Can You Get a VA Disability Rating for Osteopenia?

You generally cannot get a VA disability rating for osteopenia on its own. The VA treats osteopenia as a clinical or laboratory finding rather than a compensable disability, so a claim built around a DEXA scan in the osteopenia range will usually be denied for lack of a current disability. A rating becomes possible when the bone loss has progressed to osteoporosis, or when strong medical evidence ties the osteopenia to a service-connected condition and the Board is willing to grant secondary service connection.

Why Osteopenia Alone Isn’t Rated

A 2015 Board of Veterans’ Appeals decision stated that osteopenia “does not constitute a disability for VA compensation purposes,” comparing it to an elevated cholesterol reading: a measurable result, not an injury or disease that qualifies for benefits on its own.¹ A 2019 decision reinforced the point, finding that “a radiological finding of osteopenia alone is not a disability for VA compensation purposes.”²

In practice, this means if a DEXA scan shows T-scores in the osteopenia range but a clinician concludes the results fall short of the diagnostic threshold for osteoporosis, the VA typically denies service connection. In one case, T-scores of -1.1 at the lumbar spine, -1.4 at the right femoral neck, and -1.6 at the left femoral neck were classified as osteopenia, and a VA physician found these did not meet the criteria for osteoporosis.² Osteoporosis, by contrast, is a recognized disability the VA can rate.

When Osteopenia Can Still Support a Claim

The bright line between osteopenia and osteoporosis is not always as rigid at the Board level as those denials suggest. Two paths have worked for veterans.

Secondary Service Connection

Under 38 C.F.R. § 3.310, a condition qualifies for secondary connection if it is “proximately due to or the result of a service-connected disease or injury.” Osteopenia and osteoporosis have both been granted on this theory when the medical evidence is strong.

In a 2014 Board decision, service connection for osteopenia was granted after a VA examiner concluded it was at least as likely as not that the veteran’s low bone mass was caused or aggravated by service-connected diabetes mellitus, based on evidence that diabetes affects bone turnover and collagen formation.³ The Board in that case recharacterized the veteran’s claim to address osteopenia specifically. A 2023 Board decision similarly granted service connection for osteoporosis and osteopenia secondary to type II diabetes, relying on opinions from the veteran’s endocrinologist and a private physician who linked abnormal bone metabolism to microvascular complications of diabetes.⁴

Other service-connected conditions veterans have raised as causes of secondary bone loss include thyroid disorders, gastrointestinal conditions, autoimmune disorders, cancer, and kidney or liver disease. Medications prescribed for service-connected conditions, such as anticonvulsants or proton pump inhibitors, have also been raised, with mixed results. In a 2014 decision, a veteran argued that proton pump inhibitors prescribed for service-connected GERD and IBS caused his osteopenia by depleting calcium; a VA medical reviewer found it “less likely than not” that the bone condition was related to the medications or the underlying conditions, and the claim was denied.⁵ In another case, osteopenia attributed to long-term use of Phenytoin (Dilantin) for a service-connected seizure disorder was denied because osteopenia was treated as a clinical finding rather than a compensable disability.¹

The pattern in these cases is clear. A secondary claim needs more than a plausible theory. It requires a well-reasoned medical opinion from a qualified professional explaining the specific mechanism linking the service-connected condition to the bone loss. Medical articles or treatises alone, without an expert opinion applying the literature to the veteran’s own case, carry minimal weight.⁵

The Spicer Ruling

A 2023 Federal Circuit decision in Spicer v. McDonough broadened the standard for secondary service connection. The court held that “but-for” causation is sufficient under 38 U.S.C. § 1110, meaning a veteran can establish secondary connection by showing that a service-connected condition prevented or impeded treatment for the bone condition, worsening its functional impact.⁶ The court declared that to the extent 38 C.F.R. § 3.310(b) required a stricter standard, the regulation was “unlawful as inconsistent with” the statute. This ruling was cited in the 2023 Board decision granting service connection for osteoporosis secondary to diabetes.⁴

Direct Service Connection

Direct service connection requires a current diagnosis, an in-service event or condition that caused or contributed to it, and a medical opinion linking the two. Because bone density loss typically develops gradually over many years, direct service connection for osteoporosis is relatively uncommon.

