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C&P Exam Prep: Femur, Impairment of
DBQ Overview
Interview + Physical- Form Name
- Hip_and_Thigh
- Form Code
- Hip_and_Thigh
- Page Count
- 13
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To evaluate the nature, severity, and functional impact of femur impairment - including fractures (shaft or neck), nonunion, malunion, false joint, flail hip, and leg length discrepancy - in order to assign a disability rating under DC 5255. The examiner will document range of motion, functional loss, pain behavior, and any structural abnormalities of the femur to support adjudication.
What the examiner evaluates:
- Type and location of femur pathology (fracture nonunion, malunion, false joint, surgical neck fracture)
- Active and passive range of motion of the hip joint in all planes (flexion, extension, abduction, adduction, internal rotation, external rotation)
- Weight-bearing vs. non-weight-bearing ROM differences
- Presence and severity of pain on motion, at rest, and with repetitive use
- DeLuca factors: pain, weakness, fatigability, and incoordination with repeated use and during flare-ups
- Leg length discrepancy and measurement in centimeters
- Presence of loose motion (flail joint) or preserved weight bearing with or without brace
- Need for assistive devices (cane, crutches, walker, wheelchair, brace)
- Surgical history including total hip replacement, hip resurfacing, arthroscopic repair, ORIF, or other procedures
- Functional impact on activities of daily living including standing, walking, sitting, and locomotion
- Presence of muscle atrophy, deformity, swelling, instability, or heterotopic ossification
- X-ray and imaging results relevant to fracture healing and alignment
- Any secondary diagnoses such as avascular necrosis, post-traumatic arthritis, or osteoarthritis
Exam will typically be conducted in person at a VA medical center or contracted facility. You may be asked to perform standing, walking, and lying-down maneuvers. Wear comfortable clothing that allows access to the hip and thigh. If you use an assistive device, bring it to the exam. You have the right to request the exam be recorded in most states - verify your state's law in advance.
Typical duration: 30-45 minutes
Hip Flexion (Active)
Ability to raise the thigh toward the chest; normal is 0-125 degrees
What to expect:
You will lie on your back and bend your knee toward your chest as far as pain and mobility allow. The examiner uses a goniometer to measure the endpoint in degrees.
Key thresholds:
- Less than 45- flexion — Supports higher-rating evaluation under DC 5256 (ankylosis) or demonstrates severe functional loss
- 45-90- flexion — Moderate limitation; may support intermediate functional loss rating
- Pain before endpoint — Can support additional DeLuca functional loss even if ROM appears adequate on goniometer
Tips:
- Perform the motion slowly and stop at the point where pain begins or motion is genuinely limited - do not push through to a falsely improved number
- Inform the examiner if your range is worse on bad days or after activity
- If testing is weight-bearing (standing), your numbers may differ from lying down - both should be documented
Pain considerations: Tell the examiner specifically where pain occurs during flexion (groin, lateral thigh, anterior hip), at what degree it begins, and its severity on a 0-10 scale. Pain on motion, even without restricted ROM, can establish functional loss under DeLuca.
Hip Extension (Active)
Ability to extend the leg behind the body; normal is 0-20 degrees
What to expect:
You will lie prone or stand while extending the leg backward. The examiner measures the degree of extension achieved.
Key thresholds:
- 0-5- extension — Severe limitation; can document effectively as near-ankylosis in extension
- Pain at initiation of extension — Establishes pain-on-motion functional loss even with preserved ROM
Tips:
- Extension is often more limited than flexion in femur injuries - make sure the examiner tests it separately
- If you cannot lie prone due to pain, inform the examiner immediately - this itself documents functional limitation
Pain considerations: Note whether extension causes groin pull, anterior hip pain, or radiating thigh pain. Describe whether pain limits your ability to walk with a normal stride.
Hip Abduction and Adduction (Active)
Lateral movement of the leg away from (abduction, normal 0-45-) and toward (adduction, normal 0-25-) the midline
What to expect:
You will lie on your back and move your leg outward and then inward while the examiner measures degree of motion.
Key thresholds:
- Abduction less than 10- — Severely limited; significant functional impact on gait and standing
- Adduction causing crossover limitation — May indicate malunion deformity or heterotopic ossification
Tips:
- Abduction and adduction limitations often go underdocumented - ensure the examiner tests both directions
- If adduction is restricted and causes interference with sitting or crossing legs, describe this explicitly
Pain considerations: Lateral hip pain with abduction may suggest trochanteric involvement secondary to femur fracture malunion. Describe any snapping, catching, or grinding sensations with motion.
