VA Disability Rating for Paget's Disease of Bone

Diagnostic Code 5016 · 38 CFR §4.71a

What Is It?

Paget's disease of bone is a chronic condition where the normal process of bone renewal becomes disrupted, leading to bones that are enlarged, misshapen, and weakened. The affected bones break down and rebuild faster than normal, resulting in bone that is structurally abnormal. It most commonly affects the pelvis, skull, spine, and leg bones. Many people have no symptoms, but the condition can cause bone pain, deformities, fractures, and complications like arthritis in nearby joints or hearing loss if the skull is affected. The exact cause is not fully understood, but it may relate to both genetic factors and environmental triggers. 38 CFR 4.71a lists the disease under its older name — DC 5016, "Osteitis deformans" — and gives it no percentage column. It is governed by the Note to the codes from 5013 to 5024: "Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts." So the diagnosis, the bone scan and the alkaline phosphatase level establish the condition but do not produce a percentage. The evaluation comes from the motion each affected part has lost, under its 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 block. Complications outside the musculoskeletal system, such as hearing loss, are evaluated under their own codes.

Rating Criteria

Rating	Criteria
See pathways	DC 5016 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 5016 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 elevated alkaline phosphatase levels
Bone imaging showing characteristic Paget's disease changes
Bone scan identifying all affected sites
Range of motion in degrees for each joint near an affected bone, with painful motion noted — this is what the evaluation is taken from
Medical records documenting symptoms and treatment
Evidence connecting the onset or aggravation to military service

C&P Exam Tips

Describe which bones are affected and the symptoms in each area
Ask that range of motion be measured for every joint the disease affects, and say where pain begins in the motion
Show any visible bone deformities such as bowed legs
Bring laboratory results showing alkaline phosphatase levels over time
Explain how bone pain and deformity limit your activities
Mention any complications like hearing loss or joint arthritis

How to File

File under DC 5016 for Paget's disease of bone (the schedule calls it osteitis deformans). Include laboratory and imaging evidence documenting the diagnosis and extent of the disease. Because DC 5016 assigns no percentage itself, name the joints and spinal segments the disease affects so the examination measures their motion — the evaluation is written under each part's limitation-of-motion code. If the condition has caused secondary problems like hearing loss, file those as separate secondary claims.

Common Mistakes

Not getting a bone scan to identify all affected sites.
Expecting the diagnosis or the alkaline phosphatase level to be rated. DC 5016 has no percentages of its own; the evaluation comes from limitation of motion of the affected parts.
Relying on X-ray findings for a percentage. DC 5003 Note (2) bars the X-ray-based 20 and 10 percent ratings for conditions under DCs 5013 through 5024.
Failing to file for secondary conditions caused by Paget's disease, such as hearing loss.

Frequently Asked Questions

What percentage does DC 5016 pay?

None by itself. 38 CFR 4.71a lists DC 5016 as "Osteitis deformans" 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.

Can Paget's disease cause hearing loss?

Yes, when Paget's disease affects the skull bones, particularly the temporal bone near the ear, it can cause hearing loss. This hearing loss can be rated separately under the hearing loss diagnostic codes if it is documented as a complication of your service-connected Paget's disease.

Does Paget's disease get worse over time?

Paget's disease is generally a progressive condition, though the rate of progression varies widely. Some people have stable disease for years while others experience gradual worsening. Regular monitoring and treatment help document changes — and because the evaluation is taken from limitation of motion, a re-measurement of the affected joints is what shows a worsening for rating purposes.

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 5016 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.