Bursitis is a common and painful condition affecting many veterans. It occurs when the bursae small fluid-filled sacs that cushion your joints become inflamed. This inflammation leads to pain, swelling, and limited joint movement, making everyday activities difficult. If you’re suffering from bursitis and wondering whether you qualify for a VA disability rating, this guide will help you understand how the VA evaluates this condition, the criteria for eligibility, and the different rating percentages based on the severity of your bursitis.
What is Bursitis?
Bursitis is the inflammation of the bursae, which are small, fluid-filled sacs that provide cushioning for your joints. When these sacs become irritated or inflamed, it can lead to pain, swelling, and limited mobility. Common symptoms of bursitis include joint pain, swelling, and difficulty moving the affected area.
Treatment for Bursitis
Treatment typically includes:
- Medication: Antibiotics may be prescribed if the inflammation is caused by infection.
- Physical Therapy: Exercises to strengthen the muscles around the affected joint.
- Injections: Corticosteroid injections to reduce pain and inflammation.
- Assistive Devices: Canes or other devices to relieve pressure on the joint.
- Surgery: In rare cases, surgery may be required to drain the inflamed bursa.
Bursitis VA Ratings
The VA evaluates bursitis using Diagnostic Code (DC) 5019, which falls under the category of “Other Impairments of the Musculoskeletal System.” Disability ratings for bursitis range from 10% to 90%, depending on the severity of your condition and the body part affected. Below are the details of how bursitis is rated for different joints.
Hip Bursitis VA Ratings
Bursitis in the hip is evaluated using Diagnostic Codes 5250-5255. The rating can range from 10% to 90%, with a 90% rating making you eligible for Special Monthly Compensation (SMC), which can significantly increase your monthly VA disability compensation. The rating depends on:
- The severity of limitation in range of motion.
- Whether the hip joint is your major or minor joint.
“VA disability for hip bursitis is complex, with different diagnostic codes based on the severity of your condition,” says Dr. John Taylor, a VA claims expert.
Shoulder Bursitis VA Ratings
Shoulder bursitis is evaluated using Diagnostic Codes 5200-5203. The disability rating ranges from 10% to 80%, based on:
- The degree of limited motion in the shoulder.
- The severity of pain and immobility.
- Whether it affects your major or minor joint.
For example, if your shoulder is completely immobile, it falls under DC 5200, and the rating will depend on whether it’s your dominant or non-dominant arm.
Elbow Bursitis VA Ratings
Elbow bursitis is rated using Diagnostic Codes 5205-5212. If your elbow is completely immobile (ankylosis), the rating can go up to 60% under DC 5205. Other ratings are based on the range of motion and impairments such as:
- Flexion, extension, or ulna/radius impairment.
- Whether the condition affects your major or minor joint.
“The key to getting a higher VA rating for elbow bursitis is demonstrating how much the condition restricts your joint movement and causes pain,” explains Lisa Garcia, a disability claims consultant.
Knee Bursitis VA Ratings
Knee bursitis VA ratings range from 0% to 60%. Your condition can be rated under several diagnostic codes, such as 5256-5262, depending on:
- Whether the knee is locked or cannot move properly (DC 5256).
- The degree of bending or straightening the knee.
- Whether there is instability in the joint.
Whether the bursitis affects your major or minor joint also plays a role in determining your rating.
Service Connecting Your Bursitis
To qualify for VA disability compensation, you must prove that your bursitis is service-connected. This means demonstrating that your military service either caused or worsened the condition. The “Caluza Triangle” outlines the necessary criteria for proving service connection:
- Current Diagnosis: You must have a formal medical diagnosis from a healthcare professional.
- In-Service Event: There must be evidence that an event during your military service caused or contributed to your bursitis.
- Medical Link: There must be a medical opinion linking your in-service event to the bursitis.
This is typically expressed in a Nexus Letter, with probabilities such as:
- “Is due to” = 100% certain.
- “More likely than not” = greater than 50% certain.
- “At least as likely as not” = equal to 50% certain.
- “Not likely due to” = less than 50% certain.
- “Is not due to” = 0% chance.
C&P Exams Related to Bursitis
Once you file a VA claim for bursitis, the VA may request a Compensation and Pension (C&P) exam. This exam evaluates the severity of your condition and helps determine your disability rating. Failing to attend the C&P exam can result in delays or a denied claim.
“Missing a C&P exam without a valid reason can severely hinder your chances of receiving the disability benefits you’re entitled to,” warns William Henson, a veteran service officer.
What to Do If Your VA Disability Claim for Bursitis Is Denied?
If your VA bursitis claim is denied, there are several options for appealing the decision:
- Notice of Disagreement (NOD): You can file an NOD to formally challenge the VA’s decision.
- Higher-Level Review (HLR): This request involves a senior rating specialist reviewing your case without new evidence.
- Supplemental Claim: If you have new evidence, you can submit it through a Supplemental Claim to strengthen your case.
Remember, you have one year from the date of the denial to file a Notice of Disagreement.
FAQs
How is bursitis rated by the VA?
Bursitis is rated based on the severity of the condition and the affected joint. The rating can range from 10% to 90%, depending on the symptoms and the joint involved.
Can I qualify for VA disability if I have hip bursitis?
Yes, if you have hip bursitis, you can qualify for a VA disability rating between 10% and 90%, depending on the limitation of motion and severity.
What if my VA claim for bursitis is denied?
If your claim is denied, you can file an appeal using a Notice of Disagreement, request a Higher-Level Review, or submit new evidence through a Supplemental Claim.
Does my bursitis have to be service-connected to qualify for VA disability benefits?
Yes, to qualify for VA disability compensation, you must prove that your bursitis is service-connected, meaning it was caused or aggravated by your military service.
What should I expect during a C&P exam for bursitis?
A C&P exam for bursitis will assess the severity of your condition and its impact on your daily life. It is important to attend this exam to avoid delays or denials in your claim.
