Posted by Berry Law on December 14, 2022 in Disability Ratings
Back pain and injuries are some of the most common issues that Veterans face due to their time in service. Back injuries can be chronic, debilitating, and very painful. However, many Veterans also develop secondary hip pain or conditions as a direct result of their initial back injuries suffered while on active duty.
If that’s the case for you, you may be entitled to additional compensation for that hip pain. The VA has disability ratings for hip pain secondary to back injury. Let’s break down how this works and what kind of future compensation you may receive.
Disability Ratings for Hip Pain
The VA rates hip pain using several different disability diagnostic codes depending on the condition or pain level. Let’s take a look at some of the most common disability ratings and diagnostic codes for hip pain or hip-related conditions.
Osteoarthritis
Osteoarthritis is assigned the diagnostic code 5003 by the VA. If you have hip pain due to osteoarthritis, you could see a disability rating of between 10% and 20%.
Hip Replacements
The VA also rates hip replacements. If you have a complete hip replacement, it will be rated under diagnostic code 5054. You’ll also have a disability rating of 100% for at least four months post-surgery.
After your convalescent period ends, your disability rating will be analyzed and rated again. You could have a disability rating between 30% (the minimum) and 90% (the maximum, which is only applied after the 100 percent evaluation period post-replacement and you still experience painful motion or weakness in your hips).
Limitations of Motion
You may receive disability benefits if you have hip pain that limits your mobility. However, this condition doesn’t have a separate diagnostic code. Instead, the VA will measure various aspects of your range of motion. Specifically, the VA measures flexion, abduction, adduction, rotation, and extension when determining your disability rating.
Ankylosis
If one or both hips suffer from ankylosis, which is characterized by abnormal immobility or stiffening of your joints due to the fusion of one or more bones, it will be rated under diagnostic code 5250. You could be assigned a disability rating of between 60% to 90% depending on how limited your range of motion is.
Do You Need a Diagnosed Condition?
No. You do not need a diagnosable condition with a diagnostic code to receive disability benefits for hip pain. Thanks to the April 2018 verdict in Saunders v. Wilkie, the VA is legally obligated to award disability benefits for hip pain even if you don’t have an underlying diagnosis.
However, you still need to prove that the hip pain was due to an in-service event, injury, or illness or that it is a secondary condition. This can be done through notes from medical professionals like your doctor, a therapist, and other licensed sources.
How Is Hip Pain Rated Secondary to Back Injury?
Hip pain can be related to back injury due to several pre-existing injuries, like degenerative disc disease (also called osteoarthritis of the spine). However, any major back injury may lead to hip injury over time. That’s because the spine and hips are intrinsically connected in the body.
Your spine affects how you walk, how you carry your weight, and how much pressure is placed on your hip joints. If your spine is negatively affected due to your military service – for example, you have to place more weight on your hips than your spine – that could lead to a secondary condition.
That said, spine injuries or conditions do not always lead to hip pain. If you seek disability benefits for your secondary hip pain, you’ll need to prove that the hip pain comes from your back injury or condition.
Secondary Conditions Explained
In a nutshell, secondary conditions are medical conditions or injuries that develop because of your primary service-connected injury/illness. Secondary conditions do not need to be directly connected to your active-duty service.
For instance, a Veteran suffers a back injury during their time in active service. Over the years, their hips start to develop consistent pain and immobility because they walk differently due to that back injury. In this instance, the hip pain is a secondary condition linked to a Veteran’s time in service through the original back injury.
In order to receive a service connection for a secondary condition, it’s important to prove a positive nexus opinion or link to your service. Otherwise, your benefits claim may be denied by the VA.
Furthermore, you must have a service-connected condition already filed with the VA to qualify for secondary condition benefits. If you no longer receive benefits for a service-connected condition, you may not be eligible for benefits for your secondary condition or injury, even if those secondary symptoms are still present.
For this reason, it’s a good idea to consult legal experts before filing your secondary benefits claim.
How Secondary Conditions Affect Your Disability Rating
Secondary conditions can increase your total disability rating. With the VA rating system, Veterans are rated proportionately in terms of how much they are “disabled” versus “non-disabled.” For example, a Veteran with a disability rating of 30% is counted as 70% non-disabled and 30% disabled.
