VA Disability Rating for Osteomyelitis
Diagnostic Code 5000 · 38 CFR §4.71a
What Is It?
Osteomyelitis is an infection of the bone that can develop after open fractures, surgical procedures, or through bloodborne spread from infections elsewhere in the body. The infection causes inflammation, pain, and can destroy bone tissue if not treated effectively. It can be acute, meaning it developed recently, or chronic, meaning it has persisted or keeps coming back over time. Veterans commonly develop osteomyelitis from combat wounds, open fractures sustained during training, surgical complications from service-connected injuries, or infections that spread from soft tissue wounds. 38 CFR 4.71a lists DC 5000 as "Osteomyelitis, acute, subacute, or chronic" and prints five evaluations: 100, 60, 30, 20 and 10 percent. There is no 0 percent row. The top figure turns on where the infection is and how long and how hard it has run: osteomyelitis of the pelvis, vertebrae, or extending into major joints, or with multiple localization, or with a long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms. Frequent episodes with constitutional symptoms are 60 percent. Definite involucrum or sequestrum, with or without a discharging sinus, is 30. A discharging sinus or other evidence of active infection within the past 5 years is 20. Inactive disease, following repeated episodes, without evidence of active infection in the past 5 years, is 10. Two Notes decide how those figures are used. Note (1) makes 10 percent an exception to the amputation rule in any case of active osteomyelitis where the amputation rating for the affected part is no percent, and provides that the 10 percent and the other partial ratings of 30 percent or less are combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening and the like, subject to the amputation rule. The 60 percent rating, because it rests on constitutional symptoms, is not subject to the amputation rule. And no osteomyelitis rating applies after cure by removal or radical resection of the affected bone. Note (2) governs the historical ratings: the 20 percent rating for activity within the past 5 years requires an established recurrent osteomyelitis and is not assignable after an initial infection with no later reactivation; the 10 percent rating requires 2 or more episodes following the initial infection; and either one is assigned once only, to cover every site of previously active infection, with a future ending date in the case of the 20 percent rating.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms. |
| 60% | Frequent episodes, with constitutional symptoms. Under Note (1), this rating rests on constitutional symptoms and is not subject to the amputation rule. |
| 30% | With definite involucrum or sequestrum, with or without discharging sinus. Under Note (1), ratings of 30 percent or less are combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening, etc., subject to the amputation rule. |
| 20% | With discharging sinus or other evidence of active infection within the past 5 years. Under Note (2), this rating is not assignable following the initial infection with no subsequent reactivation: it requires an established recurrent osteomyelitis, is assigned once only to cover all sites of previously active infection, and carries a future ending date. |
| 10% | Inactive, following repeated episodes, without evidence of active infection in past 5 years. Under Note (2), 2 or more episodes following the initial infection are required. Under Note (1), 10 percent is also assigned, as an exception to the amputation rule, in any case of active osteomyelitis where the amputation rating for the affected part is no percent. |
Evidence Needed
- Medical records documenting the bone infection and its connection to military service
- Bone imaging such as X-rays, MRI, or bone scans showing infection
- Laboratory results including blood cultures and inflammatory markers
- Surgical records if debridement or bone removal was performed
- Records of antibiotic treatment courses and their duration
C&P Exam Tips
- Describe the frequency and duration of flare-ups including drainage episodes
- Bring records of all antibiotic courses you have received
- Show any visible draining sinuses or scars from surgical debridement
- Explain how flare-ups affect your ability to work and perform daily tasks
- Mention any constitutional symptoms like fevers, chills, or fatigue during episodes
How to File
File under DC 5000 for osteomyelitis. Include all imaging studies and culture results that document the bone infection. If the osteomyelitis developed from a combat wound or training injury, establish that connection clearly. Then document the history the criteria actually turn on: the site of the infection (pelvis, vertebrae, or extension into a major joint carries the 100 percent criterion), any constitutional symptoms such as anemia or debility, imaging showing involucrum or sequestrum, and the date of every episode of active infection or drainage. The 20 and 10 percent ratings are historical — they depend on recurrence after the initial infection and on whether there has been active infection in the past 5 years — so the dates matter as much as the findings. Claim limited motion, ankylosis, nonunion, malunion or shortening of the affected part as well; Note (1) combines those ratings with osteomyelitis ratings of 30 percent or less, subject to the amputation rule.
Common Mistakes
- Not documenting the chronic nature of recurrent infections.
- Failing to track and report each flare-up episode and treatment course.
- Not getting follow-up imaging to show persistent bone changes.
- Missing the connection between an old wound infection and current bone infection.
Frequently Asked Questions
Can osteomyelitis come back after treatment?
Yes, chronic osteomyelitis is known for recurring even after prolonged antibiotic treatment. Bacteria can survive in dead bone tissue and reactivate months or years later. Each recurrence should be documented, because the schedule counts them: Note (2) to DC 5000 makes the 20 percent rating for activity within the past 5 years depend on an established recurrent osteomyelitis, and the 10 percent rating on 2 or more episodes following the initial infection.
Can I get rated for both osteomyelitis and the joint it affects?
Often, yes. Note (1) to DC 5000 provides that the 10 percent rating and the other partial ratings of 30 percent or less are combined with ratings for ankylosis, limited motion, nonunion or malunion, shortening, and similar residuals, subject to the amputation rule. The 60 percent rating, which rests on constitutional symptoms, is not subject to the amputation rule.
Is there a 0 percent rating for osteomyelitis?
No. DC 5000 prints 100, 60, 30, 20 and 10 percent and nothing lower. The lowest figure, 10 percent, is for inactive disease following repeated episodes without active infection in the past 5 years, and Note (2) requires 2 or more episodes after the initial infection for it. An initial infection that never reactivated does not qualify for the 20 or 10 percent historical ratings.
What happens if the infected bone is removed?
Note (1) to DC 5000 states that a rating for osteomyelitis will not be applied following cure by removal or radical resection of the affected bone. The evaluation then follows what the surgery left — limitation of motion, shortening, amputation, or scarring under their own codes.