Ankylosis VA Disability: 2026 Ratings & Service Connection Guide

Ankylosis VA Disability: 2026 Ratings, Service Connection & How to File

Ankylosis is the immobilization and consolidation of a joint due to disease, injury, or surgical procedure. VA rates ankylosis under diagnostic codes specific to each joint, ranging from 10% to 100% depending on the joint affected and whether the fixation is in a favorable or unfavorable position.

Quick Facts

What Is Ankylosis?

Ankylosis is the immobilization and consolidation of a joint due to disease, injury, or surgical procedure. It is the permanent stiffening or fixation of a joint.

What it is: Ankylosis occurs when the bones of a joint fuse together, eliminating the joint’s range of motion. This can be caused by trauma, infection, inflammatory arthritis, or intentional surgical fusion (arthrodesis) performed to stabilize a damaged joint.

Who qualifies: Veterans who developed ankylosis during military service or as a secondary condition to a service-connected disability. National Guard and Reserve members with qualifying service may also be eligible.

Why it matters: Ankylosis is a severe disability that affects mobility, dexterity, and quality of life. VA compensation provides tax-free monthly income to help veterans manage the financial impact of this permanent condition.

What veterans should do next: If you have a diagnosis of ankylosis in any joint, gather your medical records and file a claim using VA Form 21-526EZ. Document the specific joint affected and whether the fixation is in a favorable or unfavorable position.

How VA Rates Ankylosis: Favorable vs. Unfavorable

VA distinguishes between favorable ankylosis and unfavorable ankylosis when assigning disability ratings. The position of the fused joint determines which category applies.

Favorable Ankylosis

Favorable ankylosis is fixation of a joint in a functional, neutral position. For spinal segments, fixation in a neutral position (zero degrees) always represents favorable ankylosis.

For joints, favorable ankylosis means the joint is fixed in a position that allows for some functional use. The specific criteria vary by joint:

• Spine: Fixation in neutral position (zero degrees)

• Knee: Full extension or slight flexion between 0° and 10°

• Shoulder: Abduction to 60 degrees with the ability to reach the mouth and head

• Ankle: Fixation in a favorable weight-bearing position

Unfavorable Ankylosis

Unfavorable ankylosis is fixation of a joint in a non-functional or severely limiting position. For the spine, unfavorable ankylosis is defined as a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following:

• Difficulty walking because of a limited line of vision

• Restricted opening of the mouth and chewing

• Breathing limited to diaphragmatic respiration

• Gastrointestinal symptoms due to pressure of the costal margin on the abdomen

• Dyspnea or dysphagia

• Atlantoaxial or cervical subluxation or dislocation

• Neurologic symptoms due to nerve root stretching

For the knee, unfavorable ankylosis means the knee is fixed in flexion between 10° and 45° or more.

VA Ratings for Ankylosis by Body Part

VA rates ankylosis under diagnostic codes specific to each joint. The rating depends on the joint affected and the position of fixation.

Ankylosis of the Spine

VA rates spinal ankylosis under the General Rating Formula for Diseases and Injuries of the Spine (38 C.F.R. § 4.71a, Diagnostic Codes 5235–5243).

Important: The cervical spine and thoracolumbar spine are rated separately, except when there is unfavorable ankylosis of both segments.

Ankylosis of the Knee (DC 5256)

VA rates ankylosis of the knee under Diagnostic Code 5256.

Ankylosis of the Shoulder (DC 5200)

VA rates ankylosis of the shoulder under Diagnostic Code 5200.

Ankylosis of the Ankle (DC 5270)

VA rates ankylosis of the ankle under Diagnostic Code 5270.

Ankle tendonitis is also rated according to ankylosis of the ankle under DC 5270.

Ankylosis of the Hip (DC 5250)

VA rates ankylosis of the hip under Diagnostic Code 5250. Ratings range based on the position of fixation:

Ankylosis of the Elbow (DC 5205)

VA rates ankylosis of the elbow under Diagnostic Code 5205. Ratings depend on the angle of fixation and whether the arm is dominant or non-dominant.

