Hip pain is a common issue faced by many veterans, often arising as a secondary condition linked to back pain. Understanding the connection between these conditions can be crucial for veterans seeking disability benefits from the Department of Veterans Affairs (VA). Leah will explore how hip pain can be service-connected as a secondary condition to back pain, the various hip conditions that may arise, their VA disability ratings, and relevant studies that support these connections.
Service Connection for Hip Conditions
Veterans can establish service connections for hip conditions on a direct or secondary basis.
Direct connection occurs if the hip injury or condition was incurred or worsened during active duty.
Aggravation happens when a pre-existing hip condition worsens beyond its natural progression due to service-related activities or a service-related disability.
Secondary connections occur when the hip condition is linked to another service-connected disability, such as back pain, knee problems, muscle weakness, or significant weight gain.
How Can a Back Injury Cause Hip Pain?
Lower back injuries can lead to inflammation, which may put pressure on nearby nerves, including the sciatic nerve. When the sciatic nerve is compressed, it can cause pain that radiates into the hips and legs. This hip pain often worsens with prolonged sitting and can be triggered by walking or other daily activities.
The National Center for Health Statistics reports that one in four adults suffers from chronic low back pain, typically due to arthritis, inflammation, previous injuries, or disc disorders. For veterans, spinal issues are a major disability cause, largely due to the physical demands of military duties like lifting heavy loads and high-impact movements.
Early intervention can help prevent long-term back problems and severe spinal disability.
Hip Conditions Related to Back Pain
Several hip conditions can develop as secondary to back pain. These include, but are not limited to:
- Hip Strains and Sprains: Often resulting from altered gait or posture due to back pain.
- Osteoarthritis: Degeneration of hip joints can be accelerated by abnormal movement patterns stemming from chronic back pain.
- Rheumatoid Arthritis: Inflammatory arthritis that can be exacerbated by systemic stress and altered biomechanics.
- Femoroacetabular Impingement (FAI): A condition where a person may have a CAM or pincer lesion in their hip joint that can be potentially linked to compensatory movements due to back pain.
- Osteoporosis: Weakened bones that can result from systemic conditions and reduced mobility associated with chronic back pain.
- IT Band Syndrome: Tightening of the iliotibial band caused by altered gait or posture due to back pain.
- Labral Tears: Damage to the cartilage in the hip joint, which can be a result of chronic compensatory movements.
Studies Linking Back Pain and Hip Pain
Several studies have investigated the relationship between back pain and subsequent hip pain. These studies provide valuable insights and evidence for veterans seeking to establish a secondary service connection for hip pain.
Lumbar Degeneration and Hip Osteoarthritis
A study published in the American Journal of Orthopedics in 2013 examined the relationship between lumbar spine degeneration and hip osteoarthritis. The study analyzed 340 cadaver specimens and found a significant association between lumbar conditions and hip changes. The findings suggest that lumbar degeneration often precedes hip injuries, indicating that back issues can lead to or exacerbate hip problems.
Kinematics and Joint Coordination
Research published in Spine in 2005 explored the effects of low back pain on the kinematics and joint coordination of the lumbar spine and hip during activities such as sitting and standing. The study found that individuals with low back pain exhibited altered movement patterns and joint coordination, which can contribute to the development or worsening of hip conditions.
Adaptations in Pelvis, Hip, and Knee Kinematics
A study published in the Journal of Back and Musculoskeletal Rehabilitation examined adaptations in pelvis, hip, and knee kinematics in individuals with low back pain. The research highlighted that low back pain leads to compensatory movements and muscle imbalances, affecting the hip and potentially leading to secondary hip conditions.
Hip Exercises for Chronic Low Back Pain
The Journal of Physical Therapy Science published a study in 2015 discussing the effects of hip exercises on patients with chronic low back pain and lumbar instability. The study demonstrated that strengthening and rehabilitating the hip can alleviate lower back pain, further supporting the interconnectedness of these conditions.
VA Disability Ratings for Hip Conditions
The Department of Veterans Affairs (VA) assigns disability ratings based on the severity of a veteran’s hip condition and its impact on their daily functioning and employability. The following are some common ratings for hip-related conditions:
Osteoarthritis
Osteoarthritis of the hip is typically assigned the diagnostic code 5003. The VA rates this condition between 10% and 20%, depending on the severity of the pain and the limitation of motion in the hip joint.
