What Is the VA Disability Rating for Ankylosis?

The VA disability rating for ankylosis runs from 20% to 100%, depending on which joint is fused and the angle at which it’s locked. Ankylosis means a joint has zero movement, permanently fixed in one position by injury, disease, or surgery, and the VA rates it more severely than limited range of motion because the functional loss is complete. Compensation for a single fused joint can reach $2,362.30 per month in 2026, and the most severe cases can qualify for additional benefits beyond the standard schedule.

What Counts as Ankylosis

The rating criteria appear in 38 C.F.R. § 4.71a, the schedule for musculoskeletal disabilities.¹ To qualify under an ankylosis diagnostic code, medical evidence must show the joint is completely immobile. A joint that still moves even a few degrees, however painfully, gets rated under limited range of motion codes instead.

The distinction is worth pausing on because ankylosis ratings are substantially higher than limited-motion ratings for the same joint. A knee with severely limited flexion might warrant 10% or 20%. A fully fused knee starts at 30%. The VA draws a hard line: the joint must have zero movement. A physician describing “near-ankylosis” or a “functionally ankylosed” joint isn’t enough. The examiner has to confirm that the joint physically cannot move at all.

Favorable vs. Unfavorable Position

Once the VA confirms a joint is fused, the rating depends on the angle at which it’s locked. Every ankylosed joint position is classified as either favorable or unfavorable, and that single determination can double the percentage.

A favorable position means the joint is frozen at an angle that still allows some functional use of the limb. A knee locked in full extension lets a veteran stand, bear weight, and walk with a limp. An unfavorable position means the joint is stuck at an angle that makes the limb nearly useless. That same knee locked at 45 degrees of flexion makes stable standing impossible and often requires crutches. The framework applies to every joint the VA rates for ankylosis, from spine down to individual fingers.

Spine Ankylosis

Spinal ankylosis carries some of the highest ratings in the schedule because a rigid spine affects nearly every physical activity. The VA rates the spine using the General Rating Formula for Diseases and Injuries of the Spine, which covers diagnostic codes 5235 through 5243.¹ The percentages depend on which segment is fused and whether the position is favorable:

Entire spine, unfavorable: 100%. This is the only musculoskeletal condition that reaches the maximum schedular rating on its own.
Entire thoracolumbar spine, unfavorable: 50%
Entire thoracolumbar spine, favorable: 40%
Entire cervical spine, unfavorable: 40%
Entire cervical spine, favorable: 30%

Unfavorable spinal ankylosis has a specific definition: the spine must be fixed in flexion or extension in a way that causes at least one serious functional consequence, such as difficulty walking because you can’t see ahead of you, restricted ability to open your mouth and chew, breathing limited to the diaphragm, digestive problems from the rib cage pressing on the abdomen, or nerve damage from stretched nerve roots.² A spine fixed in neutral position, at zero degrees, always counts as favorable ankylosis.³

Knee Ankylosis

The knee is rated under diagnostic code 5256, with four tiers based on the angle of fixation:⁴

Favorable, at full extension or slight flexion between 0° and 10°: 30%
Flexion between 10° and 20°: 40%
Flexion between 20° and 45°: 50%
Extremely unfavorable, flexion at 45° or more: 60%

The practical impact is significant. A knee locked near straight lets you walk stiffly but functionally. A knee locked at 45 degrees or more means you can’t straighten the leg, can’t stand without crutches, and can’t use the limb for weight-bearing. The rating jumps from 30% ($552.47 per month for a veteran with no dependents) to 60% ($1,435.02 per month).⁵

Hip Ankylosis

Hip ankylosis, rated under diagnostic code 5250, carries some of the highest percentages for any single joint because the hip is essential for sitting, standing, and walking:⁶

Favorable, flexion between 20° and 40° with slight adduction or abduction: 60%
Intermediate: 70%
Extremely unfavorable, foot doesn’t reach the ground, crutches required: 90%

Even the favorable rating starts at 60%, which reflects how debilitating a fused hip is regardless of position. At the 90% level, compensation for a veteran with no dependents reaches $2,362.30 per month.⁵

Shoulder Ankylosis

Shoulder ankylosis is rated under diagnostic code 5200, covering the ball-and-socket joint where the arm meets the shoulder. Unlike most joints, the shoulder is rated differently depending on whether it’s the dominant or non-dominant arm:⁷

Favorable, abduction to 60° with ability to reach mouth and head: 30% dominant / 20% non-dominant
Intermediate, between favorable and unfavorable: 40% dominant / 30% non-dominant
Unfavorable, abduction limited to 25° from the side: 50% dominant / 40% non-dominant

The dominant-arm distinction adds a meaningful bump. A veteran with an unfavorable fusion of the dominant shoulder gets 50%, while the same condition on the non-dominant side gets 40%, a difference of roughly $337 per month in base compensation.

