Service-connected hip pain isn’t just a localized issue; it can lead to a range of secondary conditions affecting various parts of the body.
Whether due to altered gait, overcompensation, or chronic pain, veterans with service-connected hip pain may develop other related health issues.
This Insider’s Guide covers the 11 most common secondary conditions to hip pain, from musculoskeletal problems like knee and back pain to mental health issues such as anxiety and depression.
Knowing these conditions and how they’re connected can help you prove secondary service connection for VA disability benefits.
Let’s begin!
Table of Contents
List of VA Secondary Conditions to Hip Pain
Here’s a list of the most common conditions that can be linked as secondary to your service-connected hip pain for VA disability compensation benefits:
1. Anxiety and Depression Secondary to Hip Pain
Explanation: Chronic hip pain can significantly affect mental health. Studies show that persistent pain disrupts neurotransmitter function and can lead to anxiety and depressive disorders. The emotional strain of living with chronic pain, coupled with limitations in daily activities, can contribute to mental health issues. Veterans with hip pain may experience these conditions as they struggle with mobility, independence, and quality of life.
Medical Research: According to the Journal of Pain Research, chronic pain increases the risk of mood disorders, with a prevalence of depression among chronic pain sufferers as high as 40-50%.
VA Ratings: The VA rates anxiety and depression secondary to hip pain under Diagnostic Codes 9400 and 9434, as described in 38 CFR § 4.130. These ratings range from 0% to 100%, based on the severity of symptoms and their impact on occupational and social functioning. A 0% rating is given for minimal symptoms that do not impair functionality. A 10% rating indicates mild symptoms causing slight occupational and social impairment. A 30% rating represents moderate symptoms, such as occasional panic attacks, that reduce work efficiency. A 50% rating reflects more severe symptoms like impaired judgment, panic attacks more than once a week, or difficulty maintaining work and social relationships. A 70% rating is assigned for even more debilitating symptoms, such as near-continuous panic or depression affecting nearly all areas of life, including work, family relations, and self-care. A 100% rating indicates total occupational and social impairment, such as persistent delusions, grossly inappropriate behavior, or a risk of harm to self or others.
2. Foot and Ankle Problems Secondary to Hip Pain
Explanation: Hip pain can alter gait and posture, causing abnormal weight distribution. This can place undue stress on the feet and ankles, leading to issues such as plantar fasciitis, Achilles tendonitis, and even stress fractures. The body compensates for hip pain by shifting weight to alleviate discomfort, which disrupts normal biomechanics.
Medical Research: A study in the Journal of the American Podiatric Medical Association noted that hip pathology often contributes to foot and ankle dysfunction due to compensatory gait patterns.
VA Ratings: Foot and ankle problems secondary to hip pain may be evaluated under various diagnostic codes, such as 5276 for flatfoot, 5278 for claw foot, 5280 for hallux valgus, and 5284 for other foot injuries. For example, flatfoot (pes planus) can be rated from 10% to 50%, depending on the severity, such as mild pain relieved by orthopedic support (10%), severe pain not relieved by support (30%), or pronounced deformity (50%). Other conditions like hallux valgus may receive a 10% rating if it requires surgery or is severe enough to limit function. Diagnostic Code 5284 is used for other foot injuries, providing ratings of 10%, 20%, or 30%, depending on whether the injury is moderate, moderately severe, or severe.
3. Fibromyalgia Secondary to Hip Pain
Explanation: Chronic hip pain can potentially trigger fibromyalgia, a condition characterized by widespread musculoskeletal pain. This may occur due to the body’s heightened pain sensitivity and altered central nervous system processing as it tries to cope with persistent hip pain.
Medical Research: The Arthritis and Rheumatology journal reports that individuals with chronic localized pain, like that in the hip, are more susceptible to developing fibromyalgia, due to the chronic stress placed on the nervous system.
VA Ratings: Fibromyalgia secondary to hip pain is rated under Diagnostic Code 5025. The VA assigns ratings based on the severity and impact of symptoms, as well as their response to treatment. A 10% rating is given for symptoms that require continuous medication for control and cause minimal impact on daily functioning. A 20% rating is assigned when symptoms are episodic, with exacerbations that occur more than one-third of the time and impair the ability to work or perform daily activities. A 40% rating, the maximum under this code, is warranted when symptoms are constant or nearly constant, resistant to therapy, and significantly impair work, daily activities, and overall quality of life.
4. Herniated Discs Secondary to Hip Pain
Explanation: Altered gait and posture due to hip pain can cause uneven pressure on the spine, leading to herniation of intervertebral discs. This condition occurs when the soft center of a spinal disc pushes through a crack in the tougher exterior casing, irritating nearby nerves and causing pain.
Medical Research: According to the Journal of Orthopedic Research, mechanical imbalance from hip dysfunction can lead to compensatory spinal changes, increasing the risk of disc herniation.
