Category: Veterans Disability Law
Arthritis VA Rating: Types of Arthritis and VA Disability
Arthritis is a condition that plagues many people across the United States. Arthritis is considered a disability, emerging in various forms at differing levels of severity. More than 1 in 3 veterans suffer from arthritis. The Department of Veteran Affairs (VA) grants VA disability to those who have arthritis, yet the degree of benefits varies depending on the type and intensity of the arthritis. If you experience arthritis due to your time in the service, you may be eligible to make an arthritis claim and be awarded compensation.
Different Types of Arthritis
There are two main types of arthritis: degenerative arthritis and rheumatoid arthritis. The two types have similarities and differences, but it’s important to know exactly what type you have to get the benefits you need. Knowing what your condition is will impact your arthritis VA rating, so it’s important that a thorough examination and documentation takes place.
There are many different categories of arthritis, but degenerative and rheumatoid are the types that affect veterans the most. If you do have another type of arthritis, you may still be eligible for care under VA benefits.
Similarities Between Degenerative and Rheumatoid Arthritis
Both types are arthritis can affect your joints and have overlapping symptoms:
- Persistent or recurring pain that affects your wellbeing and how you function on a day-to-day basis
- Joint swelling that can cause joint stiffness
- Decrease in range of motion
Degenerative arthritis is also referred to as osteoarthritis. It can also be called “wear and tear” arthritis and is the most common form of arthritis.
On the ends of each of our bones, we have cartilage that protects the bones from one another. Osteoarthritis occurs when that cartilage is worn down. It typically happens gradually and develops from overuse, injury, and/or aging.
Degenerative arthritis is most painful in weight-bearing joints:
Other joints that are affected are:
- Major joints, which include wrist, shoulder, elbow, ankle, hip, and knee
- Minor joints, which include spine, toes, fingers, and sacroiliac (or SI joint)
Damaged joints from injury are also subject to degenerative arthritis. It is common for bone spurs to develop on osteoarthritic joints, making the bone harder and causing the joint to become inflamed.
Rheumatoid arthritis, on the other hand, is an autoimmune disease. The body’s immune system produces chemical substances that attack joint surfaces. Joint linings may also swell and move into spaces where tissue should be. It can affect large and small joints and cause joint pain even when joints aren’t being used.
VA Disability for Arthritis: Service Connection
There are three main service connections for arthritis: direct service, presumptive service, and secondary service. Since arthritis is a gradual disability, there does not have to be an event or injury to prove service connection.
Wondering how to prove arthritis is service connected? Direct service connection is easier to show if you documented pain throughout and after your service. It will be much easier to determine your rating if you have past medical records indicating the presence of arthritis. Yet, arthritis is characterized as a presumptive service connection, so if you do not have any past records, you are still eligible for service-connected benefits.
It’s important to mention that arthritis commonly worsens over time. Veterans who wait to claim VA disability for arthritis or to even receive an immediate VA disability rating may find it harder to make a VA claim. The closer to your discharge your arthritis begins to flare up, the easier it is to claim service connection.
Direct Service Connection
This is where recording your injuries throughout service will benefit you. Though there does not need to be a specific injury, in-service injuries and the overall overuse of your joints warrant the possibility of arthritis to develop later in life. 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.
Presumptive Service Connection
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. This service connection will be useful for making your VA claim for arthritis benefits, especially if there is no record of injury or overuse of joints during your service.
Secondary Service Connection
Arthritis may be a secondary condition as a result of another service-related disability. Under the Code of Federal Regulations, arthritis can be considered as service incurred if it is directly connected to the service-related injury. For example, if you have a service-connected knee injury and develop arthritis later in life caused by your injury, the arthritis is considered a secondary service connection. It is also possible that arthritis can cause secondary conditions like depression. If you do develop secondary conditions and the VA determines a connection, you may claim secondary service connection.
VA Disability Rating for Arthritis
Both degenerative and rheumatoid arthritis are rated under the musculoskeletal system conditions. Range of motion and pain levels are key factors to your disability rating. Physicians should be using a goniometer to get exact measurements for your joint’s range of motion. This is important because the VA looks first at range of motion for each joint, which determines your rating. Sometimes, you may have full motion, in which case the VA under the degenerative arthritis code.
There are multiple levels of rating that is on a percentage-based system. Rheumatoid arthritis levels of rating are under Diagnostic Code 5002; degenerative arthritis levels are under Diagnostic Code 5003. Percentages range from 10% to 100%. A rating for limited range of motion cannot be given in addition to either degenerative or rheumatoid arthritis. Your rating will affect your arthritis claim and the benefits you receive.
