Hip pain is a common and often overlooked consequence of service-connected knee injuries. For many veterans, years of compensating for knee pain, instability, or limited motion eventually take a toll on the hips. The good news is that the VA does recognize hip pain as a secondary condition to knee disabilities when the proper medical and legal standards are met.
In this in-depth guide from VA disability expert Brian Reese, we break down everything veterans need to know about filing a secondary VA disability claim for hip pain caused or aggravated by knee conditions, including eligibility rules, rating criteria, required medical evidence, and strategies to maximize your compensation.
Understanding Hip Pain in Veterans
Hip pain refers to discomfort, stiffness, or reduced mobility in the hip joint or surrounding structures. Because the hip is a major weight-bearing joint, even small changes in walking mechanics can result in significant stress over time.
Common Symptoms of Hip Pain
- Persistent aching or sharp pain in the hip or groin
- Reduced range of motion and stiffness
- Pain while walking, sitting, or standing
- Difficulty climbing stairs or bending
- Limping or uneven gait
For veterans with service-connected knee conditions, these symptoms often develop gradually as the body compensates for knee dysfunction.
What Are Knee Conditions and Why Do They Matter?
Knee conditions are among the most common service-connected disabilities in the VA system. These include:
- Degenerative arthritis
- Meniscus tears
- Ligament injuries (ACL, MCL, PCL)
- Chronic knee strain or instability
- Post-surgical residuals
How Knee Problems Lead to Hip Pain?
Knee injuries frequently alter the way a veteran walks. This altered gait places abnormal forces on the hips, pelvis, and lower spine. Over time, this compensation can result in hip pain, arthritis, bursitis, or reduced range of motion.
Is There a Medical Link Between Knee Conditions and Hip Pain?
Yes. Medical research consistently supports a strong connection between knee pathology and secondary hip disorders.
Key Mechanisms
- Altered Gait: Favoring one leg increases stress on the opposite hip
- Joint Misalignment: Knee degeneration disrupts lower-body alignment
- Referred Pain: Pain from one joint manifests in adjacent joints
- Overuse Injuries: The hip compensates for reduced knee function
This biomechanical relationship is widely accepted in both orthopedic medicine and VA disability law.
Does the VA Allow Hip Pain as a Secondary Condition?
Absolutely. Under VA regulations, a disability may be service-connected on a secondary basis when it is:
- Proximately due to a service-connected condition, or
- Permanently aggravated by a service-connected condition
Hip pain secondary to knee conditions fits squarely within this framework.
As Brian Reese explains:
“When a knee injury forces the hip to do extra work for years, that hip condition didn’t come out of nowhere it’s a downstream effect of service.”
VA Ratings for Hip Pain Secondary to Knee Conditions
Hip conditions are rated under multiple diagnostic codes in 38 CFR, Part 4, depending on diagnosis and severity. Ratings range from 10% to 90%.
VA Rating for Hip Ankylosis and Severe Motion Loss (DC 5250)
| VA Rating | Criteria |
|---|---|
| 90% | Extremely unfavorable ankylosis, crutches required |
| 70% | Intermediate ankylosis |
| 60% | Favorable ankylosis |
Ankylosis refers to severe joint immobility and represents the most disabling hip conditions.
VA Rating for Hip Arthritis (DC 5003)
| VA Rating | Criteria |
|---|---|
| 20% | X-ray evidence + incapacitating episodes |
| 10% | X-ray evidence without incapacitating episodes |
Important notes:
- These ratings cannot be combined with limitation-of-motion ratings
- Arthritis often supports higher ratings when ROM is restricted
VA Rating for Hip Bursitis
Hip bursitis is rated analogously under arthritis criteria or limitation-of-motion diagnostic codes if ROM is affected. Pain, swelling, and functional loss are key rating factors.
VA Rating for Hip Replacement (DC 5054)
- 100% temporary rating for four months after surgery
- Permanent ratings from 30% to 90% based on residual pain, weakness, and motion loss
Hip replacements often result from long-term compensation injuries tied to knee disabilities.
Bilateral Hip Conditions and the Bilateral Factor
When both hips are service-connected, the VA applies the bilateral factor, adding 10% of the combined value of both hips. This can significantly increase overall compensation.
The VA Painful Motion Rule (Critical for Hip Claims)
The VA must consider painful motion even when range-of-motion measurements appear normal.
Key Principles
- Pain during motion qualifies as functional loss
- Pain alone is not a separate rating but supports compensation
- Veterans are entitled to at least a 10% rating when painful motion exists
This rule is especially important for hip claims where pain limits daily activities.
Medical Evidence Required to Win a Secondary Hip Claim
1. Current Medical Diagnosis
You must have a documented diagnosis of a hip condition from a qualified medical provider. This may include arthritis, bursitis, strain, or limited range of motion.
2. Proof of a Service-Connected Knee Condition
Your knee disability must already be service-connected at 0% or higher. A VA Rating Decision satisfies this requirement.
3. Nexus Letter for Secondary Service Connection
A nexus letter is often the most important piece of evidence. It must state that your hip condition is:
“At least as likely as not (50% probability or greater)”
caused or aggravated by your service-connected knee condition.
A strong nexus letter explains:
- Altered gait mechanics
- Medical research support
- Clinical findings
- Clear medical reasoning
4. Evidence of Functional Impact
The VA evaluates how hip pain affects your:
- Ability to work
- Daily activities
- Mobility and endurance
- Social and recreational life
Helpful evidence includes:
- VA and private medical records
- Lay statements from family or coworkers
- Disability Benefits Questionnaires (DBQs), if available
Why Secondary Hip Claims Are Often Denied?
Common reasons include:
- No nexus opinion
- Inadequate medical rationale
- Failure to document altered gait
- Lack of functional impact evidence
As Reese often notes:
“Most denials aren’t because the condition isn’t real it’s because the evidence wasn’t connected properly.”
Final Thought
Hip pain secondary to knee conditions is one of the most medically and legally supportable secondary VA claims. When supported by a strong diagnosis, credible nexus evidence, and documented functional loss, these claims are highly winnable.
As Brian Reese puts it:
“If your knee injury changed the way you walk and your hip paid the price, the VA system already has a path to compensate you you just have to follow it correctly.”
With the right preparation, veterans can secure the benefits they earned through service.
FAQs
Can hip pain be rated by the VA?
Yes, when tied to a diagnosed hip condition.
Does my knee need to be service-connected first?
Yes, the knee condition must already be service-connected.
Do I need a nexus letter?
Strongly recommended for secondary claims.
What’s the highest hip rating possible?
Up to 90%, depending on diagnosis.
Can both hips be rated?
Yes, with a bilateral factor applied.