How Osteoporosis Is Rated Once Service-Connected

Osteoporosis does not have its own standalone rating percentage. It is evaluated under Diagnostic Code 5013 (osteoporosis with joint manifestations), which directs raters to apply the criteria for degenerative arthritis under Diagnostic Code 5003.⁷ The rating turns on how the condition affects the joints and movement.

Limitation of Motion

The primary method is rating based on how much the condition restricts movement in specific joints. If a joint has a compensable degree of limited motion, the veteran receives the percentage assigned by that joint’s own diagnostic code. Osteoporosis affecting the hip, for example, could be rated under the codes for hip flexion or ankylosis, with ratings reaching as high as 90 percent in cases of extreme limitation.⁸ If motion is limited but not enough to qualify under the joint-specific code, a 10 percent rating is assigned for each major joint or group of minor joints affected.⁷

The VA defines major joints as the shoulder, elbow, wrist, hip, knee, and ankle. Groups of minor joints, rated on par with major joints, include the small joints of the hands and feet and the segments of the spine.⁹

The X-Ray-Only Rating Doesn’t Apply

A wrinkle catches many veterans off guard. Under DC 5003, arthritis that shows on X-rays but produces no measurable limitation of motion can still support a 10 or 20 percent rating on the imaging alone. Note (2) under DC 5003, however, explicitly excludes conditions rated under Diagnostic Codes 5013 through 5024, which includes osteoporosis, from these X-ray-only ratings.¹⁰ If osteoporosis appears on imaging but does not actually limit range of motion, the imaging alone will not support a compensable rating.

That makes functional impairment the central issue in most osteoporosis rating decisions. The VA weighs pain on movement, weakness, fatigability, and incoordination, but pain by itself, without demonstrated loss of normal movement, is generally not enough to constitute functional loss for rating purposes.¹¹ DEXA T-scores play a diagnostic role in establishing whether the veteran has osteopenia or osteoporosis, but they do not translate directly into a rating percentage. A 2018 Board decision emphasized that objective findings such as range-of-motion measurements take priority over lay statements or scan results when assigning a rating.¹²

A Presumptive Path for Former POWs

Former prisoners of war have a presumptive route to service connection for osteoporosis under 38 C.F.R. § 3.309(c). Veterans with PTSD who were held as prisoners of war qualify as of October 10, 2008, regardless of length of detention. Veterans interned for at least 30 days qualify under a separate provision effective September 28, 2009.¹³ In either case, the osteoporosis must be rated at least 10 percent disabling. This presumption does not extend to osteopenia.

What to Bring to a Claim

Veterans file for disability compensation using VA Form 21-526EZ, which can be submitted online through VA.gov, by mail to the VA Claims Intake Center in Janesville, Wisconsin, in person at a regional office, or through an accredited representative or Veterans Service Organization.¹⁴ The VA may schedule a Compensation and Pension examination, and missing that exam can result in denial.

For a bone-density claim to succeed, the file usually needs three things: current medical evidence of the diagnosis (osteoporosis for a standard rating, or osteopenia paired with a strong nexus theory), documentation of functional limitations tied to specific joints, and a medical opinion from a qualified provider explaining how a service-connected condition or its treatment caused or aggravated the bone loss. Submitting those materials with the initial claim, rather than waiting for the VA to develop the record, is what separates the grants from the denials in the Board decisions above.

1
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 1513639
2
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 19103043
3
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 1414397
4
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr A23035533
5
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 1452482
6
U.S. Court of Appeals for the Federal Circuit. Spicer v. McDonough, No. 2022-1239
7
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 0841840
8
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr A20015724
9
Legal Information Institute. 38 CFR 4.45 – The Joints
10
GovInfo. 38 CFR 4.71a – Schedule of Ratings, Musculoskeletal System
11
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 1414763
12
U.S. Department of Veterans Affairs. BVA Decision, Citation Nr 1810908
13
eCFR. 38 CFR 3.309 – Disease Subject to Presumptive Service Connection
14
U.S. Department of Veterans Affairs. How to File a VA Disability Claim