Hip Replacements
Hip replacements are rated under diagnostic code 5054. Following a complete hip replacement surgery, veterans receive a temporary 100% disability rating for at least four months to cover recovery and any mobility limitations.
After this period, the VA re-evaluates the condition, assigning a permanent disability rating between 30% and 90%, depending on ongoing symptoms like painful motion, weakness, or chronic issues that impact the veteran’s ability to work and perform daily activities.
Limitations of Motion
Hip pain that restricts mobility can result in disability benefits, even though this condition does not have a dedicated diagnostic code. Instead, the VA evaluates the extent of the veteran’s limited range of motion using several specific measurements:
- Flexion (bending the hip)
- Abduction (moving the leg away from the body)
- Adduction (moving the leg toward the body)
- Rotation (turning the leg inward or outward)
- Extension (straightening the hip)
Each of these movements is assessed to determine the overall VA disability rating, with more severe limitations resulting in higher ratings.
Ankylosis
Ankylosis, or abnormal stiffness and immobility of the hip joint due to bone fusion, is rated under diagnostic code 5250. The VA assigns disability ratings for ankylosis ranging from 60% to 90%, depending on the degree of immobility and the position in which the hip is fused. A higher rating is given when the hip is fixed in an unfavorable position, severely impacting the veteran’s ability to sit, stand, or walk.
Bilateral Hip Conditions
Conditions affecting both hips, like arthritis or avascular necrosis, are rated under diagnostic codes 5313-5318 or 5250-5255, depending on motion limitations. The VA assigns ratings from 0% to 90%, based on the severity and impact on both hips.
Hip Labral Tear
A hip labral tear, often caused by physically demanding military service, is rated according to the severity of pain, functional impairment, and response to treatment. The VA evaluates how the tear affects daily activities to determine the appropriate rating.
Functional Impairment and Unemployability
If a veteran’s hip condition severely limits their ability to work, the VA may increase their overall disability rating. Hip pain contributing to unemployability could result in a higher combined rating or qualify the veteran for Total Disability based on Individual Unemployability (TDIU), allowing compensation at the 100% disability rate even if their combined rating is below 100%.
Service Connection for Hip Pain Secondary to Back Pain
If you are a veteran experiencing hip pain due to a service-connected back injury, you may be eligible for additional VA benefits through a secondary service connection. Here’s how to navigate the process:
- Initiate Your Claim: Start by filing VA Form 21-526EZ to apply for a service connection for hip pain secondary to your back injury.
- Gather Medical Evidence: Collect essential medical records, including doctor’s notes and personal records, to demonstrate that your hip pain is linked to your service-connected back injury. This evidence is vital for proving the existence of a current disability, as required by VA regulations.
- Obtain a Medical Opinion: Secure a medical opinion that establishes a “nexus” between your hip pain and the service-connected back injury such as degenerative disc disease. This connection is critical for the VA to link your hip pain to your military service.
- Submit Your Claim: Once all necessary evidence is compiled, submit your claim to the VA.
- Appeal if Necessary: If the VA denies your claim, you may need to appeal the decision or provide additional documentation to support your case.
Establishing a service connection for this secondary condition can be vital for receiving the support and compensation you deserve.
Seeking Professional Assistance
Navigating the VA disability claims process can be complex. Veterans are encouraged to seek assistance from accredited representatives such as Veterans Service Officers (VSOs), attorneys, or claims agents. These professionals can guide veterans in filing claims, gathering evidence, and understanding the VA disability rating process. Medical professionals, like primary care providers or specialists, can also provide necessary medical opinions to support secondary service connection claims.
Hip Pain Secondary to Back Pain
Hip pain secondary to back pain is a significant issue for many veterans. Establishing a secondary service connection requires understanding the interplay between these conditions and leveraging medical evidence and studies that support this relationship. Veterans should seek professional assistance to navigate the claims process and ensure they receive the benefits they deserve for their service-connected secondary condition. By doing so, they can better manage their conditions and improve their quality of life.
Also read: Reports of Bad Veteran C&P Examiners
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
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Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
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