Hip and ankle ratings: motion, pain and the exam

How VA rates a joint

38 CFR 4.45 and 4.59

Range of motion (ROM) is how far a joint moves, in degrees. The rating schedule (38 CFR 4.71a) sets percentages at certain limits. 38 CFR 4.45 tells VA to look past the number at:

• less movement than normal, or more movement than normal
• weakened movement and excess fatigability
• incoordination
• pain on movement, swelling, deformity, or atrophy from disuse
• instability of station, disturbed locomotion, and trouble with sitting, standing and weight-bearing

The hip

Values printed on VA's Hip and Thigh exam form

• Flexion (knee toward chest): 0 to 125 degrees
• Extension (leg back): 0 to 30
• Abduction (leg out to the side): 0 to 45
• Adduction (leg across the body): 0 to 25
• External rotation: 0 to 60
• Internal rotation: 0 to 40

A Board of Veterans’ Appeals decision quoting 38 CFR 4.71a Plate II gives the same hip values.

The ankle

Values printed on VA's Ankle exam form

• Dorsiflexion (toes toward the shin): 0 to 20 degrees
• Plantar flexion (toes pointed down): 0 to 45

Those two are what the rating schedule uses for limited ankle motion. VA's ankle form has no inversion or eversion motion measurements. They appear only as deformity checkboxes under ankylosis, which means a fixed, stiff joint.

For the knee, see Knee Ratings.

What the schedule pays for the hip

38 CFR 4.71a, as it reads on eCFR

DC 5252, flexion of the thigh limited to:

• 45 degrees: 10%
• 30 degrees: 20%
• 20 degrees: 30%
• 10 degrees: 40%

DC 5253, impairment of the thigh:

• Abduction, motion lost beyond 10 degrees: 20%
• Adduction, cannot cross the legs: 10%
• Rotation, cannot toe out more than 15 degrees on the affected side: 10%

The flexion code starts at 45 degrees. Normal is 125.

Ankylosis, flail hip and the femur

38 CFR 4.71a, as it reads on eCFR

• DC 5250, hip ankylosis (a fixed hip): favorable, in flexion 20 to 40 degrees with slight adduction or abduction, 60%; intermediate, 70%; unfavorable or extremely unfavorable, with crutches needed, 90%.
• DC 5251, thigh, extension limited to 5 degrees: 10%.
• DC 5254, flail hip joint: 80%.
• DC 5255, femur: nonunion of the shaft or anatomical neck with loose motion, 80%; nonunion without loose motion, brace needed, 60%; surgical neck with a false joint, 60%. Malunion is rated under the hip or knee codes, whichever gives the higher evaluation.

DC 5054: replacement or resurfacing

Rule as of February 7, 2021

• 100% for four months after the implant or resurfacing. Before February 7, 2021 it was one year.
• After that, 90% for painful motion or weakness needing crutches, 70% for markedly severe residuals, 50% for moderately severe residuals.
• Minimum 30% for a total replacement. A resurfacing is evaluated under the hip codes (DC 5250 to 5255) once the 100% period ends, with no minimum.

The four-month figure and the old one-year figure come from the eCFR text and from Board of Veterans’ Appeals decisions that describe both.

What the schedule pays for the ankle

38 CFR 4.71a, as it reads on eCFR

DC 5271, limited motion:

• Marked, dorsiflexion under 5 degrees or plantar flexion under 10: 20%
• Moderate, dorsiflexion under 15 or plantar flexion under 30: 10%

DC 5270, ankylosis (a fixed ankle):

• Plantar flexion under 30 degrees: 20%
• Plantar flexion 30 to 40 degrees, or dorsiflexion 0 to 10: 30%
• Plantar flexion beyond 40, or dorsiflexion beyond 10, or with deformity: 40%

Arthritis in the hip or ankle

DC 5003 and DC 5010

• X-ray-confirmed arthritis with limited motion is rated under the joint’s own motion code. If that limit is not compensable, VA assigns 10% per major joint, with the limit shown by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.
• Without limited motion, X-ray arthritis in two or more major joints is 10%, or 20% with occasional incapacitating exacerbations. These are not combined with motion ratings.
• Post-traumatic arthritis (DC 5010) is rated on limited motion, dislocation, or instability of the joint.

38 CFR 4.45 names the hip and ankle among the major joints.

“Incapacitating exacerbations” is not defined in the arthritis codes. In two 2022 decisions on a related code (DC 5002) the Board said so. One used a dictionary meaning. The other borrowed the back code’s wording, bed rest prescribed by a physician. Keep records of each flare and any treatment.

What VA's exam forms ask the examiner to do

VA Ankle and Hip and Thigh exam forms

• Measure active motion, and passive motion (the examiner moves the joint).
• Ask whether you can do repetitive-use testing with at least three repetitions, and whether you lose motion or function after them.
• Ask whether the exam is happening during a flare-up, and estimate motion during flare-ups.
• Address pain on weight-bearing and non-weight-bearing.

Flare-ups and testing

• Flare-ups. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), as the Board describes it, the examiner has to try to get the severity, frequency and length of flare-ups, and what you lose, from the record and from you. “Cannot estimate” has to rest on a gap in medical knowledge generally, not just the examiner’s own.
• Active, passive, weight-bearing. Correia v. McDonald, 28 Vet. App. 158 (2016), applies the last sentence of 38 CFR 4.59: test for pain on both active and passive motion, weight-bearing and non-weight-bearing.

Where it can be done, the exam should also measure the opposite, undamaged joint.

Pain counts even when the number looks good

38 CFR 4.59

VA’s rule is that actually painful, unstable, or malaligned joints from a healed injury are entitled to at least the minimum compensable rating for the joint. That depends on the diagnostic code allowing a compensable rating, and on the pain being shown. A credible statement can help show it. See the full explanation on the C&P exam page.

Both sides rated? The bilateral factor (38 CFR 4.26) may apply to both hips or both legs.

What I could not verify

• Subtalar (inversion and eversion) normal values. I found none in the regulation, in any VA decision, or on VA’s ankle form, so they are not on this page.
• Ankle and foot codes beyond DC 5270 and 5271, and the knee and leg codes other than those on the knee page. I did not read them here.
• A single VA definition of “incapacitating exacerbations.” I found none in the rule. The Board decisions I read treat it differently, and they concern DC 5002, not DC 5003.
• Whether the schedule has changed. eCFR, current as of October 16, 2026, shows the last amendment to 38 CFR 4.71a as February 4, 2021. eCFR is an unofficial copy, and the official source wins over me.
• The court cases come from Board of Veterans’ Appeals decisions that describe them. I did not read the court opinions.