Diseases of the Musculoskeletal System

Topics:

Degenerative Arthritis
Other Conditions Rated as Degenerative Arthritis
Rheumatoid Arthritis
Other Conditions Rated as Rheumatoid Arthritis
Caisson Disease of the Bones
Tuberculosis of the Bones and Joints
Osteomyelitis
Fibromyalgia
DBQs for Musculoskeletal Diseases
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

The VASRD occasionally uses the terms like “incapacitating.” Unless specifically noted, there are no clear-cut definitions for terms like this, and so the Rating Authorities will have to decide exactly what it means in each case. The general rule for defining "incapacitating", however, is whether or not the condition makes it impossible for the service member to do his job or function well in daily life. If it does, then it most likely would be considered incapacitating.

 


Degenerative Arthritis

Code 5003: Degenerative arthritis is the second most common rating for any joint condition, and it can get VERY confusing. The most common rating for joint conditions is limitation of motion, partly because conditions are required to be rated under limitation of motion first before they can be rated as degenerative arthritis. If any condition causes a decreased range of motion in a joint, then it MUST be rated on that limited motion.

A joint condition can only be rated as degenerative arthritis if it does not have a limited enough range of motion to rate under those codes. Conditions CANNOT be rated under both limitation of motion and degenerative arthritis. Limited motion first, and if not, then only arthritis. Got it?

So on to the rating: Once a condition cannot possibly be rated as limited motion of the affected joint, we can proceed with rating it as degenerative arthritis.

Please note that there must be x-ray evidence of arthritis in the joints to rate under this code.

For rating arthritis, the shoulder, wrist, elbow, hip, knee, and ankle are considered major joints. The finger and toe joints, spine, and sacroiliac joint are considered minor joints. If two or more major or minor joint groups have arthritis and it is occasionally incapacitating, then it is rated 20%. If two or more major or minor joint groups have arthritis but it is never incapacitating, then it is rated 10%.

If only a single major or minor joint group has arthritis, it can only be rated more than 0% under code 5003 if there is painful motion. If it hurts to move it, then it rates 10% because of the Painful Motion principle.

Code 5010: Traumatic arthritis is arthritis that is due to an accident or injury. This code doesn’t have its own ratings, but is rated as degenerative arthritis. The final code for this condition will look like this: 5010-5003. The first four-digit code defines the condition as traumatic arthritis, and the second four-digit code tells how it is rated.

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Other Conditions Rated as Degenerative Arthritis

There are numerous conditions and diseases that say to rate it as 5003, degenerative arthritis. In reality, however, all of the codes below are only allowed to rate under limited motion of the affected body part and are not allowed to be rated on the rating system of 5003. Insane? I know. Why didn’t they just say that they could only be rated on limited motion in the first place and not mention 5003 at all? If only life were simple.

A note on the codes: Since these codes are actually rated under code 5003, their final codes will look like this: 5024-5003. The first four-digit code defines the condition as tenosynovitis (code 5024), and the second four-digit code tells how it is rated (degenerative arthritis). The 5003 is deceiving, though, since it is actually rated on limited motion 5261, but the Rating Authorities could put either on the rating decision.

As it is, here are those pesky codes and conditions that are actually only allowed to be rated on limited motion:

Code 5013: Osteoporosis is the thinning of the bones over time.

Code 5014: Osteomalacia is the softening of the bones over time.

Code 5015: Non-cancerous bone growth occurs when extra bone continues to grow beyond the normal needed amount. These groups of bone can grow anywhere in the body.

Code 5016: Osteitis deformans (Paget’s disease) causes bone tissue to break down. The bones then rebuild themselves with thicker and weaker tissue which results in deformity.

Code 5018: Intermittent hydrarthrosis is the periodic swelling most commonly of major joints, although other joints could also be affected, on a regular and predictable schedule.

Code 5019: Bursitis is the swelling of fluid sacs that pad around tendons.

Code 5020: Synovitis is the swelling of a membrane that lines synovial joints.

Code 5021: Myositis is the swelling of the muscles.

Code 5022: Periostitis is the swelling of the tissue that surrounds the bones.

Code 5023: Myositis ossificans is a disorder where bone cells build up and replace muscles and connective tissue.

Code 5024: Tenosynovitis is the swelling of the tissues that surround the tendons.

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Rheumatoid Arthritis

Code 5002: Rheumatoid arthritis is the destruction of the soft tissues in a joint because of swelling. Regardless of how many joints are affected, if the arthritis is severe enough that you cannot function, but are completely incapacitated and must stay in bed always, then it is rated 100%. If severe incapacitating episodes happen 4 or more times a year, then it is rated 60%. These episodes must also be accompanied by symptoms of weight loss, anemia or other significant health problems. If the incapacitating episodes happen 3 or more times a year with a definite, but not necessarily significant, decrease in health, then it is rated 40%. One or two episodes a year rates 20%. These ratings cannot be used in addition to ratings for limited motion. One or the other.

