VA Disability Ratings for Ankle Conditions

Jenna Zellmer: Good afternoon, and welcome to CCK Live.  My name is Jenna Zellmer.  Joining me today are Matt Fusco and Rachel Foster, and together the three of us represent veterans before the VA and before the Court of Appeals for Veterans Claims.

Today, we are going to be discussing VA disability for some common ankle conditions.  As always, please feel free to check out our website at cck-law.com and as we go through today’s video, we will be linking some of our blog posts and our other videos for you to check out.  So, as a little bit of a background, ankle injuries are fairly common among veterans, pressure is often put on the ankle, which is one of the main weight-bearing joints in the body.  Veterans go through rigorous training and physical demands during active duty or active duty for training which includes frequently carrying heavy gear for long periods of time.

So, ankle conditions are common and they can lead to the development of other issues such as disabilities of the feet and of the knees.  So, today, we will be breaking down some common ankle conditions that we see in veterans and explain how they are rated.  So, Matt, why don’t you kick us off by talking a little bit about arthritis.

Matt Fusco: Thanks, Jenna.  So, ankle arthritis is a clinical condition where the joints that connect the foot to the leg have damaged or worn-out cartilage.  The three bones involved in this joint are the tibia, the fibula, and the talus, and ankle arthritis can involve any or all of these bones.

Symptoms of arthritis and ankle include things like tenderness when you touch the joint; pain when you move it; stiffness and swelling, especially after sitting or sleeping; and trouble moving, walking, or putting weight on the joint as well.

Now, there are two main types of ankle arthritis or arthritis in general, and they can both occur in the ankle.  The first is osteoarthritis, which is the most common type of arthritis, and this occurs when the cartilage in a person’s ankle joint breaks down.  It can be painful because the breakdown of that cartilage can cause the bones to actually rub together.  Osteoarthritis can also damage the cartilage and change how the entire ankle works over time.

Second, we have rheumatoid arthritis, which is actually an autoimmune condition, categorized by the body’s immune system attacking its own tissue including joint tissue.  Rheumatoid arthritis can be extremely painful and it mostly impacts smaller joints such as the joints in the ankle.  Some specific things that can affect are it can make standing and basic walking painful and that stuff becomes more difficult as it advances, as well.

Jenna Zellmer: Typically, a veteran is just going to know that he has pain in his ankle and like you said Matt, that he’s having trouble walking or standing.  And so Rachel, how exactly does a veteran know whether or not they have osteoarthritis or rheumatoid arthritis.  And how do they go through the steps of getting that initial diagnosis?

Rachel Foster: Sure.  So, doctors will look at the veteran’s medical history, examine the ankle, and take imaging tasks to diagnose arthritis and determine what type it is.  And while there is no cure, treatment options that may offer some relief include things like non-steroidal anti-inflammatory drugs, or NSAIDs for short; oral corticosteroids and steroid injections.  Other treatments can include topical creams which are applied directly to the skin.  You can also treat it with heat, ice, and physical therapy.  If you need some additional support for the ankle joint, you can use things like ankle braces and assistive devices.  And in more severe cases, the ankle disability may require surgery.

Jenna Zellmer: And once the veteran has a diagnosis, the next step — we’ve talked a lot in our other videos about how to get service-connected for disabilities not just ankles, but all of our disabilities — but once the veteran has service-connected for his ankle diagnosis, let’s talk a little bit about how VA rates those ankle disabilities.

Rachel Foster: Yeah, so the way that arthritis is rated depends on the manifestation of the symptoms.  If there is osteoarthritis in the ankle that is not compensable based on the limitation of motion, then it will be rated under 38 CFR § 4.71a, diagnostic code 5003 at either 10 or 20 percent.  So, a rating under this diagnostic code depends on the involvement of major and minor joint groups and whether there are incapacitating episodes.  Importantly, the ratings under diagnostic code 5003 are based on x-ray findings.  And this will also not be used in combination with rating ankles, arthritis, based on the limitation of motion.  VA also rates the ankle based on multi-joint arthritis.  So, if there is a diagnosis of some things such as rheumatoid arthritis and the ankle under 38 CFR § 4.71a, diagnostic code 5002.

To be rated under this code, the arthritis must be active.  It must be affecting at least two joints and the veteran must submit a definitive diagnosis of the condition.  Ratings here depend mostly on the number of incapacitating episodes that veteran experiences due to their multi-joint arthritis, and they can be rated at either 0, 20, 40 60, and 100 percent.  In other cases, VA may assign a rating for arthritis in the ankle under diagnostic code 5271, and that’s based on the limitation of motion of the ankle itself.

This rating could be a 10 or 20 percent based on whether that limited motion is considered moderate or marked.

Jenna Zellmer: Great.  Yeah, I think the takeaway so far is that the VA rating system is incredibly complicated and as is getting that initial diagnosis, so it’s really important to one, go to your doctor and make sure that you’re being diagnosed properly.  And once you have that diagnosis and get service-connected, you really want to talk to your VA rep, whether it’s a service officer or an attorney, to figure out what the best diagnostic code is that will appropriately compensate you for your arthritis.

The term and incapacity and episodes and the limitation of motion are both things that there are some ways to interpret them.  And there’s some medical evidence that I’m sure that you can talk to your rep about to make sure that you are presenting the best and most accurate representation of your disability.

So, moving on from arthritis, another common ankle disability is ankle tendinitis, which is also called peroneal tendonitis, which is a little bit of a mouthful which is why we call it ankle tendonitis, and that’s inflammation of one or two of the tendons that surround the ankle joint.  Tendons are thick bands of tissue that connect muscles to the bone and enable the movement of the joints.  So, the main function of tendons is to stabilize the foot and the ankle and that protects them from injury.

