Hip Flail Joint VA Disability Rating
Diagnostic Code 5254 · 38 CFR §4.71a
What Is It?
DC 5254 is one line in the schedule: "Hip, flail joint" — 80 percent. There is no ladder, no major and minor column, and no lesser step. It is among the highest single-joint evaluations anywhere in the musculoskeletal schedule, which tells you how the schedule regards the finding. A flail joint is not a painful hip, a stiff hip, or a hip that has been replaced. It is a hip that has lost its structural integrity — the joint no longer constrains movement, so the limb moves in directions and to extents a hip should not, and it cannot be relied on to bear weight. The usual routes to it are destruction of the femoral head and acetabulum by trauma, resection for infection or tumor, a girdlestone procedure or another situation where the joint has been removed or has failed catastrophically, and severe bone loss around failed hardware. Because there is one step and it is high, the entire claim is the finding. What the record has to establish is not how much the hip hurts or how far it moves, but that the joint is flail — abnormal, uncontrolled mobility with loss of the structural constraint that makes a hip a hip. Imaging that shows the joint destroyed or resected, and an orthopedic description of abnormal mobility and inability to bear weight, are what carry it. Two neighboring provisions matter. DC 5054 covers hip replacement and resurfacing, including a 100 percent period following implantation, a minimum evaluation of 30 percent for total replacement, and a Note directing that at the conclusion of the 100 percent period resurfacing be evaluated under diagnostic codes 5250 through 5255 with no minimum. And DC 5255, femur impairment, was rewritten into a routing instruction: evaluate under diagnostic codes 5256, 5257, 5260 or 5261 for the knee, or 5250 through 5254 for the hip, whichever results in the highest evaluation. So a claim that starts as a femur problem can end up here.
Rating Criteria
| Rating | Criteria |
|---|---|
| 80% | Hip, flail joint. This is the only evaluation under DC 5254 — the schedule lists a single figure with no severity gradation and no separate dominant or non-dominant column. The finding required is a hip that has lost structural integrity, with abnormal uncontrolled mobility and loss of reliable weight-bearing, rather than a painful, stiff or replaced hip. |
Evidence Needed
- Imaging showing the state of the joint — destruction or resection of the femoral head and acetabulum, bone loss, migrated or failed hardware. This is the anatomical basis for the finding.
- An orthopedic examination describing abnormal mobility of the hip and stating in terms that the joint is unstable or flail. The word matters, because the code is written around that finding and no other.
- A weight-bearing assessment: whether the limb can bear weight at all, whether it can do so reliably, and what assistive devices are required.
- Operative reports for every procedure on that hip, including any resection, girdlestone, revision or explantation, and the reason each was performed.
- Records of infection where the joint was lost to infection, including cultures, the antibiotic course, and any staged revision.
- Leg length measurement and gait analysis, since a flail hip commonly shortens and destabilises the limb.
- Documentation of the assistive devices actually prescribed and used, and of any wheelchair use.
- Findings for the knee, the opposite hip and the lumbar spine, which take up the load a flail hip cannot carry.
C&P Exam Tips
- Make sure the examiner addresses stability directly and records whether the hip is flail. A report full of range-of-motion degrees and no statement about structural integrity does not answer the question this code asks.
- Bring the operative reports, especially for any resection or explantation. What was removed from the joint is often the clearest evidence in the file.
- Demonstrate weight-bearing honestly, including what happens when you try to stand on the limb without support.
- Bring and use the assistive devices you actually rely on, and say which were prescribed.
- Describe how you move around the house and outside it — distances, stairs, transfers, and whether you use a wheelchair for any part of the day.
- Have leg length measured and any shortening recorded.
- Ask that the knee on the same side, the opposite hip and the low back be examined. Those are the joints that absorb what the hip cannot, and they are separately evaluated.
- If the joint was lost to infection, make sure that history is in the report rather than only in the older records.
