VA Disability Rating for Hip Pain

What is Hip Pain?

Hip pain is a fairly common complaint among the general public and can cause a variety of additional problems and complications.  The specific location of an individual’s hip pain can provide important information about the underlying cause.

It often occurs in the following areas:

• Inside of the hip or groin
• Outside of the hip, upper thigh, or outer buttock (usually caused by problems with muscles, ligaments, tendons, and other soft tissues surrounding the hip joint)
• The hip and the lower back

Causes of Hip Pain

Importantly, when hip pain is caused by another condition, such as a lower back issue, it is called “referred pain.”  While the causes tend to vary dramatically, some common examples include:

• Arthritis (e.g., osteoarthritis, psoriatic arthritis, rheumatoid arthritis)
• Injuries (e.g., bursitis, dislocation, hip fracture, hip labral tear, inguinal hernia, sprains, tendinitis)
• Pinched nerves (e.g., sacroiliitis, sciatica)
• Cancer (e.g., bone cancer, leukemia, advanced cancer that has spread to the bones)
• Osteoporosis (i.e., disease in which the density and quality of bone are reduced, increasing risk of fracture)
• Osteomyelitis (i.e., a bone infection)

Treatment of Hip Pain

In some cases, mild hip pain can be treated with simple self-care tricks or at-home remedies, such as rest (i.e., avoiding repeated bending at the hip), pain relievers (i.e., over-the-counter medications), and ice/heat (i.e., applying ice or heat to the affected area).  However, more severe hip pain may require surgical interventions.

How Veterans Can Prove Service Connection for Hip Pain

In order for VA to award service connection on a direct basis, veterans must show:

1. A current diagnosis of hip pain*;
2. An in-service event, injury, or illness; and
3. A medical nexus linking the veteran’s hip condition to their in-service event, injury, or illness.

*Note: In some cases, veterans may not have to provide an actual medical diagnosis of hip pain.

In April 2018, the United States Court of Appeals for the Federal Circuit ruled in Saunders v. Wilkie that VA must award disability benefits for pain (without an underlying diagnosis) due to military service.

• Pain must cause functional impairment or loss; subjective complaints of pain are not enough to be awarded disability compensation. Through this, veterans with hip pain who do not meet the traditional first element of service connection (i.e., current diagnosis) are still eligible for benefits.

Veterans can also be rated for hip pain on a secondary basis.  For example, a veteran may receive VA benefits for hip pain secondary to knee pain. 

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How Does VA Rate Hip Pain?

VA disability ratings for hip pain depend on the underlying cause and the severity of the pain itself.

Osteoarthritis

If the hip pain is due to osteoarthritis, VA will assign a rating according to 38 CFR § 4.71a, Schedule of Ratings – Musculoskeletal System, Diagnostic Code 5003.  The rating criteria are as follows:

• 20% – with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations
• 10% – with X-ray evidence of involvement of two or more major joints or two or more minor joint groups

Ankylosis

A hip that suffers from ankylosis (i.e., abnormal stiffening and immobility of a joint due to fusion of the bones) will be rated under Diagnostic Code 5250 as follows:

• 90% – unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated
• 70% – intermediate
• 60% – favorable, flexion at an angle between 20 degrees and 40 degrees, and slight adduction or abduction

Limitation of Motion

If the hip pain does not result in ankylosis, it will be rated based on limitation of motion.  The following measurements are taken into consideration when determining the range of motion:

• Flexion – forward motion of the leg at the hip
• Extension – backward motion of the leg at the hip
• Adduction – inward motion of the leg at the hip
• Abduction – outward motion of the leg at the hip
• Rotation – twisting of the leg at the hip to turn the foot outward

Each of the above-mentioned motions is associated with a “normal” or “typical” range of motion.  If a veteran’s hip pain causes limitation of motion outside of the normal range, a disability rating will be assigned accordingly (see 38 CFR § 4.71a).

Hip Replacements

Again, hip pain may become so severe that it requires a hip replacement.  VA rates hip replacements under Diagnostic Code 5054:

• 100% – for one year following implantation of prosthesis
• 90% – following implantation of prosthesis with painful motion or weakness such as to require the use of crutches
• 70% – markedly severe residual weakness, pain, or limitation of motion following implantation of prosthesis
• 50% – moderately severe residuals of weakness, pain, or limitation of motion
• 30% – minimum rating

In other words, veterans will receive a 100 percent rating for one year following their hip replacement.  After the one-year period, the hip condition will be assigned a permanent rating based on the level of severity as outlined above.

Hip Replacements at a Non-VA Hospital

Veterans often undergo hip replacement surgery at a VA Medical Center; however, some veterans may choose to go to a private, non-VA hospital for the procedure.  If this is the case, veterans must inform VA of the hip replacement surgery as soon as possible.  If they wait longer than one year following the surgery to inform VA, then the veteran is no longer eligible for the 100 percent disability rating.

TDIU and Hip Pain

If your hip pain impacts your ability to work you may qualify for Individual Unemployability benefits, or TDIU.

TDIU is a disability benefit that allows for veterans to be compensated at VA’s 100 percent disability rate, even if their combined schedular rating does not equal 100 percent.

TDIU is an alternative path to receiving maximum benefits.  It is awarded in circumstances in which veterans are unable to secure and maintain substantially gainful employment.

TDIU can be awarded on a schedular or extraschedular basis.

• 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
  • One condition rated at minimum 60 percent OR two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent

Ratings veterans receive for their hip pain can contribute to their overall combined rating.  As such, a veteran with a rating for hip pain may be eligible for TDIU based on their condition.

• 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
  • In this instance, the veteran must prove that their condition uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.

Getting Help with Your Appeal for a Hip Condition

If your claim for a hip condition was denied, CCK may be able to help.  Our experienced team has helped thousands of veterans win their appeals for hip conditions and secondary conditions related to hip pain.  Contact our office today for a free case evaluation.