Tendonitis VA Rating
What Is Tendonitis?
Tendonitis occurs when a tendon severely swells (i.e., becomes inflamed), causing pain and soreness around the joint. This condition typically occurs due to overuse or repeated injury to a specific area such as the knee or ankle.
Tendons are strong, flexible bands of fibrous tissue that connect muscles to bones and enable the movement of joints. Tendons also prevent muscle injury by absorbing some of the impact that occurs during movement. Essentially, when the proteins which form the tendon begin to degrade, the tendons become inflamed and tendonitis develops.
The following are some of the most common symptoms of tendonitis:
- Chronic or sharp pain, especially during use
- Difficulty moving the joint
- Grinding or crackling sensation when moving the tendon
If these symptoms do not improve within a few weeks or if the pain is sudden and severe, it is important to seek help from a medical professional.
Treatments for tendonitis depend on the specific tendon affected and the severity of the condition. Some doctors may recommend a combination of rest, ice, compression, and over-the-counter pain medications. In some cases, a brace, a splint, or elevation may be necessary.
If these treatments do not work, physical therapy may be required. Physical therapy for tendonitis usually includes passive modalities (e.g., heat, ultrasound, soft-tissue massage), manual therapy (i.e., hands-on techniques to mobilize joints and loosen tightness), range of motion exercises, and strengthening exercises (e.g., resistance bands, weights, and exercise balls).
In the most severe cases, surgery may be required to repair the tendon(s). Other treatments for severe tendonitis consist of steroid injections, shockwave therapy, and platelet rich plasma injections.
Common Forms of Tendonitis
Tendonitis can occur in almost any tendon in the body, although it most commonly affects the following areas:
- Shoulder tendonitis – Occurs when the rotator cuff and the biceps tendon become inflamed. The inflammation can be mild to severe. Symptoms include pain and limited mobility.
- Elbow tendonitis – Primarily produces pain where the tendons of the forearm muscles attach to the bony bump on the outside of the elbow; however, pain can also spread into the forearm and wrist. Generally, the cause of this condition involves repeated contraction of the forearm muscles that individuals use to straighten and raise their hands and wrists.
- Knee tendonitis – Also known as patellar tendonitis, this is an injury to the tendon connecting an individual’s kneecap (i.e., patella) to their shinbone. Knee tendonitis is a common overuse injury, caused by repeated stress on the patellar tendon.
- Ankle tendonitis – Also known as peroneal tendonitis, this is the inflammation of one or two of the tendons that surround the ankle joint. The most common causes of tendonitis of the ankle are overuse, traumatic injury, and wearing the wrong type of shoes over a prolonged period.
- Wrist tendonitis – There are two groups of tendons in the wrist: extensors and flexors. Extensors are in the back of the wrist, while the flexors are in the front. When a person develops wrist tendonitis, these tendons become inflamed and irritated.
These forms of tendonitis are sometimes named after the sports that increase their risk (e.g., tennis elbow, pitcher’s shoulder, swimmer’s shoulder, etc.)
Service Connection for Tendonitis
Many veterans suffer from tendonitis due to the physical demands of active-duty military service. During service, veterans may be engaged in fitness-related activities and jobs that require a lot of physical exertion. Such jobs and activities may persist throughout the duration of their service, thereby leading to overuse.
If you believe your tendonitis is related to your military service, you may be eligible for disability compensation from the Department of Veterans Affairs (VA). Veterans can receive service connection for tendonitis in several ways, including direct service connection, secondary service connection, and service connection by aggravation.
Direct Service Connection
To establish service connection on a direct basis, veterans must satisfy three requirements. Specifically, veterans must have:
- A current diagnosis of tendonitis;
- Evidence of an in-service event, injury, or illness; and
- A medical nexus linking their diagnosed condition to the in-service event.
Typically, the third requirement (i.e., a medical nexus) is satisfied by attending a Compensation & Pension (C&P) exam in which a VA healthcare provider, or VA-contracted healthcare provider, opines that the veteran’s tendonitis is “at least as likely as not” due to their time in service. However, veterans have the right to obtain a private medical opinion as well. This may be especially helpful in cases where a C&P exam yields unfavorable results.
Secondary Service Connection
A secondary service-connected condition is one that results from a separate condition that is already service-connected. If a veteran developed tendonitis due to a service-connected condition, they may be eligible for secondary service connection.
To prove secondary service connection for tendonitis, veterans must have:
- A current diagnosis of tendonitis; and
- A medical nexus linking their tendonitis to an already service-connected condition.
Similar to establishing direct service connection, veterans can request a private medical opinion from their doctor as evidence of this link. VA will also typically schedule the veteran for a C&P exam.
Service Connection by Aggravation
VA also compensates veterans for medical conditions that existed at the time of entry into service that were made worse or “aggravated” by service.
For example, a veteran has preexisting (i.e., prior to service) knee tendonitis. Following service, their knee tendonitis worsens and becomes severe, now impacting daily life. In this case, the veteran’s active-duty service aggravated their pre-existing condition beyond the natural progression of the disability. Therefore, the veteran may be eligible for service connection based on aggravation.
VA Ratings for Tendonitis
Once service connection is established, VA will assign a disability rating based on the severity of the condition. Typically, tendonitis is awarded a 10 percent minimum rating. In some instances, veterans may be awarded a higher rating if their condition is more severe.
