Tibia and Fibula - Impairment of C&P Exam Prep

Knee Range of Motion (Active)

What it measures: Active flexion and extension of the knee joint on the affected side

What to expect: Examiner asks you to bend and straighten your knee as far as you can without assistance. Normal flexion is 0-140 degrees; normal extension is 0 degrees.

Pain considerations: Tell the examiner exactly where pain occurs during the arc of motion (e.g., 'I feel sharp pain in the front of my lower leg at about 60 degrees of flexion'). This pain documentation is critical for DeLuca functional loss findings.

Knee Range of Motion (Passive)

What it measures: How far the examiner can move your knee without your active muscle effort

What to expect: Examiner will gently move your knee through its range while you relax. Per Correia v. McDonald, both active and passive ROM must be tested.

Pain considerations: Inform the examiner of any pain, crepitus, or tenderness elicited during passive testing. These findings go into the DBQ pain-on-passive-motion fields.

Weight-Bearing vs. Non-Weight-Bearing ROM

What it measures: Whether bearing weight on the limb further restricts motion or increases pain

What to expect: Per Correia requirements, the examiner should test the joint in both weight-bearing and non-weight-bearing positions when feasible.

Pain considerations: Weight-bearing pain in the lower leg directly supports functional loss and may reflect incomplete union or malunion of the tibia/fibula.

Repetitive Use Testing

What it measures: Whether repeated movement of the joint causes additional pain, weakness, fatigue, or reduced ROM

What to expect: Examiner may ask you to flex/extend the knee multiple times, or may ask about your experience with repetitive activity. Per DeLuca v. Brown, the report must address functional limitation after repetitive use.

Pain considerations: This is one of the most underreported aspects. State clearly: 'After walking two blocks, the pain in my lower leg increases from a 4 to an 8 out of 10 and I have to stop and rest.'

Leg Length Discrepancy Measurement

What it measures: Whether the tibia/fibula fracture or malunion has caused shortening of the affected extremity relative to the contralateral leg

What to expect: Examiner measures from a bony landmark (e.g., anterior superior iliac spine to medial malleolus) on both legs. Results are recorded in centimeters.

Pain considerations: Leg length discrepancy from tibia/fibula malunion can cause secondary spine and hip strain - mention any related pain patterns.

Assessment for Nonunion vs. Malunion

What it measures: Whether the tibia/fibula fracture healed improperly (malunion - healed but in abnormal position) or failed to heal (nonunion - loose motion at fracture site)

What to expect: Examiner will palpate the fracture site, review imaging, and assess for abnormal mobility or deformity. Nonunion with loose motion requiring a brace is rated at 40% under DC 5262.

Pain considerations: Pain at the fracture site with weight-bearing or palpation directly supports the severity of the impairment.

Ankle Range of Motion

What it measures: Whether the tibia/fibula impairment has affected ankle joint function (plantar flexion, dorsiflexion, inversion, eversion)

What to expect: If the fracture involved the distal tibia or fibula (near the ankle), the examiner will assess ankle ROM in active, passive, weight-bearing, and non-weight-bearing positions.

Pain considerations: Ankle pain during ROM testing should be reported immediately with location, character, and severity.

Muscle Circumference / Atrophy Measurement

What it measures: Whether disuse atrophy has developed in the thigh or calf musculature due to pain, immobility, or nerve involvement

What to expect: Examiner may measure calf or thigh circumference bilaterally at a defined landmark to document muscle wasting.

Pain considerations: Disuse atrophy from pain avoidance is a legitimate finding - describe how pain has limited your use of the affected leg.

40%

Nonunion of tibia and/or fibula with loose motion requiring a brace. This is the highest specific rating under DC 5262. The fracture has failed to heal and the fracture site demonstrates abnormal motion (loose/unstable). The veteran must require a brace to stabilize the lower leg.

From 38 CFR: 38 CFR - 4.71a, DC 5262: 'Nonunion of, with loose motion, requiring brace - 40'

0%

Malunion of tibia and/or fibula. DC 5262 does not independently rate malunion - instead, malunion is evaluated under DC 5256 (ankylosis of knee), DC 5257 (other impairment of knee), DC 5260 (limitation of flexion of the leg), or DC 5261 (limitation of extension of the leg), depending on the specific functional impairment resulting from the malunion. The rating assigned will reflect the degree of limitation of motion, instability, or ankylosis present.

From 38 CFR: 38 CFR - 4.71a, DC 5262: 'Malunion of: Evaluate under diagnostic codes 5256, 5257, 5260, or [5261]'

Pain - Location, Character, and Severity

How to describe it: Describe the exact location (e.g., mid-shaft tibia, distal fibula, fracture site), character (sharp, aching, burning, throbbing), severity on a 0-10 scale at rest and with activity, and what makes it better or worse.

Example: On my worst days, the pain at the fracture site on my shin is a 9 out of 10 when I try to walk more than half a block. The pain is sharp and stabbing when I step down on my heel and a constant deep ache at rest that wakes me from sleep.

