Thigh, impairment of — VA Diagnostic Code 5253

Abduction: motion lost beyond 10°

Abduction is the motion the schedule names in the 20 percent line: “Limitation of abduction of, motion lost beyond 10°.” The schedule does not define abduction in a sentence under this code. The Hip and Thigh DBQ records an abduction endpoint in degrees, on active and on passive motion.

Adduction: cannot cross legs

The 10 percent adduction line is a task, not a degree: “Limitation of adduction of, cannot cross legs.” The schedule does not add a further definition of “cannot cross legs.” The public Hip and Thigh DBQ asks whether a limitation in adduction prevents the veteran from crossing the legs.

Rotation: cannot toe-out more than 15°

The other 10 percent line is “Limitation of rotation of, cannot toe-out more than 15°, affected leg.” The schedule does not define “toe-out” under this code. The Hip and Thigh DBQ records external rotation and internal rotation in degrees. It does not use the words “toe-out.”

Pain, weakness, and the way the joint is tested

38 CFR § 4.40 (Functional loss) says disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. “Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled.” 38 CFR § 4.45 (The joints) directs inquiry to less movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. For arthritis, “the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints.” 38 CFR § 4.59 (Painful motion) says: “The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” The same section says the intent is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Sections 4.40 and 4.45 do not use the word “flare-up.” The Hip and Thigh DBQ does ask about flare-ups and about observed repetitive use.

Terms the schedule leaves undefined

“Motion lost beyond 10°,” “cannot cross legs,” and “cannot toe-out more than 15°” are the whole criteria. 38 CFR § 4.6 (Evaluation of evidence) requires each element affecting the evidence to be studied so that decisions will be “equitable and just.” 38 CFR § 4.7 (Higher of two evaluations) assigns the higher rating when the disability picture “more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.”

Other hip and thigh codes, instead of DC 5253

The same findings under more than one code

Both lower extremities

What is the VA rating for thigh impairment under DC 5253?

38 CFR § 4.71a rates “Thigh, impairment of” under Diagnostic Code 5253 at 20 percent for “limitation of abduction of, motion lost beyond 10°,” and at 10 percent for limited adduction (“cannot cross legs”) or limited rotation (“cannot toe-out more than 15°, affected leg”). The highest line under this code is 20 percent. Flexion and extension of the thigh are Diagnostic Codes 5252 and 5251. If a compensable line is not met, § 4.31 assigns 0 percent. Education only.

What evidence decides the DC 5253 level?

The words are a degree of abduction, the task of crossing the legs, and toe-out of the affected leg. Those findings usually live in goniometer measurements and in the Hip and Thigh DBQ, which records abduction, adduction, and rotation and asks whether adduction prevents crossing the legs. Sections 4.40, 4.45, and 4.59 require functional loss and painful-motion testing to be part of that picture. Lay evidence can describe the task. It does not replace the measurement. Education only.

Does pain count if hip motion still looks full?

VA’s musculoskeletal rules require the exam to portray functional loss, including pain and weakness, under 38 CFR §§ 4.40 and 4.45. Section 4.59 says the joints involved should be tested for pain on active and passive motion, in weight-bearing and nonweight-bearing, and, if possible, with the opposite undamaged joint. The hip is a major joint under § 4.45. The Hip and Thigh DBQ also asks about flare-ups and repetitive use. Education only.

What does DC 5253 rate?

Diagnostic Code 5253 in 38 CFR § 4.71a is titled “Thigh, impairment of.” It lists limitation of abduction, limitation of adduction, and limitation of rotation. Flexion of the thigh is DC 5252. Extension of the thigh is DC 5251. Ankylosis of the hip is DC 5250. Education only.

What does each DC 5253 level require?

Twenty percent is “Limitation of abduction of, motion lost beyond 10°.” Ten percent is “Limitation of adduction of, cannot cross legs.” The other 10 percent line is “Limitation of rotation of, cannot toe-out more than 15°, affected leg.” The code prints no 0 percent line. Section 4.31 assigns 0 percent when a compensable line is not met.

What is the maximum under DC 5253?

The highest line printed under DC 5253 is 20 percent, for abduction motion lost beyond 10 degrees. The adduction and rotation lines are 10 percent. No higher percentage is printed for this code. Other hip codes, including ankylosis, flail joint, and femur impairment, have their own lines. VA decides from the record.

How is DC 5253 different from DC 5251 and DC 5252?

DC 5251 is extension of the thigh, limited to 5 degrees, at 10 percent. DC 5252 is flexion of the thigh, at 40, 30, 20, or 10 percent depending on the degree. DC 5253 is abduction, adduction, and rotation. They are different lines in the hip and thigh table. This page does not state that more than one of them is assigned together. Section 4.14 says the same disability is not evaluated under various diagnoses.

Does pain count if the measured hip motion looks full?

Section 4.40 says functional loss may be due to pain, supported by adequate pathology and shown by visible behavior during the motion, and that weakness is as important as limitation of motion. Section 4.45 lists pain on movement and less movement than normal. Section 4.59 requires pain testing on active and passive motion, weight-bearing and nonweight-bearing, and, if possible, against the opposite joint. The Hip and Thigh DBQ also asks about flare-ups. Those sections do not use that word.