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Nexus Letters for Hip Pain
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA musculoskeletal evaluations and independent medical opinions • Last updated: June 2026
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Hips take years of marching, rucking, and hard landings. The damage often shows up later as stiffness, a limp, or arthritis. Many hip claims get denied because the wear was never tied to service on paper.
A nexus letter can fix that. Our physicians connect your hip condition to your service, or to another joint that changed how you walk, in the language the VA expects. One flat fee of $1,500, and the first consultation is free.
How VA Rates the Hip (DC 5252)
VA rates most hip claims under 38 C.F.R. § 4.71a, DC 5252, by how far you can raise your thigh, called hip flexion. A normal hip bends to about 125 degrees. Less motion means a higher rating.
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 10% | Thigh raises only to about 45 degrees; or painful motion (4.59); or you cannot cross your legs or turn the leg outward (DC 5253).Most Common | ~$180/mo |
| 20% | Thigh raises only to about 30 degrees; or you cannot move the leg outward past about 10 degrees (DC 5253). | ~$357/mo |
| 30% | Thigh raises only to about 20 degrees. | ~$552/mo |
| 40% and up | Thigh raises only to about 10 degrees; a fused hip (ankylosis, DC 5250) or severe femur damage (DC 5255) is rated 60% and up. | ~$796/mo+ |
Hip motion in other directions is also rated under DC 5253: not being able to move the leg outward past about 10 degrees is 20%, and not being able to cross your legs or to toe-out past 15 degrees is 10%. A fused hip (ankylosis) is rated 60% to 90%, and a flail or badly fractured hip can be rated up to 80% under DC 5254 and DC 5255. A hip replacement is rated 100% for a year, then a minimum of 30% (DC 5054).
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
Estimate your likely hip rating
This estimates your likely hip rating from how far you can raise your thigh. A doctor measures this at an exam, so treat it as a rough guide, not a rating.
Making a VA Disability Claim for Hip Conditions
When you file a VA disability claim for your hip, three things need to line up:
A current diagnosis
A diagnosed hip condition, usually backed by an exam and imaging such as an X-ray or MRI.
A service connection
Either a hip injury or repeated strain in service, or a link to another service-connected joint that changed how you walk.
A medical nexus
A qualified opinion that the hip condition is 'at least as likely as not' connected to your service.
The nexus is where most hip claims fall apart, especially when the wear built up slowly and was never logged. A nexus letter supplies it: a written medical opinion tying your hip to your service. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect Your Hip to Service
There are a few ways to tie a hip condition to your service. For the hip, the secondary path from an altered gait is one of the most common.
Direct connection
A hip injury or repeated strain happened in service.
- A specific injury. A fall, a hip fracture, or a hard landing.
- Wear and tear. Years of marching, rucking, and running. A sick-call visit in your records helps a lot.
Secondary connection
Another service-connected condition changed how you walk and overloaded the hip (38 C.F.R. § 3.310).
- Altered gait. A bad back, knee, ankle, or foot makes you walk differently, which strains the hip over time.
- Leg-length difference. An uneven stride loads one hip harder than the other.
Aggravation
You had hip problems before service, and service made them permanently worse.
- Worsened by service. Symptoms got worse during active duty, beyond normal aging.
Secondary Conditions
Hip problems rarely stop at the hip. These links can add to your combined rating, so they are worth documenting.
A hip condition may be secondary to
- Back conditions. An altered stride from the back loads the hips.
- Knee, ankle, or foot conditions. A changed gait from a lower-limb joint strains the hip.
- Leg-length difference. An uneven stride loads one hip more than the other.
Conditions that may be secondary to a hip
- The back and the other hip. A limp from one hip strains the back and the opposite hip.
- The knees. Walking differently to protect the hip loads the knees over time.
- Depression or anxiety. Chronic pain and lost mobility wear on mood and can be claimed as secondary.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. Tick each off as you go.
Frequently Asked Questions
How does the VA rate the hip?
Mainly by how far you can raise your thigh, called hip flexion, under 38 C.F.R. 4.71a, DC 5252. Motion in other directions is rated under DC 5253, and a fused or replaced hip is rated under nearby codes.
Can a hip be secondary to another condition?
Yes, and it is common. A service-connected back, knee, ankle, or foot that changed how you walk can strain the hip over time. That is a secondary claim under 38 C.F.R. 3.310.
Does hip pain alone get a rating?
Yes. Under 38 C.F.R. 4.59, painful motion earns at least the minimum rating, usually 10%, even if your motion looks near-normal. The VA should also account for weakness, fatigue, and flare-ups.
What if my hip was replaced?
A hip replacement is rated 100% for one year after surgery, then drops to a minimum of 30%, higher if pain or weakness remains (DC 5054). Keep your surgery records.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help.
Miles of marching wear the hips. Let your records show it.
Let our physicians prepare a hip nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 38 CFR 4.71a, Schedule of ratings, musculoskeletal system, including the hip and thigh codes (eCFR) https://www.ecfr.gov/current/title-38/section-4.71a
- 38 CFR 4.40, Functional loss (eCFR) https://www.ecfr.gov/current/title-38/section-4.40
- 38 CFR 4.45, The joints (eCFR) https://www.ecfr.gov/current/title-38/section-4.45
- 38 CFR 4.59, Painful motion (eCFR) https://www.ecfr.gov/current/title-38/section-4.59
- 38 CFR 3.303, Principles relating to service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.303
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107