Tuberculosis is an infection that usually occurs initially in the lungs. The condition is characterized by the following stages: formation of inflammatory, cheesy tubercles; death of tissue; cavity formations and finally healing by fibrosis and calcification. Furthermore, the surrounding lymph nodes become enlarged. Tuberculosis of the bones and joints occurs when the bacilli are distributed through the blood stream to the vertebrae and ends of the long bones. (See Diagnostic Code: 6730 Tuberculosis, pulmonary, chronic, active, and Diagnostic Code: 6731 Tuberculosis, pulmonary, chronic, inactive.)

Tuberculosis of the bones is caused by the organism, Mycobacterium tuberculosis spreading by way of the blood from a primary lesion in the respiratory tract. Recent resurgence has accompanied more aggressive management of chronic illness as well as emergence of immunocompromised states, particularly acquired immunodeficiency syndrome (AIDS). The disease may develop in the bone quickly or it may develop months, years, or decades after the initial infection. Occasionally direct extension from a body cavity such as from the lung, kidney or lymph nodes. Infection may also spread into the covering of a joint causing arthritis. In most cases, a single bone or joint is involved. The knees are most commonly involved, followed by bones of the wrist, hand, and elbow. Tuberculosis of the thoracic or lumbar spine (Potts disease) begins in the vertebral body next to the disk space in the absence of infection occurring outside of the spine.

The person is often unaware of the onset of the disease.

• Mild pain may be present, accompanied by stiffness.

• Limitation of joint muscles due to muscle contractures and destruction may be present as the disease progresses.

Signs and symptoms during the early stages may be limited to:

• tenderness

• soft tissue swelling

• joint effusion

• an increase in warmth of the skin around the involved area

Atrophy of the muscles and deformity may be present if the disease progresses without treatment. There may also be abscess formation with spontaneous drainage. A gibbus over the thoracic and lumbar regions may develop if there is progressive destruction of the bone in the spine. If the disease is not diagnosed and treated promptly, the vertebrae may collapse resulting in paralysis.

Tests for the condition include: computed tomography (CT) scan; magnetic resonance imaging (MRI); needle biopsy of the bony lesion, joint fluid (synovium) or regional lymph nodes; histological studies for an organism in the joint fluid, pus or tissue specimens; polymerase chain reaction (PCR); and cultures.

Treatment for tuberculosis of the bone includes primarily drug therapy and general measures. Drug therapy is continued for at least 9 months or more. Immobilization of the bone by a splint, aspiration, and chemotherapy may control the infection. General measures related to hazards of immobility during prolonged periods of rest in a reclining position are considered.

Destruction of the bones or joints may occur if adequate treatment is not provided. Residuals may include deformities due to joint destruction, abscess formation and sinus formation. As severe joint lesions heal, joint immobility may occur. Paralysis may result from complications of spinal tuberculosis.

• 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)).

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under §3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of §3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], §3.309(a). [chronic disease].

• Following the total rating for the 1 year period after date of inactivity, the schedular evaluation for residuals of nonpulmonary tuberculosis, i.e., ankylosis, surgical removal of a part, etc., will be assigned under the appropriate diagnostic code for the residual preceded by the diagnostic code for tuberculosis of the body part affected. For example, tuberculosis of the hip joint with residual ankylosis would be coded 5001-5250. Where there are existing residuals of pulmonary and nonpulmonary conditions, the evaluations for residual separate functional impairment may be combined. CFR 38 §4.88c [Ratings for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968]

• 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) – Special Monthly Compensation (SMC).

• Where there are existing pulmonary and nonpulmonary conditions, the total rating for the 1 year, after attainment of inactivity, may not be applied to both conditions during the same period. However, the total rating during the 1-year period for the pulmonary or for the nonpulmonary condition will be utilized,combined with evaluation for residuals of the condition not covered by the 1-year total evaluation, so as to allow any additional benefit provided during such period. 38 CFR 4.88(c) [Ratings for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968]

• None.