VA Ratings for Joint Pain Explained: The Ultimate Guide

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If you’re a veteran dealing with joint pain, you’re not alone—and you may be leaving tax-free VA compensation and benefits on the table.

Whether your joint pain stems from intense physical training, overuse, or service-related injuries, you may be eligible for VA disability compensation.

In this high-value guide from VA disability expert Brian Reese, I’ll break down how to get a VA rating for joint pain, how the VA evaluates it under 38 CFR Part 4, and what you need to know about secondary service connection, the bilateral factor, and even TDIU eligibility.

Let’s begin!

Summary of Key Points

• Joint pain is one of the most common and debilitating conditions faced by veterans—and it’s eligible for VA disability compensation when properly documented. The VA does not assign ratings for “joint pain” by itself, but instead evaluates the underlying condition (e.g., arthritis, tendinitis, or joint instability) and rates based on measurable limitation of motion, ankylosis, or functional loss as outlined in 38 CFR Part 4 using diagnostic codes 5200–5274.

• There are dozens of potential causes of joint pain in military veterans, including degenerative conditions, injuries from service, repetitive overuse, autoimmune disorders, infections, and environmental exposures. Military-related stressors such as ruck marching, parachute landings, carrying heavy gear, or exposure to cold weather and toxins can all contribute to chronic joint damage. Pain can also result secondarily from altered gait, compensation patterns, or secondary to other service-connected conditions.

• Veterans may qualify for additional VA benefits if their joint pain leads to secondary conditions or impacts both sides of the body. Common secondary conditions include osteoarthritis, depression, GERD from NSAID use, chronic pain, and many others. The bilateral factor (38 CFR § 4.26) may apply when joint pain affects both upper or lower extremities, potentially increasing your combined rating. These factors are essential to maximizing compensation.

• Veterans with severe joint pain that limits their ability to work may be eligible for TDIU (Total Disability based on Individual Unemployability), even if they don’t have a 100% rating. TDIU requires at least one disability rated at 60% or a combined rating of 70% with one condition at 40%. Veterans must clearly document how joint pain limits their ability to perform sedentary or physical work. C&P exam preparation is critical—veterans should describe flare-ups, pain with motion, and the use of assistive devices, and ensure proper range of motion testing is performed and documented with a goniometer.

1. What Is Joint Pain for VA Disability Purposes?

Joint pain in military veterans is often caused or made worse by the following:

Degenerative and Inflammatory Conditions:

• Osteoarthritis (Degenerative Joint Disease) – wear-and-tear from repetitive use, aging, or prior joint injury.
• Rheumatoid Arthritis – autoimmune condition causing chronic joint inflammation.
• Psoriatic Arthritis – inflammatory arthritis associated with psoriasis.
• Ankylosing Spondylitis – inflammatory disease affecting the spine and sacroiliac joints.
• Gout – uric acid buildup in the joints, often affecting the big toe, knees, or ankles.
• Fibromyalgia – widespread musculoskeletal pain, often presenting with joint pain.
• Reactive Arthritis – joint inflammation following a bacterial infection.

Injuries and Overuse:

• Service-related trauma – including joint dislocations, fractures, or sprains from training or combat.
• Repetitive motion injuries – caused by marching, rucking, lifting, or jumping.
• Joint instability – due to ligament tears, meniscus injuries, or tendon damage.
• Post-traumatic arthritis – joint degeneration following a previous injury.
• Stress fractures – repetitive impact that can lead to joint degeneration over time.

Mechanical and Structural Causes:

• Tendinitis – inflammation of tendons such as the rotator cuff, Achilles, or patellar tendons.
• Bursitis – inflammation of the fluid-filled sacs that cushion joints, common in shoulders and hips.
• Meniscal or labral tears – cartilage damage in the knee or shoulder causing joint pain and instability.
• Ligament injuries – including ACL, MCL, and other stabilizing ligaments.
• Chondromalacia patella – softening and breakdown of cartilage behind the kneecap.
• Plantar fasciitis or foot misalignment – abnormal foot structure or injury impacting joint alignment.

Infectious and Systemic Causes:

• Septic arthritis – joint infection caused by bacteria.
• Osteomyelitis – bone infection that may affect adjacent joints.
• Lupus or other autoimmune diseases – systemic conditions that inflame joints.
• Lyme disease – tick-borne illness that can cause chronic joint inflammation.

