VA Disability Rating for Arthritis

Arthritis is a debilitating condition that affects countless veterans, impacting their daily lives.

If you’re a veteran struggling with this impairment, understanding VA disability ratings can significantly influence access to the benefits and support you need.

Read on to learn about the types of arthritis the VA recognizes, the process of establishing service connections, disability rating criteria, and tips for maximizing your benefits.

Arthritis Recognized by the VA

The government acknowledges the following types of arthritis that can qualify for disability benefits.

Osteoarthritis

Often called “wear and tear” arthritis, osteoarthritis occurs when the cartilage between joints breaks down, causing pain, stiffness, and swelling. It commonly affects weight-bearing joints like the knees, hips, and spine.

Rheumatoid Arthritis

This autoimmune disorder causes the body’s immune system to attack healthy joint tissue, leading to inflammation, pain, and joint deformity. It can affect multiple joints symmetrically, such as the hands, wrists, and feet.

Psoriatic Arthritis

Linked to the skin condition psoriasis, psoriatic arthritis causes joint pain, stiffness, and swelling. It can affect any joint and cause fatigue and changes in the nails and skin.

Gout

Caused by a buildup of uric acid crystals in the joints, gout results in sudden, severe attacks of pain, swelling, and redness. It most commonly affects the big toe but can also occur in other joints.

Establishing Service-Connection for Arthritis

To receive VA disability benefits for arthritis, you must first establish a service connection.

Direct Service Connection

If your arthritis began during your military service, you can establish a direct service connection. This connection requires medical evidence and service records showing the onset of arthritis while in the service.

Presumptive Service Connection

The VA may presume arthritis is service-connected under certain conditions, including if it manifested within a specific time frame after leaving the military. For arthritis, the presumptive period is typically one year from your discharge date.

Secondary Service Connection

If another service-connected disability caused or aggravated your arthritis, you may establish a secondary service connection.

• FOR EXAMPLE – If you have a service-connected knee injury that leads to osteoarthritis in that hip, or a neighboring joint, you may be eligible for additional benefits.

VA Disability Rating Criteria for Arthritis

The VA assigns disability ratings for arthritis based on the specific type and severity of the condition.

The VA’s Schedule for Rating Disabilities (VASRD) outlines rating criteria under diagnostic codes 5002, 5003, and 5004-5024.

Diagnostic Code 5002: Rheumatoid Arthritis

• Characterized by periods of flares and remissions
• Evaluation considers:
  • Constitutional symptoms (anemia, weight loss, fever)
  • Incapacitating exacerbations
  • Chronic residuals like a limitation of motion
• Rating criteria:
  • 100%: Constitutional manifestations associated with active joint involvement, totally incapacitating
  • 60%: Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring four or more times a year
  • 40%: Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring three or more times a year
  • 20%: One or two exacerbations a year in a well-established diagnosis

Chronic residuals like limited motion are rated under the appropriate diagnostic codes for the specific joints involved.

Diagnostic Code 5003: Degenerative Arthritis (Osteoarthritis)

• Rated under 38 CFR 4.71a, Diagnostic Code 5003
• Requires X-ray evidence to substantiate the diagnosis
• Evaluation based on limitation of motion of the affected joint(s):
  • If the limitation of motion is compensable under another diagnostic code, it is rated under that code
  • If limitation of motion is non-compensable, a 10% rating is assigned for each major joint or group of minor joints affected by limitation of motion
• When there is no limitation of motion:
  • 20%: With X-ray evidence of involvement of 2 or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations
  • 10%: With X-ray evidence of involvement of 2 or more major joints or two or more minor joint groups
• Ratings based solely on X-ray findings cannot be combined with ratings based on limitation of motion

Note: The VA considers factors such as painful motion, functional loss, weakness, fatigue, and incoordination when evaluating arthritis.

Gathering Evidence for Your Arthritis Claim

To support your VA disability claim for arthritis, you’ll need to provide compelling evidence.

Medical Evidence

A qualified medical professional’s diagnosis, treatment records, imaging studies, and lab results are all helpful. Regular visits with a rheumatologist or orthopedic specialist can also strengthen your claim.

Lay Evidence

Personal statements from you and buddy statements from family, friends, or fellow service members can attest to the frequency of exacerbations or the impact of your arthritis on your daily life and ability to work. Lay statements may also be important in describing an in-service injury or the types of duties or exposures you had in service that caused your arthritis.

VA Examinations

The VA may schedule a Compensation and Pension (C&P) exam to assess the severity of your arthritis and seek medical opinions on whether the arthritis is related to service. Attending these exams is important since missing an appointment can result in denial of benefits.

Special Considerations for Arthritis Claims

The government makes a few special considerations when examining a VA disability claim for arthritis.

Multiple Joint Involvement

If you have arthritis in multiple joints, the VA will assign a combined rating, taking into account the individual ratings for each affected joint. Additionally, if you have arthritis in paired joints (e.g., both knees), you may be eligible for the bilateral factor, which can increase your overall rating.

Flare-ups and Intermittent Symptoms

Arthritis symptoms can vary in intensity over time, with periods of remission and flare-ups. Documenting the frequency and severity of your flare-ups and their impact on your daily activities can help support your claim for a higher rating.

Tips for Maximizing Your Arthritis VA Disability Rating

Consider these tips to increase your chances of receiving the highest possible VA disability rating for arthritis.

Seek Regular Medical Treatment

Consistently seeking medical care for your arthritis demonstrates the ongoing severity of your condition. Maintain a strong relationship with your treating physicians and follow their recommended treatment plan.

Keep a Symptom Journal

Recording your daily symptoms, flare-ups, and functional limitations can provide valuable evidence for your claim. Use a mobile app or diary to track your symptoms and how they impact your daily life.

Gather Supporting Evidence

Obtain medical opinions from your treating physicians and collect lay statements from loved ones who have witnessed the effects of your arthritis firsthand.

Appeal Unfavorable Decisions

If you have been denied, you should consult an accredited attorney or agent to help you evaluate the appeal options available to you under the Appeals Modernization Act. While you have the right to appeal on your own, it may be wise to get guidance from someone familiar with the ins and outs of the VA system.

Avoiding Common Mistakes in Arthritis Claims

To give yourself the best chance of success, avoid these common mistakes when filing an arthritis VA disability claim.

Failing to Establish Service Connection

Providing clear evidence linking your arthritis to your military service is imperative. Without a solid service connection, the government may deny your claim. This involves evidence that you have a current diagnosis, evidence of an in-service injury, and in some cases, you may want to seek a private medical opinion linking the current condition to what happened in service or to another service-connected condition.

Missing VA Examinations

Skipping scheduled C&P exams can result in a denial of benefits. If you can’t attend an appointment, notify the exam company immediately to reschedule, and if they are unable to reschedule, notify VA explaining why you were unable to attend the scheduled exam, and requesting they assist in rescheduling it for you.

Resources for Veterans with Arthritis

As a veteran with arthritis, you’re not alone.

There are numerous resources available to help you navigate the claims process and access the support you need:

• Veterans Service Organizations (VSOs) and accredited attorneys: Organizations like Disabled American Veterans (DAV), Veterans of Foreign Wars (VFW), and law firms like ProVet Legal offer assistance with VA disability claims and appeals.
• Arthritis Foundation: The Arthritis Foundation provides educational resources, support programs, and local chapters for individuals living with arthritis.
• VA Health Care Services: If you’re eligible for VA health care, you can access treatment for your arthritis at VA medical centers and outpatient clinics nationwide.