multiple evaluations for musculoskeletal disability, see , and . Medical evidence used to evaluate functional impairment due to pain must h. Assessing Medical account for painful motion, pain on use, and pain during flare-ups or with Evidence for repeated use over a period of time. Functional Loss Due to Pain 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 findings, he or Important: 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: , 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. For more information on evaluating functional impairment due to Reference: pain, see M21-1, Part III, Subpart iv, 4.A.1.g. i. Entering The findings of DeLuca repetitive ROM testing or the functional loss and DeLuca expressed in the opinion will be used to evaluate the functional Mitchell Data in Mitchell impairment of a due to pain. the Evaluation Builder Only the most advantageous finding will be utilized to evaluate the joint condition.
multiple evaluations for musculoskeletal disability, see , and . h. Assessing Medical Evidence for Functional Loss Due to Pain Medical evidence used to evaluate functional impairment due to pain must account for painful motion, pain on use, and pain during flare-ups or with repeated use over a period of time. 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 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 due to pain. Only the most advantageous finding will be utilized to evaluate the joint condition.
1-11-16_Key%20Changes_M21-1III_iv_4_SecA.docx