VA Disability Rating for Ankle Instability

What is Ankle Instability?

Ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle.  The giving way may occur while an individual is walking or doing other activities, but for some, it can also happen while standing.  Typically, this condition develops after repeated ankle sprains.  During an ankle sprain, the ligaments in the ankle may have been stretched out or torn.  Although ankle sprains heal, the ligaments often remain weak and stretched out.  The most common signs and symptoms of instability of the ankle include the following:

• A repeated turning of the ankle, especially on uneven surfaces or when participating in sports or other activities
• Persistent (chronic) discomfort and swelling
• Pain (dull or intense) or tenderness
• The ankle feeling “wobbly” or unstable

Causes

Again, this condition usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely.  An unhealed ankle sprain increases the likelihood of another ankle sprain occurring in the future.  Repeated ankle sprains often cause and perpetuate ankle stability as well.  Additional sprains lead to further weakening, or stretching, of the ligaments thereby producing greater instability.

Diagnosis

Ankle instability is most often diagnosed during an examination or after X-rays or other imaging studies.  For example, a doctor or an ankle surgeon may ask individuals about any previous ankle injuries and instability.  From there, they will likely examine the ankle for tender areas, signs of swelling, and evidence of instability by turning the foot inwards.

Treatment

Once diagnosed with ankle instability, individuals can explore various treatment options.  Treatment for instability of the ankle is based on the results of the examination and imaging studies, as well as the individual’s level of activity.  Nonsurgical treatment options include the following:

• Physical therapy – exercises to strengthen the ankle, improve balance, and range of motion, and retrain the muscles
• Bracing – wearing an ankle brace gives support to the ankle and keeps it from turning; can also prevent additional sprains
• Medications – nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen), may be prescribed to reduce pain and inflammation

In severe cases, ankle surgery may be necessary.  This approach is usually employed after non-surgical options have failed.  Surgery involves the repair or reconstruction of the damaged ligaments.  The surgeon will select the surgical procedure best suited for each individual depending on the severity of the instability.

VA Service Connection for Ankle Instability

To establish service connection for ankle instability on a direct basis, veterans must establish the following: (1) a current diagnosis of ankle instability; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the instability of the ankle to the in-service incurrence.  Many veterans suffer from ankle instability due to the physical demands of military service and training.  Specifically, veterans may have engaged in fitness-related activities and jobs that required physical exertion while serving.  Such activities and jobs may have resulted in ankle sprains and injuries throughout service, thereby leading to instability of the ankle later on.

In addition, a veteran may have been involved in an accident resulting in a traumatic injury to their ankle.  For example, veterans involved in parachuting accidents often report ankle injuries later in life, such as ankle instability.  Veterans will likely have to attend a Compensation & Pension (C&P) exam to obtain a medical nexus opinion.  If the examiner concludes that their ankle instability is “at least as likely as not” due to their time in service, then service connection should be awarded.

How Does VA Rate Ankle Instability?

Once service connection is established, VA will assign a disability rating depending on the severity of the condition.  Ankle instability is usually rated under 38 CFR § 4.71, Schedule of Ratings – Musculoskeletal System, Diagnostic Code (DC) 5271.  Under DC 5271, ankle instability is rated according to limited motion of the ankle.  The rating criteria is as follows:

• 20% – marked limitation of motion
• 10% – moderate limitation of motion

Importantly, if veterans feel as though their ankle instability warrants a higher rating, they have the right to file an appeal.

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