How VA rates hip condition
VA rates hip ankylosis, motion loss, flail joint, and femur impairment under 38 CFR § 4.71a, DCs 5250–5255. Flexion bands under DC 5252 are 45°/10%, 30°/20%, 20°/30%, and 10°/40%. Paired hip ratings may receive the bilateral factor.
38 CFR § 4.71, Plate II: normal hip flexion is 0–125° and abduction is 0–45°.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 60/70/90% | DC 5250: favorable, intermediate, or extremely unfavorable hip ankylosis |
| 10–40% | DC 5252: flexion limited to 45°, 30°, 20°, or 10° |
| 80% | DC 5254: hip flail joint |
| 60–80% | DC 5255: qualifying femur fracture nonunion or false joint; malunion is evaluated under the affected hip or knee codes |
DBQ and symptom topics to review
Review these topics against your own records and symptoms. Do not exaggerate or minimize; describe functional impact accurately.
- Hip flexion limited to 45 degrees10%DC 5252
- Hip flexion limited to 30 degrees20%DC 5252
- Hip flexion limited to 20 degrees30%DC 5252
- Hip flexion limited to 10 degrees40%DC 5252
- Documented favorable hip ankylosis: fixed in flexion between 20 and 40 degrees, with slight adduction or abduction60%DC 5250; stiffness alone is not ankylosis
- Hip flail joint80%DC 5254
What may happen in the exam room
- Goniometer measurement of flexion, extension, abduction, adduction, and rotation
- Active, passive, weight-bearing, and non-weight-bearing motion when feasible
- Repetitive-use testing
- Gait and assistive-device observation
Measurements and findings to understand
- Angle where pain begins
- Motion after at least three repetitions
- Estimated loss during flare-ups or repeated use
- Whether the joint is fixed
- Functional effect on sitting, stairs, dressing, and walking
Questions the examiner may cover
- How often do hip flare-ups occur and how long do they last?
- How far can you walk or sit before symptoms increase?
- Do you use a cane, crutch, or walker?
- Does the hip alter your gait or affect the back or opposite leg?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- Describe the actual range-limiting point, not the furthest motion you can force.
- Explain difficulty putting on socks, entering a vehicle, climbing stairs, or rising from a chair.
- Describe gait changes and which side bears extra weight.
Common mistakes to avoid
- Pushing through painful ROM
- Saying it is fine today without describing flare-ups
- Confusing hip-joint motion with a separate thigh muscle injury
Evidence to organize before the exam
- Hip and Thigh Conditions DBQ
- Imaging and orthopedic notes
- Physical therapy ROM measurements
- Assistive-device prescription
- Flare and walking-distance log
Preparation notes
- Identify the affected side and whether both hips are involved.
- Describe the worst typical functional day accurately.
DeLuca and flare-up notes
DeLuca and painful motion: Under 38 CFR §§ 4.40, 4.45, and 4.59, the examiner should address pain, weakness, fatigability, incoordination, repeated use, and flare-ups. Explain pain onset and the actual functional endpoint separately. Follow the examiner's safety instructions; do not force movement or alter it to match a rating.
Official rating source
38 CFR 4.71a, DCs 5250-5255. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Review when altered gait is documented and a clinician supports causation or aggravation.
Compensatory loading is an issue to review, not an automatic relationship.