VA Ratings: Herniated discs secondary to hip pain can be rated under Diagnostic Codes 5242 (degenerative arthritis of the spine) and 5243 (intervertebral disc syndrome). Ratings are based on the range of motion, presence of incapacitating episodes, and functional impairment. A 10% rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees or combined range of motion greater than 120 degrees. A 20% rating is warranted when forward flexion is greater than 30 degrees but not greater than 60 degrees, or when muscle spasms or guarding result in an abnormal gait or spinal contour. A 40% rating is given for forward flexion of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. The maximum rating under Diagnostic Code 5243 is 60%, assigned for incapacitating episodes lasting at least six weeks over the past 12 months.
5. Knee Pain Secondary to Hip Pain
Explanation: Hip pain often causes an altered gait, leading to increased stress on the knee joint. Over time, this can result in knee pain, ligament strain, or even conditions like patellar tendinitis or osteoarthritis. The misalignment of the hip can cause abnormal movement patterns in the knee, contributing to joint degeneration.
Medical Research: A study in the Journal of Biomechanics found that altered hip mechanics significantly affects knee joint loading, increasing the risk of knee pain and injury.
VA Ratings: Knee pain secondary to hip pain can be rated under several VA diagnostic codes, depending on the specific knee condition. Diagnostic Code 5256 covers ankylosis of the knee, with ratings ranging from 30% for favorable ankylosis to 60% for extremely unfavorable positions. Diagnostic Code 5257 addresses recurrent subluxation or instability, with ratings of 10% for slight, 20% for moderate, and 30% for severe instability. Limitation of motion is rated under Diagnostic Codes 5260 and 5261: flexion limited to 15 degrees is rated at 30%, and extension limited to 45 degrees is rated at 50%. The VA also factors in pain, stability, and overall functional limitations when assigning ratings.
6. Lower Back Pain Secondary to Hip Pain
Explanation: Hip pain can alter posture and walking mechanics, leading to compensatory movements that strain the lower back. This can cause muscle imbalances and increased stress on the lumbar spine, leading to conditions like lumbar strain, facet joint dysfunction, and degenerative disc disease.
Medical Research: Research in the Spine Journal indicates that hip joint dysfunction is a common cause of chronic lower back pain, due to the interconnected nature of hip and spinal mechanics.
VA Ratings: Lower back pain secondary to hip pain is typically rated under Diagnostic Code 5237, which pertains to lumbosacral or cervical strain. Ratings are based on the limitation of motion and severity of symptoms. A 10% rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or when the combined range of motion is greater than 120 degrees but not greater than 235 degrees. A 20% rating is warranted when forward flexion is greater than 30 degrees but not greater than 60 degrees, or when the combined range of motion is not greater than 120 degrees. Higher ratings of 40% may be assigned for forward flexion of 30 degrees or less, and a 50% rating is given for unfavorable ankylosis of the entire thoracolumbar spine. A 100% rating is assigned for unfavorable ankylosis of the entire spine. Additional symptoms such as muscle spasms, guarding severe enough to result in an abnormal gait or abnormal spinal contour, are also considered in determining the rating.
7. Osteoarthritis Secondary to Hip Pain
Explanation: Altered gait and body mechanics due to hip pain can lead to increased wear and tear on other joints, such as the knees and lower back. This excessive strain can accelerate the development of osteoarthritis in these areas.
Medical Research: A publication in Osteoarthritis and Cartilage highlights the correlation between altered joint biomechanics due to hip pain and the accelerated onset of osteoarthritis in adjacent joints.
VA Ratings: Osteoarthritis secondary to hip pain is rated under Diagnostic Code 5003. The VA assigns ratings based on the degree of limitation of motion in the affected joints and X-ray evidence of arthritis. A 10% rating is assigned when there is X-ray evidence of osteoarthritis in two or more major joints or two or more minor joint groups without incapacitating exacerbations. A 20% rating is warranted if there is X-ray evidence of osteoarthritis in two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. If the limitation of motion in the affected joint is compensable under a specific joint’s diagnostic code (e.g., the hip), the condition is rated under that diagnostic code instead of 5003. Functional limitations due to pain, stiffness, and reduced motion are also considered in the evaluation, ensuring the rating accurately reflects the veteran’s level of disability.
8. Pelvic Tilt and Misalignment Secondary to Hip Pain
Explanation: Chronic hip pain can cause the pelvis to tilt or rotate abnormally, leading to misalignment. This can result in further musculoskeletal problems, including lower back pain, leg length discrepancy, and uneven stress on the spine and hips.
Medical Research: The Journal of Rehabilitation Research and Development found that chronic hip pain is associated with pelvic tilt and rotation, contributing to lumbar spine stress and lower limb discrepancies.