Secondary and Compensatory Causes:

• Altered gait from other injuries – back, hip, or foot problems that place stress on unaffected joints.
• Secondary conditions related to service-connected disabilities – such as hip pain secondary to knee injury.
• Overcompensation injuries – due to favoring one limb or joint, placing strain on others.
• Postural imbalance or biomechanical dysfunction – often resulting from years of military wear and tear.
• Parachute landing or jump injuries – heavy impact trauma to knees, hips, and spine during airborne operations.

Environmental and Exposure-Related:

• Cold weather exposure – prolonged exposure can worsen joint pain and stiffness.
• Burn pit and toxic exposure – linked to autoimmune or inflammatory joint conditions.
• Military load-bearing equipment – sustained joint strain from carrying body armor, packs, and weapons.

Mental Health and Neurological Causes:

• Chronic pain syndrome – persistent pain without a clear underlying pathology.
• Somatic symptom disorder – physical symptoms influenced by psychological factors.
• Depression or PTSD – which can amplify the perception of pain and contribute to inflammation.
• Nerve impingement or radiculopathy – pain radiating into joints due to spinal nerve compression.

Common symptoms include swelling, stiffness, tenderness, redness, or pain during movement or even at rest.

Joint pain can severely impact your ability to walk, lift, bend, carry, or sit/stand for extended periods—core activities necessary for work and daily life.

2. How the VA Rates Joint Pain (38 CFR Part 4)

The VA doesn’t rate “joint pain” alone as a standalone condition.

Instead, it assigns a disability rating based on the underlying diagnosis and limitation of motion—according to the 38 CFR Part 4.

Key Rating Principle:

Joint pain is typically rated under limitation of motion or ankylosis using Diagnostic Codes (DC) 5200 to 5274, depending on the joint involved.

Major Joints vs. Minor Joints (M21-1 Reference)

The VA defines major joints as:

• Shoulder
• Elbow
• Wrist
• Hip
• Knee
• Ankle

Minor joint groups include:

• Small joints of the hands and feet
• Cervical spine
• Thoracolumbar spine
• Sacroiliac joints

Under 38 CFR § 4.45, joints are evaluated based on these anatomical groupings, and painful motion—even without limited range of motion—can warrant at least a 10% rating under 38 CFR §4.59.

3. VA Disability Rating for Knee Joint Pain

The knee is one of the most rated joints among veterans due to wear and tear from ruck marches, jumping, heavy gear, and combat.

Knee conditions are rated under DC 5256 to 5261 as follows:

Limitation of Flexion (DC 5260)

• Flexion limited to 15° = 30%
• Flexion limited to 30° = 20%
• Flexion limited to 45° = 10%
• Flexion limited to 60° = 0%

Limitation of Extension (DC 5261)

• Extension limited to 45° = 50%
• Extension limited to 30° = 40%
• Extension limited to 20° = 30%
• Extension limited to 15° = 20%
• Extension limited to 10° = 10%

Ankylosis of the Knee (DC 5256)

• Extremely unfavorable, flexed >45° = 60%
• Flexed 20°–45° = 50%
• Flexed 10°–20° = 40%
• Favorable angle in extension/slight flexion = 30%

Pro Tip: Always ensure your C&P exam includes a goniometer-based range of motion test with pain noted during flexion, extension, and after repeated use.

4. How to Service Connect Joint Pain

You’ll need four key elements to win your VA claim for joint pain:

• #1. A current medical diagnosis of a joint condition (e.g., arthritis, tendonitis) — preferably within the past 12 months
• #2. Evidence of an in-service event, injury, disease, or aggravation — documented in medical records, service records, and/or supported by lay evidence
• #3. A medical nexus linking your condition to military service (or to another service-connected disability) — a nexus letter is strongly recommended if you’ve been out of the military for more than 12 months or you’re claiming secondary service connection
• #4. Severity of symptoms in terms of frequency (how often), severity (how bad), and duration (how long) — documented in medical records and/or supported by lay evidence

We call these foundational elements the VA Claims Insider Golden Circle, which are part of The Caluza Triangle.

