Can I Get VA Disability for Hip Pain Secondary to Knee Conditions?

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Yes, there is a ton of medical research supporting a connection between hip pain secondary to knee conditions in veterans.

Knee issues can create significant strain on surrounding joints and muscles, and over time, this can lead to chronic hip pain.

Since the hip and knee are connected within the musculoskeletal system, injury or impairment in one area can produce a ripple effect, causing pain and discomfort in the hip joint.

To establish a secondary service connection for hip pain due to a knee condition or past injury, you’ll need to demonstrate three key elements to the VA:

• (#1) a current medical diagnosis of hip pain,

• (#2) evidence of a service-connected knee condition, and

• (#3) medical nexus evidence (nexus letter) showing how your hip pain is proximately due to, caused, or aggravated by your service-connected knee condition rated at 0% or higher.

The VA rates hip pain secondary to knee conditions under multiple diagnostic codes (DCs) from 10% to 90% based on severity of symptoms, limitation on range of motion, and the impact on your daily life.

In this high-value blog post from VA disability expert Brian Reese, we’ll guide you through the process of filing a secondary claim for hip pain related to service-connected knee issues.

We’ll cover the VA’s rating criteria for hip pain, the medical evidence required, how to prove secondary service connection, and why a strong nexus letter is essential.

Let’s begin!

Summary of Key Points

• The Connection Between Hip Pain and Knee Conditions: Medical research shows a strong connection between knee issues and hip pain, particularly due to knee symptoms like joint misalignment, arthritis, and chronic strain. Knee injuries can affect how you walk, putting extra stress on the hips, which can lead to chronic pain, especially in veterans already dealing with knee problems.

• Secondary Service Connection Requirements: To establish a VA disability rating for hip pain secondary to knee conditions, veterans must provide three essential types of evidence: (1) a current diagnosis of hip pain, (2) proof that the knee condition is service-connected, and (3) a Nexus Letter from a medical provider explaining how the service-connected knee condition caused or aggravated the hip pain.

• VA Rating for Hip Pain Secondary to Knee Conditions: The VA rates hip pain under various diagnostic codes, depending on the severity, limitations on range of motion, and frequency of pain episodes. Higher ratings are awarded when hip pain results in considerable functional impairment, such as limited mobility or inability to perform daily activities.

• Important Medical Evidence for VA Claims: To strengthen a VA claim for hip pain secondary to knee conditions, veterans need supporting documentation, including medical records detailing the diagnosis, symptoms, and treatments, as well as personal statements or lay evidence describing the negative impacts on work, daily life, and social functioning.

What is Hip Pain?

Hip pain typically refers to discomfort, soreness, or stiffness around the hip joint.

It can stem from various causes, including injury, joint inflammation, arthritis, or compensation for issues in surrounding areas like the knees.

Symptoms of hip pain can include:

• Pain or aching in the hip joint, especially when walking or sitting

• Reduced range of motion and stiffness

• Difficulty with activities like climbing stairs, standing for long periods, or bending over

Because the hip is a weight-bearing joint, it is susceptible to issues arising from conditions in other areas, such as the knees.

What are Knee Conditions?

Knee conditions encompass a range of joint issues, including arthritis, ligament injuries, cartilage tears, and tendonitis.

Knee problems can be caused by trauma, wear and tear, or degenerative joint diseases.

Common symptoms of knee conditions include:

• Pain and swelling around the knee joint

• Reduced mobility and difficulty walking

• Instability or “giving out” sensation in the knee

These conditions often result in an altered gait, which places additional stress on the hip joint, leading to secondary pain.

Hip Pain and Knee Conditions: Is There a Connection?

Yes, according to medical research, there is a strong connection between hip pain and knee conditions.

While these are distinct areas of the body, knee injuries or degenerative conditions can lead to misalignment and increased pressure on the hip.

Here’s how hip pain is linked to knee conditions as a secondary disability:

• Altered Gait: Knee pain frequently causes individuals to favor one leg, resulting in an uneven walking pattern. This altered gait places added strain on the hip joint, leading to pain and discomfort over time.