Examiner listens for: Examiner is documenting pain for the DBQ pain checkboxes (active motion, passive motion, rest) and for DeLuca functional loss. They want specificity about timing, triggers, and severity.

Avoid: Do not say 'it's not too bad' or 'I manage.' Do not minimize pain when asked about your worst days. Do not conflate your average pain with your best pain.

Functional Loss - What You Cannot Do

How to describe it: Describe specific activities you can no longer perform or perform with difficulty: walking distance, climbing stairs, standing duration, kneeling, squatting, carrying weight, recreational activities, occupational tasks.

Example: On bad days I cannot walk more than 100 feet without stopping due to pain and instability in my lower leg. I cannot stand at a kitchen counter for more than five minutes. I have not been able to run, jump, or participate in any sports since my fracture. I dropped a grocery bag last week because the pain was so severe I lost my balance.

Examiner listens for: The examiner needs to document disturbance of locomotion, interference with standing and sitting, weakened movement, and instability of station for the DBQ functional loss section.

Avoid: Do not say 'I can do most things.' Do not compare yourself to before your military service. Describe your current functional reality on your worst days.

Instability and Loose Motion at Fracture Site

How to describe it: If you have nonunion, describe any sensation of abnormal motion, clicking, giving way, or instability specifically at the fracture site. Explain that you rely on a brace to prevent the leg from buckling.

Example: Without my brace, I feel my lower leg shift at the old fracture site when I try to put weight on it. It feels like the bones are not connected. I fell last month because I tried to walk without my brace for a few seconds and my leg gave out completely.

Examiner listens for: Documentation of loose motion at a nonunion site is the key clinical finding for the 40% DC 5262 rating. The examiner needs to observe or confirm abnormal mobility and brace requirement.

Avoid: Do not fail to mention the brace if you use one. Do not describe instability vaguely - be specific about what happens when you try to weight-bear without the brace.

Deformity and Leg Length Discrepancy

How to describe it: Describe any visible or functional deformity: bowing of the lower leg, rotational asymmetry, the affected leg appearing shorter, altered gait pattern (limp, toe-out, compensatory lean).

Example: My right lower leg is visibly bowed outward since the fracture healed. My right leg is about an inch shorter than my left, which causes me to limp and has led to hip and back pain from the uneven gait. My shoe has been modified with a lift but it still does not fully correct the discrepancy.

Examiner listens for: Examiner is documenting deformity, leg length discrepancy measurements, and related gait disturbance for the DBQ fields on shortening and deformity.

Avoid: Do not fail to mention secondary problems caused by the deformity (back pain, hip pain, altered gait). Bring heel lift or shoe modification if applicable.

Fatigue, Weakness, and Incoordination (DeLuca Factors)

How to describe it: Describe how the lower leg becomes weaker, more painful, or uncoordinated with sustained or repeated use. Quantify how quickly fatigue sets in and how long recovery takes.

Example: After climbing one flight of stairs, my lower leg muscles feel completely exhausted and the pain triples. I then have to sit for at least 20 minutes before I can use the leg normally again. By the end of the day I am dragging my foot slightly because the leg muscles are so fatigued.

Examiner listens for: The DBQ has specific checkboxes for pain, weakness, fatigability, incoordination, and lack of endurance. The examiner must address each DeLuca factor. Your descriptions drive these findings.

Avoid: Do not focus only on pain. Weakness, fatigue, and incoordination are separately ratable factors under DeLuca and must be reported independently.

Flare-Ups - Frequency, Duration, and Triggers

How to describe it: Describe how often flare-ups occur, how long they last, what triggers them, and what your functional capacity is during a flare-up versus a typical day.

Example: I have severe flare-ups two to three times per week, triggered by walking more than a block, cold weather, or standing longer than ten minutes. During a flare-up, the fracture site swells, the pain reaches 9 out of 10, and I am completely unable to weight-bear. These episodes last 24 to 48 hours and I cannot leave my home during them.

Examiner listens for: The examiner is required under DeLuca to address functional limitation during flare-ups. Your description of flare-up severity directly affects the rating assigned.

Avoid: Do not say 'I occasionally have bad days.' Quantify frequency, severity, duration, and functional impact of each flare-up. This is critical for the DBQ narrative fields.

Assistive Device Use

How to describe it: Describe every assistive device you use, how often you use it, for what activities, and what happens if you try to function without it.

Example: I wear a custom ankle-foot orthosis (AFO) brace every day from the moment I get out of bed. Without it, I cannot safely weight-bear because my lower leg is unstable at the fracture site. On days when my leg is particularly bad, I also use a single cane in my opposite hand to redistribute weight.

Examiner listens for: Examiner documents specific assistive devices (cane, crutch, brace, walker, wheelchair) in multiple DBQ sections. Brace use is specifically required for the 40% DC 5262 nonunion rating.

Avoid: Do not leave your brace or assistive device at home. Do not downplay how often you use it. Bring the actual device to the exam so it can be documented.