When you acquire benefits for a secondary condition, that condition’s disability rating is added to the current disability rating you have. This is true whether the new grant of service connection is a primary service connected disability or a secondary disability. Here’s a breakdown of how this works with a hypothetical Veteran who has a disability rating of 50%:
- The Veteran applies for and receives benefits for a secondary condition related to their initial service-connected disability or injury.
- The secondary condition has a disability rating of 30%.
- However, the 30% and 50% are not simply added together. Instead, the 30% is considered as a percentage of the previous 50% disability rating.
- Because 30% of 50% is 15%, the Veteran’s total new disability rating is 50+15 or 65%.
- Since the VA always rounds to the nearest factor of 10, this is rounded up to a 70% total disability rating.
As you can see, the VA certainly doesn’t make it easy to understand how disability ratings are added up! That’s just one more reason why you should contact knowledgeable Veterans law attorneys right away if you think you have hip pain related to a service-connected back injury or condition.
How To Get a Service Connection for Hip Pain Secondary to Back Injury
Filing for and receiving benefits for a secondary service condition is similar to filing for and receiving benefits for a primary service-connected injury or illness. First, a Veteran must make sure they’ve filed their VA Form 21-526EZ — their original claim for a current condition or injury.
Then, Veterans must:
- Gather medical evidence that they are suffering from a secondary condition like hip pain. Evidence like personal journals or doctor’s notes can be very valuable during this process.
- Prove that the hip pain or other secondary condition is related to a service-connected condition already covered by disability benefits. Again, a doctor’s note can be very helpful. By linking the hip pain to a primary service-related condition, the Veteran proves there’s a nexus link to their military service.
- Finally, the Veteran must send in their application and wait for the VA to review it. If the VA finds a problem, the Veteran may need to appeal the decision or re-file an application for a different condition or diagnostic code.
Just like other service-connected conditions, some hip pain conditions might be regularly reviewed by the VA. This may cause your disability benefits to fluctuate or change over time.
For example, if your hip pain is related to a back injury currently receiving treatment, your hip pain may become less intense as your back injury treatment progresses. This might result in a new, lower disability rating for your hip pain and your back injury combined.
Throughout this process, licensed and educated Veterans law attorneys can provide important assistance.
Understanding how secondary conditions work is tough, but you don’t have to file for disability benefits alone. Instead, contact Berry Law today and get a free case evaluation and consultation. As experienced Veterans law attorneys, we’re well-equipped and ready to assist with your upcoming application for disability benefits.
Alternately, we can help you through the claim appeals process if you have already applied for benefits and been denied.
We understand the importance of securing the disability benefits you deserve for each of your military-connected conditions. If you experience hip pain secondary to back pain or any other combination of symptoms, don’t wait. Get the legal professionals you deserve on your side today and let us help.
Sources
Saunders v. Wilkie, Apr 3, 2018, 886 F. 3d 1356 (Fed. Cir. 2018) | US Department of Veterans Affairs
Types of VA Disability Claims and When To File | Veterans Affairs
FAQs
VA Disability Rating for Hip Pain Secondary to Back Injury? ›
The secondary condition has a disability rating of 30%.
How much VA disability do you get for hip pain? ›Osteoarthritis-Related Hip Pain
Diagnostic Code 5003 details the following disability ratings: If the Veteran has X-ray evidence suggesting the involvement of two or more major joints, with occasional incapacitating pain, they may receive a disability rating of up to 20%.
Arthritis (e.g., osteoarthritis, psoriatic arthritis, rheumatoid arthritis) Injuries (e.g., bursitis, dislocation, hip fracture, hip labral tear, inguinal hernia, sprains, tendinitis) Pinched nerves (e.g., sacroiliitis, sciatica) Cancer (e.g., bone cancer, leukemia, advanced cancer that has spread to the bones)
What are VA secondary conditions related to back pain? ›Here are some common physical secondary conditions to back pain: Paralysis. Erectile dysfunction. Sciatic nerve damage.
