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.

(Video) VA Disability Ratings for Hip Pain and Hip Conditions

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.

(Video) VA Disability Rating for Lower Back 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.

(Video) Hip Pain & VA Disability. What's That About?

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?

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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.

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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, and do not forgetSubscribe to our channelfor more videos. Thank you very much.


What is the VA rating criteria for hips? ›

VA disability rating for hip pain caused by hip replacement schedule is 100% for one year following the hip replacement surgery. A hip replacement surgery qualifies you for a minimum 30 percent VA disability rating for hip pain. As noted, the VA considers you totally disabled for one year after your hip replacement.

What percentage of VA disability for hip pain? ›

The criteria for a disability rating of 20 percent, but no higher, for functional loss and limitation of right hip motion due to pain and tenderness or during a flare-up are met. 38 U.S.C.A.

What is the VA 5 rule? ›

The VA disability 5 year rule allows the VA to ex-examine your VA disability rating within 5 years of your initial examination if your condition is expected to improve over time. However, the VA may still change your disability rating past the 5-year deadline if your condition has significantly improved.

Is chronic hip pain a disability? ›

As most hip conditions are short-term and minor, it is quite difficult to win a Social Security disability award for hip challenges. Only those individuals suffering long-term hip problems that are expected to last over a year will be considered for financial assistance.

Can you get VA disability for hip joint pain? ›

VA Disability Rating for Hip Pain

For example, if your hip pain is caused by arthritis, the VA will assign a rating of 10% or 20% based on 38 CFR § 4.71a. You could also receive service connection for hip pain that is the result of ankylosis, or immobility of a joint due to bone fusion.

What is the VA 85/15 rule? ›

The 85/15 rule prohibits paying Department of Veterans Affairs (VA) benefits to students enrolling in a program when more than 85 percent of the students enrolled in that program are having any portion of their tuition, fees, or other charges paid for them by the Educational and Training Institution (ETI) or VA.

What is the 10-year rule for VA? ›

VA's 10-year rule states that the U.S. Department of Veterans Affairs cannot terminate service connection for a disability that has been in place for at least 10 years unless there was evidence of fraud at the time of the grant.

What is the 5 10 20 year VA rule? ›

The 10-Year Rule is for Veterans who were honorably discharged more than five years ago but less than 10 years ago. To use this rule, you must show that your health condition began (or worsened) during active military service. The 20-Year Rule is for Veterans who were honorably discharged more than 10 years ago.

What is the VA rating for hip weakness? ›

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.

What does the VA consider chronic pain? ›

Chronic pain occurs when a person suffers from pain in a particular area of the body for at least three to six months. This type of pain lasts beyond the normal amount of time that an injury takes to heal and can come from many things, including normal wear and tear, aging, and other medical conditions.

How does VA rate hip range of motion? ›

A rating of 20 percent is assigned for limitation of abduction when motion is lost beyond 10 degrees. Normal range of motion (ROM) of the hip and thigh is flexion from 0 to 125 degrees and abduction from 0 to 45 degrees. 38 C.F.R.

What is the most common hip disorder? ›

Arthritis is the most common cause of the breakdown of hip tissue. Three kinds of arthritis commonly affect the hip: Osteoarthritis. Also referred to as "wear and tear" arthritis.

How is chronic hip pain diagnosed? ›

Assessing Hip Abnormalities

Medical imaging, including X-rays and magnetic resonance imaging (MRI), is crucial in diagnosing hip pain. An X-ray can reveal an excess of bone on the femoral head or neck and the acetabular rim. An MRI can reveal fraying or tears of the cartilage and labrum.

What does chronic hip pain feel like? ›

With hip arthritis, the pain is mainly felt in the groin, and occasionally in the outer thigh and upper buttock area. Pain can get worse after standing or walking for long periods of time or after a period of rest (waking up in the morning). Stiffness in the hip makes it difficult to move the hip or rotate the leg.

What does the VA consider a major joint? ›

Major joints include the shoulder, wrist, elbow, hip, knee, and ankle while minor joints include toes, fingers, spine, and sacroiliac. If two or more major or minor joint groups are affected, but there are no incapacitating exacerbations, a 10% rating may be assigned.

How does the VA rate joint pain? ›

Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected. A 20% rating requires that two or more major joints or two or more groups of minor joints have occasional incapacitating episodes.

Is arthritis a permanent VA disability? ›

Both rheumatoid and degenerative arthritis are considered chronic diseases that are subject to presumptive service connection. Veterans may receive a 10% VA disability rating if arthritic symptoms appear within one year of service discharge.

What is the VA 210 day rule? ›

For all cash-out refinances paying off an existing VA loan seasoning certification is required. The number of days from closing of loan being refinanced and loan closing of new loan will auto-calculate and cannot be less than 210 (days) or the guaranty will not be issued.

How do I increase my VA disability from 80% to 100? ›

You would need to have another condition rated at 80 percent in order to receive a 100 percent combined schedular rating. Alternatively, you would need to have multiple additional conditions that equaled another 80 percent rating.

