Document ID: chunk:federal_register_of_legislation:F2016L01332:reg:60:p1
Version: federal_register_of_legislation:F2016L01332
Segment Type: reg
Provision Reference: reg 60 (pt 1/6)
Character Range: 97215–99838

60

Step 2: Establish which joints in the right upper limb have some restriction of movement as a result of accepted conditions of the right upper limb.

    For the purposes of assessment under the Guide, the major joints of the upper limb are the shoulder, the elbow and the wrist.

    In addition, the joints of the thumb and fingers are also to be considered. However, only one rating is to be given for the total effect of restrictions in all joints of the thumb and fingers considered together.

    Conditions such as painful arc syndrome and fractured neck of humerus may affect the range of movement (ROM) of the shoulder. A condition such as fractured scaphoid will be likely to affect the ROM of the wrist. In cases of fractures, the ranges of movements of the joints proximal to and distal to the fracture site should generally be considered as joints the ROM of which may be affected.

    Hence, it must be determined which, if any, of
+ shoulder;
+ elbow;
+ wrist; and
+ thumb and fingers,

    potentially have loss of range of movement due to accepted conditions.

    Certain vascular conditions or neurological conditions of the upper limb, such as muscle weakness, tremor, apraxia, and loss of co-ordination, may have an effect on the function of the upper limb without restricting the range of movement of any joint of the limb. The assessment of such conditions is to be made in Step 4 of this Part.

    Step 3: Calculate the functional impairment due to restriction of range of movement of joints in the right upper limb as a result of accepted conditions of the right upper limb.

    Single functional impairment ratings may be obtained for each of the following four joints or sets of joints based on restriction of range of movement due to accepted conditions:
    + shoulder;
+ elbow;
+ wrist; and
+ thumb and fingers.

    These impairment ratings are to be obtained by applying Table 3.1.1. Such functional impairment ratings are referred to as the functional impairment rating of the upper limb based on restriction of range of movement of the shoulder, elbow, wrist, or thumb and fingers respectively.

The loss of range of movement is to be estimated to the nearest quarter of the normal range of movement.

 The range of movement relevant to assessment under this Guide is the active range of movement of the joint, that is the range through which the veteran can move the joint by virtue only of those muscles whose normal function it is to do so. The ability of a veteran to flex a joint by use of other, non-affected body parts does not reduce the rating which the impaired