According to data from the CDC, over one-third of all veterans have been diagnosed with arthritis. Arthritis can cause debilitating pain and functional limitations, which can leave many veterans disabled. The VA has an arthritis rating system that it uses to determine appropriate compensation for veterans seeking disability benefits. If you plan to apply for VA disability for arthritis, you need to understand how VA arthritis ratings work and how they can affect your disability claim.
Can Veterans Get VA Disability for Arthritis?
Veterans can qualify for disability due to arthritis if their condition stems from or was aggravated by their military service. In order to receive benefits, veterans must apply for VA disability benefits, receive a VA arthritis disability rating, and provide evidence connecting their arthritis to their military service.
Symptoms of Arthritis
Arthritis is a medical condition that manifests in pain, stiffness, and inflammation in the joints, such as the knees, spine, hips, neck, and more. There are two main types of arthritis: Degenerative arthritis (or osteoarthritis) is caused by the deterioration of cartilage between joints due to overuse and wear and tear.
Rheumatoid arthritis, in contrast, is an autoimmune condition in which the body’s own immune system attacks healthy joint tissue. Of the two kinds, osteoarthritis is more common, especially among veterans who spent their service performing highly demanding physical activity. Veterans can develop rheumatoid arthritis if they were exposed to harmful materials while serving, such as dust, munitions, or chemicals.
Both types of arthritis produce similar symptoms, including:
- Joint stiffness and increased feelings of joint friction
- Reduced range of motion or functional limitations
- Inflammation and swelling in the joints
- Popping or cracking sensation in the joints
- Bone spurs or hard bumps near joints
- Chronic or recurring pain ranging from mild to severe
How the VA Rates Arthritis for Disability
Veterans can receive disability benefits for both degenerative and rheumatoid arthritis. However, the VA uses different rating schedules for the two conditions. These ratings are crucial because they determine the amount of benefits you are entitled to due to your service-connected disability. In most cases, a VA physician will assign these ratings after performing a medical exam.
Degenerative Arthritis (Code 5003)
According to diagnostic code 5003, the VA rates degenerative arthritis based on limitations of motion in major joint groups. The greater the limitation, the higher the arthritis rating. Individual arthritis ratings are grouped by part of the body and are listed in diagnostic codes 5200 – 5274. For example, if you can’t flex your bent knee more than 45 degrees. You would receive a VA rating for knee arthritis of 60.
If motion restrictions from arthritis are not severe enough to fall under defined limitations, the VA will give a rating of either 10 percent or 20 percent.
- A 10 percent rating means you have arthritis in two or more major or minor joint groups.
- A 20 percent rating means you have arthritis in two or more major or minor joint groups, and occasional flare-ups incapacitate you.
To receive a 10 percent or 20 percent rating, X-ray evidence must show the presence of arthritis.
Rheumatoid Arthritis (Code 5002)
Non-degenerative systemic arthritis, such as rheumatoid arthritis, is included under diagnostic code 5002 as long as it affects at least two major or minor joint groups. Ratings for multi-joint arthritis reflect the degree of incapacitation and are rated between 20 and 100, with different levels at 60 and 40.
- 100: Total incapacitation due to symptoms
- 60: Severe incapacitating events at least four times per year, or significant weight loss and anemia
- 40: Incapacitating episodes at least three times per year or a significant decline in health
- 20: One or two incapacitating episodes per year and an official diagnosis
If rheumatoid arthritis causes limitations in joint motion, it can receive a diagnostic code under diagnostic code 5003. However, ratings under codes 5002 and 5003 are not combined. Instead, the VA uses the higher rating.
Establishing a Service Connection for Arthritis
A central part of applying for VA disability is proving that your condition is connected to your military service. There are multiple ways that you can establish an arthritis military service connection:
Direct Connection
Proving a direct connection means showing that your disability was the direct result of some event that happened during your service. Specifically, you need
- A current diagnosis of arthritis
- Evidence of some event that happened during your service
- A nexus (connection) between your current arthritis and the service event
The last ‘nexus’ requirement typically takes the form of a nexus letter from a physician with their professional opinion linking the disability to the event.
Presumptive Connection
If your arthritis manifested within one year after leaving military service, the VA may automatically assume it’s connected to your service. If such a presumptive connection applies, you don’t have to provide evidence proving a connection.
Secondary Connection
A secondary service connection may apply if your arthritis is due to another service-related disability. For example, disability from a separate service-connected leg injury could cause arthritis in the knee and hip.
Tips for Filing or Appealing a VA Arthritis Claim
Applying for VA disability benefits can be stressful, so here are some tips to streamline and expedite the process.
- Gather all copies of medical records from VA facilities and private facilities. You can also gather supporting statements from family, medical professionals, or other service members.
- Consider getting multiple nexus letters to have as much evidence as possible for your service connection.
- Consider filing a fully developed claim (FDC). FDCs can speed up the decision process and reduce payment delays.
- Don’t exaggerate or downplay your symptoms during medical exams. If you try to fake symptoms, you can lose benefit eligibility.
- Reply to any request for additional information as promptly as possible. If you fail to provide additional information, the VA might deny your claim.
Contact VetLaw for Help with Your Arthritis Claim
If you have any more questions about the VA’s arthritis disability ratings or would like to speak to a VA disability benefits attorney, contact VetLaw online or call (336) 355-8387 for a free case consultation.