So, if you are experiencing aching pain on the outside or the back of the ankle, some swelling or tenderness of the ankle, warmth around the ankle, or pain during physical activity such as walking or turning the foot inward, these are all signs of ankle tendinitis.  So, you’ll want to talk to your doctor and describe what types of symptoms you are experiencing to make sure that you’re getting that proper diagnosis.  Some common causes of tendonitis are overused traumatic injury or wearing the wrong type of shoes.  So, these are all situations that many veterans experience while they’re in service.  As with arthritis, treatments range from rest and physical therapy all the way to surgery in severe cases.

And so, going back to how VA rates tendonitis as opposed to arthritis, Matt, can you tell us a little bit about what ratings a veteran with tendonitis could get?

Matt Fusco: Sure.  So, ankle tendonitis is typically rated under 38 CFR § 4.17 using diagnostic codes 5270 or 5271.  Under diagnostic code 5270, ankle tendonitis is rated according to the ankylosis of the ankle, and ankylosis refers to abnormal stiffening or immobility of that joint.  And those ratings can typically be 20, 30, or 40 percent.  Under diagnostic code 5271, ankle tendonitis is rated at 10 or 20 percent based on limited motion of the ankle.  And as we previously mentioned, diagnostic code 5271 can actually also be used to rate arthritis in the ankle as well.

Jenna Zellmer: Yeah, so that’s a good note to call back is that regardless of what your diagnosis is, there’s a possibility that you’re going to be rated under the same diagnostic code.  While it’s important to make sure that you’re getting the diagnosis correct, I think the more important thing is to make sure that your rating is accurately portraying your level of functional impairment.

Rachel, why don’t you talk to us a little bit about the last common ankle disability that we have today?

Rachel Foster: Sure.  So, that would be ankle instability.  Ankle instability is a condition that’s characterized by recurring giving way of the outer or the lateral side of the ankle.  Typically, this condition is caused by repeated ankle sprains.  The reason for this is because during an ankle sprain, ligaments in the ankle may have been stretched out or torn.  So, even after that strain heals, ligaments often remain weak and stretched out.

Some common symptoms of instability include a repeated turning of the ankle, especially if there’s uneven surfaces or if you’re participating in sports or other activities.  If there is persistent or chronic discomfort and swelling in the ankle, if someone might also experience symptoms of pain that is dull or intense or maybe tenderness in the ankle, and this is probably the most hallmark symptom of the instability where the ankle is feeling wobbly or unstable.  As far as diagnosis and treatment of instability.

As with other ankle conditions, ankle instability is diagnosed through physical examination and imaging tests such as x-rays.  The treatment options also vary depending on the severity.  Generally, they can include things like physical therapy, braces to provide additional support, medications, and in some cases possibly surgery.

Jenna Zellmer: Yes.  I think we’re sensing a pattern here with both the types of symptoms and the types of treatment and all these different ankle disabilities. And so again, the way the VA rates ankle instability is similar to the way the VA rates other ankle disabilities and that’s under diagnostic code 5271.  And again, this code is based on limitation of motion of the ankle.  And so, a doctor is going to look at your ankle, examine it, and try to move it in different directions, and based on how far your ankle can move, they’ll assign a rating of either 10 or 20 percent.

As I mentioned before, sometimes ankle disabilities can lead to other disabilities of the foot and the knee.  So, veterans who have developed an ankle condition as a result of service may also develop another condition that would qualify for something called secondary service connection.  We have a lot of videos on service connection in general and secondary service connection specifically, so I would really encourage you to check out our website and our blog posts.

But just for the sake of this video, for example, an ankle disability can cause a veteran to favor one side by walking with a limp and that can ultimately result in knee or hip or back conditions because of the way your feet really provide the foundation for the way the rest of your body moves.  And so, ankle disabilities can also be secondary to other conditions such as your feet.

So, it’s always really important to talk to your doctor about the way that your different disabilities are interacting together in your body and to make sure that when you talk to your veterans service organization, your rep, your attorney, whoever it is that you’re talking to, make sure that you’re describing the full extent of your disabilities because they might have an idea of how to get service connection that you might not have thought of before.

So, as always, if your ankle condition has worsened or if you believe it deserves a higher rating, you should definitely reach out to an accredited attorney or a veteran’s advocate.  Rachel, do you have any final thoughts?

Rachel Foster: I think the only thing I would say is as you mentioned before, Jenna, once you get service-connected for an ankle disability, definitely take a look at the different symptoms.  If there’s no limitation of motion, there could be another basis for you to get compensable symptoms.  So, having someone thoroughly review what your symptoms are is very helpful.

Jenna Zellmer: Thanks, Rachel.  Thanks for joining us.  Matt, do you have any final thoughts?

Matt Fusco: Just to really stress the importance of talking about secondary service connection, Jen, as you explained, I think that’s really important to be assessed when veterans are trying to determine whether or not they may be entitled to a higher rating for a specific disability.  So, obtaining things such as medical opinions, speaking with your treatment provider, all that type of stuff will really help to get an entire picture of what’s going on with your disability.  And so, that’s just really important for veterans to keep in mind when they’re trying to figure out what they may be entitled to in terms of a higher rating.

Jenna Zellmer: Awesome.  Thanks, Matt.  As always, thanks so much for tuning in. Please feel free to reach out to CCK for a free consultation, if you think that you have an ankle disability that you would like some help with.  And please subscribe to our channel to stay up to date on all veteran-related news.  My name is Jenna Zellmer.  Thanks, Matt Fusco and Rachel Foster for joining us today, and we hope