Avascular Necrosis VA Disability Rating: Codes and Service Connection

The VA disability rating for avascular necrosis is not set by a single code. Because the rating schedule has no diagnostic code specifically for avascular necrosis, the VA rates it by analogy under the code that best matches the affected joint, the dominant symptoms, and whether surgery has occurred. In practice, that means most veterans with hip AVN see ratings between 10% and 90%, with a temporary 100% period after a total hip replacement.1eCFR. Title 38, Chapter I, Part 4

Why There Is No Standalone Code for AVN

Under 38 C.F.R. § 4.20, a condition without its own diagnostic code is rated using a “closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous.”1eCFR. Title 38, Chapter I, Part 4 The Board of Veterans’ Appeals has confirmed that AVN symptoms are typically “contemplated within the ratings assigned for osteoarthritis and subsequent arthroplasty” rather than rated as a separate disability.2VA Board of Veterans’ Appeals. Citation Nr 1626202 AVN most often affects the hip, and the codes below are the ones that come up most.

Limitation of Motion: 10% to 40%

Limited range of motion is usually the earliest symptom that earns a compensable rating. Normal hip flexion runs from 0 to 125 degrees. Three codes cover motion loss:3VA Board of Veterans’ Appeals. Citation Nr A22004524

  • DC 5252, limitation of flexion: 10% at 45 degrees, 20% at 30 degrees, 30% at 20 degrees, and 40% at 10 degrees.
  • DC 5251, limitation of extension: a maximum of 10% for extension limited to 5 degrees.
  • DC 5253, impairment of the thigh: 10% for an inability to toe-out more than 15 degrees or to cross the legs, and 20% for loss of abduction beyond 10 degrees.4VA Board of Veterans’ Appeals. Citation Nr 23002213

Even when measured motion falls short of the compensable threshold, a joint that is painful, unstable, or malaligned is entitled to at least the minimum compensable rating under 38 C.F.R. § 4.59.5VA Board of Veterans’ Appeals. Citation Nr 23065818

Ankylosis and Flail Joint: 60% to 90%

When AVN progresses to the point where the hip is completely immobilized or loses structural integrity, ratings climb quickly.

  • DC 5250, ankylosis of the hip: 60% for favorable ankylosis in flexion between 20 and 40 degrees with slight adduction or abduction, 70% for intermediate ankylosis, and 90% for unfavorable ankylosis where the foot cannot reach the ground and crutches are required.6VA Board of Veterans’ Appeals. Citation Nr 20073194
  • DC 5254, flail joint of the hip: a flat 80%.7VA Board of Veterans’ Appeals. Citation Nr 1525544

Impairment of the Femur: 10% to 80%

DC 5255 applies when AVN causes significant bone damage or structural compromise of the femur. Ratings run from 10% for malunion with slight hip disability up to 80% for fracture of the femoral neck with nonunion and loose motion.7VA Board of Veterans’ Appeals. Citation Nr 1525544 In one Board decision, a veteran’s AVN was rated at 60% under DC 5255 by analogy to a fracture of the femoral shaft with a false joint, because the condition caused severe pain, severe limitation of motion, and required frequent position changes.2VA Board of Veterans’ Appeals. Citation Nr 1626202

After a Hip Replacement: 30% to 100%

Many veterans with advanced AVN eventually undergo a total hip replacement, and DC 5054 carries some of the highest ratings in the musculoskeletal schedule:8GovInfo. 38 CFR 4.71a, DC 5054

  • 100% for one year following surgery. This begins with a one-month convalescent rating under 38 C.F.R. § 4.30, followed by four additional months at 100%, for a total of five months at that level before the schedular one-year period continues.9VA Office of Inspector General. VAOIG Report 23-00153-41
  • 90% for painful motion or weakness severe enough to require the use of crutches.
  • 70% for markedly severe residual weakness, pain, or limitation of motion.
  • 50% for moderately severe residuals.
  • 30% is the minimum floor for a total prosthetic replacement.

