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How VA Rates Arthritis

How VA Rates Arthritis
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Arthritis is usually classified as degenerative arthritis or rheumatoid arthritis. Degenerative arthritis, also known as osteoarthritis, occurs when cartilage between joints erodes over time resulting in joint stiffness, limited mobility, and pain. Rheumatoid arthritis occurs when the immune system malfunctions and attacks the membranes lining your joints causing inflammation and resulting in limited motion, stiffness, or pain. Both conditions can cause pain and symptoms may range from mildly disabling to debilitating.

The American Academy of Orthopedic Surgeons states that degenerative arthritis is the primary reason for disability discharge among service members. Over 395,000 veterans are currently receiving disability benefits for degenerative arthritis of the spine according to VA’s 2015 Annual Benefits Report. Injury and joint overuse are common causes of degenerative arthritis among service members.

It is important to note that both degenerative arthritis and rheumatoid arthritis may be eligible for presumptive service connection if symptoms appear within one year of discharge from military service. A veteran only needs to show that the condition is at least 10 percent disabling, and that symptoms began within one year of discharge.

Being aware of this short window of eligibility for presumptive service connection is important. A veteran may feel that minor arthritis is not serious enough condition for which to claim disability benefits. However, arthritis often becomes worse with age, and what starts as a minor disability may end up becoming a more serious condition in the future. If the condition worsens, filing a claim for an increased rating is much easier than claiming service connection later and then having to prove when the arthritis actually manifested.

Degenerative Arthritis (Diagnostic Code 5003)

Degenerative arthritis is rated based on the limitation of range of motion of the affected joint(s).  However, if limitation of motion for the involved joint(s) renders a noncompensable rating, a 10 percent rating will be assigned for each major or group of minor joints affected by limitation of motion.  These will be combined, not added, to determine the rating for arthritis.  Degenerative arthritis will be rated at 10 or 20 percent based upon the number of joints/joint groups affected and the level of incapacitation.

VA requires that limitation of motion be confirmed by observations such as swelling, muscle spasms, or evidence of painful motion. If no limited range of motion exists in joints, veterans will be rated for degenerative arthritis if X-ray evidence exists to support the diagnosis.

  • To be rated at 10% for degenerative arthritis, veterans must have X-ray evidence revealing two or more major joints or two or more groups of minor joints are afflicted by degenerative arthritis.
  • To receive a 20% rating for degenerative arthritis, X-ray evidence must show that two or more major joints or two or more groups of minor joints have degenerative arthritis and produce occasional incapacitating episodes.

It is important to note that veterans cannot be rated for both degenerative arthritis and limited range of motion in the same joints.

Rheumatoid Arthritis (Diagnostic Code 5002)

Rheumatoid arthritis can be evaluated at up to 100 percent if it results in complete incapacitation (e.g. bedridden). Lower ratings can 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.

  • Veterans experiencing totally incapacitating rheumatoid arthritis symptoms, no matter how many joints are affected, will be rated at 100%.
  • Those suffering 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%.
  • Veterans facing a “definitive impairment” in overall health that is supported by exam findings OR experiencing three or more incapacitating episodes each year will be assigned a 40% disability rating.
  • Veterans experiencing two or more incapacitating episodes per year who have an established diagnosis will be rated at 20%.

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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Category: Veterans Law

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