Any rheumatoid arthritis less severe than noted above is just rated upon its symptoms, such as limited motion. In these cases individual joints can be rated. So, if three joints are involved, but there are no incapacitating episodes, all three can be rated separately on limited motion. A minimum of 10% is given for every joint that at least has pain with motion.

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Other Conditions Rated as Rheumatoid Arthritis

Like with degenerative arthritis, there are numerous conditions and diseases that say to rate them as 5002, rheumatoid arthritis. The following codes are all rated as rheumatoid arthritis.

Remember: Since these codes are actually rated under code 5002, their final codes will look like this: 5008-5002. The first four-digit code defines the condition as streptococcic arthritis (code 5008), and the second four-digit code tells how it is rated (rheumatoid arthritis).

Code 5004: Gonorrheal arthritis (a.k.a. gonococcal arthritis) is the swelling of a joint caused by a gonorrheal bacteria infection.

Code 5005: Pneumococcic arthritis is the swelling of a joint that occurs after pneumonia.

Code 5006: Typhoid arthritis is the swelling of the tissues in a joint caused by a typhoid bacteria infection.

Code 5007: Syphilitic arthritis is the swelling of the joint tissues caused by syphilis.

Code 5008: Streptococcic arthritis is the infection of a joint caused by streptococcus bacteria.

Code 5009: All other arthritis is rated under this code.

Code 5017: Gout is the swelling of the joint tissues caused by uric acid building up in the blood.

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Caisson Disease of the Bones

Code 5011: Caisson disease is the premature death of bone and marrow cells. It is rated based on its most prevalent symptom. For example, if it affects the spinal cord and causes limited motion in the hip, it would be rated under that symptom. Common symptoms include deafness, arthritis in the joints, loss of motion, etc. Only the symptom that can give the highest rating can be rated for this condition. The final code for this condition would look like this: 5011-5261. The first four-digit code identifies the condition as caisson disease, and the second four-digit code tells what symptom the condition is rated under.

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Tuberculosis of the Bones and Joints

Code 5001: If the tuberculosis is an active disease, then it is rated 100%. The 100% rating will continue throughout the first year after the tuberculosis becomes inactive. After that, any symptoms that remain will be rated separately under their own codes with the tuberculosis code preceding the code for the symptoms: 5001-5261. These symptoms could include limited motion in a joint, the amputation of a body part, etc.

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Osteomyelitis

Code 5000: Osteomyelitis is an infection of the bone and marrow and can have periods of activity and inactivity. Once recurring or chronic osteomyelitis is diagnosed, a permanent rating is given that CAN be combined with ratings of the symptoms as well.

This is rare. Normally, you can only have one rating per condition, but osteomyelitis allows the disease itself to be rated and all its symptoms. Combined, however, all the different ratings cannot be more than the rating for the amputation of the affected body part. So if osteomyelitis attacks the knee, causing it to freeze in place, and the leg is shortened after a surgery to remove the affected bone, then it can be rated under code 5000 for the underlying disease, code 5256 for the freezing of the knee joint, and code 5275 for shortening of the leg. The combined rating of these three conditions, however, cannot be more than 60%, the rating for the amputation of the knee. This isn’t the case, however if the osteomyelitis itself rates a 60%. It then can also be combined with the other ratings without the 60% rating limit.

If the disease is in the major joints, pelvis, or spine, or it is in numerous locations, or if there is a long history of symptoms including liver problems, anemia, or the inability to function, then the condition is rated 100%.

If there are frequent episodes of infection with many of the same symptoms, but not constantly, then it is rated 60%.

If there is x-ray evidence of new bone growth outside the infected bone or if there is a piece of dead bone that has broken off of the main skeleton, then it is rated 30%.

If there have been 3 or more episodes of infection, and there have been signs of active infection, like sinus discharge, within the last 5 years, then it is rated 20%.

If there have been 3 or more episodes of infection, but none in the last 5 years, then it is rated 10%.

If the affected bone is successfully removed and no further episodes of infection occur, then no rating for osteomyelitis will be given.

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Fibromyalgia

Code 5025: Fibromyalgia is a disease that causes pain and sensitivity throughout the entire body. The pain must be present on both sides of the body and both above and below the waist to be rated under this code. Likewise, a rheumatologist must evaluate and diagnose the condition for it to be rated under this code.

If the pain is constant and is resistant to treatment, then it is rated 40%. If the pain is not constant, but recurring and present 1/3 of the time, then it is rated 20%. As long as the pain requires continuous medication to control it, it at least receives 10%.

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DBQs for Musculoskeletal Diseases

Here are the Disability Benefits Questionnaires (DBQs) used for musculoskeletal diseases: Osteomyelitis DBQ, Fibromyalgia DBQ, and Rheumatoid Arthritis DBQ.

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Principles that Apply

The Amputation Rule: Any ratings for a body part cannot be combined to be more than the rating for the amputation of that body part.

Painful Motion: If pain is present with motion, then the minimum compensable rating (at least 10%) must be given.

The Joints: Major joints include the shoulder, elbow, wrist, hip, knee and ankle. Minor joints include the joints in the fingers and toes, and the spine.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

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