Pain in a joint, especially one not inflammatory. However, for the purposes of this discussion, inflammatory causes of pain in the joint(s) will also be considered.

Conditions such as connective tissue disorders, joint disease, and autoimmune reactions may cause arthralgia. These types of conditions may include:

• polymyositis;

• dermatomyositis,

• arthritis;

• systemic lupus erythematosus (see Diagnostic Code: 6350);

• scleroderma; and

• vasculitis.

Other conditions which may attribute to arthralgia include:

• infections;

• trauma;

• inflammatory conditions;

• systemic disease, such as Lyme disease (see Diagnostic Code: 6319);

• medications; and

• neurologic manifestations, such as fibromyalgia (see Diagnostic Code: 5025).

In addition, its cause may be idiopathic.

Signs and symptoms of arthralgia may include

• pain, morning stiffness, and reduced joint mobility;

• flexion contracture;

• tenderness;

• crepitus;

• joint enlargement;

• deformity; and

• incomplete or partial dislocation of a joint.

Multiple joints are often involved.

A complete history and physical examination to include range-of-motion (ROM) testing may be done. Specific laboratory studies may be needed to verify the presence or absence of a specific underlying cause. These may include:

• erythrocyte sedimentation rate (ESR);

• C-reactive protein (CRP);

• serum uric acid;

• antinuclear antibodies (ANA); and

• synovial fluid biopsy.

Radiological studies may be indicated in conjunction with certain laboratory studies, such as

• computed tomography (CT) scan,

• magnetic resonance imaging (MRI) scan, and

• x-rays of involved joints.

Treatment may depend on the cause of joint pain, and include

• supportive care,

• exercise balanced with rest,

• heat,

• weight reduction, and

• education.

In addition, treatment also includes:

• rehabilitation;

• nonsteroidal anti-inflammatory drugs (NSAIDs);

• muscle relaxants;

• intra-articular corticosteroids;

• analgesics;

• tricyclic antidepressants; and

• in some cases, surgery.

Residuals may depend on the severity of the underlying disease, condition, or injury, and the timeliness and effectiveness of treatments, as well as the individual's body response to the cause and treatments. Range of motion of joints may vary and result in limited activities based on the severity of the symptoms. Residuals can vary from zero disability to total disability.

• 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)).

• Pain alone or any condition resulting in functional impairment of earning capacity, even in the absence of a specific diagnosis or otherwise identified disease or injury, may constitute a disability under 38 U.S.C. 1110 or 38 U.S.C. 1131 for which SC may be granted. The Veteran’s pain or condition must result in functional impairment of earning capacity to constitute a disability.

• 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).

• 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.

• None.