Ankylosis of the Hand and Fingers

VA rates ankylosis of the hand and fingers under multiple diagnostic codes, including:

• DC 5216 — Five digits of one hand, unfavorable ankylosis: 60% (dominant), 50% (non-dominant)

• DC 5217 — Four digits of one hand, unfavorable ankylosis: 40%–60%

• DC 5219 — Two digits of one hand, unfavorable ankylosis: 20%–40%

• DC 5225 — Ankylosis of index finger: 10%

Ankylosis of the Subastragalar or Tarsal Joint (DC 5272)

VA rates ankylosis of the subastragalar or tarsal joint under Diagnostic Code 5272. Ratings range up to 20% depending on the severity of fixation.

How to Establish Service Connection for Ankylosis

Service connection for ankylosis can be established through three pathways: (1) direct service connection, (2) secondary service connection, or (3) presumptive service connection (limited circumstances).

Pathway 1: Direct Service Connection

Direct service connection requires evidence that ankylosis began during or was aggravated by military service. This is the most straightforward pathway for veterans whose ankylosis resulted from an in-service injury, infection, or surgical procedure.

What you need:

• Current diagnosis of ankylosis from a qualified provider

• In-service event, injury, or disease that caused or aggravated ankylosis

• Medical nexus linking the two

Common in-service causes: Traumatic joint injuries, infections (septic arthritis, tuberculosis), surgical fusions performed during service, and inflammatory arthritis that began in service.

Pathway 2: Secondary Service Connection

Secondary service connection applies when ankylosis is caused or aggravated by another service-connected condition. This is a common pathway for veterans whose ankylosis developed after years of altered gait, compensatory movement patterns, or progressive joint disease.

Examples of secondary service connection for ankylosis:

• Ankle ankylosis causing knee or hip arthritis: An altered gait from a service-connected ankle condition places abnormal stress on the knees, hips, and lower back, often leading to secondary arthritis and ankylosis.

• Hip ankylosis causing lumbar strain: Common secondaries include lumbar strain, contralateral hip pain/osteoarthritis, and knee pain/knee osteoarthritis due to gait alteration.

• Spinal ankylosis causing radiculopathy: Neurologic abnormalities, including bowel or bladder impairment and radiculopathy, are evaluated separately from the spine rating.

What you need:

• Service-connected condition (the primary disability)

• Current diagnosis of ankylosis in the secondary joint

• Nexus letter from a qualified provider stating ankylosis is “at least as likely as not” caused by or aggravated by the service-connected condition

Pathway 3: Presumptive Service Connection

Ankylosis itself is not a presumptive condition under the PACT Act. However, veterans with toxic exposures may be able to service-connect ankylosis on a direct or secondary basis if a medical nexus can be established. For example, ankylosing spondylitis (a form of inflammatory arthritis that causes spinal ankylosis) may be service-connected under DC 5240 with a medical nexus linking it to service.

VA Diagnostic Codes for Ankylosis

Source: 38 C.F.R. § 4.71a

Required VA Forms for an Ankylosis Claim

How to Complete VA Form 21-526EZ for Ankylosis

1. Section I — Provide your identifying information (name, SSN, contact info)

2. Section II — List your service information

3. Section III — Check “Yes” for “Are you claiming a disability?”

4. Section V — List ankylosis as your claimed condition. Be specific: “Ankylosis of the left knee, DC 5256” or “Ankylosis of the lumbar spine secondary to service-connected ankle condition.”

5. Section VI — Provide direct deposit information

6. Sign and date — Unsigned claims will be returned

Common mistake: Veterans often list only the primary condition and forget to explicitly claim ankylosis as a secondary condition. Always list every condition you are claiming on the 21-526EZ.