VA Ratings: Pelvic tilt and misalignment secondary to hip pain are rated under various diagnostic codes, depending on the condition, impairment, and specific symptoms. For example, pelvic tilt causing spinal issues such as scoliosis or abnormal curvature may be rated under Diagnostic Code 5237 (Lumbosacral or cervical strain) or Diagnostic Code 5243 (Intervertebral Disc Syndrome), where the ratings are based on the range of motion, pain, and functional impairment. Ratings for these conditions generally range from 10% for mild impairments to 100% for severe conditions like unfavorable ankylosis of the entire spine. For muscle spasms or abnormal gait due to pelvic misalignment, ratings are often assigned under these same musculoskeletal codes based on the severity of functional limitations and impact on daily activities.
9. Peripheral Neuropathy Secondary to Hip Pain
Explanation: Hip pain, particularly when associated with nerve compression or damage, can lead to peripheral neuropathy. This condition involves damage to the peripheral nerves, causing symptoms such as tingling, numbness, and pain in the extremities.
Medical Research: The Journal of Neurology reports that chronic hip joint pathology can lead to nerve compression and peripheral neuropathy, especially in cases where altered gait or posture affects nerve pathways.
VA Ratings: Peripheral neuropathy secondary to hip pain is rated under Diagnostic Codes 8520-8730, depending on the affected nerve and severity of symptoms. For example, sciatic nerve involvement is rated under Diagnostic Code 8520, with 10% for mild incomplete paralysis, 20% for moderate, 40% for moderately severe, and 60% for severe with marked muscle atrophy. Complete paralysis, where the foot dangles and no active movement is possible, warrants an 80% rating. Ratings for other nerves, such as the femoral nerves, follow similar criteria depending on the severity of symptoms.
10. Sciatica Secondary to Hip Pain
Explanation: Hip issues, such as arthritis or bursitis, can lead to inflammation or compression of the sciatic nerve, causing pain that radiates down the leg. This condition, known as sciatica, can result in significant discomfort and mobility issues.
Medical Research: According to the Journal of Pain Research, conditions like hip osteoarthritis are associated with sciatic nerve irritation, leading to radiating pain and functional limitations.
VA Ratings: Sciatica secondary to hip pain is rated under Diagnostic Code 8520. The VA assigns ratings based on the severity of the nerve impairment and its impact on function. Mild incomplete paralysis warrants a 10% rating, moderate incomplete paralysis receives 20%, and moderately severe receives 40%. Severe incomplete paralysis with marked muscle atrophy can be rated at 60%, and complete paralysis, where the foot dangles with no active movement below the knee, is rated at 80%.
11. Spinal Stenosis Secondary to Hip Pain
Explanation: Changes in posture and gait due to chronic hip pain can lead to the narrowing of the spinal canal, a condition known as spinal stenosis. This can compress spinal nerves, causing pain, numbness, and weakness in the legs.
Medical Research: Studies in the Journal of Spinal Disorders & Techniques indicate that hip dysfunction can contribute to compensatory spinal changes, increasing the risk of developing spinal stenosis.
VA Ratings: Spinal stenosis secondary to hip pain is rated under Diagnostic Code 5238. The VA assigns ratings based on the degree of spinal canal narrowing and its impact on nerve function. Ratings range from 10% to 100% depending on the severity of symptoms and degrees of limitation of range of motion of the spine to include functional impairment or loss.
How to Prove Secondary Service Connection for VA Disability Benefits
In accordance with 38 CFR § 3.310 disabilities that are “proximately due to,” or “aggravated by,” or the “result of” a service-connected disease or injury shall be service-connected.
There are three evidentiary elements that must be satisfied for secondary service connection:
- A medical diagnosis of the secondary condition you’re attempting to link to the service-connected primary condition AND
- A current service-connected primary condition rated at 0% or higher AND
- Medical nexus evidence establishing a connection between the service-connected primary condition and the non-service-connected secondary condition.
The FIRST part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The SECOND part can be satisfied with evidence of a veteran’s existing service-connected disability rated at 0% or more.
The THIRD part, and often the missing link needed to establish secondary service connection, can be satisfied with a credible Nexus Letter from a private healthcare provider.
Pro Tip: The Importance of a Nexus Letter for Secondary Conditions
A nexus letter can be the linchpin piece of evidence when filing a VA claim for a secondary condition.
It serves as the medical link or connection between your primary service-connected condition and the new condition you’re claiming.
The VA won’t simply assume your secondary condition is related, so a detailed nexus letter from a qualified doctor is mission critical.
In the nexus letter for a secondary condition, your doctor should clearly explain how your secondary condition (e.g., sleep apnea or tinnitus) is “proximately due to” or “aggravated by” the primary condition (e.g., migraines).
The doctor should use certain nexus language, stating that it is “at least as likely as not” that the primary condition is responsible for the secondary one.
Without this, the VA might reject your claim due to a lack of medical evidence linking the two conditions.
A well-written nexus letter is often the difference between VA claim approval and denial.
Need a Nexus Letter for a Secondary Condition?
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