Can you get VA secondary to lower back pain? ›Lumbar Radiculopathy Secondary to Back Pain
Lumbar radiculopathy is a common condition among veterans. This occurs when a nerve in the lower portion of the back is pinched, and it can cause numbness and tingling in the hips and legs. Incontinence can also occur as a result.
All hip replacements are rated at least 30% disability irrespective of the effect on the veteran. Even if the veteran is fully recovered and pain free, a 30% rating is still assigned. However, if the veteran experiences pain or ROM limitations one year after surgery, they can receive a higher VA rating.
What is the range of motion for hip VA disability rating? ›The Veteran's hip disabilities have primarily been rated under Diagnostic Code 5252 for limitation of flexion of the thigh (hip). A 10 percent rating contemplates flexion limited to 45. A 20 percent rating contemplates flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees.
Can hip pain be related to back problems? ›Most lower spine problems are caused by a herniated disk that presses on nerves in the spinal column. This produces the pain known as sciatica, which can be felt in the hip. You may have a herniated disk if pain: Is limited to your back, buttocks or hip.
What causes back and hip pain together? ›Share on Pinterest Possible causes of lower back and hip pain include sprains, strains, and a herniated disk. It is easy to overwork the lower back and hips because they are responsible for lifting, twisting, and moving the legs and trunk. Pains due to overuse and minor injury are common in these areas of the body.
Can hip and back pain be connected? ›If you suffer from chronic back pain, your hips may be the cause. Back pain can sometimes lead to hip pain or vice versa. There are many ways these two problems can affect each other – but it's important to know how they're related in the first place!
What is a secondary condition to back injury? ›
Myelopathy. Myelopathy is a serious condition that can occur if you have a previous back injury or trauma. It is caused by compression on the spine and causes symptoms such as sharp, radiating pain and a loss of bowel or urinary control. Myelopathy can affect the cervical spine, thoracic spine, and lumbar spine.
How does VA rate secondary conditions? ›If your application is approved, your secondary condition will be rated with the VASRD (Veteran Affairs Schedule for Rating Disabilities) scale that is used to apply ratings to all disabilities based on the severity of symptoms.
What is the average VA rating for back pain? ›The average VA disability rating for back pain is only 10 percent. In general, back injuries are rated low for the anguish and disability they cause. Our attorneys understand how the VA rates back conditions and secondary conditions.
What is the average VA rating for degenerative disc disease? ›The VA generally rates degenerative disc disease between 10 and 20%, depending on the number of joints affected.
What is the highest VA rating for lower back pain? ›A 40 percent rating is the maximum schedular rating for limitation of motion of the lumbosacral spine under Diagnostic Code 5292. The Board has considered rating the veteran's low back disability under all potentially applicable diagnostic codes to determine whether a more favorable rating is warranted.
What does the VA consider chronic pain? ›Chronic pain is pain that lasts 6 months or more, long after the event or injury that caused it. Some people can have chronic pain even without prior injury. Migraine and back pain are two of the top service-connected conditions for women Veterans.
What is the average VA rating for arthritis? ›The osteoarthritis disability ratings are either 10% or 20% depending on the following symptoms: 10%: a veteran has degenerative arthritis in two or more major joints or two or more groups of minor joints seen with X-ray evidence. through X-ray evidence) along with occasional incapacitating exacerbations.
What is the highest VA rating for arthritis of back? ›Arthritis of the back will be rated at 10 or 20 percent based upon the number of joints/joint groups affected and the level of incapacitation. VA requires that limitations of motion be confirmed by observations such as swelling, muscle spasms, or evidence of painful motion.
What is the VA code for hip? ›Diagnostic Code 5252 provides for evaluation of the hip on the basis of limitation of flexion of the thigh. An increase is also feasible for the hip disabilities under rating provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5250, which provides for evaluation based on ankylosis.
How is hip range of motion measured? ›To measure flexion of the right hip and extension of the left hip, the patient lies supine with the examiner's hand under the lower lumbar spine thereby palpating the lumbosacral junction from which flexion-extension of the pelvis can be easily detected.
