VA Disability Ratings for Hip Pain and Hip Conditions
Kayla D’Onofrio: Hi. Welcome to today’s episode of CCK Live. My name is Kayla D’Onofrio and I’m joined today by Rachel Foster and Michelle DeTore. Today we’re going to be talking about VA disability ratings for hip pain.
So first, we’ll just get started by talking about what exactly hip pain is very generally. Hip pain is fairly common among both the general public and veterans alike, we certainly see it with a lot of our veteran clientele. It can cause a variety of additional problems or complications, and the specific location of an individual’s pain can provide important information to both medical personnel as well as VA in terms of what the underlying causes are and how they would go about rating it.
So, hip pain can often occur in either the inside of the hip or the groin, the outside of the hip, including the upper thigh or the outer buttock, and that’s usually caused by problems with the muscles or tendons or soft tissue surrounding the joint, or commonly in the hip or the lower back itself. So Rachel, can you talk a little bit more about what some of the common causes for this hip pain are, and how one might go about treating it?
Rachel Foster: Sure. So while the causes of hip pain tend to vary dramatically, some common examples that we see are arthritis. It’s probably the number one example that can manifest as different diagnoses. For example, osteoarthritis which is where the protective cartilage just begins to wear down over time, psoriatic arthritis, so there’s an underlying diagnosis of psoriasis, and the arthritis is secondary to that condition, or rheumatoid arthritis, which is an autoimmune and inflammatory disease.
Another etiology of hip pain could be past injuries. For example, something like bursitis, if there’s damage to the bursae that are surrounding the joints, dislocation at the joint, and injury that causes a hip fracture or a labral tear, which is that ring of cartilage that follows the outside rim of the hip joint socket, and inguinal hernia. So, with a hernia occurs when the tissue such as part of the intestine protrudes to a weak spot in the abdominal muscles. And when that person is moving, they’re lifting, they’re trying to stand up, that can cause strain, and actually can, because of the close proximity of the hip pain, can cause pain in the hip there. Sprains and tendonitis are also some other injuries.
Hip pain can also stem from pinched nerves. So, for someone who has sacroiliitis or sciatica, they can experience hip pain because of that. If someone is also experiencing cancer, that affects the bones or bone marrow that can cause hip pain. So, for example, bone cancer, leukemia, or any other advanced kind of cancer that has spread to the bones.
Another cause of hip pain is osteoporosis, which is a disease in which the density and quality of the bone are reduced, which, in turn, increases the risk of injury or fracture. And one of our last examples is osteomyelitis, which is a bone infection, so that can also cause pain in the hip.
Interestingly enough, in some cases, hip pain can actually be caused by a completely separate condition such as a low back issue. So, even though it’s your back that is the primary source of the pain, it can spread out and start affecting other parts of the body, which is called referred pain. So, even though you have back pain, if it’s starting to affect your hip, that is referred pain.
So, as far as just treating these conditions, if the hip pain is mild, it can be treated with some simple self-care tricks or at-home remedies, such as rest or ice, heat, depending on the situation, or over-the-counter pain relievers. If the hip pain is more severe, it could require surgical intervention, which we’ll actually talk about later on when discussing how VA rates these disabilities.
Kayla: Now, if a veteran has one of these hip conditions and they think it’s related to their service, what might they do to try to get benefits for their hip pain?
Michelle DeTore: So typically, at that point in time you want to apply for benefits. So, we usually see hip pain getting, or hip conditions getting, service-connected under two different bases. So, you have a direct or you have a secondary. For direct, you currently need a current medical diagnosis, you need an in-service event injury or illness, and you need medical nexus which is essentially a medical opinion linking the current diagnosis to the in-service event injury or illness.
Keep in mind though, there is case law that came out from VA in 2018 in Saunders v. Wilkie, where they did say that if a veteran doesn’t have a diagnosis, pain alone can constitute a disability as long as there is functional impairment or loss due to said pain. But keep in mind, you will also still need the other two elements; you would still need an event or injury or illness in-service, and you would still need that medical opinion. It’s also important to know that you would also need treatment for that medical condition, showing that you are treating consistently for pain.
The other common way is secondary service connection. So this is where VA can see that you have a hip condition or hip pain that is caused by, so it’s secondary to a service-connected disability, or that it’s aggravated beyond the natural progression of the disease by a service-connected condition. Typically, we see this when people have lower extremity ailments, so you have a foot condition, ankle, knees. And you do sometimes see in the back where maybe the injury to your feet or your knees cause maybe an altered gait, which basically means that you don’t walk correctly, which then causes problems with the alignment of your hips, and then could cause a hip condition or a hip disability.
So, that’s probably the second most common way we see them. For that, again, you’re going to need still–it’s almost of the same criteria, you’re still going to need either treatment for pain, a diagnosis of a hip condition, but you don’t need that event in-service, you do need a service-connected condition linking it to, and then you will need that medical opinion linking your current condition for your hip to that service-connected condition. So, those are typically the two most common ways we see service connection for the hip conditions.
Kayla: Yeah, thank you, Michelle. And it’s important to kind of remember that if you bring up multiple theories of entitlement to VA, they do have to kind of consider all of those different ways that it could be related to service, and schedule exams, and follow up with the necessary development for all of those different theories.
So, once VA goes about connecting it to your service, the next thing that they’re going to be looking at is how severe it is, and assign you a disability rating based on the severity and the underlying cause of the hip pain or the hip disability.