The C&P Exam for Ankylosis

A Compensation and Pension (C&P) exam is VA’s evaluation of your claimed condition. For an ankylosis claim, the examiner will evaluate both the severity of your condition and its connection to service (if secondary).

What to Expect

1. Review of medical history — The examiner will review your service records and medical history

2. Completion of the joint-specific DBQ — The examiner will document findings on the appropriate DBQ form

3. Range of motion measurements — The examiner will use a goniometer to measure joint angles

4. Ankylosis assessment — The examiner will document whether ankylosis is present, which joint is affected, and whether the fixation is favorable or unfavorable

5. Functional impact — How ankylosis affects your ability to work and perform daily activities

C&P Exam Tips for Ankylosis

• Bring your records — If the examiner does not have them, bring copies of your treatment notes, imaging studies, and surgical reports

• Be specific about the joint — Identify exactly which joint is affected and describe the position of fixation

• Describe functional limitations — Explain how the fused joint affects walking, sitting, standing, lifting, and other daily activities

• Mention all symptoms — Include pain, weakness, and any neurologic symptoms in other areas caused by altered movement patterns

• Don’t minimize — Veterans often downplay symptoms. Be honest about how ankylosis affects your daily life

Common Mistakes Veterans Make With Ankylosis Claims

Mistake 1: Assuming all ankylosis is rated the same. VA rates ankylosis differently depending on the joint affected and whether the fixation is favorable or unfavorable. A knee ankylosis rating is different from a spine ankylosis rating.

Mistake 2: Failing to claim secondary conditions caused by ankylosis. Ankylosis in one joint often causes compensatory problems in other joints. For example, ankle ankylosis can lead to knee, hip, and lower back arthritis. Always claim secondary conditions.

Mistake 3: Not documenting functional loss during flare-ups. VA must consider functional loss due to pain, weakness, and fatigability under 38 C.F.R. §§ 4.40 and 4.45. Even if range of motion appears normal on exam day, you may be entitled to a higher rating based on functional loss.

Mistake 4: Submitting a weak or generic nexus letter. A nexus letter that merely states “the veteran has ankylosis” without explaining the causal link to service is worthless. The letter must specifically state “at least as likely as not” and provide medical rationale.

Mistake 5: Missing the C&P exam. If you miss your C&P exam without good cause, VA may deny your claim. If you cannot attend, reschedule immediately.

Mistake 6: Not appealing a denial. Many ankylosis claims are denied initially but granted on appeal. Do not give up after a denial. File a Supplemental Claim with new evidence or a Higher-Level Review.

Appeals Process: What to Do If Your Ankylosis Claim Is Denied

If VA denies your ankylosis claim or assigns a rating lower than expected, you have three appeal options:

1. Supplemental Claim (VA Form 20-0995) — Submit new and relevant evidence. This is the most common path for ankylosis denials. A stronger nexus letter or additional medical records can support your claim.

2. Higher-Level Review (VA Form 20-0996) — Request a review by a senior VA rater based on the existing record. No new evidence is allowed.

3. Board Appeal (VA Form 10182) — Appeal to the Board of Veterans’ Appeals. You can choose a direct review, evidence submission, or hearing.

Deadline: You have one year from the date of your decision letter to file an appeal and preserve your original effective date.

Ankylosis and Special Monthly Compensation (SMC)

Veterans with extremely unfavorable ankylosis may qualify for Special Monthly Compensation (SMC). SMC is a higher rate of compensation paid in addition to basic disability compensation for certain severe disabilities.

SMC-K for Loss of Use

SMC-K is paid for loss of use of a creative organ, a hand, a foot, or other specified body parts. For example:

• Ankylosis of the knee with extremely unfavorable position may constitute loss of use of the foot, making the veteran eligible for SMC-K.

• Loss of use of a foot is held to exist when no effective function remains other than that which would be equally well served by an amputation stump with a suitable prosthetic appliance.

