## Facts

- Tyra K. Mitchell served on active duty in the U.S. Navy (1988–1991) and later served in the U.S. Air Force Reserves.
- In June 2005, during inactive duty for training, Mitchell’s left knee “popped,” buckled, and she fell; she was diagnosed with a torn ACL and torn anterior aspect of the lateral meniscus.
- Mitchell underwent left-knee reconstructive surgery on August 16, 2005.
- In December 2005, Mitchell filed a claim for VA disability compensation for residuals of her left-knee ACL reconstruction.
- At a January 2006 VA examination, Mitchell reported intense knee pain with standing, walking, and certain movements. The examiner noted pain through a significant portion of the available range of motion but stated that the measured range of motion was not significantly limited by pain.
- The examination recorded left-knee motion findings including extension to 0 degrees and flexion measurements reported as 100 degrees passive without pain and 115 degrees active with pain (normal flexion is 140 degrees).
- The VA regional office granted service connection and assigned an initial 10% rating based on degenerative arthritis under Diagnostic Code (DC) 5003, rather than assigning a rating based on compensable limitation of flexion (DC 5260) or extension (DC 5261).
- Mitchell appealed for a higher initial rating. In February 2009, the Board of Veterans’ Appeals denied a rating above 10%.
- Mitchell appealed to the United States Court of Appeals for Veterans Claims (CAVC).

## Issues

1. Whether pain, by itself, throughout a joint’s range of motion constitutes a functional loss that entitles a veteran to a higher disability rating under VA regulations governing range-of-motion ratings.
2. Whether the Board erred by relying on a VA examination and analysis that did not sufficiently describe any additional functional loss caused by pain during repeated use or flare-ups, as required by DeLuca and 38 C.F.R. §§ 4.40 and 4.45.
3. Whether DC 5003 was properly used for a 10% arthritis rating when the record did not clearly address whether pain produced additional limitation of motion that could meet the compensable criteria under DCs 5260 or 5261.

## Decision

- The CAVC held that pain alone does not constitute functional loss for VA purposes when a disability is evaluated based on limitation of motion.
- The court explained that “painful motion” is not the same as “limited motion”; a higher rating under range-of-motion diagnostic codes requires evidence that pain results in actual functional impairment (for example, additional limitation of motion or other impairment of normal working movements).
- The court determined that the Board improperly relied on a VA examination that documented pain but did not adequately describe whether, and to what extent, pain caused additional functional loss during repetitive use or flare-ups in terms that would allow application of the rating criteria.
- The court noted that Mitchell’s argument focused on functional loss only as it affected range of motion (excursion), not on other possible components of joint function.
- Disposition: the court vacated the Board’s decision and remanded the matter for further proceedings consistent with the opinion.

## Legal Principles

- Under 38 C.F.R. § 4.40, functional loss concerns impairment of normal working movements of the body; pain is relevant only to the extent it produces such impairment.
- Pain may cause functional loss, but pain itself is not functional loss; the presence of pain during motion does not automatically establish entitlement to a higher rating under limitation-of-motion diagnostic codes.
- When a musculoskeletal disability is rated based on limitation of motion, VA must consider functional loss due to pain, weakness, fatigability, and incoordination under 38 C.F.R. §§ 4.40 and 4.45, including during flare-ups and after repeated use (DeLuca v. Brown).
- Examinations used for rating purposes should describe the effect of pain on function in a way that can be applied to the rating schedule—ideally by identifying additional range-of-motion loss (in degrees) or otherwise describing the severity, frequency, and resulting functional limits.
- DC 5003 provides a 10% rating for degenerative arthritis shown by X-ray when limitation of motion is present but remains noncompensable under the specific joint limitation-of-motion codes; if pain-related functional impairment produces compensable limitation under DC 5260 or DC 5261, evaluation should be based on those codes rather than relying solely on DC 5003.

## Conclusion

Mitchell v. Shinseki holds that pain throughout a joint’s range of motion does not, by itself, equal functional loss for purposes of higher ratings based on limited motion; however, VA must obtain and rely on examinations that meaningfully describe whether pain causes additional functional impairment—particularly during flare-ups or repeated use—so the Board can correctly apply the limitation-of-motion criteria and determine whether DC 5003 or the specific range-of-motion codes govern the rating.


Mitchell v. Shinseki, 25 Vet. App. 32 (2011)