Internal and External Hip Rotation (Active)
Rotational ROM of the femoral head in the acetabulum; normal internal rotation 0-45-, external rotation 0-45-
What to expect:
You will sit at the edge of the table or lie supine while the examiner passively and actively rotates the lower leg to assess hip rotation.
Key thresholds:
- Internal rotation less than 15- — Common finding in femoral neck fracture malunion and post-traumatic arthritis
- External rotation less than 15- — May indicate heterotopic ossification or severe joint involvement
Tips:
- Rotation is often the first motion lost in femur injuries - do not skip describing rotation-related pain
- If rotation causes groin or medial thigh pain, specify this as it differs from lateral pain and supports distinct pathology documentation
Pain considerations: Rotation-related pain in the groin is highly significant and should be described with onset degree and severity. It directly supports documentation of painful motion for rating purposes.
Passive Range of Motion Testing
ROM when the examiner moves the joint without the veteran's muscular effort; per Correia v. McDonald, passive ROM must be measured and compared to active ROM
What to expect:
The examiner will physically move your leg through each plane of motion without you actively participating. Passive ROM values will be compared to active ROM values.
Key thresholds:
- Passive ROM greater than active ROM — Suggests pain-limited active motion - this gap supports DeLuca functional loss credit
- Passive ROM equal to active ROM and both limited — Structural limitation; supports fixed anatomical restriction finding
Tips:
- Per Correia, if the examiner does NOT test passive ROM separately, you can note this as an exam deficiency - the exam may be inadequate
- Relax your muscles during passive testing so the examiner gets accurate passive measurements
- If passive motion causes significant pain, say so clearly - this is not the same as painless structural restriction
Pain considerations: Pain on passive motion suggests intrinsic joint or bone pathology rather than pure muscle guarding. This is clinically significant for rating purposes and should be clearly communicated.
Weight-Bearing vs. Non-Weight-Bearing ROM
Difference in ROM and pain when the joint bears body weight versus when non-weight-bearing
What to expect:
The examiner may test ROM in different positions (standing vs. supine). For femur conditions, weight-bearing status is a direct rating criterion under DC 5255.
Key thresholds:
- Weight-bearing preserved with aid of brace only — Supports 60% rating for nonunion without loose motion under DC 5255
- Weight-bearing not preserved even with brace — Supports 80% rating (nonunion with loose motion) or referral to ankylosis codes
Tips:
- If you require a brace to walk, bring it to the exam and demonstrate how you use it
- Describe whether you can bear weight without the brace and what happens when you try - instability, pain, buckling, or inability to stand
Pain considerations: Weight-bearing pain is distinct from non-weight-bearing pain. Describe if the affected leg buckles, gives way, or feels unstable under load - these are indicators of loose motion or false joint.
Leg Length Measurement
True and apparent limb length discrepancy resulting from femur fracture malunion or shortening; measured in centimeters
What to expect:
The examiner will measure from a fixed bony landmark (typically anterior superior iliac spine to medial malleolus) on both legs and compare measurements.
Key thresholds:
- 1.0-2.5 cm shortening — Mild discrepancy; may support functional gait abnormality documentation
- Greater than 2.5-3.8 cm shortening — Moderate discrepancy; supports disturbance of locomotion and gait alteration
- Greater than 3.8 cm shortening — Severe discrepancy; can support separate rating consideration under DC 5275
Tips:
- Leg length discrepancy from femur shortening should be distinguished from apparent discrepancy due to pelvic tilt
- Describe any compensatory limping, back pain, or shoe lift requirement resulting from the discrepancy
Pain considerations: Secondary low back pain from leg length discrepancy caused by femur malunion may be ratable as a secondary condition - document this connection explicitly with the examiner.
Flare-Up and Repetitive Use Assessment (DeLuca Factors)
Additional functional limitation occurring during flare-ups or after repeated use due to pain, weakness, fatigability, or incoordination - per DeLuca v. Brown
What to expect:
The examiner should ask about how your condition behaves during flare-ups, after prolonged activity, and with repeated use. This may or may not happen automatically - you may need to proactively raise these topics.
