Musculoskeletal

Primary malignant bone neoplasms rate 100 percent during active disease and for 6 months after completion of treatment under 38 CFR 4.71a, DC 5012. Residuals rate under the affected body part. Listed as a radiation presumptive cancer under 38 CFR 3.311.

Costochondritis is rated under diagnostic code 5021 (myositis) by analogy to limitation of motion at the affected site.

Fibromyalgia is rated under diagnostic code 5025 at 10, 20, or 40 percent based on the frequency and persistence of symptoms.

Since February 7, 2021, gout under diagnostic code 5017 is rated as degenerative arthritis based on limitation of motion of the affected joints. The old ladder that paid 20 to 100 percent for incapacitating exacerbations no longer applies to gout; the current multi joint arthritis code, 5002, explicitly excludes it. Each affected joint is rated on its own motion and painful motion evidence.

Ankylosis, a joint frozen solid by bone or fibrous union, has a dedicated code per joint: knee (diagnostic code 5256) rates 30 to 60 percent, hip (5250) 60 to 90, shoulder (5200) 30 to 50 by handedness, wrist (5214) 30 to 50, ankle (5270) 20 to 40, and unfavorable ankylosis of the entire spine rates 100. The angle the joint froze at decides favorable versus unfavorable, and unfavorable always rates higher.

Residuals of muscle injuries, classically from gunshot and shell fragment wounds, are rated under diagnostic codes 5301 to 5323, one code per muscle group, graded slight (0 percent), moderate (about 10), moderately severe (about 20 to 40), or severe (about 30 to 50 depending on the group and dominant side). The grading rules in 38 CFR 4.56 turn on the wound track, debridement, infection history, and the cardinal signs of muscle disability.

Myositis is rated under diagnostic code 5021 on the limitation of motion of the affected parts, like degenerative arthritis: compensable limitation rates under the joint codes, and where motion limits are noncompensable, 10 percent applies per major joint or muscle group with satisfactory evidence of painful motion. Inflammatory autoimmune myositis (polymyositis, dermatomyositis) with systemic effects may instead be rated by analogy to lupus.

Osteomalacia (bone softening from vitamin D or mineral deficiency) is rated under diagnostic code 5014 on the limitation of motion of affected parts, as degenerative arthritis: compensable limitation rates under the joint codes, and painful noncompensable limitation rates 10 percent per major joint or muscle group.

Osteomyelitis is rated under 38 CFR 4.71a DC 5000 at 10 to 100 percent based on frequency of recurrence, draining sinuses, and constitutional symptoms.

Osteoporosis residuals are rated under diagnostic code 5013 as degenerative arthritis, based on limitation of motion of the affected parts. There is no severity ladder for the bone density itself: a fragility or compression fracture is rated under the code for what it broke, most often the spine formula for vertebral compression fractures, and painful or limited motion drives the percentage.

Paget's disease of bone (osteitis deformans) is rated under 38 CFR 4.71a diagnostic code 5016, which directs VA to rate it on limitation of motion of the affected parts, as degenerative arthritis. The percentage comes from the joint or spine code for each affected area, with 10 percent available per major joint or joint group when limitation is present but noncompensable.

Psoriatic arthritis is rated under diagnostic code 5002 (rheumatoid arthritis) at 20, 40, 60, 80, or 100 percent based on flare frequency and chronic residuals.

Reactive arthritis (formerly Reiter's syndrome) is rated by analogy under 38 CFR 4.71a DC 5099-5002 (rheumatoid arthritis) at 10 to 100 percent.

Rheumatoid arthritis is rated under diagnostic code 5002 at 20, 40, 60, 80, or 100 percent based on incapacitating episodes and chronic residuals.

The skin manifestations of scleroderma are rated under diagnostic code 7821 (cutaneous manifestations of collagen vascular diseases) using the General Rating Formula for the Skin, at 0 to 60 percent based on the body area affected and the systemic therapy required. Internal organ involvement, such as lung, heart, kidney, or esophageal disease, is rated separately under the code for each affected system, and those ratings often carry the claim.

Sjogren's syndrome is rated under diagnostic code 6350 by analogy to systemic lupus erythematosus at 10, 60, or 100 percent based on flare frequency and impact.

Systemic lupus erythematosus is rated under diagnostic code 6350 at 10, 60, or 100 percent based on flare frequency and impact on health.