Flare-Ups: How They Impact Orthopedic Ratings
What is a Flare-Up?
In regards to orthopedic conditions, a flare-up is defined as a sudden and temporary increase in symptoms. Flare-ups are typically recurrent, but unpredictable and arise without warning. The abrupt escalation in symptoms, including pain and loss of mobility, can sometimes result in complete incapacitation. If you are service-connected for an orthopedic condition, the presence of flare-ups could impact your disability rating.
How Does VA Rate Orthopedic Conditions?
When evaluating orthopedic conditions, VA uses a schedule of ratings based on the location and type of injury. Typically, VA will rate orthopedic conditions based on diagnostic testing of a veteran’s range of motion as well as functional loss. Functional loss can be shown through weakness, incoordination, and in some cases instability. Additionally, VA is supposed to consider if a veteran experiences pain during motion, and whether that pain causes functional loss. However, assigning a disability rating based on the above factors alone, does not always provide a complete picture of the extent of the orthopedic condition and its impact on daily life. This is where it becomes important for VA to take flare-ups into account.
How Do Flare-Ups Impact Orthopedic Ratings?
A higher rating may be awarded when there is additional loss or limitation of motion due to pain during flare-ups. For example, a veteran is granted service connection for a back condition and receives a 10 percent disability rating. On most days, the veteran is unable to bend forward more than 60 degrees. However, when experiencing a flare-up, the veteran is unable to bend forward more than 30 degrees. Therefore, during the flare-up the veteran’s back condition becomes much more disabling than 10 percent. As such, VA should assign a disability rating in accordance with this additional loss.
How Are Flare-Ups Addressed in C&P Exams?
When attending a C&P exam for an orthopedic condition, veterans should mention if they experience flare-ups and any accompanying functional limitations. Importantly, examiners must address flare-ups when assessing orthopedic conditions. In a 2017 Court of Appeals for Veterans Claims case, Sharp v. Shulkin, the court decided that examiners must offer an opinion on how the veteran could be functionally limited during a flare-up, even if the exam is not being performed during a flare-up. If an examiner fails to do so, then the exam is inadequate for VA rating purposes and a new exam may be warranted. If the examiner is unable to provide an opinion, they must prove they have considered all of the evidence available before arriving at that conclusion.
