Most veterans searching for a hip rating want one answer: what does the record have to show to reach the next percentage. The answer sits in the hip and thigh codes of 38 CFR 4.71a, Diagnostic Codes 5250 through 5255. They are short, specific, and measured in degrees.
Normal hip motion under Plate II of 38 CFR 4.71 is flexion 0 to 125 degrees and abduction 0 to 45 degrees. Every percentage below is a departure from that baseline.
Diagnostic Code 5250 - Hip ankylosis
Ankylosis means the joint is fixed and does not move. It is the most severely rated hip condition and the least common. Ratings run from 60 percent for favorable ankylosis in flexion at an angle between 20 and 40 degrees with slight adduction or abduction, to 70 percent for intermediate ankylosis, to 90 percent for extremely unfavorable ankylosis with the foot not reaching the ground and crutches necessary.
Very few hip claims reach this code. It matters mainly because it sets the ceiling the other codes sit beneath.
Diagnostic Code 5251 - Limitation of extension of the thigh
A single rating: 10 percent when extension is limited to 5 degrees. There is nothing higher under this code, which is why extension findings alone rarely drive a hip rating, though they can be combined with other codes when the criteria for each are separately met without violating the pyramiding rule in 38 CFR 4.14.
Diagnostic Code 5252 - Limitation of flexion of the thigh
This is the code most hip ratings run through. The levels are 10 percent for flexion limited to 45 degrees, 20 percent for flexion limited to 30 degrees, 30 percent for flexion limited to 20 degrees, and 40 percent for flexion limited to 10 degrees.
Each step is a large drop in function. Flexion limited to 30 degrees means real difficulty sitting in a normal chair or getting into a car. This is where an accurately measured, repeated-use exam is worth more than any argument.
Diagnostic Code 5253 - Impairment of the thigh
Two levels. 10 percent when there is limitation of rotation such that the veteran cannot toe out more than 15 degrees on the affected leg, or limitation of adduction such that the legs cannot be crossed. 20 percent when abduction is lost beyond 10 degrees.
This code is frequently overlooked. Rotation and adduction findings are easy for an examiner to skip and easy for a veteran not to mention, and a 10 or 20 percent evaluation can turn on whether they were recorded.
Diagnostic Code 5254 - Flail hip joint
A single 80 percent rating for a flail joint, meaning the joint is unstable to the point of being nonfunctional. Like ankylosis, it is uncommon and usually follows major trauma or failed surgery.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service or an already service-connected disability.
Diagnostic Code 5255 - Impairment of the femur
This code covers the thigh bone itself. Malunion with slight knee or hip disability rates 10 percent, moderate disability 20 percent, and marked disability 30 percent. Fracture of the surgical neck of the femur with a false joint rates 60 percent, and fracture of the shaft or anatomical neck with nonunion rates 60 percent, rising to 80 percent where there is loose motion requiring a brace.
Veterans with an old femur fracture from a service-era accident are often rated here rather than on motion, and the distinction can be worth a great deal.
Painful motion and the minimum rating
When motion is limited but not enough to reach a compensable level under the codes above, 38 CFR 4.59 still requires the minimum compensable rating for the joint where there is actually painful motion. Read alongside 38 CFR 4.40 and 4.45, it means a hip that moves reasonably well but hurts throughout the arc should not automatically be rated 0 percent.
For that protection to work, the exam has to record where pain begins in the range, not just where motion ends. Our hip C&P exam guide explains what to expect and what the examiner is required to document.
Arthritis and the hip
Degenerative arthritis established by X-ray is rated under Diagnostic Code 5003 when motion is noncompensable, producing 10 percent for a major joint with satisfactory evidence of painful motion. The hip is a major joint. Our hip arthritis guide covers how this interacts with the motion codes and where pyramiding limits stacking them.
Both hips and combined ratings
Each hip is rated separately on its own findings. Two ratings are then combined using the table in 38 CFR 4.25, which is why 20 percent and 20 percent is 36 percent rounded rather than 40 percent, and the bilateral factor may add to that. Our guide to nexus letters and increased ratings covers when a second opinion helps.
Where to go next
If your hip follows a service-connected back or knee condition, read our secondary hip guide. If you have had joint replacement surgery, the rating scheme is entirely different - see the hip replacement guide. Before your exam is scheduled, the evidence guide covers what belongs in the file.