Key thresholds:
- ROM significantly worse during flare-up — Examiner must document estimated ROM at worst - this can elevate the effective rating
- Weakness causing inability to perform repeated movements — Supports functional loss beyond static ROM measurements
- Fatigability after minimal activity — Supports additional functional impairment documentation
Tips:
- If the examiner does not ask about flare-ups, proactively say: 'I want to describe how this condition affects me during my worst days and after repeated use'
- Describe frequency, duration, and trigger of flare-ups in specific terms
- Describe what activities you can do for how long before pain forces you to stop
Pain considerations: During the examination, your ROM may appear better than on your worst days. Tell the examiner your typical worst-day ROM, what triggers a flare-up (walking distance, standing time, weather, activity level), and how long flare-ups last. Per M21-1 guidance, examiners must address whether functional ability is significantly limited during flare-ups.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 80% | Fracture of shaft or anatomical neck of femur with nonunion, with loose motion (spiral or oblique fracture). This represents a severely unstable femur where the fracture has failed to heal and results in abnormal movement at the fracture site (pseudoarthrosis or false motion). |
CFR: 38 CFR - 4.71a, DC 5255: Fracture of shaft or anatomical neck of femur with nonunion, with loose motion (spiral or oblique fracture) - 80%. |
| 60% | Two separate 60% criteria exist under DC 5255: (1) Fracture of shaft or anatomical neck of femur with nonunion, without loose motion, where weight bearing is preserved but only with the aid of a brace; OR (2) Fracture of the surgical neck of the femur with false joint (pseudoarthrosis at the surgical neck). |
CFR: 38 CFR - 4.71a, DC 5255: (a) Fracture of shaft or anatomical neck with nonunion, without loose motion, weight bearing preserved with aid of brace - 60%; (b) Fracture of surgical neck with false joint - 60%. |
| 0% | Malunion of the femur is not independently rated under DC 5255. Instead, malunion is directed to be evaluated under DC 5256 (ankylosis of hip), DC 5257 (knee instability), DC 5260 (knee flexion limitation), or DC 5261 (knee extension limitation), as appropriate to the functional impairment caused. The examiner should document the specific functional deficit to support rating under the appropriate analogous code. |
CFR: 38 CFR - 4.71a, DC 5255: Malunion of the femur - evaluate under DC 5256, 5257, 5260, or 5261 as applicable to the functional impairment present. |
80% Fracture of shaft or anatomical neck of femur with nonunion, ...
Fracture of shaft or anatomical neck of femur with nonunion, with loose motion (spiral or oblique fracture). This represents a severely unstable femur where the fracture has failed to heal and results in abnormal movement at the fracture site (pseudoarthrosis or false motion).
Key Symptoms
- Abnormal movement at fracture site (loose motion / false joint at shaft or anatomical neck)
- Inability to bear weight without significant assistance or bracing
- Severe instability during weight-bearing and ambulation
- History of spiral or oblique fracture pattern
- Significant functional limitation of the entire lower extremity
- Possible requirement for crutches or wheelchair for ambulation
CFR: 38 CFR - 4.71a, DC 5255: Fracture of shaft or anatomical neck of femur with nonunion, with loose motion (spiral or oblique fracture) - 80%.
60% Two separate 60% criteria exist under DC 5255: (1) Fracture ...
Two separate 60% criteria exist under DC 5255: (1) Fracture of shaft or anatomical neck of femur with nonunion, without loose motion, where weight bearing is preserved but only with the aid of a brace; OR (2) Fracture of the surgical neck of the femur with false joint (pseudoarthrosis at the surgical neck).
Key Symptoms
- Nonunion of femoral shaft or anatomical neck without pathological motion at fracture site
- Weight-bearing possible only with brace or significant assistive device support
- False joint (pseudoarthrosis) at surgical neck of femur
- Significant gait abnormality requiring brace for ambulation
- Marked limitation of hip ROM with pain and functional loss
- Requirement for brace for ambulation as medically prescribed
CFR: 38 CFR - 4.71a, DC 5255: (a) Fracture of shaft or anatomical neck with nonunion, without loose motion, weight bearing preserved with aid of brace - 60%; (b) Fracture of surgical neck with false joint - 60%.
0% Malunion of the femur is not independently rated under DC 52 ...
Malunion of the femur is not independently rated under DC 5255. Instead, malunion is directed to be evaluated under DC 5256 (ankylosis of hip), DC 5257 (knee instability), DC 5260 (knee flexion limitation), or DC 5261 (knee extension limitation), as appropriate to the functional impairment caused. The examiner should document the specific functional deficit to support rating under the appropriate analogous code.
