What is Rheumatoid Arthritis?
Rheumatoid arthritis is a form of arthritis that occurs when the immune system does not work properly and attacks the lining of the joints, causing inflammation and pain. As such, rheumatoid arthritis is categorized an autoimmune disease. Commonly, rheumatoid arthritis affects the hands, knees, and ankles. Usually, the same joint on both sides of the body will be affected. For example, both hands, knees, or ankles may be affected, as opposed to only one hand, knee, or ankle.
Rheumatoid arthritis may also affect a person’s organs such as the heart, circulatory system, or lungs. It most commonly affects women, and often develops in middle age. Genetics may play a role in a person’s likelihood to develop rheumatoid arthritis. Additionally, some research indicates that genes may be affected by triggers in the environment, viruses, bacteria, physical and emotional stress, and other factors, which may then manifest in rheumatoid arthritis.
Symptoms of Rheumatoid Arthritis
- Joint pain
- Tenderness in areas surrounding joints
- Swelling or stiffness, especially in the morning
- Dryness, redness, or difficulty seeing in the eyes
- Gum inflammation or infection in the mouth
- Small lumps in the skin
- Shortness of breath
- Low red blood cell count
- Weight gain
- Severe inflammation that may last for varying periods of time
- Symptoms affecting more than one joint, usually the same joints on each side of the body
If symptoms are not treated, specifically inflammation, rheumatoid arthritis may cause damage to the bones and cartilage. Rheumatoid arthritis may also cause joint deformity which is non-reversible.
Diagnosing and Treating RA
Diagnosing rheumatoid arthritis may take the expertise of a rheumatologist, or a doctor with specialized training in treating arthritis. To diagnose, the doctor may perform certain tests and physical examinations, as well as examine the person’s medical history.
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Specifically, a rheumatologist may perform a blood test to look for certain blood proteins, or antibodies, related to rheumatoid arthritis. One of these antibodies is called rheumatoid factor, or RF, and is found in about 80 percent of people who have rheumatoid arthritis. Imaging tests may also indicate if the ends of the bones within a joint have been worn down, or eroded. Some imaging tests may include an x-ray, ultrasound, or MRI.
To treat rheumatoid arthritis, a person may be prescribed certain medications to reduce symptoms and keep inflammation at the lowest possible level. Some topical products, such as creams or gels, may also provide relief for rheumatoid arthritis symptoms. Some supplements can also help reduce stiffness, such as omega-3 fish oil.
VA Service Connection for Rheumatoid Arthritis
When filing a claim for service connection for rheumatoid arthritis, the veteran will need to demonstrate a connection between their military service and their rheumatoid arthritis. The veteran will also need to submit a diagnosis of their condition. In total, the veteran will need to submit the following to VA:
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- A diagnosis of rheumatoid arthritis;
- An in-service event, illness, or injury; and
- A nexus linking the veteran’s in-service occurrence with their rheumatoid arthritis
To support their claim for service connection, the veteran may submit lay evidence. Lay evidence, or lay statements, can be written by the veteran or anyone who knows the veteran and can speak to their condition. Importantly, lay evidence may also be submitted by fellow service members.
Compensation and Pension (C&P) Exams for Rheumatoid Arthritis
When a veteran files a claim for rheumatoid arthritis, VA may request a Compensation and Pension exam, or . To do this, VA may call the veteran or send a letter. It is very important to make sure VA has the veteran’s up-to-date contact information so that no C&P exam requests are missed. It is also very important to attend the exam, as failure to attend can result in VA denying the veteran’s claim.
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The exam will usually be performed by a VA physician or a VA contracted physician. Before the exam, the examiner will review the veteran’s c-file. This will contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and service records. During the exam, the examiner may physically exam the joints which have been affected by rheumatoid arthritis.
The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim. A Disability Benefits Questionnaire is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities. The veteran may also have their private doctor fill out a DBQ for them. In claims for rheumatoid arthritis, DBQs can be helpful because a private doctor, or a rheumatologist, can provide insight into the veteran’s condition.
VA Disability Ratings for Rheumatoid Arthritis
VA rates rheumatoid arthritis under Diagnostic Code 5002. Rheumatoid arthritis can be evaluated up to 100 percent if it results in complete incapacitation, such as causing the veteran to be bedridden. Lower ratings may be given for occasional incapacitating episodes. As with degenerative arthritis, a rating for limited range of motion cannot be given in addition to a rating for rheumatoid arthritis.
- 20%—This rating can be given to veterans who experience two or more incapacitating episodes per year and who have an established diagnosis of rheumatoid arthritis.
- 40%—Veterans who are facing a “definitive impairment” in overall health, that is supported by exam findings or experiencing three or more incapacitating episodes each year, will receive this rating.
- 60%—Veterans who suffer severely incapacitating episodes four or more times per year, or are experiencing weight loss, anemia, and a decline in health, will be rated at 60 percent.
- 100%—This rating is given to veterans who experience totally incapacitating rheumatoid arthritis, no matter how many joints are affected.
If a veteran’s rheumatoid arthritis is less severe than the symptoms depicted above, they can be rated under the diagnostic codes for each specific major or group of minor joints. To be rated under these specific diagnostic codes, a limited range of motion must be confirmed by symptoms such as swelling, muscle spasms, or evidence of painful motion.
Burn Pit Exposure and Rheumatoid Arthritis
As mentioned above, environmental factors have been identified as a potential trigger for rheumatoid arthritis. Toxins released by military burn pits can be the cause of such environmental factors.
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What are Military Burn Pits?
