Hip Ankylosis C&P Exam Prep

Hip Flexion (Active)

What it measures: How far you can bring your knee toward your chest under your own power; normal is 0-125-. In ankylosis, this motion will be severely limited or absent.

What to expect: Examiner asks you to lift your knee toward your chest while standing or lying supine. A goniometer may be used to measure the angle. You will be asked to report pain onset and endpoint.

Pain considerations: Per DeLuca, pain that prevents further motion counts as a functional endpoint. Tell the examiner: 'I can only move to [X] degrees before the pain stops me.' This should be documented as pain-limited ROM.

Hip Extension (Active)

What it measures: Ability to move the leg backward behind the body; normal is 0-20-. In ankylosis, this is typically absent or severely restricted.

What to expect: Examiner asks you to move your leg backward while standing or lying prone. Document any pain onset and endpoint angle.

Pain considerations: Extension is often the most painful movement in hip ankylosis. Clearly communicate whether pain is constant at rest or only provoked by movement.

Hip Abduction and Adduction (Active)

What it measures: Movement of the leg away from (abduction, normal 0-45-) and across (adduction, normal 0-30-) the midline. Position of adduction or abduction at the ankylosed joint affects favorable vs. unfavorable classification.

What to expect: Examiner asks you to move your leg outward and inward. In true ankylosis, this movement is absent or minimal.

Pain considerations: Even minimal attempts at abduction/adduction in an ankylosed hip can cause severe pain. Communicate this clearly.

Internal and External Rotation (Active)

What it measures: Rotational capacity of the hip joint; normal internal rotation 0-45-, external rotation 0-45-. Rotation is typically absent in true ankylosis.

What to expect: Examiner may test rotation with you sitting or lying, rotating the knee inward and outward. May also be tested passively.

Pain considerations: Report pain with any rotational attempt and describe its character: sharp, burning, aching, radiating.

Passive Range of Motion Testing

What it measures: Examiner moves your hip through its range without your muscular effort; compares to active ROM. Per Correia requirements, both active and passive ROM must be documented.

What to expect: Examiner will hold your leg and attempt to move the hip through its range while you relax. Differences between active and passive ROM are clinically significant.

Pain considerations: Pain during passive motion is highly relevant - it demonstrates true joint pathology rather than muscular guarding. State 'Even when you move my leg passively, I have pain at [X] degrees.'

Weight-Bearing vs. Non-Weight-Bearing Assessment

What it measures: Whether the veteran can bear weight on the affected limb and how weight-bearing affects pain and function. Required under Correia standards.

What to expect: Examiner observes your gait, asks you to stand, and may compare ROM measurements taken while standing versus lying down.

Pain considerations: Weight-bearing pain that limits standing and walking is a DeLuca factor. Quantify: 'I can stand for [X] minutes before pain forces me to sit or use my crutches.'

Repetitive Use Testing (DeLuca Factor)

What it measures: Whether ROM decreases and pain/fatigue increases after repetitive use of the hip, reflecting the true functional burden of the condition.

What to expect: Examiner may ask you to perform movements multiple times and reassess ROM and pain after repeated use. Functional loss after activity is documented under DeLuca.

Pain considerations: The law requires examiners to account for DeLuca factors. If these are not assessed, politely note: 'I wanted to mention that my pain and stiffness are significantly worse after any activity, and at the end of the day it is much worse than what you are seeing now.'

90%

Unfavorable or extremely unfavorable ankylosis where the foot does not reach the ground AND crutches are necessitated. This represents the most severe functional impairment - the fixed position of the hip prevents the foot from making ground contact, making independent ambulation without assistive devices impossible.

From 38 CFR: 38 CFR 4.71a DC 5250: 'Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated' - rated 90%.

70%

Intermediate ankylosis - the hip is ankylosed in a position that is neither clearly favorable nor extremely unfavorable. The foot does reach the ground but the fixed position significantly impairs function. The position does not meet criteria for the favorable 60% rating (20-40- flexion with slight adduction/abduction) but is not severe enough for 90%.

From 38 CFR: 38 CFR 4.71a DC 5250: 'Intermediate' ankylosis position - rated 70%. Hip ankylosed outside the favorable range of 20-40- flexion with slight adduction/abduction, but without the extreme presentation of foot not reaching the ground.

60%

Favorable ankylosis - the hip is fixed in flexion between 20- and 40- AND in slight adduction or abduction. This position, while still representing complete joint immobility, allows for relatively functional standing and walking posture. Despite being the lowest rating under DC 5250, 60% still represents substantial disability.

From 38 CFR: 38 CFR 4.71a DC 5250: 'Favorable, in flexion at an angle between 20- and 40-, and slight adduction or abduction' - rated 60%. Both conditions must be met: the angular position AND the adduction or abduction component.

Pain - Location, Character, and Triggers

How to describe it: Describe pain using specific anatomical locations (groin, lateral hip, buttock, radiating down the thigh), character (sharp, aching, burning, throbbing), triggers (weight-bearing, position changes, prolonged sitting or standing, any attempted movement), and severity on a 0-10 scale at rest and with activity. Describe your worst day, not your best day.

