Bursitis C&P Exam Prep

Active Range of Motion (AROM) - Affected Joint

What it measures: The maximum range of movement you can achieve on your own without assistance, measured in degrees using a goniometer.

What to expect: The examiner will ask you to move the affected joint (e.g., shoulder abduction, hip flexion, knee flexion) through its full range while they measure the degrees achieved. They will record the point at which pain begins and the endpoint of motion.

Pain considerations: Pain itself constitutes functional loss under 38 CFR 4.40 and 4.45. If pain stops you before reaching a normal endpoint, state that clearly. The examiner should record where pain begins, not just the final degree achieved.

Passive Range of Motion (PROM) - Affected Joint

What it measures: The range of movement the examiner can achieve by moving your joint for you, without your muscle effort. Compared to AROM to identify pain-versus-structural limitation.

What to expect: The examiner will gently move your affected limb while you relax the muscles. They will note any difference between active and passive ranges and whether pain occurs during passive motion.

Pain considerations: Even if passive ROM is greater than active, pain during passive motion is still relevant and should be reported to the examiner.

Weight-Bearing and Non-Weight-Bearing ROM (Lower Extremity Bursitis)

What it measures: For bursitis affecting the hip, knee, or ankle, the examiner should measure ROM both while bearing weight (standing) and while non-weight-bearing (lying or sitting) per Correia requirements.

What to expect: If your bursitis affects a lower extremity joint, the examiner may test your range of motion while you stand and then again while seated or lying down. The results may differ significantly.

Pain considerations: Weight-bearing pain is particularly relevant for demonstrating how bursitis affects your daily function, including standing at work, walking distances, and climbing stairs.

Repetitive-Use Range of Motion Testing (DeLuca Compliance)

What it measures: Whether your ROM decreases after three repetitions of the movement, indicating that pain, weakness, or fatigue during use causes additional functional limitation beyond the initial measurement.

What to expect: The examiner should ask you to repeat the ROM motion three times and then re-measure. If your range decreases or your pain increases after repetition, that additional loss is recorded as functional impairment.

Pain considerations: Many veterans with bursitis experience the most significant functional limitation during or after sustained or repetitive activity. This is your opportunity to document that reality accurately.

Inflammatory Markers (ESR, CRP, CBC)

What it measures: Blood tests that can indicate systemic inflammation, anemia of chronic disease, or other abnormalities associated with inflammatory bursitis.

What to expect: The examiner may review existing lab results from your medical records. These tests are more likely to be ordered or reviewed if your bursitis has an inflammatory or systemic cause. Bring copies of any recent labs you have.

Pain considerations: Elevated inflammatory markers provide objective corroboration for the pain and functional limitation you report during the examination.

Imaging Review (X-ray, MRI, Ultrasound)

What it measures: Structural evidence of bursitis, including bursal sac enlargement, calcific deposits, associated joint changes, or fluid accumulation visible on imaging.

What to expect: The examiner will review any available imaging results. They may also order new imaging if none is on file. MRI and ultrasound are the most sensitive for confirming bursitis; X-rays may show calcific bursitis or associated joint changes.

Pain considerations: Imaging findings provide objective support for the pain and functional limitations you report, making your overall account more credible and complete.

0%

Bursitis rated as 0% when the condition is confirmed service-connected but produces no current functional impairment or symptoms warranting a compensable rating. The condition exists but does not currently limit function.

From 38 CFR: Under DC 5019, bursitis is rated by analogy to the closest analogous joint condition under 38 CFR 4.71a. A 0% rating indicates diagnosis without compensable disability.

10%

Mild bursitis with occasional non-incapacitating exacerbations, minimal range of motion limitation, and pain controlled with over-the-counter medications or mild treatment. Functional limitation is present but minimal.

From 38 CFR: Rated by analogy under the applicable joint DC (e.g., shoulder, hip, knee). 10% reflects mild limitation consistent with early or well-controlled bursitis with objective findings.

20%

Moderate bursitis with frequent non-incapacitating exacerbations or occasional incapacitating episodes. Moderate range of motion limitation with pain on use. Requires prescription medications or corticosteroid injections.

From 38 CFR: Under the analogous joint rating, 20% reflects moderate impairment. The combination of frequent exacerbations, range of motion loss, and medication requirements supports this level.

30%

Moderately severe bursitis with marked limitation of range of motion, recurring incapacitating exacerbations, significant pain on use, and notable functional impairment affecting employment and daily activities.

From 38 CFR: Under the analogous joint DC, marked limitation of motion and recurring incapacitating episodes support a 30% rating. DeLuca factors must be fully documented to support this level.

40%

Severe bursitis with pronounced limitation of motion, chronic incapacitating exacerbations, severe pain, and profound functional impairment. May require surgical intervention or continuous high-level medical management.

From 38 CFR: The highest analogous joint ratings (40%+) apply when there is severe, chronic functional impairment. Bursitis rated under DC 5019 by analogy can reach these levels when the joint involved is severely affected and the evidence documents the full extent of impairment.

Pain - Location, Quality, and Severity

How to describe it: Describe the exact location of your pain (e.g., 'deep aching pain over the point of my shoulder,' 'sharp pain on the outside of my hip when I lie on it'). Rate pain on a 0-10 scale for both your average day and your worst day. Describe what makes it worse (overhead reaching, prolonged sitting, walking, stairs) and what, if anything, provides relief.