Military burn pits are large areas of land where waste was incinerated by the military and its contractors. The United States Military used burn pits as part of itswaste disposal protocolin places such as Iraq and Afghanistan in the post-9/11 era. The practice was effective in reducing large quantities of waste, but the pits emitted plumes of toxic smoke. The following materials have been linked to military burn pits:
- Human waste
- Medical waste
- Other toxic chemicals
- Spoiled food
What Conditions Have Been Linked to Military Burn Pits?
At this time, there is little conclusive research on the long-term health impacts of burn pits. The main dioxin released by burn pits, called TCDD, was also one of the major toxins in Agent Orange.
VA has not established a presumption for veterans exposed to burn pits as it has for veterans exposed to Agent Orange. Since there is no presumption, VA adjudicates burn pit claims on a case-by-case basis. VA does not have a consistent approach to deciding these claims, so lay evidence from veterans is key to winning burn pit claims. Often, VA does not have a way of proving veterans were near burn pits, so statements from the veteran themselves or buddy statements can help prove exposure. The following conditions have been linked to burn pit exposure:
- Asthma diagnosed after service
- Head cancer (of any type)
- Neck cancer (of any type)
- Respiratory cancer (of any type)
- Gastrointestinal cancer (of any type)
- Reproductive cancer (of any type)
- Lymphoma cancer (of any type)
- Lymphomatic cancer (of any type)
- Kidney cancer
- Brain cancer
- Pancreatic cancer
- Chronic bronchitis
- Constrictive bronchiolitis or obliterative bronchiolitis
- Granulomatous disease
- Interstitial lung disease
- Pulmonary fibrosis
- Chronic sinusitis
- Chronic rhinitis
New Proposed Burn Pit Legislation 2021
As of 2021, there are several major bills currently pending in Congress that deal with the toxic exposure caused by burn pits. These bills include:
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- Conceding Our Veterans’ Exposure Now and Necessitating Training Act (COVENANT)
- Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
- Veterans Burn Pit Exposure Recognition Act
- Toxic Exposure in the American Military Act (TEAM)
Any of these bills, if passed, would offer needed relief to veterans suffering the toxic effects of burn pit exposure. However, none of the proposed bills include rheumatoid arthritis.
Individual Unemployability (TDIU) for Rheumatoid Arthritis
Veterans who are prevented from working because of their rheumatoid arthritis, or symptoms of their rheumatoid arthritis, may be able to receive a monthly VA disability benefit called total disability based on individual unemployability, or TDIU. This benefit compensates veterans at the 100 percent rating level, even if their disability rating may be less than that.
There are generally two pathways to become eligible for TDIU:
- 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
- One condition rated at minimum 60 percent OR
- two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent
- 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
- In this instance, the veteran must prove that their condition is uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.
Veterans with multiple conditions may have a combined rating which would make them eligible for TDIU. As a result, veterans who receive a rating for their rheumatoid arthritis may be able to receive compensation at the 100 percent rating level through TIDU.
Was Your VA Disability Claim Denied?
If your VA disability claim has been denied, it is your right to appeal that decision. The accredited VA disability lawyers and advocates at Chisholm Chisholm & Kilpatrick LTD have decades of experience successfully representing veterans before the Department of Veterans Affairs, the Court of Appeals for Veterans Claims, and the Federal Circuit. Contact us for a free, confidential consultation at 800-544-9144.
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Rheumatoid Arthritis is rated under Diagnostic Code 5002. RA can be evaluated at up to a 100 percent disability rating which is not common amongst service-connected health ailments.
To prove arthritis is service connected, a doctor may be able to determine that your history with injury in your service is likely to have caused arthritis. There still needs to be a VA disability rating for arthritis and if the VA sees a link, you may claim direct service connection.
VA Service Connection for Rheumatoid Arthritis
When filing a claim for service connection for rheumatoid arthritis, the veteran will need to demonstrate a connection between their military service and their rheumatoid arthritis. The veteran will also need to submit a diagnosis of their condition.
The Social Security Administration (SSA) considers RA a disability if a person meets the following eligibility criteria: the person's condition is so severe that they will need to be out of work for 12 months or more. the person has gained enough work credits to qualify for disability benefits.
Because arthritis is so prevalent in soldiers and veterans, the United States Department of Veterans Affairs (VA) determined that this condition is service-connected if diagnosed within a year of discharge. However, if symptoms of arthritis present in later years, you may still be eligible for VA disability.
Posttraumatic stress disorder (PTSD) and rheumatoid arthritis (RA) are sometimes linked. In fact, PTSD has been found to be associated with a wide range of negative physical health conditions, including cardiac disease, diabetes, cancer, headaches, chronic pain, and arthritis.
Military personnel on active duty face physically taxing work and environments that put their bodies under extreme stress. As a result, they often develop arthritis at a younger age and at a higher rate than civilians, according to a 2011 study published in Arthritis and Rheumatism.
Your rheumatologist will order blood tests and imaging tests. The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include: Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
- Lay Evidence. A lay statement is a written statement from a veteran, family member, friend, or coworker that can be submitted to VA in support of a veteran's claim. ...
- VA Hearings. ...
- Employment Records. ...
- Medical Records. ...
- Additional Examples of Evidence.
Rheumatoid arthritis is not recognized by VA as etiologically related to exposure to herbicides, such as Agent Orange, which were used in the Republic of Vietnam during the Vietnam Era.
The most common rating VA assigns for limitation of flexion of the knee is 10 percent, although the highest rating a veteran can receive is 30 percent.
Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. Rheumatoid arthritis is a disease in which the immune system attacks the joints, beginning with the lining of joints.