How does the VA check range of motion? ›
At the C&P exam, the VA practitioner will check the ROM for your affected joint using a goniometer. This is an instrument used to measure precise angles. In this case, it would be used to measure the precise degrees of motion that you experience around a joint.
What is the VA 55yr rule? ›Revaluating VA Disability Ratings
Once you turn 55, you are typically "protected" and will no longer have to attend an exam to prove that your condition has not changed unless there is reason to suspect fraud. This is sometimes called the 55-year rule.
Damage to L4 and L5, including spondylolisthesis, can lead to hip pain. This is because the misaligned vertebrae can press on nerves that extend through the hips. When these nerves become irritated, inflamed, or damaged, the patient may experience significant hip and leg pain.
What is the pain from the lower back to the hip? ›Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the lower back through the hips and buttocks and down each leg. Sciatica most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve.
Can a herniated disc cause hip pain? ›In some cases involving a herniated disc, lower back pain can radiate into the hips. This is because the herniation can affect the nerves that travel from the lower back to the hips. The pain is often described as a sharp or shooting pain that can be felt in the front or back of the hip.
What are the three tests to tell you if your back pain is caused by SI? ›Specific physical exam provocative tests for SIJ dysfunction include FABER, compression, distraction, thigh thrust, and Gaenslen tests. Typically, SIJ pain is diagnosed when at least three out of the five provocative maneuvers are positive.
What are the symptoms of L4 L5 stenosis? ›- Pain, weakness or numbness in the legs, calves or buttocks.
- Cramping in the calves with walking, requiring frequent short rests to walk a distance.
- Pain radiating into one or both thighs and legs, similar to the lay term “sciatica”
Patients with spinal stenosis or lumbar spinal conditions can also have similar walking difficulties. Their problems usually manifest with hip pain—not in the front part of this hip, but mostly on the back or buttock part, so it's a different type of a hip problem.
How much is VA disability for erectile dysfunction? ›Unlike other disabilities, erectile dysfunction is not given a rating schedule but instead, uses the following to determine compensation: Code 7520 Partial removal of the penis. This gives a rating of 30%.
What back injuries are permanent? ›Spinal cord injury
However, injuries that result in a severed spinal cord are always permanent. Recovery usually includes physical therapy that focuses on regaining communication and limb strength.
What is the highest VA rating for lumbosacral strain? ›
§ 4.71a, Diagnostic Codes 5295- 5293. Lumbosacral strain is assigned a disability rating in the Schedule under Diagnostic Code 5295. Severe lumbosacral strain is given a 40 percent rating. See 38 C.F.R.
How far back does VA pay for secondary claims? ›The VA typically only pays disability compensation going back to the date of discharge to veterans who apply for their VA disability benefits within one year of being discharged.
How do you prove secondary conditions to the VA? ›Types of Evidence to Submit with Secondary VA Claims
VA health care providers or private physicians can offer critical medical evidence to substantiate secondary VA claims. Any relevant medical records should be submitted to VA. Lay evidence may also be helpful in proving secondary service connection.
You can file a secondary claim to get more disability benefits for a new disability that's linked to a service-connected disability you already have. For example, you might file a secondary claim if you: Develop arthritis that's caused by a service-connected knee injury you got while on active duty, or.
What percentage of VA disability is chronic pain? ›1. Entitlement to an increased rating for chronic pain disorder, currently assigned a 50 percent evaluation.
How do I get a higher VA rating for back pain? ›You can file for a rating increase if your pain has worsened, or you can also apply for total disability based on individual unemployability (TDIU). TDIU requires that you have one condition with at least a 60% rating or two disabilities that add up to 70%.
What percentage is VA chronic pain rating? ›These can all factor into your TDIU chronic pain claim. Schedular TDIU requires at least one service-connected disability rated at 60% or higher OR two or more service-connected disabilities with at least one disability rated at 40% or higher, with a combined rating of 70% or higher.
How bad does degenerative disc disease have to be to get disability? ›However, if your degenerative disc disease (DDD) has caused other physical ailments that are so severe that you will be out of work for at least 12 months, the SSA will consider you disabled and you will be able to qualify for Social Security disability.