Key Symptoms
- Femur healed in an angulated, shortened, or rotated position
- Leg length discrepancy from malunion shortening
- Secondary hip joint impairment from malunion angulation
- Secondary knee joint impairment from malunion
- Gait abnormality from malunion deformity
- Post-traumatic arthritis secondary to malunion
CFR: 38 CFR - 4.71a, DC 5255: Malunion of the femur - evaluate under DC 5256, 5257, 5260, or 5261 as applicable to the functional impairment present.
How to Describe Your Symptoms
Pain - Location, Quality, and Severity
How to describe:
Describe pain using specific anatomical location (anterior hip/groin, lateral thigh, mid-shaft femur, posterior hip), character (sharp, aching, burning, stabbing), and consistent severity ratings. Distinguish between pain at rest, pain with motion initiation, pain during movement, and pain after prolonged use.
Worst-day example:
“On my worst days, I have a 9/10 sharp pain in my right mid-thigh that radiates into my groin when I try to walk more than 20 feet. I cannot put full weight on the leg without the pain spiking, and I have to use my crutches for any distance beyond my bedroom.”
What the examiner listens for:
Pain on active and passive ROM, pain at specific degree thresholds, pain at rest vs. motion, pain intensity sufficient to limit functional activity, and pain behavior consistent with reported pathology.
Understatements to avoid:
Saying 'it's not that bad' or minimizing pain to appear stoic. Also avoid vague descriptions like 'it hurts sometimes' - be specific about frequency, intensity, location, and functional consequences.
Loose Motion and Instability
How to describe:
If you have nonunion with loose motion, describe the sensation of abnormal movement at the fracture site. Describe whether the leg feels unstable, gives way, buckles, or feels like it could 'give out' under weight. Describe any audible or palpable crepitus or clicking at the fracture site.
Worst-day example:
“When I try to stand without my brace, I can feel the bone shifting in my thigh - there's a grinding sensation and the leg just buckles under me. I fell twice in the last month because of this. I cannot stand unsupported for more than 10 seconds.”
What the examiner listens for:
Specific description of pathological motion at the nonunion site, inability to bear weight without assistive devices, falls or near-falls, and description consistent with clinical pseudoarthrosis.
Understatements to avoid:
Describing instability only as 'feeling weak' - be clear that you experience abnormal motion or the bone feels like it moves when bearing weight, if that is accurate to your condition.
Weight-Bearing Capacity and Brace Dependence
How to describe:
Clearly state whether you can bear weight at all without your brace, and if so, for how long and how far. Describe the consequences of attempting to walk without the brace - pain, instability, falls, or inability to advance the limb.
Worst-day example:
“Without my KAFO brace, I cannot take more than two or three steps before the pain and instability force me to stop. With the brace, I can walk about one block before the pain becomes unbearable. I have worn the brace daily for the past two years per my orthopedist's prescription.”
What the examiner listens for:
Whether weight-bearing is preserved with brace only (supporting 60% criteria) versus impossible even with brace (supporting 80% criteria or higher), and whether brace use is medically prescribed versus self-selected.
Understatements to avoid:
Downplaying brace dependence by saying 'I can walk a little without it' when you actually cannot safely ambulate without the device. Bring the prescription or documentation for the brace to the exam.
DeLuca Factors - Flare-Ups and Repetitive Use
How to describe:
Per DeLuca v. Brown, describe how your condition worsens with activity and during flare-ups. Quantify: how many steps before pain spikes, how many minutes you can stand, how long a flare-up lasts, what triggers it, and what your ROM and functional ability is during your worst episodes.
Worst-day example:
“After walking about a quarter mile, my thigh pain goes from a 5/10 to a 9/10 and I develop a pronounced limp. By that evening, I can barely lift my leg to get into bed and I estimate my hip flexion drops to about 30 degrees from the roughly 70 degrees I can manage when I first wake up. Flare-ups triggered by moderate walking last 2-3 days.”
What the examiner listens for:
Specific triggers, frequency, duration of flare-ups, estimated ROM change during worst episodes, inability to perform repeated movements without significant pain increment, and any secondary effects such as disturbed sleep from pain.
Understatements to avoid:
Only describing how you feel on a 'normal day' at the exam. The VA rates your worst-day functional status - ensure you explicitly communicate your condition at its worst, not at its best.
