Back pain and injuries are some of the most common issues that Veterans face due to their time in service. Back injuries can be chronic, debilitating, and very painful. However, many Veterans also develop secondary hip pain or conditions as a direct result of their initial back injuries suffered while on active duty.
If that’s the case for you, you may be entitled to additional compensation for that hip pain. The VA has disability ratings for hip pain secondary to back injury. Let’s break down how this works and what kind of future compensation you may receive.
The VA rates hip pain using several different disability diagnostic codes depending on the condition or pain level. Let’s take a look at some of the most common disability ratings and diagnostic codes for hip pain or hip-related conditions.
Osteoarthritis is assigned the diagnostic code 5003 by the VA. If you have hip pain due to osteoarthritis, you could see a disability rating of between 10% and 20%.
The VA also rates hip replacements. If you have a complete hip replacement, it will be rated under diagnostic code 5054. You’ll also have a disability rating of 100% for at least four months post-surgery.
After your convalescent period ends, your disability rating will be analyzed and rated again. You could have a disability rating between 30% (the minimum) and 90% (the maximum, which is only applied after the 100 percent evaluation period post-replacement and you still experience painful motion or weakness in your hips).
You may receive disability benefits if you have hip pain that limits your mobility. However, this condition doesn’t have a separate diagnostic code. Instead, the VA will measure various aspects of your range of motion. Specifically, the VA measures flexion, abduction, adduction, rotation, and extension when determining your disability rating.
If one or both hips suffer from ankylosis, which is characterized by abnormal immobility or stiffening of your joints due to the fusion of one or more bones, it will be rated under diagnostic code 5250. You could be assigned a disability rating of between 60% to 90% depending on how limited your range of motion is.
No. You do not need a diagnosable condition with a diagnostic code to receive disability benefits for hip pain. Thanks to the April 2018 verdict in Saunders v. Wilkie, the VA is legally obligated to award disability benefits for hip pain even if you don’t have an underlying diagnosis.
However, you still need to prove that the hip pain was due to an in-service event, injury, or illness or that it is a secondary condition. This can be done through notes from medical professionals like your doctor, a therapist, and other licensed sources.
Hip pain can be related to back injury due to several pre-existing injuries, like degenerative disc disease (also called osteoarthritis of the spine). However, any major back injury may lead to hip injury over time. That’s because the spine and hips are intrinsically connected in the body.
Your spine affects how you walk, how you carry your weight, and how much pressure is placed on your hip joints. If your spine is negatively affected due to your military service – for example, you have to place more weight on your hips than your spine – that could lead to a secondary condition.
That said, spine injuries or conditions do not always lead to hip pain. If you seek disability benefits for your secondary hip pain, you’ll need to prove that the hip pain comes from your back injury or condition.
In a nutshell, secondary conditions are medical conditions or injuries that develop because of your primary service-connected injury/illness. Secondary conditions do not need to be directly connected to your active-duty service.
For instance, a Veteran suffers a back injury during their time in active service. Over the years, their hips start to develop consistent pain and immobility because they walk differently due to that back injury. In this instance, the hip pain is a secondary condition linked to a Veteran’s time in service through the original back injury.
In order to receive a service connection for a secondary condition, it’s important to prove a positive nexus opinion or link to your service. Otherwise, your benefits claim may be denied by the VA.
Furthermore, you must have a service-connected condition already filed with the VA to qualify for secondary condition benefits. If you no longer receive benefits for a service-connected condition, you may not be eligible for benefits for your secondary condition or injury, even if those secondary symptoms are still present.
For this reason, it’s a good idea to consult legal experts before filing your secondary benefits claim.
Secondary conditions can increase your total disability rating. With the VA rating system, Veterans are rated proportionately in terms of how much they are “disabled” versus “non-disabled.” For example, a Veteran with a disability rating of 30% is counted as 70% non-disabled and 30% disabled.
When you acquire benefits for a secondary condition, that condition’s disability rating is added to the current disability rating you have. This is true whether the new grant of service connection is a primary service connected disability or a secondary disability. Here’s a breakdown of how this works with a hypothetical Veteran who has a disability rating of 50%:
As you can see, the VA certainly doesn’t make it easy to understand how disability ratings are added up! That’s just one more reason why you should contact knowledgeable Veterans law attorneys right away if you think you have hip pain related to a service-connected back injury or condition.
Filing for and receiving benefits for a secondary service condition is similar to filing for and receiving benefits for a primary service-connected injury or illness. First, a Veteran must make sure they’ve filed their VA Form 21-526EZ — their original claim for a current condition or injury.
Then, Veterans must:
Just like other service-connected conditions, some hip pain conditions might be regularly reviewed by the VA. This may cause your disability benefits to fluctuate or change over time.
For example, if your hip pain is related to a back injury currently receiving treatment, your hip pain may become less intense as your back injury treatment progresses. This might result in a new, lower disability rating for your hip pain and your back injury combined.
Throughout this process, licensed and educated Veterans law attorneys can provide important assistance.
Understanding how secondary conditions work is tough, but you don’t have to file for disability benefits alone. Instead, contact Berry Law today and get a free case evaluation and consultation. As experienced Veterans law attorneys, we’re well-equipped and ready to assist with your upcoming application for disability benefits.
Alternately, we can help you through the claim appeals process if you have already applied for benefits and been denied.
We understand the importance of securing the disability benefits you deserve for each of your military-connected conditions. If you experience hip pain secondary to back pain or any other combination of symptoms, don’t wait. Get the legal professionals you deserve on your side today and let us help.
Our monthly newsletter features about important and up-to-date veterans' law news, keeping you informed about the changes that matter.