more information on evaluating functional impairment due to Reference: pain, see M21-1, Part III, Subpart iv, 4.A.1.g. The findings of DeLuca repetitive ROM testing or the functional loss i. Entering and DeLuca expressed in the opinion will be used to evaluate the functional Mitchell Data in Mitchell impairment of a joint due to pain. the Evaluation Builder Only the most advantageous finding will be utilized to evaluate the joint condition. Do not the LOM on exam to the LOM expressed in a DeLuca “add” opinion. Mitchell For purposes of data entry in the Evaluation Builder tool, if evaluating Note: a joint where data fields are present for only initial ROM and for (but DeLuca not for enter either the or the data in the Mitchell), DeLuca Mitchell DeLuca field, whichever results in the higher disability evaluation. For examples of how to evaluate functional loss due to pain, refer Examples: to M21-1, Part III, Subpart iv, 4.A.1.j-k.
As a part of the assessment conducted in accordance with , 8 Vet.App. 202 (1995), the medical evidence must clearly indicate the exact degree of movement at which pain limits motion in the affected joint, and include the findings of at least three repetitions of ROM. Per , 25 Vet.App. 32 (2011),when pain is associated with movement, an examiner must opine or the medical evidence must show whether pain could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time, and if there is functional impairment found during flare-ups or with repeated use over a period of time, the examiner must provide, if feasible, the degree of additional LOM due to pain on use or during flare-ups. Important: If the examiner is unable to provide any of the above findings, he or she must indicate that he/she cannot determine, without resort to mere speculation, whether any of these factors cause additional functional loss, and provide the rationale for this opinion. Note: Per , 23 Vet.App. 382 (2010), the VA may only accept a medical examiner’s conclusion that an opinion would be speculative if the examiner has explained the basis for such an opinion, identifying what facts cannot be determined, or the basis for the opinion is otherwise apparent in VA’s review of the evidence. Reference: For more information on evaluating functional impairment due to pain, see M21-1, Part III, Subpart iv, 4.A.1.g. i. Entering DeLuca and Mitchell Data in the Evaluation Builder The findings of DeLuca repetitive ROM testing or the functional loss expressed in the Mitchell opinion will be used to evaluate the functional impairment of a joint due to pain. Only the most advantageous finding will be utilized to evaluate the joint condition. Do not “add” the LOM on DeLuca exam to the LOM expressed in a Mitchell opinion. Note: For purposes of data entry in the Evaluation Builder tool, if evaluating a joint where data fields are present for only initial ROM and for DeLuca (but not for Mitchell), enter either the DeLuca or the Mitchell data in the DeLuca field, whichever results in the higher disability evaluation. Examples: For examples of how to evaluate functional loss due to pain, refer to M21-1, Part III, Subpart iv, 4.A.1.j-k.