VA Disability Rating for Osteomalacia

Diagnostic Code 5014 · 38 CFR §4.71a

What Is It?

Osteomalacia is a softening of the bones caused by inadequate mineralization, typically due to vitamin D deficiency. Unlike osteoporosis where bones lose mass, osteomalacia involves bones that are present but not properly hardened. This causes diffuse bone pain, muscle weakness, and an increased risk of stress fractures. Veterans may develop osteomalacia from prolonged vitamin D deficiency during deployments with limited sun exposure, malabsorption conditions that developed during service, kidney conditions affecting vitamin D metabolism, or medications that interfere with bone mineralization. 38 CFR 4.71a lists DC 5014 as "Osteomalacia, residuals of" and gives it no percentage column. Like every code from 5013 to 5024, it is governed by one Note: "Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts." The laboratory values that prove the diagnosis do not produce a percentage. The evaluation is taken from the motion the affected joints have lost, under each joint's own limitation-of-motion code. Where that limitation is noncompensable, DC 5003 provides 10 percent for each major joint or group of minor joints affected by limitation of motion, objectively confirmed; 38 CFR 4.59 entitles actually painful, unstable, or malaligned joints, due to healed injury, to at least the minimum compensable rating for the joint; and DC 5003 Note (2) bars the X-ray-based 20 and 10 percent ratings for this whole block of codes.

Rating Criteria

Rating	Criteria
See pathways	DC 5014 assigns no percentage of its own. The Note governing diagnostic codes 5013 through 5024 directs: "Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts." The evaluation is therefore taken from the limitation-of-motion code for each affected joint. Where limitation of motion of the specific joint is noncompensable under the appropriate code, DC 5003 provides 10 percent for each such major joint or group of minor joints affected by limitation of motion, which must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Under 38 CFR 4.59, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. DC 5003 Note (2) bars the 20 and 10 percent ratings based on X-ray findings for conditions under diagnostic codes 5013 to 5024.

Rating

Criteria

See pathways

DC 5014 assigns no percentage of its own. The Note governing diagnostic codes 5013 through 5024 directs: "Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts." The evaluation is therefore taken from the limitation-of-motion code for each affected joint. Where limitation of motion of the specific joint is noncompensable under the appropriate code, DC 5003 provides 10 percent for each such major joint or group of minor joints affected by limitation of motion, which must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Under 38 CFR 4.59, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. DC 5003 Note (2) bars the 20 and 10 percent ratings based on X-ray findings for conditions under diagnostic codes 5013 to 5024.

Evidence Needed

Blood work showing vitamin D levels, calcium, phosphorus, and alkaline phosphatase — this establishes the diagnosis
Bone imaging showing characteristic changes of osteomalacia
Bone biopsy results if performed
Range of motion in degrees for each affected joint, with any painful motion noted — this is what the evaluation is taken from
Medical records connecting the condition to service or a service-connected cause
Documentation of symptoms including bone pain and muscle weakness

C&P Exam Tips

Describe the diffuse nature of your bone pain and where it is worst
Ask that range of motion be measured in each affected joint, and say where in the motion pain begins
Demonstrate any muscle weakness, especially difficulty rising from a chair or climbing stairs
Bring laboratory results showing your vitamin D and calcium levels
Explain what you believe caused the vitamin D deficiency during service
Mention any stress fractures or bone deformities that have developed

How to File

File under DC 5014 for residuals of osteomalacia. Include laboratory evidence showing abnormal vitamin D, calcium, or phosphorus levels. If the condition resulted from a service-connected kidney condition or malabsorption disorder, file it as secondary. Because DC 5014 assigns no percentage itself, name the joints that are painful or restricted so the examination measures them — the evaluation is written under each joint's limitation-of-motion code.

Common Mistakes

Confusing osteomalacia with osteoporosis, which has different causes and diagnostic criteria.
Not getting complete blood work to demonstrate the metabolic cause.
Expecting a severity scale. DC 5014 has no percentages of its own; the evaluation comes from limitation of motion of the affected parts.
Not having the painful joints measured, or not having painful motion recorded, which is what 38 CFR 4.59 turns on.
Not establishing how the vitamin D deficiency connects to service.

Frequently Asked Questions

What percentage does DC 5014 pay?

None by itself. 38 CFR 4.71a lists DC 5014 as "Osteomalacia, residuals of" with no percentage column. The Note to DCs 5013 through 5024 directs that these diseases be evaluated as degenerative arthritis, based on limitation of motion of affected parts, so the percentage in a decision is written under the limitation-of-motion code for each joint involved, and two or more joints combine under 38 CFR 4.25.

Is osteomalacia the same as osteoporosis?

No, they are different conditions. Osteoporosis involves loss of bone mass while the remaining bone is normal. Osteomalacia involves normal amounts of bone that are not properly mineralized, making them soft. They have different causes, different treatments, and different diagnostic codes — though both codes, DC 5013 and DC 5014, are evaluated the same way, on limitation of motion of the affected parts.

Can osteomalacia be cured?

In many cases, osteomalacia can be significantly improved with vitamin D supplementation and treatment of the underlying cause. However, if bone damage or deformities have already occurred, those may be permanent. VA rates the residuals as they are now, on the motion the affected joints have lost.

Can X-ray evidence of two or more joints get me 10 or 20 percent?

No. DC 5003's Note (2) states that the 20 and 10 percent ratings based on X-ray findings will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. DC 5014 sits inside that block, so the evaluation has to come from measured limitation of motion, from DC 5003's 10 percent per joint where that limitation is noncompensable, or from 38 CFR 4.59 for a painful joint.