VA Disability Assessments for Hip Pain and Hip Disorders | CCK law (2023)

video transcription

Kayla D'Onofrio:Hello. 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 are going to talk about VA disability ratings for hip pain.

So first, we'll start by talking about what exactly hip pain in general is. Hip pain is quite common among the general public and veterans alike, we certainly see it in many of our veteran clients. 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 the medical staff and the VA in terms of what the underlying causes are and how they would assess them.

Therefore, hip pain can often occur on the inside of the hip or groin, on the outside of the hip including the upper thigh, or on the outside of the buttocks, and is usually caused by problems with the muscles, tendons, or soft tissue. around the joint. , or usually in the hip or lower back. So Rachel, can you talk a little more about what some of the common causes of this hip pain are and how it can be treated?

Raquel Foster:Clear. So while the causes of hip pain tend to vary dramatically, some common examples 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 starts to wear away over time, psoriatic arthritis, where there is an underlying diagnosis of psoriasis, and the arthritis is secondary to this condition, or rheumatoid arthritis, which is an autoimmune and inflammatory disease .

Another etiology of hip pain can be previous injuries. For example, something like bursitis, if there is damage to the bursae that surround the joints, dislocation in the joint, and injury that causes a hip fracture or tearing of the labrum, which is the ring of cartilage that runs along the outer edge of the hip. joint cavity and inguinal hernia. So with a hernia, it happens when tissue, as part of the intestine, protrudes into a weak spot in the abdominal muscles. And when that person is moving, they're lifting, they're trying to get up, it can cause strain, and actually because of the proximity of the hip pain, it can cause hip pain there. Sprains and tendonitis are also other injuries.

Hip pain can also come from pinched nerves. So for someone who has sacroiliitis or sciatica, you may experience hip pain from this. If someone also has cancer, it affects the bones or bone marrow and can cause hip pain. So, for example, bone cancer, leukemia, or any other advanced cancer that has spread to the bones.

Another cause of hip pain is osteoporosis, which is a disease in which bone density and quality are reduced, which in turn increases the risk of injury or fracture. And one of our most recent examples is osteomyelitis, which is an infection of the bones, so it can also cause hip pain.

Interestingly, in some cases, hip pain can be caused by an entirely different condition, such as a lower back problem. Therefore, although the main source of pain is the spine, it can spread and start to affect other parts of the body, which is called referred pain. So even if you have back pain, if it starts to affect your hip, that's referred pain.

So, in terms of treating these conditions, if your hip pain is mild, it can be treated with some simple self-care tricks or home remedies like rest or ice, heat, depending on the situation, or over-the-counter pain relievers. If the hip pain is more severe, it may require surgery, which we'll talk about later when we discuss how VA rates these impairments.

Kayla:Now, if a veteran has one of these hip conditions and you think it's service related, what could you do to try and get benefits for your hip pain?

Michelle DeTore:This is usually when you want to apply for benefits. Thus, we generally view hip pain or hip conditions as service related on two different grounds. So, you have a direct one or you have a secondary one. For direct, you currently need a current medical diagnosis, you need a duty injury or illness, and you need a medical nexus, which is essentially a medical opinion that links the current diagnosis to the duty injury or illness.

Note, however, that there is case law that came out of the VA in 2018 in Saunders v. Wilkie, where they said that if a veteran does not have a diagnosis, pain alone can constitute a disability, as long as there is functional impairment. or loss due to such pain. But keep in mind that you'll also need the other two items; you would still need a service event, injury or illness and you would still need that medical opinion. It is also important to know that you would also need treatment for this medical condition, which goes to show that you are constantly dealing with pain.

The other common way issecondary service connection. So this is where the VA can see that you have a hip condition or pain caused by a service-related disability, secondary to a service-related disability, or aggravated beyond the natural disease progression of a service-related illness. We usually see this when people have lower extremity ailments, then you have a foot, ankle or knee condition. And sometimes you see it in the back where maybe the injury to the foot or the knee causes an impaired gait, which basically means you're not walking properly, which causes hip alignment issues and can cause a hip condition or disability.

This is probably the second most common way to see them. For that, again, you'll still need -- it's pretty much the same criteria, you'll still need treatment for pain, a diagnosis of a hip condition, but you don't need that event in the service. , you need a service-connected condition that links you, and then you will need the medical opinion that links your current hip condition to that service-connected condition. So those are typically the two most common ways to see the service connection for hip conditions.

Kayla:Yes, thank you Michele. And it's important to remember that if you come up with multiple theories about VA law, they should consider all the different ways this could relate to service, scheduling exams, and tracking necessary development. for all these different theories.

So once the VA connects you to their service, the next thing they're going to look at is how severe it is, and they're going to assign you a disability rating based on the severity and underlying cause of the hip pain or hip disability. hip.

So the first one we'll talk about is what Rachel mentioned earlier, but osteoarthritis is one of the most common causes of hip pain. Osteoarthritis is attributed todiagnostic code 5003, which is part of the qualification program for musculoskeletal systems. Osteoarthritis has a 10% or 20% disability rating. At the 10 percent level, it must show involvement of two or more major joints, or two or more minor joint groups. At the 20 percent level, you have to show the same criteria with the addition of occasional crippling flare-ups, which basically means really severe flare-ups that stop you from functioning. So if you are seeking treatment for a hip condition or attending a W&P exam and are experiencing flare-ups of hip pain, be sure to discuss them with your doctor and explain their severity. are, how often they occur, and things of that nature.