• Joint Stress and Misalignment: Knee issues can disrupt proper alignment in the lower body, increasing the risk of hip pain as the hip joint absorbs added pressure and strain due to the knee’s limitations.

• Referred Pain: Given the interconnected nature of the musculoskeletal system, knee problems can lead to pain that manifests in the hip, known as referred pain. This phenomenon is common when a nearby joint is compromised, causing other joints to compensate.

Studies consistently show that knee problems can contribute to secondary hip pain, especially in individuals with long-term or untreated knee conditions.

This connection is essential for veterans seeking secondary service connection for hip pain due to a service-connected knee condition.

Medical Research Between Hip Pain and Knee Conditions

Medical research has extensively explored the relationship between knee conditions and subsequent hip pain.

Three notable studies provide insights into this connection:

#1. Study on the Association of Knee and Hip Osteoarthritis with the Risk of Falls and Fractures

Published in Arthritis Research & Therapy in 2023, this study aimed to investigate the associations of symptomatic and radiographic knee and hip osteoarthritis (OA) with the risk of falls, recurrent falls, and fractures. The researchers conducted an electronic search of databases up to February 2023 and included studies that evaluated the association of knee and hip OA with falls and fractures. The findings indicated that both knee and hip OA are associated with an increased risk of falls and fractures, highlighting the interconnected nature of lower limb joint health.

Source Link: Arthritis Research

#2. Study on the Association of Osteoarthritis Risk Factors with Knee and Hip Pain

This research, published in BMC Musculoskeletal Disorders in 2018, examined the prevalence of knee and hip pain in a population-based cohort and investigated the association of osteoarthritis risk factors with knee and hip pain. The study found that knee and hip pain often coexist, and common risk factors such as age, obesity, and physical inactivity contribute to the development of pain in both joints. The authors concluded that addressing these risk factors is crucial in managing and preventing joint pain.

Source Link: BMC Musculoskeletal Disorders

#3. Study on the Differences Between Hip and Knee Osteoarthritis

Published in Osteoarthritis and Cartilage in 2021, this study explored how hip osteoarthritis differs from knee osteoarthritis. The researchers found that while both conditions lead to joint pain and disability, there are distinct differences in their pathophysiology, risk factors, and clinical presentations. Understanding these differences is essential for developing targeted treatment strategies for each condition.

Source Link: Oars Journal

Important BVA Decisions Granted for Hip Disorders Secondary to Knee Disabilities

#1. Entitlement to service connection for bilateral hip disorders, secondary to service-connected right knee disability IS GRANTED

• URL: https://www.va.gov/vetapp06/files4/0624574.txt            

• Background: The veteran served actively in the military from May 1943 to February 1946. He has a documented history of right knee disability from his service, causing severe arthritis, pain, and a marked limp. Over time, this knee condition led to an altered gait, which contributed to the development of lumbar spine issues and, eventually, hip pain.

• Claim: The veteran sought VA disability benefits for bilateral hip pain, asserting that his hip issues stemmed from his service-connected right knee condition. During the claim process, the veteran was also granted service connection for lumbar spine issues, which he argued contributed to his hip pain.

• Findings: Medical evidence showed the veteran’s right hip pain was aggravated by his right knee condition, and his left hip pain was related to his lumbar spine condition. Physical examinations documented limited hip motion with pain, validating functional impairment. X-rays revealed some signs of arthritis in the hips, supporting his claim of ongoing hip-related disability.

• Conclusion: The Board ruled that the veteran’s hip disabilities (both right and left) were secondary to his already service-connected disabilities (right knee and lumbar spine). Under VA regulations, this secondary service connection was sufficient for entitlement to benefits. By applying the “benefit of the doubt” standard, the Board ruled in favor of the veteran, granting service connection for his right and left hip disabilities.

• Final Decision: The Board of Veterans’ Appeals approved the veteran’s claim, officially granting service connection for his right and left hip disabilities as secondary conditions to his service-connected knee and lumbar spine disabilities.

#2. Entitlement to service connection for a right hip disability, to include as secondary to right knee disorders IS GRANTED.

This Board of Veterans’ Appeals decision reviews several service connection and disability rating issues for a Navy veteran with conditions tied to his military service.

