LOM of the knee is contemplated by the meniscus DCs. Explanation: Although , refers to cartilage and of the knee the “dislocated” “locking” rating criteria contemplate LOM of the knee through functional impairment with use (namely pain and effusion). , provides for a compensable evaluation for a knee post “symptomatic” removal of the cartilage. states 5259 requires consideration of and “DC because removal of semilunar cartilage may result in complications producing loss of motion.” h. Separate Do not assign separate evaluations for Evaluations, Knee Instability subluxation or lateral instability under , and and Meniscus a meniscus disability Disabilities , or The criteria for both of those codes contemplate instability. Explanation: Dislocation and locking under is consistent with instability. The broad terminology of "symptomatic" under also contemplates instability. Medical EPSS notes that instability is common symptomatology associated with both of these disabilities. i. Separate When evaluating genu recurvatum, which involves hyperextension of the Evaluations knee beyond 0 degrees of extension, under – Genu Recurvatum do evaluate separately under , but not also evaluate separately under other evaluations manifestations that are not do if overlapping, such as limitation of flexion under , are attributed to genu recurvatum, and do evaluate separately under ; however, if instability is manifested from not genu recurvatum at the or level, evaluate under . “moderate” “severe” j. Evaluating Evaluate shin splints analogously with . The table below explains the process Shin Splints and necessary considerations for evaluating shin splints. Step Action 1 Is a chronic disability present? If go to Step 2. yes, If deny SC. no, 2 Determine whether the shin splint disability affects the right, left, or bilateral extremity(ies). Go to Step 3.
Explanation: LOM of the knee is contemplated by the meniscus DCs. Although , refers to “dislocated” cartilage and “locking” of the knee the rating criteria contemplate LOM of the knee through functional impairment with use (namely pain and effusion). , provides for a compensable evaluation for a “symptomatic” knee post removal of the cartilage. states “DC 5259 requires consideration of and because removal of semilunar cartilage may result in complications producing loss of motion.” h. Separate Evaluations, Knee Instability and Meniscus Disabilities Do not assign separate evaluations for subluxation or lateral instability under , and a meniscus disability , or Explanation: The criteria for both of those codes contemplate instability. Dislocation and locking under is consistent with instability. The broad terminology of "symptomatic" under also contemplates instability. Medical EPSS notes that instability is common symptomatology associated with both of these disabilities. i. Separate Evaluations – Genu Recurvatum When evaluating genu recurvatum, which involves hyperextension of the knee beyond 0 degrees of extension, under do not also evaluate separately under , but do evaluate separately under other evaluations if manifestations that are not overlapping, such as limitation of flexion under , are attributed to genu recurvatum, and do not evaluate separately under ; however, if instability is manifested from genu recurvatum at the “moderate” or “severe” level, evaluate under . j. Evaluating Shin Splints Evaluate shin splints analogously with . The table below explains the process and necessary considerations for evaluating shin splints. Step Action 1 Is a chronic disability present? If yes, go to Step 2. If no, deny SC. 2 Determine whether the shin splint disability affects the right, left, or bilateral extremity(ies). Go to Step 3.
2-1-16_Key%20Changes_M21-1III_iv_4_SecA.docx