Va Service Connected Osteoarthritis Continued Degeneration to Hip Replacement

In this guide, we'll explore the 5 best ways to get a VA Rating for Arthritis even if you've already filed or been denied VA benefits in the past.

Arthritis VA Ratings can be confusing, so hang with me as I explain how the VA rates Arthritis.

Generally, Arthritis, including Osteoarthritis, is rated under Diagnostic Code (DC) 5003, Degenerative Arthritis, with VA ratings of either 10% or 20%, depending on the number of joints impacted and whether there are occasional incapacitating episodes.

However, the most common VA disability rating for Arthritis is under "joint conditions" as Limitation of Range of Motion.

Why?

Because joint conditions are required to be rated under Limitation of Range of Motion first before they can be rated as Degenerative Arthritis.

Degenerative Arthritis can only be rated under a separate Diagnostic Code (DC) if it does not cause Limitation of Range of Motion in a joint.

This is important to understand.

If any condition, such as symptoms of Arthritis, cause a decreased range of motion in a joint, then it must be rated on Limitation of Range of Motion, not as Arthritis.

Conditions cannot be rated under both Limitation of Range of Motion and Degenerative Arthritis due to the avoidance of pyramiding so, Limitation of Range of Motion first, and if not, then only Arthritis.

Okay, let's jump into this Insider's Guide for getting service connected disability for Arthritis.

What is Arthritis in Veterans?

Arthritis is the swelling and tenderness of one or more joints.

The main symptoms of Arthritis are joint pain and stiffness, and generally worsen with age.

While there are many different types of Arthritis, the most common types are Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis causes degenerate changes to the cartilage whereas Rheumatoid Arthritis is a disease whereby the immune system attacks the joints.

According to the Mayo Clinic, there are nine main types of Arthritis:

• Ankylosing spondylitis

• Gout

• Juvenile idiopathic Arthritis

• OsteoArthritis

• Psoriatic Arthritis

• Reactive Arthritis

• Rheumatoid Arthritis

• Septic Arthritis

• Thumb Arthritis

Common Signs and Symptoms of Arthritis

Signs and symptoms of Arthritis in veterans include:

• Joint pain

• Stiffness

• Swelling

• Redness

• Decreased range of motion

• Painful motion

VA Disability Rating for Arthritis: Basic Eligibility Criteria

To be eligible for an Arthritis VA Rating, a veteran must meet three (3) criteria by law:

• #1. Medical diagnosis of Arthritis in a medical record (Service Treatment Records, VA medical records, or private medical records).

• #2. Your Arthritis was caused or made worse by your active-duty military service OR by another service connected disability for secondary service connection ("Nexus" for service connection)

• #3. Persistent and recurring symptoms of Arthritis ("Severity of Symptoms") to include functional impairment or loss and how it affects your work, life, and social functioning

If you think you have some type of Arthritis, but don't have a medical diagnosis,pick-up the phone and call the VA health facility nearest you to make an appointment right away!

If you're trying to increase your VA rating for Arthritis, you need to prove to the VA that your symptoms are now worse and warrant the higher rating criteria by law.

The #1 best way to increase your VA rating for Arthritis is to have objective medical evidence (X-Rays) to show degenerative or post-traumatic changes with worsening symptoms over time.

Is Arthritis a VA Disability?

Yes, Arthritis is a VA disability, and is typically rated under one of three Diagnostic Codes.

Diagnostic Code (DC) 5003: Degenerative Arthritis

Degenerative Arthritis, also known as Osteoarthritis, is rated at 10 percent or 20 percent depending upon the Frequency, Severity, and Duration of your symptoms as well as "how" those symptoms negatively impact your work, life, and social functioning to include any functional impairment or loss.

Arthritis is a musculoskeletal disorder most often rated under CFR Title 38, Part 4, Schedule for Rating Disabilities, Diagnostic Code (DC) 5003, Degenerative Arthritis.

Arthritis can be rated under other Diagnostic Codes (DC) depending on the type and symptoms.

Pro Tip: There must be x-ray evidence of Arthritis in the joints to rate under DC 5003.

