VA Hip Range of Motion Rating

Table of Contents

• What VA measures at the hip
• The hip rating tiers: DC 5250 through 5255
• Hip replacement and resurfacing: DC 5054
• Where the first compensable step sits
• Painful motion, repeated use, and flare-ups
• Hip bursitis and hip arthritis
• What the Hip and Thigh DBQ records
• If your hip came back at 0 or 10 percent
• What we can help with

What VA measures at the hip

VA does not assign a rating for hip pain on its own. It rates measured function, and pain enters through 38 CFR 4.40, 4.45, and 4.59 — by changing the number the examiner writes down, and by making an actually painful joint eligible for at least the minimum compensable rating. If the measurements are not in your file, the rater has nothing to match against the table in 38 CFR 4.71a.

38 CFR 4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within VA. The examiner produces the degrees, not you.

The hip moves in six directions, and the Hip and Thigh Disability Benefits Questionnaire asks for all six on each side.

• Flexion — knee up toward the chest
• Extension — leg back behind the body
• Abduction — leg out away from the midline
• Adduction — leg across toward the other leg
• External rotation — leg turning outward
• Internal rotation — leg turning inward

The normal figures VA compares you to

38 CFR 4.71 says Plates I and II provide a standardized description of ankylosis and joint motion measurement, and that the anatomical position is considered as 0 degrees. Plate II sets two hip figures: normal flexion at 125 degrees and normal abduction at 45 degrees. It sets none for extension, adduction, or rotation.

VA Form 21-0960M-8, the Hip and Thigh DBQ, prints its own normal endpoint beside each of the six fields: flexion 125 degrees, extension 30 degrees, abduction 45 degrees, adduction 25 degrees, external rotation 60 degrees, internal rotation 40 degrees. Four of those six have no counterpart in Plate II. They are the form's reference points, and they are what the examiner measures against.

The flexion and extension codes are written as absolute endpoints, not as a percentage of motion lost: where your motion stops is what the rater matches. The abduction tier under DC 5253 is the exception, written as motion lost beyond 10 degrees.

The hip rating tiers: DC 5250 through 5255

These are the ankylosis, limitation-of-motion, and femur-impairment criteria in 38 CFR 4.71a. Each hip is evaluated on its own findings; the DBQ records right and left separately.

The 90 percent evaluation under DC 5250 carries a footnote in 4.71a stating entitlement to special monthly compensation. DC 5255 assigns no percentage of its own for malunion of the femur; it sends the rater to the knee codes or back to DC 5250 through 5254, so a malunion claim still turns on measured hip or knee function.

38 CFR 4.14 says the evaluation of the same disability under various diagnoses is to be avoided, so whether a second hip code applies turns on whether your exam produced separate and distinct findings.

Hip replacement and resurfacing: DC 5054

A replaced or resurfaced hip is not rated under the codes above at first. DC 5054 governs it.

The 90 percent tier carries a footnote for special monthly compensation. The Note under DC 5054 states that at the conclusion of the 100 percent evaluation period, resurfacing is evaluated under diagnostic codes 5250 through 5255, and that there is no minimum evaluation for resurfacing. A total replacement keeps the 30 percent floor; a resurfaced hip does not.

Where the first compensable step sits

Under DC 5252, the lowest tier is flexion limited to 45 degrees. Set against the 125-degree flexion endpoint printed on the DBQ, that is 80 degrees of lost motion before the first percentage point attaches under that code. A hip that flexes to 90 degrees is 0 percent under DC 5252.

Under DC 5251 there is one tier: extension limited to 5 degrees, at 10 percent. Extension limited further than 5 degrees is still 10 percent under that code.

DC 5253 has three criteria, and only one is a measured angle. Abduction with motion lost beyond 10 degrees is 20 percent. The other two are functional tests at 10 percent each: cannot cross legs, and cannot toe-out more than 15 degrees on the affected leg.

The DBQ asks the adduction test directly — does a limitation in adduction prevent the veteran from crossing his or her legs — for active motion, after observed repetitive use, after repeated use over time, and during flare-ups. It is not asked for passive motion. There is no toe-out question anywhere on the form. The DC 5253 rotation criterion has no capture field, so it reaches the rater only if the examiner writes it into a narrative box.

Painful motion, repeated use, and flare-ups

Three sections of 38 CFR govern how pain, weakness, and fatigue affect the recorded measurement.

38 CFR 4.59, painful motion

Section 4.59 states that with any form of arthritis, painful motion is an important factor of disability, and that facial expression and wincing on pressure or manipulation should be carefully noted and definitely related to affected joints. It states the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. It directs that the joints be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, against the opposite undamaged joint.

38 CFR 4.40, functional loss

Section 4.40 says disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled.

38 CFR 4.45, the joints

Section 4.45 lists the factors the inquiry is directed to: less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, deformity or atrophy of disuse. It adds instability of station, disturbance of locomotion, and interference with sitting, standing and weight-bearing, and it identifies the hip as a major joint for rating disability from arthritis.