How to File
File on the finding. DC 5254 has one evaluation and no gradations, so the claim succeeds or fails on whether the record establishes a flail hip joint — a hip that has lost structural integrity and cannot be relied on to bear weight — rather than on the degree of pain or the loss of motion. Get the operative history in front of the rater. Where the femoral head has been resected, where hardware has failed with bone loss, or where the joint was removed for infection, those reports are usually more persuasive than any current examination, because they describe what is no longer there. If the hip carries a prosthesis, look at DC 5054 as well, which covers hip replacement and resurfacing and carries a 100 percent period after implantation and a 30 percent minimum for total replacement. If the claim began as a femur injury, note that DC 5255 now directs evaluation under the knee codes 5256, 5257, 5260 or 5261, or the hip codes 5250 through 5254, whichever results in the highest evaluation — so ask that the comparison be made rather than assuming it was. Claim the knee, the opposite hip and the low back separately, then keep 38 CFR 4.68 in view: the combined rating for disabilities of an extremity cannot exceed the rating for amputation at the elective level. At 80 percent for the hip alone, that ceiling is close, and it is the reason additional lower-extremity evaluations on the same side may not increase the total as much as expected.
Common Mistakes
Filing a painful or stiff hip as a flail joint. The code describes loss of structural integrity with uncontrolled mobility, and an examination showing limited motion — however severe — is evidence for a different code. Leaving the word out of the record. Where no examiner has stated that the joint is unstable or flail, a rater has nothing to match against the criterion. Treating a failed hip replacement as automatically flail. Some are and some are not; DC 5054 governs replacement and resurfacing and has its own 100 percent period and 30 percent minimum. Missing the DC 5255 routing instruction, which requires the hip and knee codes to be compared and the highest evaluation used. Not claiming the knee, opposite hip and lumbar spine, which take the load the hip cannot. Expecting every additional lower-extremity evaluation to raise the total. 38 CFR 4.68 caps the combined rating for the extremity at the value for amputation at the elective level.
Frequently Asked Questions
Is there any evaluation under DC 5254 other than 80 percent?
No. The schedule lists a single entry — hip, flail joint — at 80 percent, with no severity gradation and no separate dominant or non-dominant figures. The claim turns entirely on whether the flail finding is established, which is why the evidence should be aimed at that finding rather than at degrees of motion.
What actually counts as a flail hip?
A hip that has lost its structural integrity, so that the joint no longer constrains the limb and cannot be relied on to bear weight. In practice it follows destruction or resection of the femoral head and acetabulum, a girdlestone or similar procedure, catastrophic failure of hardware with bone loss, or loss of the joint to infection. It is a different finding from a painful hip, a stiff hip, or a hip that has been replaced.
My hip replacement failed. Is that a flail joint?
Not automatically. Hip replacement and resurfacing are covered by DC 5054, which provides a 100 percent evaluation for a period following implantation and a minimum evaluation of 30 percent for total replacement, with a Note directing that resurfacing be evaluated under diagnostic codes 5250 through 5255 after the 100 percent period ends. Whether a failed replacement has left a flail joint depends on what remains of the bone and the joint, which is an orthopedic finding.
Does this rating come with special monthly compensation?
The entry for DC 5254 in the current schedule carries no special monthly compensation footnote, unlike some other entries in the hip table. That does not mean SMC is unavailable — SMC is decided separately under 38 CFR 3.350 on findings such as loss of use of a foot or leg — but it does not attach automatically to this code, and it should be claimed and evaluated on its own terms.
Can I get separate ratings for my knee and low back on top of this?
Yes, where those disabilities exist and are service connected, whether directly or secondarily to the hip. What limits the total is 38 CFR 4.68, the amputation rule: the combined rating for disabilities of an extremity cannot exceed the rating for amputation at the elective level. With 80 percent already assigned for the hip, additional evaluations on that same limb may be capped by that rule.
My claim started as a femur fracture. Why would it be rated as a hip?
Because DC 5255, impairment of the femur, is now written as a routing instruction rather than a rating table. It directs evaluation under diagnostic codes 5256, 5257, 5260 or 5261 for the knee, or 5250 through 5254 for the hip, whichever results in the highest evaluation. So a femur injury that destroyed the hip joint is evaluated on the hip codes, and DC 5254 is the highest of them.