Femur Impairment VA Disability Rating
Diagnostic Code 5255 · 38 CFR §4.71a
What Is It?
Femur impairment covers conditions affecting the thighbone including malunion where the bone healed in an improper position, nonunion where the bone failed to heal, and fracture of the femoral neck. The femur is the strongest bone in the body and femur injuries typically result from significant trauma such as vehicle accidents, falls from height, or blast injuries during military service. Even after treatment, femur injuries often leave lasting problems with leg length, alignment, and joint function. DC 5255 prints two figures of its own, both for fractures that have not healed: 80 percent and 60 percent for nonunion of a fracture of the shaft or anatomical neck, and 60 percent for a fracture of the surgical neck with a false joint. Malunion, where the bone healed out of position, has no percentage under DC 5255. The schedule directs: 'Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.' So a malunited femur is rated on what it has done to the knee (ankylosis, instability, or limited flexion or extension) or to the hip (ankylosis, limited motion, other thigh impairment, or a flail joint), and the higher of those results is the one used.
Rating Criteria
| Rating | Criteria |
|---|---|
| 80% | Fracture of the shaft or anatomical neck of the femur, with nonunion, with loose motion (spiral or oblique fracture). |
| 60% | Fracture of the shaft or anatomical neck of the femur, with nonunion, without loose motion, weight bearing preserved with aid of brace; or fracture of the surgical neck of the femur, with false joint. |
Evidence Needed
- Imaging showing the malunion, nonunion, or fracture pattern
- Surgical records from initial treatment and any subsequent procedures
- Range of motion measurements for both the hip and knee on the affected side
- Leg length measurements comparing both sides
- Documentation of braces, assistive devices, or gait aids prescribed
- Functional assessment describing weight-bearing capability
C&P Exam Tips
- Bring imaging that clearly shows the bone alignment or healing status
- Make sure both the hip and knee are examined since femur problems affect both joints
- Report any leg length discrepancy and whether you use a shoe lift
- Describe pain with weight bearing and how far you can walk
- Mention if the leg feels unstable or if you rely on a brace
How to File
File under DC 5255 with imaging showing the bone condition and functional evidence of how it affects your hip and knee. If you have a leg length discrepancy, get it measured and documented. File secondary claims for any joint problems that developed because of the femur impairment.
Common Mistakes
- Not having both the hip and knee evaluated since femur malunion affects both joints.
- Failing to document leg length discrepancy which supports the malunion diagnosis.
- Not getting current imaging to show the bone condition — old films from the initial injury may not show the current state.
- Missing secondary claims for arthritis that developed in adjacent joints.
Frequently Asked Questions
What is the difference between malunion and nonunion?
Malunion means the bone healed but in an incorrect position, causing alignment problems. Nonunion means the bone never fully healed and there remains a gap or false joint at the fracture site. Under DC 5255, nonunion carries the code's own 80 and 60 percent evaluations, while malunion is evaluated under the knee or hip codes.
How is malunion of the femur rated?
Not with a percentage of its own. DC 5255 directs that malunion be evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250 through 5254 for the hip, whichever results in the highest evaluation. That is why range of motion and stability measurements for both the hip and the knee on the affected side matter: the evaluation comes from those joints, and the rater compares the results and uses the highest.