VA Disability Rating for Malignant Bone Tumors

Diagnostic Code 5012 · 38 CFR §4.71a

What Is It?

Malignant bone tumors are rated under diagnostic code 5012, which 38 CFR 4.71a lists as 'Bones, neoplasm, malignant, primary or secondary' and assigns a single evaluation: 100 percent. There are no intermediate tiers. The code has one figure and one Note, and the Note is where most of the practical questions live. The Note reads: 'The 100 percent rating will be continued for 1 year following the cessation of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure. If there has been no local recurrence or metastases, rate based on residuals.' Three things follow from it. The clock starts when treatment stops, not at diagnosis and not at remission. It runs a full year from that point. And at the end of it the evaluation does not simply lapse — it converts, and what it converts to is an evaluation of whatever the cancer and its treatment left behind. That conversion is where the long-term rating is actually decided, and it is rated under other codes rather than this one. Residuals after bone cancer are commonly limitation of motion of the affected joint, amputation or loss of use of an extremity, a prosthetic joint replacement, surgical scarring, chronic neuropathic pain, and the systemic consequences of chemotherapy such as peripheral neuropathy, cardiomyopathy or hearing loss from platinum agents. Each is evaluated on its own code and the results combine under 38 CFR 4.25. Where an extremity is involved, remember the amputation rule at 38 CFR 4.68: the combined evaluation for disabilities of an extremity cannot exceed the evaluation for amputation at the elective level. One code check is worth making before anything else. Diagnostic code 5015 is 'Bones, neoplasm, benign' — a different code for a different disease, and it carries no percentage at all. If a rating decision on a malignancy cites 5015, it has cited the benign code. The two sit three lines apart in the schedule and the numbers are easy to transpose.

Rating Criteria

Evidence Needed

• Pathology report establishing the malignancy and whether it is primary bone cancer or metastatic to bone
• Oncology treatment records with the date each modality ended — surgery, radiotherapy, chemotherapy — since the one-year continuation runs from cessation of therapy
• Imaging showing current disease status and any local recurrence or metastasis
• Evidence connecting the cancer to service: exposure records for ionizing radiation, herbicides or other agents, or the service-connected condition it is claimed secondary to
• Documentation of every residual, treated as its own condition — range of motion of the affected joint, amputation or loss of use, prosthetic replacement, scars, chemotherapy-induced peripheral neuropathy, cardiac or auditory toxicity

C&P Exam Tips

• Bring the treatment end dates in writing. The one-year continuation is calculated from cessation of therapy, and an examination that records only the diagnosis date leaves the rater without the figure the Note turns on.
• Ask that the examination address residuals separately rather than as part of the cancer narrative. After the continuation period ends, residuals are the rating.
• Have range of motion measured in the affected joint and in the joints above and below it, since surgery and radiotherapy commonly restrict adjacent segments.
• Report chemotherapy consequences by name — numbness and burning in the feet and hands, hearing loss, tinnitus, fatigue, cardiac symptoms. These are separately ratable and are routinely left out because they are not bone findings.
• If maintenance therapy is ongoing, say so plainly. Therapy that has not ceased has not started the one-year clock.

How to File

File on VA Form 21-526EZ under diagnostic code 5012 with the pathology report, the oncology records, and — most importantly for the timing — the date each course of therapy ended. Where the cancer is claimed on radiation exposure, identify the exposure and the dosimetry or unit records supporting it; where it is claimed secondary to a service-connected condition, say which condition and obtain an opinion addressing causation. Then plan the second half of the claim before you need it. About a year after treatment ends VA will re-examine and re-evaluate on residuals, and residuals are rated under other codes: the joint under the limitation-of-motion codes, an amputation under the 5100-series, a prosthetic joint under DC 5054, scars under DC 7804, chemotherapy neuropathy under the 8500-series. File each residual as its own claim rather than describing them collectively, and check the decision to confirm it cites 5012 rather than 5015 — 5015 is the benign bone neoplasm code and assigns no percentage.

Common Mistakes

• Assuming the 100 percent evaluation is permanent. The Note continues it for one year after therapy ends and then directs evaluation on residuals — a scheduled conversion, not a surprise reduction.
• Measuring the year from diagnosis or from being declared in remission. It runs from cessation of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure.
• Letting the residual examination pass without documenting residuals. If nothing is documented, nothing is rated, and the evaluation after conversion reflects the record rather than the disability.
• Overlooking the systemic effects of treatment. Peripheral neuropathy, ototoxic hearing loss and cardiotoxicity are consequences of the cancer treatment and are separately ratable.
• Accepting a decision that cites DC 5015. That is 'Bones, neoplasm, benign' — a routing code with no percentage column — and it is not the code for a malignancy.

Frequently Asked Questions

How long does the 100 percent rating last?

One year from the cessation of therapy. The Note to DC 5012 continues the 100 percent evaluation for one year following the end of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure. If there has been no local recurrence or metastasis at that point, the evaluation is based on residuals instead. The clock runs from when treatment stopped, not from diagnosis or from a remission date.

What happens after the year ends?

VA re-examines and rates on what the cancer and its treatment left behind. Those residuals are evaluated under the codes that fit them — limitation of motion, amputation or loss of use, a prosthetic joint under DC 5054, scars, chronic pain, chemotherapy neuropathy — and the results combine under 38 CFR 4.25. The combined evaluation for one extremity is capped by the amputation rule at 38 CFR 4.68.

My decision cites DC 5015. Is that right?

Not for a malignancy. 38 CFR 4.71a lists 5015 as 'Bones, neoplasm, benign,' and it carries no percentage column at all — it is evaluated as degenerative arthritis on limitation of motion. Malignant bone neoplasm, primary or secondary, is DC 5012 with its single 100 percent entry. If a decision on a bone cancer cites 5015, the code is wrong and so is the framework applied to it.

Does the rating apply to cancer that spread to bone from somewhere else?

Yes. The code reads 'Bones, neoplasm, malignant, primary or secondary,' and secondary here means metastatic. Whether service connection is established will usually turn on the primary cancer rather than on the bone lesion, so the claim is normally built around the original malignancy and the metastasis is evidence of its course.

I am still on maintenance therapy. Has the year started?

No. The Note runs from cessation of the prescribed therapeutic procedure, so ongoing treatment means the continuation period has not begun. Make sure the record shows the therapy is current rather than historical, because a file that reads as though treatment finished can start a clock that should not be running yet.

What if the cancer comes back?

Local recurrence or metastasis is the express condition in the Note. Evaluation on residuals applies only if there has been no local recurrence or metastasis; where there has been, the 100 percent evaluation continues. If recurrence is found after a reduction, file for an increase with the imaging and pathology that established it, and address the effective date, since the recurrence date is what the claim should run from.