DC 5002: Multi-Joint Arthritis (Active) Including Rheumatoid Arthritis

Includes any Arthritis Diseases (Rheumatoid Arthritis, Psoriatic Arthritis, Spondyloarthropathies, etc.) that affect multiple joints in the body and could affect other body systems as well.

To be rated under this code, there must be a diagnosis, the Arthritis must be active, and at least 2 joints must be affected.

DC 5002 does not cover post-traumatic Arthritis or gout.

• If the Arthritis is so severe that you cannot function, but are completely incapacitated and bedridden, then it is rated 100%.

• If there is significant weight loss, anemia, and overall severe decrease in health but not complete incapacitation, or if severe incapacitating episodes happen 4 or more times a year, then it is rated 60%.

• If there is a definite decline in overall health, o r  if incapacitating episodes happen 3 or more times a year, then it is rated 40%.

• If there is one or two episodes a year it is rated at 20%.

Pro Tip: Any Arthritis no longer active or less severe than noted above is rated under DC 5003 as Degenerative Arthritis.

DC 5010: Post-Traumatic Arthritis

Arthritis caused by an accident or injury (post trauma).

This condition is rated as limitation or range of motion, dislocation, or  instability of the joint affected, whichever one is ratable for that joint and gives the higher rating.

VA Raters must first consider the DC 5200 series to assign a proper rating for Arthritis with limited range of motion.

Post-Traumatic Arthritis is generally rated at 10%.

Multiple ratings for a single joint cannot be combined unless the codes specifically state that they can (as is the case for instability of the knee).

Each joint, however, does receive its own rating.

What is the Osteoarthritis Disability Rating?

Osteoarthritis is a type of degenerative joint disease rated under Diagnostic Code (DC) 5003, Degenerative Arthritis, with VA ratings of either 10% or 20%, depending on the number of joints impacted and whether there are occasional incapacitating episodes.

The average VA rating for Osteoarthritis is 10%.

How to Prove Arthritis is Service Connected for VA Disability

There are 5 primary ways a veteran can prove Arthritis is service connected and get VA disability benefits:

• #1: Direct Service Connection for Degenerative Arthritis rated under DC 5003 with a rating of 10 percent or 20 percent.

• #2: Direct Service Connection for Post-Traumatic Arthritis rated under DC 5010 with a rating of 10 percent or 20 percent.

• #3: Direct Service Connection for Multi-Joint Arthritis (Active Disease) rated under DC 5002 at 20 percent, 40 percent, 60 percent, or 100 percent.

• #4: Direct Service Connection for Arthritis with Limited Range of Motion of the affected joints. This includes joint pain and painful motion associated with Degenerative Arthritis. The VA rates Arthritis with Limitation of Range of Motion under the DC 5200 series, with VA ratings from 0 percent to 100 percent. Painful motion in a joint is assigned a rating of 10 percent.

• #5: Secondary Service Connection for Arthritis rated secondary to other musculoskeletal disorders with a rating of 10 percent or 20 percent. For instance, a veteran might be rated for Degenerative Arthritis secondary to Back Pain.

Pro Tip: ANexus Letter for Arthritis with high probative value isRECOMMENDED to help establish secondary service connection.

Why?

Because "Medical Nexus Evidence" is critical to getting your VA claim approved on an "at least as likely as not"  basis.

ClickHERE to read our Top 3 Reasons Why Veterans Should Get a Nexus Letter for Arthritis.

What Are the VA Ratings for Arthritis?

DC 5003, Degenerative Arthritis:	VA Rating
Degenerative arthritis established by X-ray findings will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is non-compensable under the appropriate diagnostic codes, a rating of 10% is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below:
Arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations	20%
Arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups	10%

• Note 1: The 20% and 10% ratings based on X-ray findings above, shall not be combined with ratings based on limitation of motion.

• Note 2: The 20% and 10% ratings based on X-ray findings above, shall not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive.