Special monthly compensation can also be assignable during the 100% convalescent period from the earliest date permanent use of crutches is established.9VA Office of Inspector General. VAOIG Report 23-00153-41

Pain and Flare-Ups Can Push the Rating Higher

Range-of-motion numbers on their own do not decide the rating. Under DeLuca v. Brown, 8 Vet. App. 202 (1995), the VA must also account for how pain, weakness, fatigue, and incoordination functionally limit a veteran, especially during flare-ups or after repetitive use.2VA Board of Veterans’ Appeals. Citation Nr 1626202 This matters for AVN because the disease often causes significant pain that worsens with activity even when static measurements look relatively normal. An examiner who records only the angle of joint movement without assessing functional loss has conducted an inadequate examination. Describe your flare-ups clearly: what triggers them, how long they last, and what you cannot do during one.

Bilateral Hips Get an Extra 10%

When AVN is service-connected in both hips, the bilateral factor under 38 C.F.R. § 4.26 applies. The VA combines the two hip ratings and then adds 10% of the combined value before further combining with other rated conditions.10Federal Register. Exceptions to Applying the Bilateral Factor in VA Disability Calculations A rule that took effect in April 2023 added an exception: if applying the bilateral factor would produce a lower overall rating than treating the disabilities separately, the VA must use whichever calculation is more favorable. The adjustment is applied automatically.

When AVN Keeps You From Working

If AVN is severe enough to prevent substantially gainful employment, Total Disability Individual Unemployability pays at the 100% rate even when the combined schedular rating is lower. In one Board case, a veteran with hip AVN rated at 60% was awarded TDIU for roughly four years because severe pain and functional limitations, including the need for frequent position changes, made sustained work impossible.2VA Board of Veterans’ Appeals. Citation Nr 1626202

Getting AVN Service-Connected in the First Place

A rating percentage only matters once the VA agrees AVN is service-connected. There are two main pathways.

Direct Service Connection

Direct service connection requires a current diagnosis, evidence of an in-service injury or event, and a medical opinion tying the two together.11VA Board of Veterans’ Appeals. Citation Nr 0314227 The in-service event might be a discrete injury, cumulative trauma from activities like parachute jumping, or repeated exposure to high-pressure environments during diving. A gap between separation and diagnosis is not fatal. In a February 2025 Board decision, a former F-4 pilot was granted service connection for left hip AVN despite a 19-year gap, based on a private medical opinion linking the condition to G-force stress and ejection-seat mechanics.12VA Board of Veterans’ Appeals. Citation Nr A25009490

Secondary Service Connection From Steroid Treatment

Long-term corticosteroid use is one of the most well-established medical causes of avascular necrosis.13Johns Hopkins Medicine. Avascular Necrosis A veteran who developed AVN after receiving corticosteroids for a service-connected condition, such as bronchial asthma or a chronic inflammatory disease, can claim the AVN as secondary under 38 C.F.R. § 3.310(a).14VA Board of Veterans’ Appeals. Citation Nr 1015037 Under the Wallin v. West test, the claim needs a current diagnosis, an already service-connected disability, and a medical nexus. Evidence should establish that the type and dosage of steroids received were capable of causing bone necrosis, and it helps if a supporting opinion addresses the latency period between treatment and symptom onset, which can span years or decades.15VA Board of Veterans’ Appeals. Citation Nr 0126747

Dysbaric Osteonecrosis in Military Divers

Veterans who served as military divers face a distinct risk called dysbaric osteonecrosis, caused by cumulative exposure to high-pressure environments.16National Library of Medicine. Dysbaric Osteonecrosis in Divers It typically affects the hip and shoulder and often shows up years after service.17Merck Manuals. Decompression Sickness In one Board decision, a veteran who had performed scuba missions at depths up to 120 feet was granted service connection for AVN of both hips and both shoulders, and the Board rejected a VA opinion that had denied the connection because the veteran had never been formally diagnosed with decompression sickness.18VA Board of Veterans’ Appeals. Citation Nr 0904117

If the Claim Is Denied

Under the Appeals Modernization Act, you have three options within one year of a decision: file a supplemental claim with new and relevant evidence, request a higher-level review of the existing record by a senior adjudicator, or appeal to the Board of Veterans’ Appeals.19U.S. Department of Veterans Affairs. Supplemental Claim For AVN, the most common reason for denial is the absence of a medical nexus, which makes the supplemental claim route particularly useful because it allows a new private medical opinion. A written opinion from an orthopedic specialist addressing the specific gap identified in the denial letter, whether that gap is the steroid-to-necrosis link, the latency period, or the connection between in-service physical activity and later joint deterioration, can reopen and often resolve the claim. Filing within one year preserves the original effective date for retroactive benefits; a later filing generally sets a new effective date.