CLAIM RECON INTEL

DC 5003/5010 | 38 C.F.R. § 4.71a | M21-1, Part IV.ii.2

OVERVIEW

Degenerative arthritis (osteoarthritis) is the most common joint disease in veterans, resulting from wear and tear on joints during military service. Under DC 5003 (degenerative) or DC 5010 (traumatic), arthritis is rated based on limitation of motion of the affected joint. If ROM limitation is noncompensable (does not meet the threshold for a 10% rating), a minimum 10% rating is assigned per major joint or group of minor joints if X-ray evidence confirms arthritis. Each affected joint is rated separately.

RATING CRITERIA (2 LEVELS)

KEY EVIDENCE TO GATHER

-X-ray or MRI showing degenerative changes (joint space narrowing, osteophytes, subchondral sclerosis)

-ROM measurements for affected joints

-Service records documenting joint injuries, heavy physical demands, or repetitive stress

-Treatment records showing joint injections, physical therapy, or joint replacement

-Documentation of functional limitation in daily activities

SECONDARY CONDITIONS (2 MAPPED)

C&P EXAM TIPS (4)

1.Get X-rays of EVERY painful joint. X-ray confirmation of arthritis guarantees at least a 10% rating per major joint even if ROM is not compensably limited.

2.Each major joint is rated separately: shoulder, elbow, wrist, hip, knee, ankle. Minor joint groups (fingers, toes) are grouped.

3.DeLuca factors apply: pain, fatigue, weakness on repetitive use can increase the functional ROM limitation above what raw numbers show.

4.If you have had a total joint replacement, it is rated at 100% for one year post-surgery, then 30-60% based on residuals.

RELEVANT CASE LAW

DOLLAR IMPACT

Arthritis in multiple joints at 10% each adds up through VA combined math. Six joints at 10% each combine to approximately 47% ($795/mo tier). With bilateral factor for paired joints, even higher.

RELATED CONDITION GUIDES