DC 5002, Multi-Joint Arthritis (Active), 2 or more joints:	VA Rating
With constitutional manifestations associated with active joint involvement, totally incapacitating	100%
Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged period	60%
Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year	40%
One or two exacerbations a year in a well-established diagnosis	20%

• Note 1: Examples of conditions rated using this diagnostic code include, but are not limited to, rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies.

• Note 2: For chronic residuals, rate under diagnostic code 5003.

• Note 3: The ratings for the active process will not be combined with the residual ratings for limitation of motion, ankylosis, or diagnostic code 5003. Instead, assign the higher evaluation.

What is the Reasonable Doubt Rule for Arthritis?

The reasonable doubt rule , also known as the Benefit of the Doubt Doctrine, means that the evidence provided by the claimant/beneficiary (or obtained on his/her behalf) must only persuade the decision maker that each factual matter is "at least as likely  as  not."

This means there's a 50/50 chance.

When, after careful consideration of all evidence, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.

The courts further likened the reasonable doubt rule as akin to the principle in baseball that the "tie goes to the runner."

When in doubt, the benefit is ALWAYS given to the veteran.

Independent providers and C&P examiners must consider and give weight to the veterans self-reported symptoms when completing their DBQ for Arthritis conditions.

However, objective medical evidence, such as X-Rays, is required before awarding disability for Arthritis.

How Does the VA Rate Arthritis Due to Strain?

§ 4.58 Arthritis Due to Strain.

With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in the same extremity, or in both lower extremities, with indications of earlier, or more severe, arthritis in the injured extremity, including also arthritis of the lumbosacral joints and lumbar spine, if associated with the leg amputation or shortening, will be considered as service incurred, provided, however, that arthritis affecting joints not directly subject to strain as a result of the service incurred amputation will not be granted service connection.

This will generally require separate evaluation of the arthritis in the joints directly subject to strain.

Amputation, or injury to an upper extremity, is not considered as a causative factor with subsequently developing arthritis, except in joints subject to direct strain or actually injured.

How Does Painful Motion Impact Arthritis VA Ratings?

§ 4.59 Painful Motion.

With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints.

Muscle spasm will greatly assist the identification.

Sciatic neuritis is not uncommonly caused by arthritis of the spine.

The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability.

It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.

Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased.

Flexion elicits such manifestations.

The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint

How Does the VA Rate Arthritis with Joint Pain?

§ 4.45 The Joints.

For a joint or group of joints affected by degenerative arthritis (or a condition evaluated using the degenerative arthritis criteria), first attempt to assign an evaluation using the DC for ROM of the affected joint (38 CFR 4.71a, DC 5200-series).

When the requirements for compensable LOM of a joint are met under a DC other than38 CFR 4.71a, DC 5003, hyphenate that DC in the conclusion with a preceding "5003–."

Example :  Degenerative arthritis of the knee manifested by limitation of knee extension justifying a 10 percent evaluation under38 CFR 4.71a, DC 5261 would use the hyphenated DC "5003-5261."

When VA Raters assign a rating for a joint, consideration must be given in accordance with the following factors:

• Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.)

• More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.)

• Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.)

• Excess fatigability

• Incoordination, impaired ability to execute skilled movements smoothly

• Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions.

What Should I Expect at a C&P Exam for Arthritis?

A C&P exam for Arthritis involves a series of verbal questions, to include a physical examination, and diagnostic testing (X-Rays, CT scans, or MRIs, if none have been performed).

The following are a list of common questions asked at a VA C&P exam for Arthritis, based on theDBQ for Arthritis.

1. Does the veteran have a diagnosis of Arthritis?

If yes, indicate the type.

2. Describe the history (including onset and course) of the Veteran's inflammatory, autoimmune, crystalline or infectious arthritis, or decompression illness (brief summary).

3. Does the Veteran require continuous use of medication for the Arthritis condition?

If yes, list the medication taken for Arthritis.

4. Has the veteran lost weight due to the Arthritis condition?

If yes, provide baseline weight (average weight for 2-year period preceding onset of disease).

If yes, does the Veteran's weight loss (attributable to the arthritis condition) cause impairment of health?

