Degenerative arthritis is primarily a disorder of cartilage and the bone underlying the cartilage. All tissues in and around involved joints are enlarged (hypertrophic). The condition is noted by marked deterioration in synovial joints and vertebrae. The condition is non-inflammatory.

The cause is unknown. The condition may be from a singular event or combination of events or causes to include: genetic defects; infection; metabolic, endocrine, and neuropathic disease; acute trauma (fracture); chronic trauma (prolonged overuse of a joint through occupation, or sports, etc.); and anything that causes damage to the cartilage. Risk factors associated with the condition include aging, obesity, overuse or abuse of a joint as in sports or strenuous occupations, and trauma. Osteoarthritis is the most common form of joint disease.

The signs and symptoms are pain relieved by rest; morning stiffness which is brief and later develops into pain on motion; reduced joint mobility; flexion contracture; tenderness; crepitus; joint enlargement; deformity; and incomplete or partial dislocation of a joint.

X-ray findings are necessary for a diagnosis. The presence of Heberden's nodes or calcium deposits in the terminal joints of the fingers, with deformity, is diagnostic. Ankylosis is rare, but there may be hyperostosis and irregular notched articular surfaces of the joints. Diagnostic features include: destruction of cartilage and bone; and changes in bone involving hardening (eburnation), and the formation of osteophytes.

Treatment is supportive, and includes exercise balanced with rest, heat, weight reduction and education. Treatment also includes: rehabilitation; nonsteroidal anti-inflammatory drugs (NSAIDs); muscle relaxants; intra-articular corticosteroids; analgesics; tricyclic antidepressants; and, in some cases, surgery. Total hip and knee replacement may be done. Additional surgical treatment includes cartilage tissue grafting, osteotomy, or realignment of the leg and arthrodesis as a salvage procedure.

Residuals depend on the severity of the disease or injury, the timeliness and effectiveness of treatments, and the individual's body response to the disease and treatments. Activities may be limited based on the severity of the symptoms. Residuals can vary from zero disability to total disability, e.g., complete rigidity or fixation of spine and both hips.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• When rating severity of arthritis, the shoulders, elbows, wrists, hips, knees, and ankles are considered as major joints.

• When rating severity of arthritis, multiple involvement of the interphalangeal, metacarpal, and carpal joints; interphalangeal, metatarsal, and tarsal joints; and cervical vertebrae, thoracic/dorsal vertebrae, and lumbar vertebrae are considered minor joints or joint groups, and are ratable as major joints.

• To properly rate degenerative arthritis and arthritis due to trauma, the rater must have x-ray findings for evidence of diagnosis. "Ankylosis is rare, but there may be hyperostosis and irregular notched articular surfaces of the joints. Destruction of cartilage, bone eburnation, and the formation of "osteophytes" constitute the diagnostic features".

• When rating severity of arthritis, occasional incapacitating increases of pain in degenerative arthritis are generally considered to be occurrences that cause the individual to lose actual workdays on at least a few times within a year.

• When assigning a Diagnostic Code or rating arthritis severity, a limitation of motion of a joint due to degenerative arthritis or arthritis due to trauma should be rated under limitation of motion rather than degenerative arthritis if it is more advantageous to the veteran (e.g., degenerative arthritis of both shoulders with right (major) arm motion limited to 25 degrees, rate under "Arm, limitation of motion - 40%" vice Degenerative Arthritis - 10 or 20%).

• To properly rate arthritis disability, examinations should address the veteran's carriage, posture, and gait.

• The minimum compensable evaluation may be assigned under 38 CFR 4.59 based on subjective painful motion, and does not require objective evidence of painful motion.

• To properly rate arthritis disability, accurate measurement of joint movement limitations is required and must be reported in degrees. The use of a goniometer (device for measuring joint movements and angles) in the measurement of range of motion in a joint is indispensable 38 CFR 4.46 [Accurate measurement].

• To properly rate disability, it is important to understand the range of motion chart Plate I & II, 38 CFR 4.71 [Measurement of ankylosis and joint motion] and 38 CFR 4.71a [Schedule of ratings - musculoskeletal system]. A rater should keep in mind that while the chart shows 95 to be normal for forward flexion a given individual may have normal forward flexion of 90 if so stated by the examiner. Range of motion can be limited by non-OA factors such as heavily developed calf muscles or tight hamstring muscles, none of which constitute loss of function due to service-connected disability of OA.

• The disease must have become manifest to a degree of 10 percent or more within 1 year (for Hansen's disease (leprosy) and tuberculosis, within 3 years; multiple sclerosis, within 7 years) from the date of separation from service as specified in paragraph (a)(2) of this section. See 38 CFR 3.307(a)(3)  [chronic disease].

Please refer to the GC opinion (VAOGCPREC9-98) dated August 1998, which held:

• For a knee disability rated under DC 5257 to warrant a separate rating for arthritis based on x-ray findings and limitation of motion, limitation of motion under DC 5260 or DC 5261 need not be compensable but must at least meet the criteria for a zero-percent rating. A separate rating for arthritis could also be based on x-ray findings and painful motion under 38 CFR 4.59, provided the provisions of 38 CFR 4.14 are not violated. 

• The provisions of 38 CFR 4.40, 4.45, and  4.59  must be considered in assigning an evaluation for degenerative or traumatic arthritis under DC 5003 or DC 5010. Rating personnel must consider functional loss and clearly explain the impact of pain upon the disability.

• If a musculoskeletal disability is rated under a specific diagnostic code that does not involve limitation of motion and another diagnostic code based on limitation of motion may be applicable, the latter diagnostic code must be considered in light of sections 38 CFR 4.40, 4.45, and   4.59.

• The medical nature of the particular disability to be rated under a given diagnostic code determines whether the diagnostic code is predicated on loss of range of motion. Reference should be made to appropriate medical authorities.

• DC 5259 requires consideration of sections 38 CFR 4.40 and 4.45 because removal of the semilunar cartilage may result in complications producing loss of motion. Depending on the nature of the foot injury, DC 5284 may involve limitation of motion and therefore require consideration under sections 38 CFR 4.40 and 4.45.

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

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

• With the types of arthritis, diagnostic codes 5004 through 5009, rate the acute phase under diagnostic code 5002; rate any chronic residuals under diagnostic code 5003.