• URL: https://www.va.gov/vetapp09/files1/0907783.txt            

• Right Hip Service Connection Granted: The Board granted service connection for the veteran’s right hip arthritis, finding it was likely caused by his already service-connected right knee condition. Medical evidence linked his altered gait from knee issues to hip problems.

• Right Knee Disability Rating Increased to 20%: The veteran’s right knee condition was previously rated at 10%. Based on pain, arthritis, and mild instability, the Board increased the rating to 20%, combining a 10% rating for arthritis and another 10% for instability.

• No Increase for Right Ulna Fracture: The veteran’s request to raise the rating above 30% for his right ulna (forearm) fracture was denied. Although he experienced pain and limited movement, the evidence did not meet the criteria for a higher rating.

• Other Claims Remanded for Further Review: The Board remanded claims related to asbestos-related lung disease and a total disability rating based on individual unemployability (TDIU). The remand requires further development, including a new medical examination to clarify lung function and to collect missing medical records.

• Final Decision: In essence, the decision involved an approval for right hip service connection, a slight increase in the right knee rating, a denial for a right ulna fracture increase, and additional development on lung-related claims.

What is the VA Rating for Hip Pain Secondary to Knee Conditions?

Hip pain secondary to knee conditions and injuries can be rated between 10% and 90% under various diagnostic codes (DCs) in 38 CFR, Part 4, the VA Schedule for Rating Disabilities.

The exact rating for hip pain secondary to knee conditions depends on the predominant condition, severity of symptoms, range of motion limitations, and the extent to which it impacts your daily life, work, and social interactions, including any functional limitations or loss.

Here’s the most common diagnosis codes (DCs) used to rate hip pain:

VA Rating for Hip Ankylosis and Limited Range of Motion (ROM)

A common cause of hip pain for veterans is limited range of motion or immobility in the hip joint, known as ankylosis.

The VA uses Diagnostic Code 5250 for ankylosis of the hip.

Here’s how it’s rated:

• 90% VA Rating: Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated

• 70% VA Rating: Intermediate ankylosis

• 60% VA Rating: Favorable ankylosis, in flexion at an angle between 20° and 40°, and slight adduction or abduction

If your limited range of motion is less severe, the VA may apply other diagnostic codes, such as 5251-5255, which also cover hip mobility limitations.

VA Rating for Hip Arthritis

Arthritis, a common condition among veterans, causes pain, swelling, and stiffness in the hip joints due to inflammation.

If your arthritis leads to more severe limitations in motion, the VA may rate it under codes 5250-5255, which focus on the functional limitations caused by your arthritis.

For hip arthritis, the VA typically uses Diagnostic Code 5003.

If your arthritis leads to more severe limitations in motion, the VA may rate it under codes 5250-5255, which focus on the functional limitations caused by your arthritis.

Here’s how it’s rated:

• 20% VA Rating: Hip arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations

• 10% VA Rating: Hip arthritis with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups

• Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion.            

• Note (2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. 

VA Rating for Hip Bursitis

Bursitis is an inflammation of the fluid-filled sacs (bursae) that cushion the joints.

This can cause severe pain when moving.

The VA rates bursitis under Diagnostic Code 5003, the same code used for arthritis from 10% to 20%.

If bursitis restricts your range of motion, you may qualify for a higher rating under the range-of-motion diagnostic codes (5250-5255).

VA Rating for Hip Replacement

For veterans whose hip pain becomes severe enough to require a hip replacement, the VA offers temporary and permanent ratings under Diagnostic Code 5054:

• Temporary 100% rating for four months following surgery

• After this period, your rating is reevaluated based on any lasting limitations in range of motion, using codes 5250-5255. Permanent ratings for hip replacements range from 30% to 90%, depending on the severity of residual symptoms.

VA Rating for Bilateral Hip Strain and Hip Injuries

Hip strain occurs when the muscles in the hip are overstretched or torn, causing pain, swelling, and sometimes lasting weakness.

The VA may rate hip strain using Diagnostic Codes 5313-5318 or 5250-5255 if there’s limited range of motion.

When both hips are affected (bilateral hip strain), the VA applies a “bilateral factor.”

