Osteomalacia is a metabolic disorder in which there is inadequate mineralization of newly formed osteoid characterized by increasing softness of the bone, whereby the bone becomes flexible and brittle, causing deformities.

The condition is due to a deficiency in vitamin D, resulting in a shortage or loss of calcium salts, and a defect in the production of vitamin D metabolites. Other causes include: a calcium and phosphate deficiency; disorders of bone substance; and inhibitors of mineralization.

Signs and symptoms include: rheumatic pain in the arms, legs, spine, thorax, and pelvis and painful proximal muscle weakness. Other signs and symptoms include: anemia; signs of deficiency disease; and progressive weakness. There may also be bowing of the long bones; vertical shortening of the vertebrae; and flattening of the pelvic bones which narrow the pelvic outlet due to weight on the bones.

Diagnostic measures include x-rays and complete blood work. Changes in the serum calcium, phosphate, alkaline, vitamin D levels, and x-rays confirm the diagnosis.

Treatment of the condition involves including adequate amounts of calcium and phosphorus in the diet, with the addition of large doses of vitamin D for a limited time, and gradually decreasing the dose to the normal daily requirement for vitamin D.

There may be no residuals; however, the person may have permanent bone deformities, muscle weakness, and fractures which may occur with little or no trauma.

• 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)).

• 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].

• The provisions for 10 and 20 percent evaluations for arthritis with multiple joint involvement without limitation of motion do not apply to these conditions as is reflected in Note (2) under DC 5003.

• 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).

• Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.