Finger and Thumb Ankylosis

Fingers and thumbs are rated with a unique twist. When both joints of a single digit are fused, the VA treats the condition as unfavorable ankylosis even if each individual joint is locked in a favorable position.⁸ If a fused finger or thumb can’t come within two inches of the palm or opposing fingers, that also counts as unfavorable regardless of which joints are involved.

In the most severe cases, with both joints fused and extreme angulation or rotation, the VA rates the digit as if it were amputated. A finger locked in a completely nonfunctional position is no more useful than one that’s missing.

When a Joint Isn’t Fully Fused

Many veterans have joints so stiff they feel frozen but technically retain a few degrees of motion. Those cases don’t qualify for ankylosis codes, but painful joints still get compensated. Under 38 C.F.R. § 4.59, any joint with documented painful motion from a healed injury is entitled to at least the minimum compensable rating for that joint.⁹

During the exam, the VA must test the joint for pain on both active and passive motion, in weight-bearing and non-weight-bearing positions, and compare the results against the opposite joint when possible. If the examiner skips any of these tests, the exam is likely inadequate, and the veteran can request a new one. Verifying that your exam report includes all four testing conditions before accepting the result is worth the effort.

The Bilateral Factor

When ankylosis affects both sides of the body, both knees, both hips, or both shoulders, the VA applies a 10% boost to the combined value of those bilateral disabilities before factoring them into the overall combined rating.¹⁰ It’s not 10 percentage points added to the final rating. It’s 10% of the combined bilateral value added before further calculations. The math is modest but can push a veteran across a rounding threshold that bumps the final combined rating.

Secondary Conditions From Ankylosis

A fused joint doesn’t just affect the joint itself. It changes how the entire body moves. Veterans with ankle or knee ankylosis frequently develop back problems, hip degeneration, or knee pain on the opposite side because they’ve spent years compensating with an altered gait. Those secondary conditions can be service-connected under 38 C.F.R. § 3.310, which allows benefits for any disability caused by or aggravated by an already service-connected condition.¹¹

The Board of Veterans’ Appeals has repeatedly recognized that an altered gait from a fused ankle or knee can cause degenerative changes in the lower back and stress injuries in other joints over time.¹² Each secondary condition gets its own rating, which can substantially increase total compensation. You need a medical opinion specifically linking the secondary problem to your service-connected ankylosis. The VA won’t make that connection on its own.

One limit worth knowing: the VA prohibits “pyramiding,” which means you can’t receive two separate ratings for the same functional impairment under different diagnostic codes.¹³ Separate ratings for a fused knee and the back pain it caused are fine. Separate ratings for the same knee under both an ankylosis code and a limited-motion code are not.

Special Monthly Compensation for Loss of Use

Veterans whose ankylosis is severe enough to eliminate all useful function of a hand or foot may qualify for Special Monthly Compensation, which pays on top of the standard rating. The VA considers “loss of use” to exist when no effective function remains beyond what an amputation stump with a prosthetic could provide.¹⁴

Specific ankylosis conditions that automatically qualify include extremely unfavorable knee ankylosis and complete ankylosis of two major joints in the same extremity. SMC-K, the most common level for loss of use of a single hand or foot, pays $139.87 per month in 2026 on top of all other compensation. The amount is added independently for each qualifying loss, so a veteran with loss of use of both a hand and a foot receives it twice.

When ankylosis is so severe that a veteran needs daily help with basic tasks like eating, dressing, and bathing, the higher SMC-L level may apply. SMC-L pays $4,900.83 per month for a veteran with no dependents in 2026, which replaces the standard compensation rate rather than adding to it.¹⁵

Total Disability Based on Individual Unemployability

Veterans whose ankylosis prevents them from holding a job but whose schedular rating falls short of 100% can apply for TDIU, Total Disability based on Individual Unemployability. TDIU pays at the 100% rate, $3,938.58 per month for a veteran with no dependents in 2026, even when the actual combined rating is lower.⁵

To qualify under the standard path, you need either a single service-connected disability rated at 60% or more, or multiple service-connected disabilities with at least one rated at 40% and a combined rating of 70% or more.¹⁶ Disabilities that share a common cause or affect the same body system count as a single disability for meeting those thresholds. A veteran with a fused knee rated at 40% and secondary back pain rated at 30%, both stemming from the same service-connected injury, could combine them as one disability to meet the 60% threshold.

Veterans who don’t meet the percentage requirements can still be referred for extra-schedular TDIU consideration if the evidence shows their service-connected conditions genuinely prevent employment. The key is documenting how the physical limitations translate into an inability to perform the type of work your education and experience would otherwise support.

The Amputation Rule

No matter how many disabilities affect a single limb, the combined rating for that extremity cannot exceed what the VA would assign for amputation at the relevant level. This is the amputation rule under 38 C.F.R. § 4.68.¹⁷ The combined ratings for all disabilities below the knee, for example, cannot exceed 40%, which is the rating for a below-knee amputation.

