What Veterans Need to Know About Osteoarthritis?

Osteoarthritis (OA) is a degenerative joint disease. With OA, the tissues in the joint break down over time or have an alteration in their structure. OA is the most common type of arthritis, the inflammation of joints. It is often referred to as “wear and tear” arthritis. This is because the cartilage and other tissues within a joint start to break down, and the underlying bone begins to change.

OA occurs most frequently in weight-bearing joints such as your spine, hips, and knees. It can also impact the hands, fingers, thumb, neck, and toes.

What Is Cartilage and Its Role in Osteoarthritis?

Cartilage is a firm, rubbery material. It covers the ends of bones and joints to reduce friction in the joints. It essentially serves as a buffer between bones so they do not rub against each other, preventing swollen, achy joints.

Healthy cartilage functions as a “shock absorber” in the joints because it can change shape when compressed and then return to its normal shape once the body recovers.

If the cartilage is damaged or mechanically altered, it cannot adequately function as a buffer or shock absorber. As the cartilage deteriorates, other connective tissues inside the joint such as tendons—which connect muscles to bones—and ligaments—which connect bone to bone—stretch, thereby creating pain.

In severe or progressed OA conditions, the bones can end up rubbing on each other because the cartilage in a joint can stiffen over time, losing its rubber-like quality. Cartilage may also wear away in some areas.

What Are the Causes of Osteoarthritis?

One of the most common causes of OA is an injury to the affected joint. Another common cause of OA is repetitive injury.

For example, if you suffer an ankle injury or injury on a weight-bearing joint, the chances of reinjuring the same joint are more likely.

Upon reinjuring the weight-bearing joint, alterations in the structure of the cartilage and connective tissue in the joint can occur. These alterations are the basis and key contributing factors for your OA.

Other causes of OA are:

• Abnormal mechanical joint structure (e.g., the joint formed incorrectly)
• Hereditary and/or Genetic defect in joint cartilage (family history)
• Joint injury
• Obesity
• Overuse of joints from repetitive movements
• Underlying conditions such as other forms of arthritis (e.g., rheumatoid arthritis)

What Are the Signs and Symptoms of Osteoarthritis?

The level of severity of your condition, how long you have had it, and the impacted joint(s) are all variables in which signs and symptoms might be most prevalent in your case. They are:

• Bone spurs: These are extra bits of bone that feel like hard lumps and form around the impacted joint.
• Grating sensation: There might be popping or crackling when using the joint(s).
• Loss of flexibility: The range of motion (ROM) may be decreased.
• Pain: Your impacted joint(s) may hurt during or after movement.
• Redness: This can occur due to friction occurring in the joint.
• Stiffness: This could be most noticeable when you first wake up or after inactivity.
• Swelling: This could be due to soft tissue inflammation around the joint.
• Tenderness: The joint might is sore when you apply light pressure to or near it.

If you are experiencing these symptoms and they are not going away, it is recommended to make an appointment with your doctor.

How Is Osteoarthritis Diagnosed?

When you arrive for your doctor’s appointment, you will describe the symptoms you are experiencing in the impacted joint(s), and the doctor will complete a physical examination. The doctor will then determine if any imaging needs to be ordered, such as:

• CT scan
• Magnetic resonance imaging (MRI)
• Ultrasound
• X-rays

Imaging can help the physician rule out any other type of arthritis such as rheumatoid arthritis or other underlying conditions. It can also show the severity/progression of the damage in the joint(s) and pinpoint the specific structures that have been affected.

What Are Treatment Options for Osteoarthritis?

Since OA occurs over time, involves joint tissue, and can impact bones and the joint capsule as a whole, the treatment for OA varies based on your condition, and more than one modality at a time is often used. Exercise is a viable treatment modality, especially if obesity is the underlying cause. Losing excess weight will lower the pressure on the affected joint, especially if it is weight-bearing.

Other treatment options include:

• Medication [non-steroidal anti-inflammatory drugs (NSAIDs)]
• Physical therapy (would be weight-bearing and have a focus on strengthening the muscles around the joint)
• Hot and cold compresses
• Injection of medication into the joint
• Supportive devices to assist with weight-bearing (canes, crutches, and/or walkers)
• Addressing underlying medical conditions contributing to OA exacerbation

If these non-invasive techniques are ineffective, your doctor may recommend surgery to repair the damaged structure(s) within the joint. If the damaged structure(s) are beyond repair, the doctor may perform a fusion, joint replacement, or other such procedure as deemed appropriate. If you are considering surgical treatment for your OA, it is recommended to discuss the options with your treatment providers and your loved ones before making a final decision.

VA Disability Rating for Osteoarthritis:

The VA Disability Rating for Osteoarthritis is most often rated under CFR Title 38, Part 4, Schedule for Rating Disabilities, Diagnostic Code (DC) 5003, Degenerative Arthritis.

You must meet three legal criteria in order to be eligible for an Arthritis VA Rating:

1. There must be a medical diagnosis of Arthritis in a medical record (Service Treatment Records, VA medical records, or private medical records).
2. Active-duty military service or another service-connected disability for secondary service connection caused or made your arthritis worse (“Nexus” for service connection).
3. Recurring and persistent symptoms include functional impairment or loss and how it impacts your work, life, and social functioning (“Severity of Symptoms”).

The VA Disability Rating for Osteoarthritis is either 10% or 20% depending on your symptoms’ severity, frequency, and duration. Also, the ratings are affected by how your symptoms negatively impact your work, social, and life functioning, including any functional loss or impairment:

• 10% rating: One joint or joint group is affected, and there is evidence of painful motion.
• 20% rating: Two or more major joints or two or more groups of minor joints must have occasional incapacitating episodes.

Tips for Obtaining Service Connection for Osteoarthritis

Typically, a veteran will suffer an injury during service that heals in a few weeks. Or, a veteran is subjected to repeated wear and tear on his joints, such as multiple parachute jumps. At the time of service, there is often no evidence of any arthritis. The separation exam is usually normal, and many years go by after service without any problems. But, at some point, many years down the road, a veteran starts to develop joint problems and is eventually diagnosed with arthritis. He then makes a claim for VA compensation for osteoarthritis, and VA denies the claim. The VA’s cited reasons for denial often include that the separation exam was normal, and many years elapsed between service and the onset of the diagnosis.

A veteran should not accept VA’s denial. The VA fails to understand that degenerative conditions like osteoarthritis take years to develop slowly. This is why nothing is diagnosed at separation from service. This also explains why it takes years to get to the point that the condition produces disabling symptoms. The VA often has an unrealistic idea about the effects of an injury.

For example, VA expects you to injure yourself and the next day have arthritis show up on an x-ray. This makes no sense and is not even medically possible. The better way to view these claims is that the events of service, such as an injury or multiple wear and tear events like parachute jumps, are risk factors for the degenerative process to occur and later manifest years after service. So, in preparing these claims for service connection, veterans are advised to characterize the in-service events as the risk factors for the later development of degenerative arthritis.