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How VA Rates Joint Problems

How VA Rates Joint Problems

VA rates joint problems based on specific criteria and measurements of the range of motion in that joint. For a veteran to receive a disability rating for their joint condition, they must have a documented limitation of their range of motion for that joint through medical records or treatment notes, or fall under specific criteria outlined under particular diagnostic codes.

 

Common Joint Conditions and Ratings

Two common joint problems for veterans are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis occurs when the cartilage in a person’s joint breaks down, mostly impacting weight-bearing joints such as knees, the back, and ankles. Osteoarthritis can be painful because the breakdown of the cartilage can cause bones to rub together. Osteoarthritis is common among veterans in part due to the rigorous training and physical demands of active duty, including frequently carrying heavy gear for long periods of time. This can put pressure on a veteran’s joints and eventually could cause osteoarthritis.

VA rates osteoarthritis based on 38 C.F.R. 4.71(a), under diagnostic code 5003 for arthritis, degenerative (hypertrophic or osteoarthritis). Diagnostic code 5003 states that “degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion for the appropriate diagnostic cods for the specific joint or joints involved.” However, if the veteran is only eligible for a noncompensable (0%) rating under those diagnostic codes, a veteran can receive a 10% rating for each major joint or group of minor joints under 5003.

However, it is important to note that a veteran cannot receive both a rating under the appropriate diagnostic code for their affected joint AND a 10% rating under 5003; they can only receive one or the other.

 

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune condition characterized by the body’s immune system attacking its own tissue, including joint tissue. Rheumatoid arthritis can be very painful and mostly impacts smaller joints.

VA rates rheumatoid arthritis under 38 C.F.R. 4.71(a) diagnostic code 5002. The ratings range from 0 to 100% disabling and depend mostly on the number of incapacitating episodes a veteran experiences due to their rheumatoid arthritis.

The rating criteria are:

  • 20%: “One or two exacerbations a year in a well-established diagnosis”
  • 40%: “Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year”
  • 60%: “Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a less number over prolonged periods”
  • 100%: “With constitutional manifestations associated with active joint involvement, totally incapacitating”

 

Commonly-Impacted Joints

One of the common joints that veterans experience problems with is the spine, both the lumbar and cervical spine. There are two separate categories for spine conditions – one for the cervical spine and the other for the thoracolumbar spine, both of which are based on limitation of range of motion.

VA rates cervical and thoracolumbar spine conditions under 38 C.F.R. 4.71(a) diagnostic codes 5335 to 5243. Although there are different diagnostic codes, they are all rated using the same criteria. One exception to this is a condition rated under diagnostic code 5243 using the criteria for Intervertebral Disc Syndrome.

Veterans also frequently experience joint problems in their knees and ankles which can cause pain and limitation of motion depending on the severity. VA rates knee conditions under three separate criteria: 1.) functional loss, 2.) instability, and 3.) pain.

For ankle conditions, VA rates these under various separate diagnostic codes depending on a veteran’s diagnosis, and the rating criteria are dependent on limited motion, deformity, or limitations of plantar flexion or dorsiflexion.

 

Pain is Now a Disability Eligible for VA Benefits

In April 2018, the Unite States Court of Appeals for the Federal Circuit ruled that pain is a disability eligible for VA disability compensation. Prior to the ruling in Saunders v. Wilkie, VA required veterans to show that they had a diagnosed disability in order to receive disability benefits. However, the Court ruled in Saunders that veterans can receive VA disability for pain alone without an underlying diagnosis, as long as they satisfy the other two prongs required for service connection: 1.) they experienced an in-service event, injury, or symptom; and 2.) they provide a medical nexus linking their pain to the occurrence in service. This means veterans may be able to receive disability benefits for pain from undiagnosed joint problems if they meet the criteria.

Category: Veterans Law

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