What is the VA rating for high blood pressure? ›The VA uses the following criteria to rate hypertension: 60% rating is given if your diastolic pressure is 130 or higher. 40% rating is given if your diastolic pressure measures between 120 and 129. 20% rating is given if your diastolic pressure is 110-119, or your systolic pressure is 200 or higher.
What percentage do you get for a bulging disc from the VA? ݤ 4.124a. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent disability rating applies where the Veteran has incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months.
What should I tell my VA for back pain? ›
- A current diagnosis of a back condition;
- An in-service event, injury, or illness; and.
- A medical nexus (i.e. link) between the current, diagnosed back condition and the in-service event, injury, or illness.
Chronic secondary musculoskeletal pain comes from the bones, joints, muscles, spine, and related soft tissues. It may be caused by local or systemic conditions, and pain may be induced by movement or happen spontaneously.
At what point is chronic pain a disability? ›To that end, if your long-term pain has been prevalent for a year or more; or, if it is likely to continue for at least a year, (or for the remainder of your life), and it significantly impacts your daily activities, potentially, it could be considered a disability.
How do you prove chronic pain for disability? ›Unfortunately, pain is subjective and hard to prove – just stating you have pain is not enough. In order to qualify for Social Security Disability Income, you must show you have a medically determinable mental or physical impairment (MDI) that is established by objective symptoms and laboratory tests.
What is the average VA disability rating for joint pain? ›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.
How do I get disability for my hip? ›- Applicant must have had hip replacement surgery;
- Applicant must not be able to walk well enough to work; and.
- Applicant's inability to walk must last 12 months.
A frequent kind of arthritis in Veterans is degenerative arthritis (osteoarthritis), which is classified under Diagnostic Code 5003 as the result of joint overuse or injury. Depending on the symptoms and the number of joints affected, Veterans are mostly given a 10% or 20% grade.
Is chronic hip pain a VA disability? ›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.
Is joint pain considered a permanent disability? ›While some conditions that cause joint pain can be treated over a period of time, others are permanent. The conditions that are expected to last for a duration of more than 12 months are cases that may be considered eligible to receive disability or Social Security benefits.
What percentage is VA knee rating? ›VA ratings for knee pain range from 0% to 60%. The more pain or lack of mobility in the knee, the higher the rating. If there is too much wear and tear on the knee and it requires surgery, a veteran may be granted a temporary 100% rating following surgery.
What is the most common cause of hip disability? ›
Osteoarthritis of the hip is a major cause of pain and disability in western populations.
Is degenerative hip a disability? ›Yes, you can get a disability benefit for osteoarthritis of the spine, knee, and/or hip, so long as the severity and symptoms of your osteoarthritis meet the criteria of the Social Security Administration's (SSA) Blue Book listing.
What is hip disability? ›The hip disability and osteoarthritis outcome score (HOOS) is a questionnaire intended to be used to assess patient's opinion about their hip and associated problems, and to evaluate their symptoms and functional limitations during a therapeutic process.
How do you prove arthritis in VA? ›To prove arthritis is service connected, a doctor may be able to determine that your history with injury in your service is likely to have caused arthritis. There still needs to be a VA disability rating for arthritis and if the VA sees a link, you may claim direct service connection.
How do I prove arthritis for VA disability? ›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.
What is the maximum VA rating for back pain? ›VA disability ratings for back pain go from 10% to 100% depending on how severe your symptoms are, including your range of motion and pain frequency and level. Claims involving both the cervical spine and the thoracolumbar spine are rated under the same general rating formula.
What VA disabilities are permanent and total? ›Certain types of service-connected disabilities automatically are deemed to support a VA rating of Permanent and Total Disability. They include the irreversible loss of use of both hands, both feet, one hand, and one foot, loss of vision in both eyes, or the Veteran being permanently bedridden.
What disabilities get the highest VA rating? ›Disabling mental health conditions are generally regarded as “high-value” claims. This is because mental health issues are much more likely than neurological, skin, auditory, or most musculoskeletal conditions to receive a disability rating of 30% or higher.