None of these three sections creates a new percentage. They decide which number goes in the measurement box. If pain, fatigability, or weakness stops the hip at a smaller angle after use, and the examiner records that angle, the tier is applied to it.

Hip bursitis and hip arthritis

Bursitis is diagnostic code 5019, and it carries no percentages. The Note to DCs 5013 through 5024 instructs raters to evaluate those diseases as degenerative arthritis, based on limitation of motion of affected parts. A trochanteric bursitis diagnosis produces no percentage by itself; the measured range of motion decides it, using the DC 5251, 5252, and 5253 tiers above.

Two arthritis codes reach the hip, and they are not interchangeable. DC 5003 is captioned "Degenerative arthritis, other than post-traumatic." DC 5010 is "Post-traumatic arthritis." The Hip and Thigh DBQ lists both as separate diagnosis lines.

Two notes under DC 5003 limit that table. Note (1): the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2): those X-ray ratings will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive, which closes the X-ray route for bursitis under DC 5019.

DC 5010 is separate. Its full text is to rate as limitation of motion, dislocation, or other specified instability under the affected joint, and if 2 or more joints are affected, each rating shall be combined in accordance with 38 CFR 4.25. It does not route through DC 5003, so the X-ray tiers above do not apply. If your hip arthritis followed an injury, check which of the two codes your rating decision used.

What the Hip and Thigh DBQ records

VA Form 21-0960M-8 is the Hip and Thigh Conditions Disability Benefits Questionnaire. A private physician completing it answers the same questions a C&P examiner does. The fields that produce ratable findings:

• Active range of motion for all six planes, in degrees, with the instruction that examiners should also test the contralateral joint unless medically contraindicated
• Passive range of motion for all six planes, recorded separately, with a "same as active ROM" option
• Which planes exhibited pain, plus a second set of degree endpoints where a limitation is specifically attributable to pain, weakness, fatigability, or incoordination
• The adduction functional test, whether a limitation in adduction prevents the veteran from crossing his or her legs
• Observed repetitive use, objective findings after three or more repetitions of range of motion testing
• Repeated use over time, an estimated range of motion drawn from the objective findings, the veteran's history, and the medical evidence
• Flare-ups, the veteran's description of frequency, duration, precipitating and alleviating factors, and functional impairment, plus an estimated range of motion during a flare-up
• Ankylosis, graded unfavorable with the foot not reaching ground and crutches needed, intermediate, or favorable in flexion between 20 and 40 degrees
• Femur or flail hip joint impairment, including nonunion with or without loose motion, false joint at the surgical neck, malunion, and leg length discrepancy measured from the anterior superior iliac spine to the internal malleolus
• Muscle atrophy, circumference in centimeters of the more normal side and the atrophied side, at maximum muscle bulk
• Assistive devices used as a normal mode of locomotion, with frequency
• Functional impact on occupational tasks such as standing, walking, lifting, and sitting

The form also addresses blank estimates. Where an estimate is not feasible, it says the examiner should explain why, and that the explanation should not be based on an examiner's shortcomings or a general aversion to offering an estimate on issues not directly observed. The word is "should," not "must." A blank estimate with no explanation departs from the form's own instruction, which is something you can point to rather than a rule you can enforce.

If your hip came back at 0 or 10 percent

Pull the exam report and read it against the fields above. Were all six planes measured, or only flexion? Were active and passive both recorded? Was the other hip tested? Are there results after three or more repetitions, or was the section checked without figures? Is there an estimate for flare-ups and for repeated use over time, or a blank? Was the crossing-the-legs question answered? Is toe-out addressed anywhere in the narrative, since the form has no field for it?

A rater cannot assign a tier from a plane that was never measured, and cannot apply 4.40, 4.45, or 4.59 to a functional loss nobody wrote down. Evidence that fills those specific gaps is a different thing from a letter restating how much the hip hurts.

Your part is function, not degrees. Describe what the hip stops you from doing: putting on socks and shoes, getting in and out of a car, stairs, how long you can stand or walk before you stop, how long you can sit before you shift, what you use to get around, and what a flare-up looks like from the outside. The DBQ has fields for that functional description, and it is what the examiner draws on for the repeated-use and flare-up estimates.

What we can help with

TYFYS coordinates private medical evidence for veterans filing VA disability claims, including Hip and Thigh DBQs completed by independent physicians, nexus letters, and independent medical opinions. If your file is missing measured degrees, repetitive-use findings, or flare-up estimates, that is the gap we work on. We can also read your exam report against the fields above and tell you which are blank. We cannot change the findings a physician records.

TYFYS is not VA-accredited representation and does not represent veterans before VA. Nothing here promises a rating outcome; the decision belongs to VA and is made from the evidence in your file. The criteria quoted on this page are from 38 CFR Part 4, the VA Schedule for Rating Disabilities.