Securing a VA Rating for Hip Pain Secondary to Back Pain 

You may qualify for a VA rating for hip pain secondary to back pain if your hip issues stem from a service-connected back condition. 

The VA recognizes that back injuries, especially those involving the lower spine, can cause long-term complications in the hips, including joint damage, altered gait, or nerve compression. 

In this guide, we’ll walk you through how the VA evaluates hip pain secondary to back pain, what VA disability ratings may apply, and why medical evidence like a nexus letter can significantly improve your chances of approval.

Key Takeaways

• Hip pain can result from back-related conditions such as spinal stenosis, herniated discs, or degenerative joint disease.  

• If your back injury is service connected, you may qualify for a secondary service connection for hip pain. 

• The VA often awards separate ratings for hip conditions involving joint replacements or limited range of motion. 

• A nexus letter is crucial to proving that your hip pain is “at least as likely as not” caused or aggravated by your back condition. 

How Back Pain Leads to Hip Pain

Because the spine and hips are part of the same musculoskeletal system, injury or dysfunction in one area can directly affect the other. 

When your back doesn’t function properly, poor posture, muscle weakness, nerve impingement, or abnormal movement can trigger or worsen hip pain. 

Common complications include: 

• Hip joint misalignment 

• Overcompensation during movement 

• Nerve impingement 

• Chronic inflammation 

Even mild back issues can alter your gait or posture, leading to chronic hip pain. 

Common Military-Related Causes of Hip and Back Pain

Military service often involves intense physical activity, such as: 

• Heavy lifting 

• Ruck marches 

• Falls and training accidents 

These can result in lasting injuries to the spine or hips. Over time, chronic pain can significantly limit your mobility and quality of life. 

Hip Pain Secondary to Back Pain

The VA grants secondary service connection when a new condition develops or worsens because of an existing service-connected disability. 

For example, if your back condition alters your gait and leads to hip joint degeneration, the hip condition may qualify as secondary. 

Common secondary hip conditions include: 

• Hip bursitis 

• Trochanteric pain syndrome 

• Osteoarthritis 

• Tendonitis 

• Labral tears 

Veterans affected by these conditions may struggle with daily tasks such as walking, driving, or standing for extended periods. 

Establishing Service Connection for Hip Pain

To receive a VA rating for hip pain secondary to a back condition, you must meet three key criteria: 

1. A current medical diagnosis 

2. Documentation of an in-service event, injury, or illness 

3. A nexus (a medical link) between the back injury and hip pain 

A diagnosis alone is not enough. You must demonstrate that your hip pain is “at least as likely as not” caused or aggravated by your back condition. 

Did you know? If your claim lacks a clear medical opinion, it may be denied. Telemedica offers expertly written nexus letters tailored for musculoskeletal claims, including hip and back pain.

How the VA Rates Hip Conditions

The VA evaluates hip disabilities under 38 C.F.R. § 4.71a, Schedule of ratings—musculoskeletal system, based on: 

• Range of motion limitations 

• Pain caused by motion 

• Joint inflammation or instability 

• Symptoms of degenerative joint disease 

Types of hip movement considered in ratings: 

• Flexion: The movement that brings your thigh toward the abdomen 

• Extension: The movement of the thigh away from the body or backward 

• Adduction: The movement of your leg inward, toward the body’s midline 

• Abduction: The movement of your leg outward, away from the body 

The VA’s Painful Motion Rule

The VA recognizes that pain alone, especially pain caused by moving your hip, can qualify you for disability benefits. 

Key points about the VA’s painful motion rule: 

• Painful motion can result in a rating, even if the range of motion isn’t limited. 

• The VA must consider pain during movement when rating either or both hips. 

• The minimum compensable rating for painful motion is 10%. 

This rule can significantly affect your rating, especially when pain interferes with function. 

Hip Pain with Limited Range of Motion

When hip pain is accompanied by restricted mobility, the VA uses Diagnostic Codes (DCs) 5250–5255: 

VA ratings for hip pain with limited range of motion include: 

• 80% VA rating – DC 5254 Hip, flail joint 

• 20% VA rating – DC 5253, limitation of abduction of, motion lost beyond 10° 

• 10% VA rating – DC 5253, limitation of adduction of, cannot cross legs 

• 10% VA rating – DC 5255, limitation of rotation of, cannot toe-out more than 15° of the affected leg 

If your hip pain severely limits your mobility or causes chronic discomfort, particularly when linked to a back condition, you may qualify for a 40% or higher rating.  