Here’s how it works:

• The VA rates each hip separately, combines those ratings, and then adds 10% of the combined rating. This additional 10% can have a significant impact on your final combined rating and monthly compensation.

Understanding the VA’s rating system is essential to receiving fair compensation for hip pain and related conditions.

If you’re dealing with any of these hip issues, make sure you have the medical evidence needed to support your claim and maximize your rating.

Hip Pain and The Painful Motion Principle

There are two key principles to be aware of with the VA’s painful motion rule:

• First, the VA painful motion rule recognizes that pain during motion can serve as a basis for a disability rating, even when there is no measurable limitation of motion in the affected joint or limb; if you experience pain during the motion of one or both hips, the VA must consider it when determining your disability rating.

• Second, if you experience any painful motion, regardless of the extent of the limitation in the range of motion, the VA is required to award you at least the minimum compensable rating for hip pain, which is 10%.

Important Notes:

• Pain as a Factor: The rule acknowledges that pain is a significant factor that can contribute to functional loss, even if the range of motion is not significantly limited. However, it’s important to note that pain alone is not compensable as a separate VA rating. Instead, pain is considered within the context of the overall disability and must be tied to a specific condition or functional impairment to qualify for a compensable rating.

• Minimum Compensable Rating: When painful motion is present, the VA must assign at least the minimum compensable rating for the affected joint or condition, which is 10%.

Important Medical Evidence to Service-Connect Hip Pain Secondary to Knee Conditions for VA Disability

To file a successful VA claim for hip pain secondary to a service-connected knee condition, you’ll need to provide specific medical evidence that satisfies the VA’s criteria for secondary service connection.

#1. Current Medical Diagnosis of Hip Pain or Other Hip Condition

The first step in establishing secondary service connection for hip pain is to obtain a current diagnosis of your hip condition.

Your diagnosis must come from a qualified healthcare provider and be thoroughly documented in your medical records.

This diagnosis should include information on the type and severity of the hip condition and any limitations or functional impairments you experience.

#2. Evidence of a Service-Connected Knee Condition Rated at 0% or Higher

Since your hip pain is being claimed as secondary to a service-connected knee condition, you must already have a confirmed VA rating for the knee condition.

The VA will require proof of service connection for the knee condition, such as your VA Rating Decision.

This documentation will confirm that your knee injury is recognized by the VA as a service-connected disability, serving as the basis for claiming hip pain as a secondary condition.

#3. Nexus Letter for a Secondary Condition from a Private Healthcare Provider

A critical element of any VA claim for secondary service connection is a Nexus Letter for a secondary condition from a private healthcare provider.

This letter must establish a clear medical link between your service-connected knee condition and your hip pain.

The provider should state that it is “at least as likely as not” (a 50% or greater probability) that your hip pain is proximately due to, caused, or aggravated by your knee condition.

The letter should detail how the knee injury has impacted the hip joint, using medical history, relevant medical research, BVA decisions, and the provider’s expert opinion.

A well-crafted Nexus Letter with high probative value is crucial to winning your VA disability claim for secondary service connection!

#4. Documentation of Severity of Symptoms and Negative Impacts on Your Work, Life, and Social Functioning

The VA will need to understand the extent of your hip pain symptoms and how they affect your ability to function in daily life, including work and social situations.

Be ready to submit evidence that demonstrates how hip pain limits your daily tasks and overall quality of life.

This may include:

• Military, VA, or Private Medical Records: Records should outline your symptoms, treatments (e.g., physical therapy, medications), and the ways in which hip pain impacts your daily life.

• Lay Evidence: Personal statements from you, family members, or friends can provide firsthand accounts of how hip pain limits your activities and quality of life.

• Disability Benefit Questionnaires (DBQs): If available, a DBQ for hip and thigh conditions completed by your healthcare provider can provide detailed documentation of your symptoms and any functional limitations related to your hip pain. Note: musculoskeletal condition DBQs require an in-person examination and ROM test with a goniometer. To save yourself time and money, you might want to wait for your C&P exam to get your DBQ completed.

Providing this comprehensive evidence can strengthen your claim and improve your chances of establishing a secondary service connection for hip pain due to a knee condition.

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