If yes, describe the impairment.

5. Does the veteran have anemia due to the Arthritis condition?

6. Does the Veteran have any joint involvement (e.g., pain, limitation of motion, joint deformity) attributable to the Arthritis condition?

If yes, indicate the type:

• Cervical spine
• Thoracolumbar spine
• Sacroiliac joints

If yes, indicate which side (right or left) and the joint affected:

• Shoulder
• Elbow
• Wrist
• Hand/fingers
• Hip
• Knee
• Ankle
• Foot/toes
• Shoulder
• Elbow

7. Does the veteran have any involvement of any body systems, other than joints, attributable to the Arthritis condition?

If yes, indicate systems involved, and check all that apply:

• Ophthalmological
• Skin and mucous membranes
• Hematological
• Neurological
• Renal
• Gastrointestinal
• Vascular
• Pulmonary
• Cardiac
• Other

8. Due to the Arthritis condition, does the veteran have exacerbations which are not incapacitating?

Date of most recent non-incapacitating exacerbation:

Duration of most recent non-incapacitating exacerbation:

Describe non-incapacitating exacerbation:

Indicate frequency of non-incapacitating exacerbations per year (on average):

9. Due to the Arthritis condition, does the veteran have exacerbations which are incapacitating?

If yes, indicate frequency of incapacitating exacerbations per year (on average):

Describe incapacitating exacerbation:

Duration of most recent incapacitating exacerbation:

Date of most recent incapacitating exacerbation: < 1 week, 1 week to < 2 weeks, 2 weeks to < 4 weeks, 4 weeks to < 6 weeks, 6 weeks or more

Indicate the total duration of incapacitation over the past 12 months:

10. Is the veteran's Arthritis manifested by constitutional manifestations associated with active joint involvement which are totally incapacitating?

Yes or no

11. Is the veteran's Arthritis manifested by weight loss and anemia productive of severe impairment of health?

Yes or no

12. Is the veteran's Arthritis manifested by severely incapacitating exacerbations occurring four or more times a year, or a lesser number over a prolonged period?

Yes or no

13. Is the veteran's Arthritis manifested by symptom combinations productive of definite impairment of health, objectively supported by examination findings?

Yes or no

14. Due to the veteran's Arthritis condition, is there functional impairment of an extremity such that no effective function remains, other than that which would be equally well-served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance, propulsion, etc.)

Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran

No

If yes, indicate extremities for which this applies: Right upper, Left upper, Right lower, Left lower

For each checked extremity, identify the condition causing loss of function, describe loss of effective function and provide specific examples (brief summary):

15. Have imaging studies been performed in conjunction with this examination?

Yes or no

16. Was Arthritis documented?

Yes or no

If yes, indicate the type and results.

17. Regardless of the veteran's current employment status, do the conditions listed in the diagnosis section impact his/her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)?

Yes or no.

If yes, describe the functional impact of each condition, providing one or more examples:

Brian Reese

Brian Reese

Founder & CEO

Brian Reese is a VA benefits expert, author of the #1 Amazon Bestseller You Deserve It: The Definitive Guide to Getting the Veteran Benefits You've Earned, and founder of VA Claims Insider –"The Most Trusted Name in Education-Based Resources for Veterans."

His frustration with the8-step VA disability claims process led him to create"VA Claims Insider," which provides U.S. military veterans with tips, strategies, and lessons learned for successfully submitting or re-submitting a winning VA disability compensation claim.

Brian isalso the CEO ofMilitary Disability Made Easy, which is the world's largest free searchable database for all things related to DoD disability and VA disability claims and has served more than 4,600,000 military members and veterans since its founding in 2013.

His eBook, the"9 Secrets Strategies for Winning Your VA Disability Claim" has been downloaded more than 300,000 times in the past three years and is the #1 rated free VA disability claims guide for veterans.

He is aformer active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.

Brian is a Distinguished Graduate of Management from theUnited States Air Force Academy, Colorado Springs, CO and he holds an MBA from Oklahoma State University's Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).

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