Genu Recurvatum C&P Exam Prep

Knee Flexion Range of Motion

What it measures: Active and passive flexion of the knee joint; normal is 0-140 degrees

What to expect: Examiner will use a goniometer to measure how far you can bend your knee. You will be tested in both active (you move it) and passive (examiner moves it) conditions, and in weight-bearing and non-weight-bearing positions. Expect testing before and after repetitive use.

Pain considerations: Inform the examiner at exactly which degree of flexion pain begins, not just the endpoint. Per DeLuca v. Brown, pain on movement, weakness, and fatigability must be documented as they can support additional limitation of motion beyond the measured endpoint.

Knee Extension / Genu Recurvatum Measurement

What it measures: The degree to which the knee hyperextends beyond 0 degrees of neutral extension; this is the primary measurement for DC 5263

What to expect: Examiner will measure passive and active extension of the knee. Hyperextension (recurvatum) is documented in degrees past 0. The examiner will also observe your knee during standing and walking for objective evidence of buckling, instability, or abnormal gait pattern indicative of weakness and insecurity in weight-bearing.

Pain considerations: Describe pain that occurs specifically when weight is placed on the affected knee, including aching, instability, or the sensation of the knee 'giving out.' These are directly relevant to the 'insecurity in weight-bearing' criterion under DC 5263.

Repetitive Use Range of Motion Testing

What it measures: Whether range of motion decreases after repeated movement, reflecting fatigue and functional deterioration

What to expect: After initial ROM testing, the examiner may ask you to perform repeated knee flexion/extension cycles (typically 3 repetitions). ROM is then re-measured. Any decrease in ROM, increase in pain, or onset of weakness or fatigue is documented.

Pain considerations: State clearly if the pain or instability is worse after repeated use than at the start of the exam. This directly supports a finding of functional impairment beyond what the initial measurement captures.

Weight-Bearing vs. Non-Weight-Bearing ROM

What it measures: Differences in range of motion and symptoms when the joint bears body weight versus when it is unloaded

What to expect: Per Correia requirements, ROM should be measured in both weight-bearing (standing) and non-weight-bearing (seated or supine) positions for the knee. Your examiner should compare these values.

Pain considerations: Pain and instability in weight-bearing that is absent at rest is highly relevant to DC 5263, which specifically requires insecurity in weight-bearing to be objectively demonstrated. Verbalize this distinction clearly.

Knee Instability Assessment

What it measures: Degree of anterior, posterior, medial, or lateral instability of the knee joint

What to expect: Examiner will perform stress tests (Lachman, anterior/posterior drawer, valgus/varus stress tests) to assess ligamentous stability. Findings of instability are relevant if they coexist with genu recurvatum and may qualify for separate evaluation under DC 5257 if the instability is not overlapping with the recurvatum evaluation.

Pain considerations: Instability that occurs on uneven ground, on stairs, or when pivoting is especially important to mention. Describe the sensation of the knee shifting, buckling, or collapsing under load.

10%

Acquired and/or traumatic genu recurvatum with weakness and insecurity in weight-bearing objectively demonstrated. This is the only rating level available under DC 5263. The deformity must be (1) acquired or traumatic in origin, (2) involve hyperextension of the knee beyond 0 degrees, and (3) be accompanied by objectively demonstrated weakness and insecurity in weight-bearing. A purely congenital or positional genu recurvatum without objective functional impairment does not qualify.

From 38 CFR: 38 CFR 4.71a DC 5263: 'Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) - 10%'. The rating note references the Ankle Rating schedule for consideration of analogous codes.

Weight-Bearing Insecurity and Instability

How to describe it: Describe the specific sensations and events that occur when you put weight on the affected knee. Use concrete language: the knee 'buckles,' 'gives out,' 'collapses,' or 'feels like it will bend backward.' Quantify frequency (e.g., 'several times per week'), triggers (uneven ground, stairs, pivoting, prolonged standing), and consequences (falls, near-falls, compensating gait).

Example: On my worst days, my right knee buckles at least two to three times while walking on flat ground. I have fallen twice this month because the knee bent backward unexpectedly when I shifted my weight. I cannot stand for more than 10 minutes without gripping a wall or furniture because I do not trust the knee to hold me up. I avoid stairs without a railing entirely.

Examiner listens for: Specific description of objective episodes where the knee fails under load; frequency and predictability of instability; adaptive behaviors that confirm functional insecurity; history of falls attributable to the knee giving way; use of assistive devices or bracing

Avoid: Do not say 'my knee is a little weak' or 'it sometimes feels unstable.' These vague descriptions may not be sufficient to document the 'objectively demonstrated' standard. Use specific, event-based language.

Hyperextension Deformity (Recurvatum)

How to describe it: Explain when you first noticed the knee bending backward past straight, the circumstances of the injury or condition that caused it, and how it has changed over time. Describe whether the hyperextension is visible to others, whether it is worse with fatigue, and whether it causes pain or structural discomfort when it occurs.

