Understanding Bilateral Hip Condition VA Ratings: A Comprehensive Guide

Veterans who have suffered hip injuries or developed hip conditions due to their military service may be eligible for disability compensation from the Department of Veterans Affairs (VA). The VA uses a rating system to determine the severity of a veteran’s hip condition and the corresponding level of compensation.

For bilateral hip conditions, which affect both hips, the VA considers each hip separately and then applies a special provision called the bilateral factor. This factor recognizes that having a condition affecting both sides of the body can be more disabling than the sum of the individual ratings.

Understanding how the VA rates hip conditions is crucial for veterans seeking fair compensation for their service-connected disabilities. The rating process takes into account various factors, including pain, range of motion, and the impact on daily activities.

Common Causes and Symptoms of Hip Pain

Hip pain in veterans can stem from various causes, many of which are related to the physical demands of military service. Common causes include:

• Osteoarthritis
• Traumatic injuries
• Repetitive stress injuries
• Hip fractures
• Bursitis
• Tendinitis
• Labral tears

Symptoms of hip conditions can vary but often include:

• Pain in the hip, groin, or thigh
• Stiffness and reduced range of motion
• Difficulty walking or bearing weight
• Swelling or tenderness around the hip joint
• A clicking or popping sensation in the hip

Veterans experiencing these symptoms should seek medical attention and consider filing a claim for VA disability benefits if their condition is service-related.

How the VA Evaluates Hip Conditions

The VA evaluates hip conditions based on several factors, including:

1. Range of motion
2. Pain levels
3. Functional loss
4. Instability
5. X-ray evidence of arthritis
6. Need for assistive devices

During a Compensation and Pension (C&P) exam, a healthcare provider will assess these factors and provide a report to the VA. The VA then uses this information, along with other medical evidence, to assign a disability rating.

It’s important for veterans to provide thorough documentation of their hip condition, including private medical records, service treatment records, and lay statements describing how the condition impacts their daily life.

The Bilateral Factor in VA Ratings

The bilateral factor is a crucial concept for veterans with conditions affecting both hips. This provision acknowledges that bilateral disabilities are more severe than simply adding the ratings for each side.

According to VA regulations, the bilateral factor is calculated by increasing the combined rating of the bilateral conditions by 10% of that value. For example, if a veteran has a 20% rating for the right hip and a 10% rating for the left hip, the combined rating would be 28%, which is then increased by 10% of 28%, resulting in a final rating of 31%.

The bilateral factor can significantly increase a veteran’s overall disability rating and, consequently, their compensation. Veterans with bilateral hip conditions should ensure that both hips are properly evaluated and rated to take full advantage of this provision.

Diagnostic Codes for Hip Conditions

The VA uses specific diagnostic codes to rate hip conditions. Some common codes include:

• 5250: Hip ankylosis
• 5251: Thigh limitation of extension
• 5252: Thigh limitation of flexion
• 5253: Thigh impairment (limitation of abduction, adduction, or rotation)
• 5254: Hip flail joint
• 5255: Femur impairment

Each of these codes has specific criteria for different rating percentages. For example, under Code 5252 (limitation of flexion), ratings range from 10% for flexion limited to 45 degrees to 40% for flexion limited to 10 degrees.

Veterans should familiarize themselves with these codes and the corresponding criteria to better understand how their hip condition might be rated.

How Hip Replacement Impacts VA Ratings

Veterans who have undergone hip replacement surgery may be eligible for different ratings based on the outcome of the procedure. The VA assigns ratings for hip replacements as follows:

• 100%: For one year following implantation of prosthesis
• 90%: Following implantation of prosthesis with painful motion or weakness requiring use of crutches
• 70%: Markedly severe residual weakness, pain, or limitation of motion
• 50%: Moderately severe residuals of weakness, pain, or limitation of motion
• 30%: Minimum rating

After the initial 100% rating period, the VA will re-evaluate the condition to determine the appropriate ongoing rating based on residual symptoms and limitations.

Ratings for Ankylosis and Range of Motion Limitations

Ankylosis, which is the abnormal stiffening and immobility of a joint, can result in higher disability ratings. The VA rates hip ankylosis under Code 5250, with ratings ranging from 60% to 90% depending on the position of the hip and the severity of the ankylosis.

For range of motion limitations, the VA considers both flexion (Code 5252) and extension (Code 5251) of the hip. Ratings are based on the degree to which motion is limited, with more severe limitations resulting in higher ratings.

It’s important for veterans to have accurate range of motion measurements taken during their C&P exam, as these measurements directly impact the assigned rating.

VA Ratings for Arthritis and Bursitis

Arthritis and bursitis are common hip conditions among veterans. The VA rates these conditions based on X-ray evidence and limitation of motion:

• Arthritis (Code 5003): Ratings of 10% or 20% based on the number of joints involved and the presence of occasional incapacitating exacerbations\
• Bursitis (Code 5019): Rated based on limitation of motion of the affected part, as degenerative arthritis

Veterans with hip arthritis or bursitis should ensure that their medical records include X-ray evidence of the condition and thorough documentation of any limitations in motion or function.

Total Disability Individual Unemployability (TDIU) for Hip Conditions

Veterans whose hip conditions prevent them from maintaining substantially gainful employment may be eligible for Total Disability Individual Unemployability (TDIU). This benefit allows veterans to receive compensation at the 100% rate, even if their combined schedular rating is less than 100%.

To qualify for TDIU, veterans must have:

1. One service-connected disability rated at 60% or more, OR
2. Two or more service-connected disabilities with a combined rating of 70% or more, with at least one rated at 40% or more

Veterans who don’t meet these criteria may still be eligible for TDIU on an extraschedular basis if their hip condition(s) uniquely impact their ability to work.

Tips for Filing a Successful VA Claim for Hip Pain

To increase the chances of a successful VA claim for hip conditions, veterans should:

1. Gather all relevant medical records, including service treatment records and post-service treatment records
2. Obtain a medical nexus opinion linking the hip condition to military service
3. Submit lay statements from themselves and others describing how the hip condition impacts daily life
4. Attend all scheduled C&P exams and provide thorough information about symptoms and limitations
5. Consider seeking assistance from a Veterans Service Organization (VSO) or an accredited attorney

It’s crucial to provide as much detail as possible about how the hip condition affects daily activities and employment to ensure an accurate rating.

Appealing a VA Decision on Hip Condition Ratings

If a veteran disagrees with the VA’s decision on their hip condition rating, they have the right to appeal. The appeals process includes several options:

1. Higher-Level Review: Request a review by a more senior VA employee
2. Supplemental Claim: Submit new and relevant evidence to support the claim
3. Board Appeal: Appeal directly to the Board of Veterans’ Appeals

Veterans have one year from the date of the decision to file an appeal. It’s often beneficial to seek assistance from a VSO or accredited attorney when navigating the appeals process.

By understanding the VA rating system for hip conditions and following these guidelines, veterans can work towards receiving the compensation they deserve for their service-connected hip disabilities. Remember, persistence and thorough documentation are key to a successful claim.