VA evaluates tendonitis under 38 CFR § 4.71a, VA’s Schedule of Ratings for the Musculoskeletal System. According to diagnostic code 5024, tendonitis can be evaluated “as degenerative arthritis, based on the limitation of motion of affected parts.”
The VA rating criteria for the different forms of tendonitis are as follows:
VA typically rates elbow tendonitis based on limitation of motion of the forearm, which falls under 38 CFR § 4.71a, diagnostic codes 5206, 5207, and 5208. Importantly, the higher percentage is reserved for the dominant forearm whereas the lower percentage is reserved for the non-dominant forearm.
For diagnostic code 5206, forearm, limitation of flexion:
- 50/40% – flexion limited to 45 degrees
- 40/30% – flexion limited to 55 degrees
- 30/20% – flexion limited to 70 degrees
- 20/20% – flexion limited to 90 degrees
- 10/10% – flexion limited to 100 degrees
- 0/0% – flexion limited to 110 degrees
For diagnostic code 5207, forearm, limitation of extension:
- 50/40% – extension limited to 110 degrees
- 40/30% – extension limited to 100 degrees
- 30/20% – extension limited to 90 degrees
- 20/20% – extension limited to 75 degrees
- 10/10% – extension limited to 45 degrees
For diagnostic code 5208, veterans receive a disability rating of 20 percent if their forearm flexion is limited to 100 degrees and their forearm extension is limited to 45 degrees.
Ankle tendonitis is usually rated under 38 CFR § 4.71a, diagnostic code 5270 or 5271. Under 5270, this condition is rated according to ankylosis of the ankle (i.e., abnormal stiffening and immobility):
- 40% –in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion, or eversion deformity
- 30% – in plantar flexion, between 30 and 40 degrees, or in dorsiflexion, between 0 and 10 degrees
- 20% – in plantar flexion, less than 30 degrees
Under diagnostic code 5271, limited motion of the ankle, the rating criteria is as follows:
- 20% –marked limitation of motion
- 10% – moderate limitation of motion
VA most commonly rates knee tendonitis under 38 CFR § 4.71a, diagnostic codes 5260 and 5261.
Under diagnostic code 5260, VA measures limitation of flexion of the knee based on the range of motion that exists as the veteran moves curls their knee inward towards the body. The rating criteria are as follows:
- 30% –flexion limited to 15 degrees
- 20% –flexion limited to 30 degrees
- 10% –flexion limited to 45 degrees
- 0% –flexion limited to 15 degrees
Under diagnostic code 5261, limitation of extension of the knee, VA assigns a rating based on how far the veteran can extend their knee outward. The criteria are:
- 50% –flexion limited to 45 degrees
- 40% –flexion limited to 30 degrees
- 30% –flexion limited to 20 degrees
- 20% –flexion limited to 15 degrees
- 10% –flexion limited to 10 degrees
- 0% –flexion limited to 5 degrees
VA may rate shoulder tendonitis under 38 CFR § 4.71a, diagnostic codes 5200, 5201, 5202, or 5203, based on the range of motion of a major/minor joint group.
For diagnostic code 5200, scapulohumeral articulation, ankylosis (abnormal stiffening and immobility) of:
- 50% (major)/40% (minor)– unfavorable, abduction limited to 25 degrees from side
- 40/30%– intermediate between favorable and unfavorable
- 30/20%– favorable, abduction to 60 degrees, can reach mouth and head
For diagnostic code 5201, arm, limitation of motion of:
- 40/30%– to 25 degrees from side
- 30/20%– midway between side and shoulder level
- 20/20%– at shoulder level
For diagnostic code 5202, humerus, other impairment of:
- 80/70%– loss of head of (flail shoulder)
- 60/50%– nonunion of (false flail joint)
- 50/40%– fibrous union of
- Recurrent dislocation of scapulohumeral joint:
- 30/20%– with frequent episodes of guarding of all arm movements
- 20/20%– with infrequent episodes, and guarding of movement only at shoulder level
- Malunion of:
- 30/20%– marked deformity
- 20/20%– moderate deformity
For diagnostic code 5203, clavicle or scapula, impairment of:
- 20/20%– dislocation of
- Nonunion of:
- 20/20% – with loose movement
- 10/10% – without loose movement
- 10/10%– malunion of
Bilateral Factor for Tendonitis
If a veteran is suffering from tendonitis in both arms, both knees, both shoulders, or both ankles, they may be eligible for the VA bilateral factor, which increases a veteran’s overall disability rating. Specifically, the bilateral factor adds an additional 10 percent rating to the bilateral disabilities.
For example, the combined rating of a veteran’s two elbow tendonitis percentages would be calculated, and then an additional 10 percent would be combined to that rating. Our VA disability calculator accounts for the bilateral factors when determining a veteran’s combined disability rating.
Was Your VA Claim for Tendonitis Denied?
If VA denied your claim for tendonitis, Chisholm Chisholm & Kilpatrick LTD may be able to help. Our experienced veterans’ advocates know how to navigate the complicated VA appeals system and may be able to help you develop a successful appeal. Call CCK today at 800-544-9144 for free consultation with a member of our team.
About the Author
Share this Post