5. VA Secondary Conditions to Joint Pain

If you already have service-connected joint pain, you may be eligible for additional ratings through secondary service connection.

Here’s a list of common secondary conditions to joint pain for VA disability:

• Osteoarthritis – Joint instability or trauma often leads to degenerative changes over time, resulting in osteoarthritis.
• Depression and Anxiety – Chronic joint pain can severely affect daily life, leading to mental health conditions due to limited mobility, isolation, and constant discomfort.
• Somatic Symptom Disorder – When joint pain becomes long-term and impacts multiple areas of life, it may develop into somatic symptom disorder, which is a mental health condition.
• Insomnia – Pain in weight-bearing joints or the spine can make it difficult to sleep, especially when trying to get comfortable or lying still for long periods.
• GERD and Acid Reflux – Many veterans use NSAIDs to manage chronic joint pain. Over time, this can lead to acid reflux or gastrointestinal issues like GERD.
• Obesity as an Intermediate Step – Reduced activity from joint pain can lead to weight gain, which may contribute to other secondary conditions such as sleep apnea, diabetes, or hypertension.
• Spinal Conditions – Altered gait or posture caused by painful knees or hips can lead to back pain or aggravation of pre-existing spinal conditions.
• Radiculopathy – Nerve impingement can result from joint degeneration, especially in the spine, causing radiating pain, numbness, or weakness.
• Overuse Secondary Injuries in Other Joints – Compensating for one painful joint often leads to strain or injury in adjacent or opposite joints (e.g., right knee pain leading to left hip or ankle issues).
• Migraines (Headaches) – Pain from the cervical spine or jaw joints (TMJ) can radiate into the head and contribute to chronic tension headaches or cervicogenic migraines.

Pro Tip: If you’re filing for secondary service connection, a Nexus Letter is highly recommended. Why? Because secondary service connection requires medical nexus evidence showing that your new secondary disability is “proximately due to” or “aggravated by” a current service-connected disability rated at 0% or higher.

6. Bilateral Factor for Joint Pain

If you have joint pain in both upper or lower extremities, the VA’s bilateral factor under 38 CFR § 4.26 may apply.

Here’s how it works:

You have a 40% rating for your left knee and a 20% rating for your right knee—both considered part of the lower extremities.

Step #1: Combine the ratings using VA math

40% + 20% = 52% combined (per the VA Combined Ratings Table)

Step #2: Apply the bilateral factor

10% of 52% = 5.2%, which rounds to 5%

Step #3: Add the bilateral factor

52% + 5% = 57%

Step #4: Round the result up or down

57% rounds up to a 60% combined VA rating

7. TDIU for Joint Pain

If your joint pain prevents you from maintaining substantially gainful employment, you may be eligible for Total Disability based on Individual Unemployability (TDIU).

TDIU Requirements:

• One disability rated 60% or higher, or
• Two or more disabilities with one at least 40% and a combined rating of 70% or higher

Example: If you have 50% for knee arthritis, 30% for back pain, and 10% for depression, you may qualify for TDIU if your conditions prevent you from working.

Many veterans are denied because they don’t properly document the work-related functional impacts—especially with joint pain.

Be sure your medical records and personal statements describe how your condition affects your ability to sit, stand, walk, lift, or carry.

8. Tips for Your C&P Exam for Joint Pain

• Describe flare-ups clearly (frequency, duration, impact)
• Mention pain during repetitive motion
• Ensure examiners use a goniometer and document motion limits in degrees
• Note whether you use braces, canes, or other assistive devices

If the examiner doesn’t perform proper testing or underreports your symptoms, consider requesting a new C&P exam or submitting a DBQ from a private provider.

>> Click here to view our Top 10 Expert-Level C&P Exam Tips!

9. Conclusion & Wrap-Up

If you’re a veteran suffering from chronic joint pain, remember this:

Joint pain is real.

It’s common.

And it’s ratable.

Whether you’re applying for direct service connection, a secondary condition, or even TDIU, the key to winning is understanding how VA ratings for joint pain work and submitting strong medical evidence that proves how your condition limits your daily life.

YOU SERVED; YOU DESERVE!

Now it’s time to get the VA disability benefits you’ve earned for serving our country.

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