Example: On my worst days, the pain in my left hip and groin is a constant 8 out of 10 even at rest. When I try to stand up from a chair, it spikes to a 10 and I have to grab onto something to not fall. I cannot walk more than half a block before the pain forces me to stop. By evening, the pain is so severe I cannot find a comfortable position and my sleep is disrupted every night.

Examiner listens for: Pain onset during range of motion testing, pain at rest vs. on movement, pain that limits repetitive use, radicular or referred pain patterns, pain requiring medication, and functional limitations caused directly by pain.

Avoid: Saying 'it's manageable' or 'I'm used to it' minimizes documented severity. If you have adapted your life around your limitations, that adaptation itself is evidence of disability - describe what you can no longer do, not how you cope.

Ankylosis Position and Fixed Deformity

How to describe it: Describe precisely how your hip is fixed. Can you straighten your leg fully? Is your leg held in a bent position at rest? Does your foot reach the floor when you stand? Do you lean or tilt to compensate? Has anyone measured the angle of fixation on imaging or examination?

Example: My hip is completely frozen - I cannot move it at all. My leg is stuck in a slightly bent and turned-out position. When I stand up, my foot just barely touches the floor but my pelvis tilts severely to one side to make it happen. I have to use my crutches for any distance because I cannot generate any power from that leg.

Examiner listens for: Confirmation of immobility, description of the resting position, ability to achieve ground contact with the foot, and need for assistive devices. These directly determine favorable vs. intermediate vs. unfavorable classification.

Avoid: Do not describe partial ankylosis as 'some stiffness.' If the joint does not move in any plane, state clearly: 'My hip does not move at all - it is completely locked.' Minimizing the immobility can result in rating under a limitation-of-motion code rather than the higher ankylosis code.

Ambulation and Assistive Device Use

How to describe it: Describe exactly what you use for walking (cane, crutches, walker, wheelchair), when you use it (all the time, only on bad days, only outside), how far you can walk, and what happens when you push beyond your limit.

Example: I use crutches every time I leave my home. Inside the house, I hold onto walls and furniture. Without crutches, I fall or my hip gives out within a few steps. The last time I tried to walk without crutches, I fell and injured myself. On my worst days, I cannot get from my bedroom to the bathroom without stopping due to pain and exhaustion.

Examiner listens for: Consistent use of assistive devices, prescribed vs. self-initiated device use, distance walked before stopping, fall history, and whether crutches are truly necessitated (relevant to 90% rating criterion).

Avoid: Do not say 'I only use the crutches sometimes' if you need them for anything more than truly optional use. If your doctor prescribed them or you would fall without them, they are necessitated. Bring them to the exam and use them as you normally would.

DeLuca Factors - Fatigue, Weakness, and After-Activity Worsening

How to describe it: Describe how your condition changes after activity. Does walking a short distance make your hip worse for the rest of the day? Do you experience muscle weakness or give-way episodes? Do you fatigue significantly faster than before the injury?

Example: If I walk more than half a block, my entire leg becomes so weak and fatigued that I have to lie down for the rest of the afternoon. My hip and thigh muscles feel like they have no strength left. By the end of any active day, my pain increases from a 4 to a 9 and I am completely exhausted from the effort of just moving around.

Examiner listens for: Pain, fatigability, weakness, and incoordination that are specifically provoked or worsened by use - the examiner must check these boxes on the DBQ. If they only test you once at rest, these factors may not be captured.

Avoid: Do not only describe your baseline - explicitly state 'After activity, my condition is much worse than what you are observing right now.' The exam typically happens in the morning; your end-of-day condition may be your more representative worst-day experience.

Interference with Activities of Daily Living

How to describe it: Describe specific activities you cannot do or can only do with modification or assistance: bathing, dressing (putting on pants, shoes, socks), driving, climbing stairs, sitting for extended periods, sexual activity, exercise, household chores, and employment tasks.

Example: I cannot put on my own shoes and socks because I cannot bend my hip far enough to reach my foot. I have to use a shower chair because I cannot stand on one leg. I cannot drive a standard vehicle. I cannot sit in a normal chair for more than 20 minutes before the pain becomes unbearable. I had to leave my job because I could not stand or walk for any meaningful period.

Examiner listens for: Concrete functional limitations, occupational impact, and how the ankylosed hip affects the veteran's ability to perform work and self-care - directly relevant to the functional impact field on the DBQ.

Avoid: Do not say 'I get by' without explaining the workarounds required. Each adaptation (shower chair, sock aid, handicap parking, home aide) is evidence of functional limitation.

Flare-Ups

How to describe it: Describe episodes when your condition is significantly worse than your baseline - what triggers them, how long they last, how severe they get, and what you must do to recover (bed rest, medication, ER visits, increased assistive device use).

Example: When I overdo any activity - even just a short shopping trip - I have flare-ups that last 3-5 days where I am essentially bedridden. The pain goes from a 6 baseline to a 10, I cannot bear any weight at all, and I need help from my family for everything including getting to the bathroom. I have these flares at least twice a month.

Examiner listens for: Frequency, duration, severity, and triggers of flare-ups - the DBQ has a specific field for flare-up description. This is a required DeLuca consideration that can significantly impact functional loss documentation.

Avoid: Veterans often minimize flare-ups by only describing their stable baseline. If you have regular episodes of severely worsened function, describe them in detail. The examiner must document the veteran's own description of flare-ups in the DBQ.