Weakness and Fatigability
How to describe:
Describe specific muscle groups that feel weak (quadriceps, hip flexors, hip abductors) and quantify how quickly fatigue sets in. Describe whether weakness causes you to stumble, drag the foot, or shorten your stride.
Worst-day example:
“My right thigh feels like it has no strength after even a short walk. When I try to climb stairs, my hip flexors give out after the third step and I have to pull myself up using the railing. By midday I need to sit down because the leg is too fatigued to keep walking.”
What the examiner listens for:
Credible description of strength loss proportional to the injury, fatigability that limits repetitive use beyond static ROM measurements, and functional consequences of weakness on daily activities.
Understatements to avoid:
Failing to mention weakness and fatigue entirely, or attributing them to general aging rather than specifically to the service-connected femur injury.
Functional Impact on Daily Activities
How to describe:
Describe specific activities you cannot do or can only do in a modified way: walking distance, climbing stairs, getting in/out of vehicle, sitting for extended periods, standing, sleeping positions, ability to work, and recreational activities you have had to abandon.
Worst-day example:
“I cannot walk my dog more than one block. I cannot stand at the kitchen counter for more than five minutes without needing to sit. I sleep with a pillow between my knees because any position without it causes thigh pain that wakes me up. I had to stop coaching my son's soccer team because I cannot stand on uneven ground.”
What the examiner listens for:
Specific, credible functional limitations tied directly to the femur condition, with concrete examples that illustrate the impact across multiple life domains.
Understatements to avoid:
Generic statements like 'I can't do much anymore' without specifics. The examiner and rater need concrete, quantifiable examples tied to the femur condition.
Common Mistakes to Avoid
Performing maximally during the ROM examination
Veterans often push through pain to demonstrate effort, resulting in ROM measurements that do not reflect their actual functional capacity or their worst-day condition. The rating is based on the limitation, not the effort.
Instead: Stop motion at the point where pain genuinely limits you. Tell the examiner 'this is where my pain stops me' and state the pain level at that point. Do not continue motion past your genuine pain threshold.
Impact: All rating levels under DC 5255 and any applicable ROM-based analogous codes
Failing to disclose brace use or bringing the brace to the exam
Under DC 5255, the 60% rating for nonunion without loose motion specifically requires that weight-bearing be preserved only with the aid of a brace. If the examiner does not document brace dependence, this criterion cannot be met.
Instead: Bring all prescribed braces, orthotics, and assistive devices to the exam. Show the examiner how you use them and explain that you cannot safely ambulate without them. Bring the orthopedic prescription for the device.
Impact: 60% under DC 5255 (nonunion without loose motion, weight-bearing preserved with brace)
Not describing loose motion or instability clearly
The 80% rating criterion requires documentation of loose motion at the fracture site. Veterans may describe this as 'weakness' or 'instability' without clearly communicating the pathological movement the regulation requires.
Instead: If you have been diagnosed with nonunion with pseudoarthrosis, use specific language: describe the sensation of the bone moving or shifting, any audible crepitus, and the inability to bear weight due to this instability rather than due to pain alone.
Impact: 80% under DC 5255 (nonunion with loose motion)
Not raising DeLuca factors proactively
Examiners do not always ask about flare-ups and repetitive use deterioration. If the examiner only documents static ROM at the time of exam, functional loss from DeLuca factors will not be captured, potentially understating the true disability level.
Instead: If the examiner does not ask, proactively state: 'I want to describe how this condition affects me during flare-ups and after repeated use.' Describe your worst-day ROM estimate, what triggers flare-ups, their frequency, duration, and the functional limitations at those times.
Impact: All rating levels - DeLuca functional loss can effectively elevate the rating even when static ROM appears less limiting
Failing to mention secondary conditions caused by femur impairment
Femur malunion and nonunion frequently cause secondary conditions - post-traumatic arthritis of the hip or knee, leg length discrepancy with compensatory low back pain, and gait abnormalities. These are separately ratable and need to be raised.
Instead: Tell the examiner about any back pain, knee pain, hip arthritis, or other conditions you believe developed as a result of your femur injury. Ask whether these should be documented as secondary conditions.
Impact: Overall combined rating - secondary conditions add to total evaluation
Describing your best-day condition rather than your worst-day condition
Per M21-1 guidance, the rating should reflect how the condition affects you on your worst days, not on a good day when you happen to be examined. Examiners sometimes see veterans on atypically good days.