Example: On my worst days, the pain in my shoulder bursa is a 9 out of 10. I cannot lift my arm above waist height, cannot dress myself without help, and the pain wakes me from sleep multiple times per night. Even lying still, I have a constant 5 out of 10 aching that makes it impossible to rest comfortably.

Examiner listens for: Specific location consistent with known bursae, pain severity on a numeric scale, activities that provoke pain, radiation of pain, impact on sleep, and whether pain is present at rest versus only with activity.

Avoid: Do not say 'the pain is not that bad' or 'I manage it okay' if you are actually limiting your activities, taking pain medication regularly, or avoiding movements due to pain. Describe your reality accurately, including on difficult days.

Range of Motion Limitation

How to describe it: Describe specifically which movements you cannot perform or can only partially perform. Use functional examples: 'I cannot reach above my shoulder to get items from a shelf,' 'I cannot fully straighten my knee when walking,' 'I cannot rotate my hip enough to put on my socks without pain.'

Example: On a bad day, I cannot raise my arm above elbow height at all. I cannot reach across my body, and any attempt to lift even a light object causes sharp pain that forces me to stop immediately. I have stopped doing any overhead work entirely.

Examiner listens for: Specific functional limitations tied to the affected joint, consistency between reported limitations and objective ROM findings, whether limitation is pain-driven or structural, and how limitation has changed over time.

Avoid: Do not demonstrate full range of motion if it causes pain to do so - stop where you genuinely stop in daily life. Do not perform movements you would never attempt at home just because someone in a clinical setting is watching.

Flare-Ups (Exacerbations) - Frequency, Duration, and Severity

How to describe it: Clearly distinguish between non-incapacitating exacerbations (increased pain that limits some activities but does not require bed rest) and incapacitating exacerbations (periods when you are essentially confined to bed or completely unable to perform any meaningful activity). For each, state how often they occur and how long they last.

Example: I have incapacitating flare-ups about twice a month, each lasting 3 to 5 days. During these episodes, I cannot get out of bed without help, I cannot drive, and I have missed work on multiple occasions. My non-incapacitating flare-ups happen almost weekly and last 1 to 2 days each.

Examiner listens for: Clear distinction between incapacitating and non-incapacitating episodes, specific frequency (times per week/month), duration of each episode, what triggers them, what relieves them, and documented missed work or activity days.

Avoid: Do not describe every episode as 'mild' or say you 'just push through it.' If you have had to stay home from work, cancel plans, or rely on others for basic tasks during a flare, that is an incapacitating episode and should be described as such.

DeLuca Factors - Fatigue, Weakness, and Incoordination with Use

How to describe it: Describe how your symptoms change after sustained or repetitive use of the affected joint. For example: 'After using my arm for 20 minutes of light activity, my shoulder becomes so painful I have to stop for at least an hour,' or 'After walking two blocks, my hip pain increases from a 4 to an 8 and I need to sit down.'

Example: If I try to use my shoulder for more than 10 consecutive minutes - even light tasks like typing or stirring - the pain increases dramatically and my arm becomes weak and shaky. I then need to rest it completely for hours before I can try again. This severely limits my ability to work.

Examiner listens for: Whether symptoms worsen with repetitive use, how quickly fatigue or increased pain develops, what recovery time is needed, and whether weakness or incoordination accompany pain during use.

Avoid: Do not skip mentioning post-activity pain increases just because you were able to perform the movement during the exam. The exam is a snapshot; your daily experience of fatigue and increased pain after use is equally important and legally recognized under DeLuca v. Brown.

Functional Impact - Work, ADLs, and Social Activities

How to describe it: Be specific about which job tasks, household tasks, and recreational activities you can no longer perform or can only perform with significant limitation. Name the activity and describe how the bursitis affects it: 'I cannot type for more than 15 minutes,' 'I cannot carry groceries,' 'I had to stop coaching my child's sports team.'

Example: On my worst days, I cannot prepare my own meals, shower without a shower chair, or drive to medical appointments. I have had to ask family members to help me dress, and I have been unable to work my full shift on multiple occasions each month due to the pain.

Examiner listens for: Specific named activities and how they are affected, whether limitations are consistent with the diagnosed condition and affected joint, use of adaptive strategies, and impact on employment including missed days or reduced hours.

Avoid: Do not give vague answers like 'it affects a lot of things.' Name the specific things. The examiner needs concrete functional examples to document accurately in the DBQ field for functional impact.

Treatment History and Medication Use

How to describe it: Provide a complete list of all treatments you have received for bursitis, including: corticosteroid injections (how many, how often, which joint), physical therapy (how many sessions, what period), NSAIDs, prescription pain medications, biologics, and any surgical procedures. Note which treatments helped and which did not.

Example: I have received six corticosteroid injections into my shoulder bursa over the past three years, and each provides only 4 to 6 weeks of partial relief before pain returns. I take prescription meloxicam daily and still have significant pain. I completed 12 weeks of physical therapy with only temporary improvement.

Examiner listens for: The extent and chronicity of treatment, whether conservative measures have failed, the frequency of injections, use of prescription versus over-the-counter medications, and whether more aggressive intervention has been required.

Avoid: Do not downplay the number of treatments you have received or imply that treatment has fully resolved the condition if you are still symptomatic. The need for repeated injections or ongoing prescription medication is objective evidence of an active, chronic condition.