So, the first one we’ll talk about is, Rachel mentioned this one earlier, but osteoarthritis is one of the more common causes of hip pain. Osteoarthritis is assigned under diagnostic code 5003, which is under the schedule of ratings for musculoskeletal systems. Osteoarthritis is rated at either a 10 percent or a 20 percent disability rating. At the 10 percent level, you have to show involvement of two or more major joints, or two or more minor joint groups. At the 20 percent level, you have to show that same criteria with the addition of having occasional incapacitating exacerbations, which basically just means really severe flare-ups that prevent you from being able to function. So, if you are seeking treatment for the hip condition or you’re attending a compensation and pension exam, and you do have flare-ups for your hip pain, make sure you do talk about those with the medical professional and explain how severe they are, how frequently they occur and things of that nature.
Another way that VA can go about reading hip disabilities is based on ankylosis, which is an abnormal stiffening and immobility of the joint due to fusion of the bones. It’s a pretty severe condition and VA does rate it at higher ratings because it is a little bit more severe, a little bit more incapacitating. The ratings for those are found under diagnostic code 5250 under the same musculoskeletal section of their regulations.
So, the ratings for ankylosis are 60 percent, 70 percent, or 90 percent. At 60 percent, a veteran has to show that they have favorable flexion at an angle between 20 degrees and 40 degrees, and slight adduction or abduction. At 70 percent, they just have to show that they have intermediate ankylosis. And at 90 percent, they have to show unfavorable or extremely unfavorable ankylosis where the foot doesn’t reach the ground and they require crutches to be able to move around and ambulate as necessary.
One of the more common ways that we do see hip pain rated is under limitation of motion. So Rachel, can you talk a little bit more about how the rates limitation of motion?
Rachel: So, with limitation of motion, that is really an objective measurement where VA is looking at the amount of movement that specifically talking about what the hip and the extremity is able to move. So, this can be objectively assessed in a medical environment with a goniometer, but it can also be something that is observed as well. The five main types of movement that VA takes a look at and assesses are flexion, extension, adduction, abduction, and rotation.
So with flexion, VA is looking at the forward motion of the leg at the hip. With extension, we’re looking at the backward motion of the leg at the head. Adduction, we’re looking at the inward motion, so moving close to the body. In abduction, the movement of the leg and the hip away from the body, so that outward motion. And lastly, rotation, VA takes a look and sees with the twisting of the leg at the hip, and whether you’re able to turn that foot outward. So, taking all of these different ranges of motion in mind, VA will then determine whether those objective measurements are within a normal or typical range of motion.
If they don’t, if they’re considered abnormal or outside of that normal range, that’s when the diagnostic criteria apply, based on the limitation of motion. VA will then compensate the veteran for the degree of loss of range of motion based on that grading schedule.
Kayla: Thank you, Rachel. And another thing to keep in mind is that you can get separate ratings for all of those different limited motion ratings without running into VA’s pyramiding issues, which can result in a higher combined rating. So Michelle, one of the things that Rachel mentioned in terms of treatment for hip pain was having surgery to treat it, so what happens if a veteran has a hip replacement? How does VA go about rating that?
Michelle: So, if a veteran has a hip replacement, typically, you rate it at 100 percent for one year following the actual process of putting the prosthesis in. At that point in time, once the year is coming to an end or once the year expires, VA then will typically schedule the veteran for a new examination to determine the severity of the condition. And then the veteran is then rated based on what the findings show after they’ve had that year of recovery from their surgery.
So, at that point in time, the veteran can be rated at 90 percent because there’s painful motion or weakness, such as to require the use of crutches. They can be rated at 70 percent because there’s severe residual weakness, pain, or limitation of motion following the surgery. There’s 50 percent for moderately severe residual weakness, pain, or limitation of motion. And then 30 percent is the minimum rating, following the expiration of the 100 percent for one year.
One thing to be mindful of is that even if you got your surgery at a VA facility, you should always be trying to file a claim as soon as possible. Also, keep in mind, if you’re within the appeal period of a decision on your hip, you could also submit records or just explaining that you had this hip surgery as new and relevant evidence for VA standards in the appeal process. But it’s very important if you have a surgery, to not wait for VA to find out to file because there is the potential if you’re not in an ongoing appeal, that if you don’t file within the year, you basically lose your entitlement. So, you want to be making sure that you do file as soon as possible. And it also ensures that your claim gets adjudicated sooner rather than later because other than that, you would be waiting for VA to get records, even if it is a VA Medical Center that shows that you had this procedure done.
Kayla: And another thing to keep in mind is when VA is assigning disability ratings, they do have a duty to maximize your benefits. So, depending on what the underlying causes and how severe it is, they do have to assign you under the diagnostic code that’s going to result in the highest rating. So, for example, if you have a diagnosis of osteoarthritis, but you have all of those limitations of motion that are going to result in a higher combined rating, they should be assigning you the higher rating based on the limitation of motion.
But if you don’t feel that VA is rating you high enough, but you don’t have those sort of objective range of motion or objective symptoms that are going to result in the higher rating, you can also consider applying for individual unemployability or TDIU, which basically you would need to show that your hip pain or your hip pain with a combination of your other service-connected disabilities result in you being unable to secure and follow substantially gainful employment. So, it prevents you from working.
It’s another way for a veteran to obtain that maximum benefits, so VA would pay them at the 100 percent compensation rate without them actually having the combined 100 percent disability rating total. So they should be entitled to the same payment rate per month, as well as a lot of those other additional benefits that come along with that.
We’re not going to dive too much deeper into TDIU today, but we do have several blog posts on our website, as well as other videos that you can check out that have a lot more information about what TDIU is and how to apply for it and what you would need to show to get it granted.
So, I think that’s a good place for us to wrap up today. Thank you, Rachel and Michelle, and thank you all for joining us.
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