The cap matters most for veterans who have ankylosis plus additional problems in the same limb, such as a fused knee combined with nerve damage and muscle atrophy in the same leg. Each condition gets its own rating, but combined they hit a ceiling. Disabilities above the amputation level can still be combined separately, so a fused knee plus a fused hip on the same side are not capped by the below-knee amputation rating.

Medical Evidence That Wins Ankylosis Claims

Ankylosis claims live or die on the quality of the medical documentation. The VA needs to see three things: proof that the joint has zero movement, the exact angle at which it’s fixed, and imaging that explains why the joint is fused.

The examiner must use a goniometer, a protractor-like instrument for measuring joint angles, to document that range of motion is zero degrees. Goniometer measurements are required; eyeball estimates aren’t sufficient.¹⁸ The examiner also needs to record the fixed angle in degrees, because that number determines whether the position is favorable or unfavorable. If the examiner notes even minimal movement, the claim gets processed under limited-motion codes instead, which pay less.

Imaging (X-rays, CT scans, or MRI) needs to show the structural reason for the fusion, whether that’s bony bridging across the joint, advanced destruction of the joint surfaces, or surgical hardware from a prior fusion procedure. The physical exam and the imaging should tell the same story. A claim where the examiner documents zero movement but imaging shows a structurally intact joint will draw scrutiny.

For an initial service-connection claim, the evidence must also include a nexus opinion linking the current ankylosis to military service, stated at the “at least as likely as not” standard. Veterans already service-connected for the underlying joint who are seeking an increased rating to ankylosis don’t need a new nexus letter. They need an updated examination showing the condition has worsened to complete fusion.

Effective Dates and Payment Start

The effective date of a compensation award, and therefore when payments start, is generally the date the VA receives your claim or the date entitlement arose, whichever is later.¹⁹ If you file within one year of discharge, the effective date goes back to the day after separation. For an increased rating claim, moving from a limited-motion rating to ankylosis, the effective date can go back to the earliest date the increase is documented, as long as you file within one year of that date.

Filing delays cost real money. Every month between when ankylosis develops and when you file is a month of lost compensation that typically cannot be recovered. Veterans who suspect their joint has become fully fused should file promptly even while gathering supporting evidence, since the claim date establishes the earliest possible effective date.

If the Rating Is Too Low

If the VA assigns a lower rating than the evidence supports, rating a fused joint as limited motion, or calling an unfavorable position favorable, three options exist to challenge the decision.²⁰

A Supplemental Claim submits new and relevant evidence the VA didn’t have before, such as a more detailed exam, updated imaging, or a specialist’s opinion clarifying that the joint has zero movement.
A Higher-Level Review asks a senior reviewer to re-examine the existing record for errors. New evidence isn’t allowed, but this path works well when the C&P exam clearly documented ankylosis and the rater misapplied the diagnostic code.
A Board of Veterans’ Appeals review puts the case before a Veterans Law Judge. New evidence and a hearing are both possible, and this path provides a fresh, independent look at the claim.

The most common problem with denied or underrated ankylosis claims is an inadequate C&P exam: no goniometer, no testing of all four conditions required under 38 C.F.R. § 4.59, or a description of “minimal” motion without actual measurements. When the exam itself is deficient, a supplemental claim with a thorough private examination is usually the fastest path to correction.

1
eCFR. 38 CFR 4.71a Schedule of Ratings – Musculoskeletal System
2
eCFR. 38 CFR 4.71a Musculoskeletal System – Note 5
3
Department of Veterans Affairs. Board of Veterans Appeals Decision 22020125
4
eCFR. 38 CFR 4.71a Musculoskeletal System – DC 5256
5
U.S. Department of Veterans Affairs. Current Veterans Disability Compensation Rates
6
eCFR. 38 CFR 4.71a Musculoskeletal System – DC 5250
7
Department of Veterans Affairs. Board of Veterans Appeals Decision 18149761
8
Federal Register. Ankylosis and Limitation of Motion of Digits of the Hands
9
eCFR. 38 CFR 4.59 Painful Motion
10
eCFR. 38 CFR 4.26 Bilateral Factor
11
eCFR. 38 CFR 3.310 Disabilities That Are Proximately Due To, or Aggravated By, Service-Connected Disease or Injury
12
Department of Veterans Affairs. Board of Veterans Appeals Decision 1428375
13
eCFR. 38 CFR 4.14 Avoidance of Pyramiding
14
eCFR. 38 CFR 3.350 Special Monthly Compensation Ratings
15
U.S. Department of Veterans Affairs. Current Special Monthly Compensation Rates
16
eCFR. 38 CFR 4.16 Total Disability Ratings for Compensation Based on Unemployability of the Individual
17
eCFR. 38 CFR 4.68 Amputation Rule
18
eCFR. 38 CFR 4.71 Measurement of Ankylosis and Joint Motion
19
Office of the Law Revision Counsel. 38 USC Part IV Chapter 51 Subchapter II Effective Dates
20
U.S. Department of Veterans Affairs. VA Decision Reviews and Appeals