Other factors, such as the need for assistive devices or ankylosis, can also influence the final decision. 

Arthritis of the Hip VA Ratings

The VA generally rates osteoarthritis of the hip under DC 5003 with the following ratings: 

• 20% VA Rating: 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: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. 

The VA doesn’t use the 20% and 10% ratings based on X-ray results to rate conditions listed under DCs 5013 to 5024. Instead, these conditions are rated based on how much the joint’s movement is limited.  

Some examples include: 

• Various forms of arthritis 

• Benign bone neoplasms (i.e., non-cancerous tumors of the bone) 

• Osteoporosis (i.e., softening of the bone) 

• Bursitis and other types of joint inflammation 

The VA may rate hip arthritis under DCs 5250-5255 if your arthritis severely limits your mobility. These diagnostic codes address the functional limitations associated with arthritis. 

Hip Bursitis VA Ratings

Bursitis of the hip causes severe pain when moving. The VA uses the same code as arthritis (i.e., DC code 5003) to rate bursitis from 10% to 20%. 

You may qualify for a higher VA rating under DCs 5250- 5255 if your bursitis limits your range of motion.  

Ankylosis VA Ratings

Ankylosis is a condition involving abnormal stiffening and immobility of a joint due to fusion of the bones, which often occurs due to long term inflammation.  

The VA rates limited range of motion, caused by ankylosis of the hip joint under DC 5250.  

VA ratings for ankylosis are: 

• 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 (i.e., movement of your leg inward, toward the body’s midline) or abduction (i.e., movement of your leg outward, away from the body) 

Note: Depending on the severity of your limited range of motion, you may be assigned another diagnosis code, such as 5251-5255, that also covers hip mobility limitations. 

Hip Replacement VA Ratings

If you’ve undergone a total hip replacement due to a service-connected condition, you may be eligible for a hip replacement VA disability rating of up to 100%, depending on the severity of your symptoms and recovery. 

The VA rates hip replacement under DC 5054 -Hip, resurfacing or replacement (prosthesis). 

VA ratings for hip replacement are as follows: 

• 100% VA Rating: For 4 months following implantation of prosthesis or resurfacing 

Prosthetic replacement of the head of the femur or of the acetabulum: 

• 90% VA Rating: Following implantation of prosthesis with painful motion or weakness such as to require the use of crutches 

• 70% VA Rating: Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis 

• 50% VA Rating: Moderately severe residuals of weakness, pain, or limitation of motion 

• 30% VA Rating: Minimum evaluation, total replacement only 

Note: After the 100% evaluation period ends, your resurfacing will be reviewed using diagnostic codes 5250 through 5255. There is no minimum rating for resurfacing. 

For detailed information on hip replacement ratings, refer to the VA’s decision documents: VA Decision on Hip Replacement Ratings. 

Bilateral Hip VA Ratings

The VA uses the “bilateral factor” to boost your overall rating when both sides of your body, like both hips, are involved. 

A bilateral hip condition VA rating includes a combined rating for both hips plus an extra 10% to reflect the added impact on mobility. 

Pro Tip: Use our VA disability calculator to see how the bilateral factor could increase your combined rating. 

FAQs | Frequently Asked Questions

Can I get a VA rating for hip pain if I already have a back condition rated?

Yes. If your hip pain is linked to your service-connected back condition, you may qualify for a secondary service connection and separate rating. 

What is the average VA rating for hip pain?

Ratings vary from 10% to 100%, depending on severity, range of motion, and surgical history. Many secondary hip pain VA ratings fall between 10% and 40%, but higher is possible. 

How important is a nexus letter for secondary hip pain claims?

Extremely important. The VA requires medical evidence connecting your hip condition to your back injury. A Nexus Letter can provide the necessary language and documentation to support your claim. 

Do I need surgery to receive a VA hip rating?

No. Ratings can be based on pain, functional loss, or limited range of motion without the need for surgery. 

Medical Evidence Wins VA Claims

Did you know that a lack of medical evidence is the #1 reason VA disability claims are denied?  

Medical evidence is a crucial piece of the puzzle that VA raters consider when reviewing a disability claim. Telemedica provides solutions for veterans looking to bolster their claims through high-quality medical evidence that wins claims.   

Schedule your 20-minute consultation and learn how to get the supporting medical evidence you need to strengthen your claim.