Can you draw 100% VA disability and still work? ›

If your 100% VA Disability Rating comes because you qualify for the 100% rating specified for a single (or combination of multiple) service-connected conditions using the Schedule of Ratings, then you have NO limitations on your ability to work.

At what age does VA disability become permanent? ›

20 Years: Continuous Rating

If, after twenty years, a service-connected disability is rated at or above the originally assigned rating level, it may not be lowered below the original level.

At what age does VA disability stop? ›

Your VA benefits will last for your whole life. Even if your disability is classified as less than total and not permanent, if you've been collecting benefits for 20 years or more, the amount of your benefit won't go down.

What will 2023 VA disability rates be? ›

VA disability pay for 2023 increased by 8.7%. The new disability compensation rates took effect on December 1, 2022. See the current VA disability pay chart, and calculate your monthly compensation.
2023 Pay Rates for 10% – 20% Disability Rating.
Disability RatingMonthly Pay
1 more row

What is the 20 year rule for VA disability? ›

TWENTY YEAR RULE -The VA 20 year rule means if your rating has been in effect for 20 years or more, the VA cannot reduce it below the lowest rating it has held for the previous 20 years. Again, the only exception to this rule is if the VA can prove fraud.

What is the 8 year rule for VA disability? ›

If you are rated as totally disabled as a result of a service-connected disability for at least eight continuous years preceding death, your spouse is entitled to an additional $246. An additional $286 is payable for each dependent child.

What is the VA 8 year rule? ›

8-year provision: VA provides an 8-year provision for surviving spouses of totally disabled veterans (including those eligible for TDIU).

What is the average VA rating for arthritis? ›

Degenerative arthritis, caused by overuse of the joints or an injury, is the most common form of arthritis in veterans and is rated under Diagnostic Code 5003. Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected.

Can you get disability for hip problems? ›

A hip injury can seriously affect your quality of life and ability to work. If you have a hip injury that prevents you from working, you may be eligible for Social Security disability benefits. Some common hip injuries that lead to disabilities are: failed hip replacements.

How do you prove arthritis in VA? ›

To establish a service connection for arthritis, a veteran must prove that the condition was a result of an event that occurred during service, such as an in-service injury or overuse of a joint during a service-related task that caused the condition to develop.

Can a wife use her husband's VA benefits? ›

If you're the spouse, surviving spouse, dependent child, or family caregiver of a Veteran or service member, you may qualify for health care benefits. In certain cases, you may also qualify for health care benefits due to a disability related to your Veteran's service. Find out if you qualify and how to apply.

How do you prove arthritis? ›

What imaging techniques may be used to diagnose arthritis?
  1. X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. ...
  2. Ultrasound. Ultrasound uses sound waves (not radiation) to see the quality of synovial tissue, tendons, ligaments, and bones.
  3. Magnetic resonance imaging (MRI). ...
  4. Arthroscopy.

What is the VA rating for erectile dysfunction? ›

Erectile dysfunction is rated under 38 C.F.R. § 4.115b, Diagnostic Code 7522. Under DC 7522 a 20 percent rating is warranted for deformity of the penis with loss of erectile power. This is the sole disability rating provided under this diagnostic code provision.

What is a C&P exam for arthritis? ›

At a Compensation & Pension examination (C&P exam) for arthritis, the VA examiner will review your medical history and claims file and gather pertinent facts regarding your case. The examiner will also look to see if there is an X-ray on file that definitively shows the presence of arthritis.

Is arthritis in the hips a disability? ›

Arthritis is considered a disability by the Social Security Administration (SSA), as it is one of the most common disabilities that can effect someone's ability to work full time.

What medical conditions cause hip pain? ›

  • Hip fractures -- can cause sudden and acute hip pain. ...
  • Infection in the bones or joints.
  • Osteonecrosis of the hip (necrosis from loss of blood supply to the bone).
  • Arthritis -- often felt in the front part of the thigh or groin.
  • Labral tear of the hip.

Is hip pain a medical condition? ›

There are lots of possible causes of hip pain. It might be caused by a sudden injury or a longer-lasting problem such as arthritis. Your symptoms might give you an idea what could be causing the pain. But do not self-diagnose, see a GP if you're worried.


1. VA Disability for Chronic Pain
(Chisholm Chisholm & Kilpatrick LTD)
2. Erectile Dysfunction VA Disability Ratings
(Chisholm Chisholm & Kilpatrick LTD)
3. Plantar Fasciitis VA Disability Ratings
(Chisholm Chisholm & Kilpatrick LTD)
4. Flat Feet VA Disability Ratings (Pes Planus)
(Chisholm Chisholm & Kilpatrick LTD)
5. VA Disability for Knee Conditions & Pain
(Chisholm Chisholm & Kilpatrick LTD)
6. VA Doctors Deny Claims? How to Watch What You Say!
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