VA Disability Ratings for Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a form of arthritis that occurs when the immune system does not work properly and attacks the lining of the joints, causing inflammation and pain.   As such, rheumatoid arthritis is categorized an autoimmune disease.  Commonly, rheumatoid arthritis affects the hands, knees, and ankles.  Usually, the same joint on both sides of the body will be affected.  For example, both hands, knees, or ankles may be affected, as opposed to only one hand, knee, or ankle.

Rheumatoid arthritis may also affect a person’s organs such as the heart, circulatory system, or lungs.  It most commonly affects women, and often develops in middle age.  Genetics may play a role in a person’s likelihood to develop rheumatoid arthritis.  Additionally, some research indicates that genes may be affected by triggers in the environment, viruses, bacteria, physical and emotional stress, and other factors, which may then manifest in rheumatoid arthritis.

Symptoms of Rheumatoid Arthritis

• Joint pain
• Tenderness in areas surrounding joints
• Swelling or stiffness, especially in the morning
• Fatigue
• Fever
• Dryness, redness, or difficulty seeing in the eyes
• Gum inflammation or infection in the mouth
• Small lumps in the skin
• Shortness of breath
• Low red blood cell count
• Weight gain
• Severe inflammation that may last for varying periods of time
• Symptoms affecting more than one joint, usually the same joints on each side of the body

If symptoms are not treated, specifically inflammation, rheumatoid arthritis may cause damage to the bones and cartilage.  Rheumatoid arthritis may also cause joint deformity which is non-reversible.

Diagnosing and Treating RA

Diagnosing rheumatoid arthritis may take the expertise of a rheumatologist, or a doctor with specialized training in treating arthritis.  To diagnose, the doctor may perform certain tests and physical examinations, as well as examine the person’s medical history.

Specifically, a rheumatologist may perform a blood test to look for certain blood proteins, or antibodies, related to rheumatoid arthritis.  One of these antibodies is called rheumatoid factor, or RF, and is found in about 80 percent of people who have rheumatoid arthritis.  Imaging tests may also indicate if the ends of the bones within a joint have been worn down, or eroded.  Some imaging tests may include an x-ray, ultrasound, or MRI.

To treat rheumatoid arthritis, a person may be prescribed certain medications to reduce symptoms and keep inflammation at the lowest possible level.  Some topical products, such as creams or gels, may also provide relief for rheumatoid arthritis symptoms.  Some supplements can also help reduce stiffness, such as omega-3 fish oil.

VA Service Connection for Rheumatoid Arthritis

When filing a claim for service connection for rheumatoid arthritis, the veteran will need to demonstrate a connection between their military service and their rheumatoid arthritis.  The veteran will also need to submit a diagnosis of their condition.  In total, the veteran will need to submit the following to VA:

• A diagnosis of rheumatoid arthritis;
• An in-service event, illness, or injury; and
• A nexus linking the veteran’s in-service occurrence with their rheumatoid arthritis

To support their claim for service connection, the veteran may submit lay evidence.  Lay evidence, or lay statements, can be written by the veteran or anyone who knows the veteran and can speak to their condition.  Importantly, lay evidence may also be submitted by fellow service members.

Compensation and Pension (C&P) Exams for Rheumatoid Arthritis

When a veteran files a claim for rheumatoid arthritis, VA may request a Compensation and Pension exam, or C&P exam.  To do this, VA may call the veteran or send a letter.  It is very important to make sure VA has the veteran’s up-to-date contact information so that no C&P exam requests are missed.  It is also very important to attend the exam, as failure to attend can result in VA denying the veteran’s claim.

The exam will usually be performed by a VA physician or a VA contracted physician.  Before the exam, the examiner will review the veteran’s c-file.  This will contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and service records.  During the exam, the examiner may physically exam the joints which have been affected by rheumatoid arthritis.

The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim.  A Disability Benefits Questionnaire is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities.  The veteran may also have their private doctor fill out a DBQ for them.  In claims for rheumatoid arthritis, DBQs can be helpful because a private doctor, or a rheumatologist, can provide insight into the veteran’s condition.

VA Disability Ratings for Rheumatoid Arthritis

VA rates rheumatoid arthritis under Diagnostic Code 5002.  Rheumatoid arthritis can be evaluated up to 100 percent if it results in complete incapacitation, such as causing the veteran to be bedridden.  Lower ratings may be given for occasional incapacitating episodes.  As with degenerative arthritis, a rating for limited range of motion cannot be given in addition to a rating for rheumatoid arthritis.

• 20%—This rating can be given to veterans who experience two or more incapacitating episodes per year and who have an established diagnosis of rheumatoid arthritis.
• 40%—Veterans who are facing a “definitive impairment” in overall health, that is supported by exam findings or experiencing three or more incapacitating episodes each year, will receive this rating.
• 60%—Veterans who suffer severely incapacitating episodes four or more times per year, or are experiencing weight loss, anemia, and a decline in health, will be rated at 60 percent.
• 100%—This rating is given to veterans who experience totally incapacitating rheumatoid arthritis, no matter how many joints are affected.

If a veteran’s rheumatoid arthritis is less severe than the symptoms depicted above, they can be rated under the diagnostic codes for each specific major or group of minor joints.  To be rated under these specific diagnostic codes, a limited range of motion must be confirmed by symptoms such as swelling, muscle spasms, or evidence of painful motion.

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Burn Pit Exposure and Rheumatoid Arthritis

As mentioned above, environmental factors have been identified as a potential trigger for rheumatoid arthritis.  Toxins released by military burn pits can be the cause of such environmental factors.

What are Military Burn Pits?

Military burn pits are large areas of land where waste was incinerated by the military and its contractors.  The United States Military used burn pits as part of its waste disposal protocol in places such as Iraq and Afghanistan in the post-9/11 era.  The practice was effective in reducing large quantities of waste, but the pits emitted plumes of toxic smoke.  The following materials have been linked to military burn pits:

• Human waste
• Medical waste
• Ammunition
• Paint
• Plastic
• Rubber
• Styrofoam
• Other toxic chemicals
• Spoiled food
• Lubricants
• Petroleum

2022 PACT Act Adds Presumptive Conditions for Burn Pit Exposure

Enacted in August 2022, the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act offers needed relief to veterans suffering the toxic effects of burn pit exposure.  The bill added 23 burn pit and toxic exposure-related conditions to VA’s presumptive list for covered veterans:

At this time, rheumatoid arthritis is not included on the list of presumptive conditions for burn pit and other toxic exposure.  However, the PACT Act does create a framework for adding and removing presumptive conditions and strengthening federal research on toxic exposure.

Individual Unemployability (TDIU) for Rheumatoid Arthritis

Veterans who are prevented from working because of their rheumatoid arthritis, or symptoms of their rheumatoid arthritis, may be able to receive a monthly VA disability benefit called total disability based on individual unemployability, or TDIU.  This benefit compensates veterans at the 100 percent rating level, even if their disability rating may be less than that.

There are generally two pathways to become eligible for TDIU:

• 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

• 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 is uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.

Veterans with multiple conditions may have a combined rating which would make them eligible for TDIU.  As a result, veterans who receive a rating for their rheumatoid arthritis may be able to receive compensation at the 100 percent rating level through TIDU.

Was Your VA Disability Claim Denied?

If your VA disability claim has been denied, it is your right to appeal that decision.  The accredited VA disability lawyers and advocates at Chisholm Chisholm & Kilpatrick LTD have decades of experience successfully representing veterans before the Department of Veterans Affairs, the Court of Appeals for Veterans Claims, and the Federal Circuit.  Contact us for a free, confidential case evaluation at 800-544-9144.