Rheumatoid arthritis disability rating can change throughout your lifespan because the intensity of the arthritis may worsen. Rheumatoid arthritis is also rated depending on the joints involved, yet can only be rated as either an active condition or for residual chronic conditions.
Under Diagnostic Code 5002, the VA rates your rheumatoid arthritis case based on the following:
- 100%: The veteran’s rheumatoid arthritis results in incapacitation. Multiple organs and body systems are affected along with your joints.
- 60%: The veteran has severe incapacitating episodes four or more times per year. Episodes are accompanied by anemia, weight loss, and decreased overall health.
- 40%: The veteran has three or more incapacitating episodes per year or a medically diagnosed health condition and day-to-day impairment.
- 20%: The veteran has one-to-two or more incapacitating episodes per year and has a well-established diagnosis.
Residual effects (e.g., limited motion or ankylosis) are rated for the specific joint experiencing other conditions. A 10% rating may be applied for effects such as swelling, muscle spasms, or experiences of pain while moving if they are separate from conditions under Diagnostic Code 5002. The amount of rheumatoid arthritis VA disability you can claim is dependent on whatever rating you receive. Again, since rheumatoid arthritis is a chronic condition that can worsen, you can claim rheumatoid arthritis VA disability multiple times as your rating increases.
Osteoarthritis is the most common type of arthritis found in veterans. Soldiers who are currently in service may experience degenerative arthritis, making it easier to claim service connection.
Your degenerative arthritis VA rating is based on the number of joint/joint groups that have a limited range of motion. This is often determined via X-rays. If there is a limited range of motion, but arthritis does not show up on the X-ray, there is an automatic 10% rating for each major or minor joint group affected. Note that the 10% is not in addition to any rating under Diagnostic Code 5003 (the determiner for degenerative arthritis).
In order to receive a rating of limited motion, the VA must confirm swelling, muscle spasms, or other evidence of pain through observation.
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.
If you request a VA disability rating for arthritis in your back and a VA disability rating for arthritis in your hands, this counts as two or more minor groups. They will be evaluated separately and combined (but not added together) for your overall rating. Subsequently, a VA disability rating for arthritis in the knee and a VA disability rating for arthritis in an ankle count as two major injuries, separate from each other, but combined in an overall rating. Of course, if you only have one area that is affected by arthritis, there still is a chance for a rating.
Other Arthritis Ratings
If you have arthritis that does not fall under the umbrella of degenerative or rheumatoid, then different codes may apply; for example, post-traumatic arthritis is rated under Diagnostic Code 5010. Chronic residuals will be rated under Diagnostic Code 5003. The VA will assign your code depending on the conditions, symptoms, and type of arthritis.
Painful Motion Rule
In general cases of arthritis, ratings for different joints are combined, not added. Yet, there is an exception. The VA’s painful motion rule may apply if you experience pain on motion because of your arthritis. The rule creates the possibility of receiving a 10% rating separate from your VA disability rating for arthritis. If you are only receiving one rating per joint (not doubling up), you can separate your 10% ratings.
In order for this to be possible, VA examiners need to test for pain in the following categories:
- Active motion
- Passive motion
- Weight-bearing pain
- Non-weight-bearing pain
- Range of pain and motion in the opposite, undamaged joint, if available
If you feel that your test results did not come back as expected or if you feel the exam was incomplete, you are allowed to argue against the adequacy of the exam.
Temporary 100% VA Disability Ratings
Sometimes with arthritis, surgery is needed to improve joint functionality. If you do need to undergo surgery because of your arthritic disability, the VA will adjust your rating for a temporary period of time. The VA will grant a temporary 100% disability rating for severe medical conditions if it’s the result of your service-connected arthritis. If this is the case, your VA disability compensation for arthritis rises. The temporary rating can occur during hospitalization and convalescence.
Hospitalization ratings are assigned when a veteran is in the hospital for more than 21 days. It starts when a veteran’s hospital stay is initiated and ends when treatment is finished.
Convalescence ratings are given during a recovery period following a surgery or other severe medical condition. To obtain this rating, a veteran must have a post-surgery recovery time of at least one month and experience postoperative residual effects such as an extended healing time, or immobilization of major joints because of a cast. Convalescence ratings start one month after hospital discharge.
It is possible that service-connected arthritis leaves you unable to start and/or keep employment. If this is the case, you may be eligible for total disability based on individual unemployment (TDIO) benefits.
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