Another way the VA can interpret hip impairments is based on ankylosis, which is abnormal stiffness and immobility of the joint due to fusion of the bones. It's a very serious condition and the VA rates it higher because it's a little more severe, a little more disabling. Ratings for them are found under diagnostic code 5250 in the same musculoskeletal section of their regulations.

Therefore, ankylosis ratings are 60%, 70%, or 90%. At 60 percent, a veteran must demonstrate favorable flexion at an angle between 20 and 40 degrees and slight adduction or abduction. At 70 percent, they just need to show that they have intermediate ankylosis. And 90 percent have unfavorable or extremely unfavorable ankylosis, where the foot does not reach the ground and requires crutches to be able to move and ambulate as needed.

One of the most common ways of classifying hip pain is under limitation of motion. Rachel, can you talk a little more about how fees limit movement?

Raquel:So with motion limitation, this is really an objective measure where the VA looks at the amount of motion that specifically speaks to what the hip and limb can move. So this can be evaluated objectively in a medical setting with a goniometer, but it can also be something that is observed. The five main types of movement that the AV discusses and evaluates are flexion, extension, adduction, abduction, and rotation.

Thus, with flexion, VA observes the forward movement of the leg at the hip. With the extension, we are looking at the backward movement of the leg at head height. Adduction, we're looking at internal movement, so we're moving closer to the body. In abduction, the movement of the leg and hip away from the body so that it moves outward. And lastly, the rotation, VA takes a look and sees with the twist of the leg at the hip and if you can turn the foot out. Therefore, taking into account all of these different ranges of motion, the VA will determine whether these objective measurements are within a normal or typical range of motion.

If they do not, if they are considered abnormal or outside this normal range, then the diagnostic criteria, based on limitation of movement, apply. The VA will then compensate the veteran for the degree of loss of range of motion based on this qualifying schedule.

Kayla:Thank you, Rachel. And another thing to keep in mind is that you can get separate rankings for all the different limited movement rankings without running into VA pyramid issues, which can result in a higher combined ranking. So, Michelle, one of the things that Rachel mentioned in terms of treating her hip pain was having surgery to treat it, so what happens if a veteran has a hip replacement? How does the VA assess this?

Michele:Therefore, if a veteran has a hip replacement, he typically qualifies at 100% for one year after the actual hip replacement process. At that point, when the year is coming to an end or when the year expires, the VA will typically schedule the veteran for a reexamination to determine the severity of the condition. And then the veteran is scored based on what the results show after he's had that year of recovery from his surgery.

So at that point, the veteran may qualify as 90 percent because there is a painful movement or weakness, such as requiring the use of crutches. They may be scored at 70 percent because there is severe residual weakness, pain, or limitation of movement after surgery. There is 50% for moderately severe residual weakness, pain, or limitation of movement. And then 30 percent is the minimum rating, after the expiration of 100 percent for one year.

One thing to keep in mind is that even if you had your surgery at a VA facility, you should always try to file a claim as soon as possible. Also, remember that if you are on appeal against a decision about your hip, you can also submit records or simply explain that you had hip surgery as relevant new evidence to VA standards in the appeals process. But it's really important that if you're going to have surgery that you don't wait for the VA to find out about it to apply because there's a chance, if you're not on an ongoing appeal, if you don't apply within the year, you basically lose your right. Therefore, you must make sure that you apply as soon as possible. And it also ensures that your claim is adjudicated sooner rather than later, because moreover, you would expect the VA to get the records, even if it's a VA Medical Center showing that this procedure was performed.

Kayla:And another thing to keep in mind is that when the VA assigns disability ratings, they have a duty to maximize your benefits. So, depending on the underlying causes and their severity, they should assign you the diagnostic code that will result in the highest score. So, for example, if you have a diagnosis of osteoarthritis, but you have all those movement limitations that will result in a higher combined score, they should give you the highest score based on the movement limitation.

But if you don't think the AV rates you high enough, but you don't have that kind of target range of motion or objective symptoms that will result in a higher rating, you might also want to consider applyingindividual payment or TDIU, who basically would need to show that your hip pain or hip pain with a combination of your other service-related impairments results in your inability to obtain and pursue substantial paying employment. Therefore, it prevents you from working.

It's another way for a veteran to get maximum benefits so the VA would pay them at a 100% compensation rate without actually having the combined total disability rating of 100%. Therefore, they should be entitled to the same rate of pay per month, as well as the many other additional benefits that come with it.

We're not going to delve too deeply into TDIU today, but we do have several blog posts on our website, as well as other videos you can watch with a lot more information about what TDIU is, how to apply, and what you need to prove to get granted.

So I think that's a good place to end today. Thank you, Rachel and Michelle, and thank you all for joining us.

For more content and information about the VA law, please feel free to visit our website atcck-law.com, and do not forgetSubscribe to our channelfor more videos. Thank you very much.