Instead: Explicitly tell the examiner: 'Today may not reflect my worst days. On my worst days, my condition is as follows...' and then describe the worst functional picture accurately.
Impact: All rating levels - worst-day description is essential to accurate rating
Not documenting malunion as requiring evaluation under analogous codes
DC 5255 directs malunion to be rated under DC 5256, 5257, 5260, or 5261. If the examiner only documents 'malunion' under DC 5255 without evaluating for hip ankylosis, knee instability, or ROM limitation, the claim may be under-evaluated.
Instead: Ensure the examiner documents not just the malunion but its functional consequences - hip ROM limitation, knee joint effects, leg length discrepancy, and gait disturbance - so the appropriate analogous code can be applied.
Impact: Malunion cases - which may warrant rating under DC 5256, 5257, 5260, or 5261 at various percentages
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request a copy of your completed C&P examination report (DBQ) at any time through your VA Regional Office, VSO, or through VBMS.
- You have the right to challenge an inadequate examination - if the DBQ fails to address required elements (DeLuca factors, passive ROM per Correia), you may request a new examination or submit additional private evidence.
- You have the right to submit a private Independent Medical Opinion (IMO) or nexus letter from your own physician if you believe the C&P examiner's findings are inaccurate or incomplete.
- You have the right to record your C&P examination in states where one-party consent recording is permitted - verify your state's law before the exam and notify the facility in advance.
- You have the right to have a VSO representative, accredited claims agent, or attorney assist you throughout the claims process, including reviewing your exam results before a rating decision is issued.
- You have the right to file a Notice of Disagreement (NOD) or Supplemental Claim if you disagree with the rating decision, and to request a Board of Veterans' Appeals hearing.
- You have the right to submit lay statements (buddy statements) from yourself, family members, or caregivers describing the observable functional impact of your femur impairment.
- You have the right to request that the VA obtain all relevant VA treatment records before your C&P examination - ensure all VA facilities where you have been treated for this condition are identified in your claim.
- Under 38 CFR - 4.7, when the evidence is in equipoise (approximately equal for and against a higher rating), the benefit of the doubt must be resolved in your favor.
- Under 38 CFR - 4.3, reasonable doubt regarding the degree of disability shall be resolved in favor of the veteran.
Related Conditions
- Ankylosis of Hip (DC 5256) DC 5255 directs evaluation of femur malunion to DC 5256 if the impairment results in effective ankylosis of the hip joint. Hip ankylosis may also develop secondary to femur nonunion or post surgical complications.
- Knee Instability (DC 5257) Femur malunion is rated under DC 5257 if the primary functional impairment is knee joint instability. Malunion induced angulation can place abnormal stress on the knee joint, causing secondary instability.
- Limitation of Flexion of the Knee (DC 5260) DC 5255 directs malunion of the femur to DC 5260 if the resulting functional deficit is primarily limitation of knee flexion. Femoral malunion can restrict knee mechanics through altered biomechanics.
- Limitation of Extension of the Knee (DC 5261) DC 5255 directs malunion evaluation to DC 5261 if limitation of knee extension is the dominant functional impairment. Distal femur malunion particularly affects knee extension mechanics.
- Post-Traumatic Arthritis (DC 5010) Femur fractures and malunion frequently cause secondary post traumatic arthritis of the hip or knee joint. This is separately ratable as a secondary condition caused by the service connected femur impairment.
- Avascular Necrosis of the Hip (DC varies) Femoral neck fractures carry a high risk of avascular necrosis (osteonecrosis) of the femoral head due to disruption of blood supply. AVN may develop secondary to service connected femur fracture and is separately ratable.
- Limitation of Motion of the Hip (DC 5252) Femur impairment frequently results in limitation of hip motion, which may be separately rated under DC 5252 (extension limitation), DC 5253 (abduction limitation), or DC 5254 (rotation limitation) in addition to or instead of DC 5255, depending on the predominant functional impairment.
- Lumbosacral Strain / Low Back Condition (DC 5237) Leg length discrepancy from femur shortening and gait abnormalities from femur impairment commonly cause secondary low back strain. This may be ratable as a secondary service connected condition caused by the femur disability.
- Heterotopic Ossification Heterotopic ossification can develop as a complication of femur fracture, particularly post surgically. It may cause additional limitation of hip ROM and pain beyond the primary femur pathology, warranting separate documentation.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.