Example: My left knee bends backward past straight every time I stand up from a chair or lock my leg while standing. My physical therapist pointed it out on video - the knee visibly bows backward about 10 degrees when I stand. It is worse at the end of the day when my muscles are fatigued; the hyperextension becomes more pronounced and I feel a sharp pull behind the knee.

Examiner listens for: Observable or reported hyperextension beyond neutral; correlation with fatigue and functional use; traumatic or acquired onset distinguishable from congenital presentation; description of the deformity worsening with activity or at end of day

Avoid: Do not minimize the deformity by saying 'my knee just goes straight.' Clarify that it goes beyond straight - past 0 degrees into hyperextension. The distinction is clinically and legally meaningful for DC 5263.

Pain with Weight-Bearing and Activity

How to describe it: Describe pain using location (behind the knee, along the joint line, diffuse), character (aching, sharp, burning, pressure), onset timing (immediate with weight, after prolonged standing, during or after activity), and severity on a 0-10 scale for typical and worst-day scenarios. Include pain at rest versus during motion versus at the end of range.

Example: On my worst days, the pain in the back of my right knee is a 7 out of 10 when I am standing or walking. It starts as a deep ache within the first five minutes of standing and becomes sharp when the knee hyperextends. Even at night I wake up with a 4 out of 10 aching pain that prevents restful sleep. I took 800mg of ibuprofen three times yesterday and it only took the edge off.

Examiner listens for: Pain that is specifically provoked by or worsened during weight-bearing; pain at end-range of extension; pain that persists after activity; use of pain medications and their effectiveness; sleep disruption attributable to pain

Avoid: Do not say you are 'doing okay' or 'managing the pain fine.' If you take medications, use ice, or limit activity because of pain, those are important facts. Describe what your life looks like on a bad day, not your best adapted day.

Weakness, Fatigue, and Lack of Endurance

How to describe it: Per DeLuca v. Brown, weakness, fatigability, and lack of endurance are separately ratable factors of functional impairment. Describe specifically how the knee muscles fatigue faster than normal, how weakness prevents or limits activities, and how the knee performs worse after repeated use compared to initial use.

Example: My quadriceps on the left leg are noticeably weaker than the right - I cannot do a single-leg squat on that side without the knee collapsing. After walking one block, the knee feels heavy and unreliable, and I have to sit down. By mid-afternoon I cannot trust the knee to hold me through a normal gait cycle, so I switch to using a cane. The weakness is worse at the end of the day compared to the morning.

Examiner listens for: Muscle atrophy or asymmetry; functional deficit in quadriceps or hamstring strength testing; decreased performance after repetitive use; veteran's subjective account of earlier onset of fatigue compared to before injury; adaptive behaviors due to weakness

Avoid: Do not say 'I get tired' without connecting it to the knee specifically. Describe the knee giving out, the thigh muscle burning or cramping, or the leg feeling like it cannot support your weight after a certain amount of activity.

Flare-Ups

How to describe it: Describe periods when the genu recurvatum and associated symptoms are significantly worse than baseline. Include triggers (weather changes, increased activity, prolonged standing, stress), duration of flare-ups, symptoms during flare-ups, and how they impact daily functioning and work capacity.

Example: I have flare-ups two to three times per month, usually triggered by any activity involving more than 20 minutes of walking or standing. During a flare-up, the hyperextension is much more pronounced and I cannot bear full weight on the leg. The knee swells slightly behind the joint, and the pain increases to 8 out of 10. Flare-ups last two to four days during which I am essentially housebound and cannot work or perform basic household tasks.

Examiner listens for: Distinct periods of worsened symptoms beyond baseline; identifiable triggers; duration and frequency; impact on work and daily function during flare-ups; treatment required during flare-ups (rest, ice, medication escalation)

Avoid: Do not omit flare-ups because you are having a good day at the exam. The examiner is required to rate your condition at its worst typical presentation, not only as observed on exam day. Proactively describe your worst-day scenario even if today is better.

Functional Impact and Activities of Daily Living

How to describe it: Connect the genu recurvatum directly to specific limitations in daily activities, work tasks, and recreational activities. Be specific: which tasks, how frequently impacted, what workarounds you use, what you can no longer do that you previously could.

Example: I can no longer walk more than a quarter mile without stopping due to knee giving out and pain. I cannot kneel, squat, or climb ladders safely. I was a construction worker and had to change careers because I cannot stand on scaffolding or uneven surfaces. I cannot play with my children on the floor. I dropped a plate last week when my knee buckled without warning while I was standing at the sink.

Examiner listens for: Direct causal link between the knee condition and functional limitations; impact on employment and vocational activities; personal care activities affected; social and recreational restrictions; safety risks from instability

Avoid: Do not say 'I get around okay' or 'I adapt.' Describe what you cannot do, what you have stopped doing, and what you do differently because of the knee - not how well you have compensated.