Diagnostic code
Diagnostic Code 5009: Other specified forms of arthropathy (excluding gout) Rating Criteria
- CFR section
- 38 CFR § 4.71a
- Rating range
- 20% to 100%
- Rating levels
- 4
- Body system
- Musculoskeletal system
The VA rates Other specified forms of arthropathy (excluding gout) under diagnostic code 5009 in 38 CFR § 4.71a. The table below is the full set of rating criteria, from the schedule itself, with the evidence factors raters look for at each level.
DC 5009 rating criteria
| Rating | Criteria |
|---|---|
| 20% | One or two exacerbations a year in a well-established diagnosis What raters look fordocumented diagnosis; 1-2 flares/year |
| 40% | Definite impairment of health with 3+ incapacitating exacerbations per year What raters look for3+ exacerbations/year; DMARD therapy; regular rheumatology follow-up |
| 60% | Severe impairment with weight loss/anemia or 4+ severely incapacitating exacerbations per year; or biologic therapy required What raters look forbiologic therapy (Humira, Enbrel, etc.); 4+ exacerbations/year; severe functional limitation; weight loss or anemia |
| 100% | Constitutional manifestations associated with active joint involvement, totally incapacitating What raters look fortotally incapacitating; active disease despite maximum treatment |
Frequently asked questions
What is VA diagnostic code 5009?
Diagnostic code 5009 is the VA rating schedule entry for Other specified forms of arthropathy (excluding gout), found in 38 CFR § 4.71a. The VA assigns this code when it rates the condition and applies the criteria listed on this page.
What ratings are possible under DC 5009?
DC 5009 provides ratings of 20%, 40%, 60%, 100%. The percentage depends on which criteria your medical evidence documents, not on the diagnosis alone.
What does the highest rating under DC 5009 require?
The 100% rating for Other specified forms of arthropathy requires: Constitutional manifestations associated with active joint involvement, totally incapacitating.