Other SMC Levels

Higher SMC levels (L, M, N, O, R.1, R.2) may be available for veterans who need aid and attendance or who have severe disabilities. If you believe you qualify for SMC, file a claim with medical evidence supporting the higher level of impairment.

Treatment Options for Ankylosis

Treatment for ankylosis depends on the underlying cause and the joint affected.

General Treatment Approaches

• Physical therapy — Maintains joint function and prevents further loss of motion

• Range of motion exercises — Keeps the joint in a functional position

• Surgical intervention — If ankylosis was surgically created (arthrodesis), the joint is kept immobilized in correct body alignment for 6 to 12 weeks until the bone is healed

• Medications — Treat underlying conditions such as arthritis that contribute to ankylosis

VA Healthcare for Ankylosis

Veterans with service-connected ankylosis are eligible for VA healthcare. Treatment may include:

• Orthopedic consultations

• Physical therapy and occupational therapy

• Pain management

• Prosthetics and adaptive equipment

• Surgical consultation for joint replacement or fusion

What veterans should do: If you are enrolled in VA healthcare, discuss ankylosis treatment options with your VA primary care provider. You may be referred to an orthopedic specialist or physical therapist.

Common Questions

Q: What is ankylosis and how does VA rate it?

Ankylosis is the permanent stiffening or fixation of a joint due to disease, injury, or surgery. VA rates ankylosis under diagnostic codes specific to each joint, with ratings ranging from 10% to 100% depending on the joint and whether fixation is favorable or unfavorable.

Q: What is the difference between favorable and unfavorable ankylosis?

Favorable ankylosis is fixation in a functional, neutral position. Unfavorable ankylosis is fixation in a non-functional or severely limiting position. For the spine, fixation in a neutral position (zero degrees) is always favorable. Unfavorable spinal ankylosis causes difficulty walking, breathing limitations, or neurologic symptoms.

Q: What is the VA rating for ankylosis of the knee?

VA rates knee ankylosis under DC 5256: 60% for fixation at 45° or more, 50% for 20°–45°, 40% for 10°–20°, and 30% for favorable ankylosis (0°–10°).

Q: What is the VA rating for ankylosis of the spine?

Unfavorable ankylosis of the entire spine warrants a 100% rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50% rating. Favorable ankylosis of the entire thoracolumbar spine or forward flexion of 30° or less warrants a 40% rating.

Q: Can ankylosis be service-connected as a secondary condition?

Yes. Ankylosis can be service-connected as secondary to another service-connected condition. For example, ankle ankylosis can cause knee or hip arthritis, and hip ankylosis can cause lumbar strain. A nexus letter linking the ankylosis to the primary service-connected condition is required.

Q: What VA forms do I need for an ankylosis claim?

You need VA Form 21-526EZ (Application for Disability Compensation). Your provider will complete a joint-specific DBQ. You may also need VA Form 21-4142 (Authorization to Disclose Information) and VA Form 21-4138 (Statement in Support of Claim).

Q: How long does an ankylosis claim take?

Initial claims take an average of 125–150 days. Supplemental claims average 60–120 days. Appeals to the Board of Veterans’ Appeals can take one to three years.

Q: Can I get SMC for ankylosis?

Yes. Extremely unfavorable ankylosis of the knee may constitute loss of use of the foot, making the veteran eligible for SMC-K. Higher SMC levels may be available for veterans who need aid and attendance.

Q: What if my ankylosis claim is denied?

You can file a Supplemental Claim with new evidence (like a stronger nexus letter), request a Higher-Level Review, or appeal to the Board of Veterans’ Appeals within one year.

Q: Is ankylosis a presumptive condition under the PACT Act?

No. Ankylosis is not on the PACT Act presumptive list. However, veterans with toxic exposures may be able to service-connect ankylosis on a direct or secondary basis with a medical nexus.

Key Takeaways

• Ankylosis is the immobilization and consolidation of a joint due to disease, injury, or surgical procedure.

• VA rates ankylosis under diagnostic codes specific to each joint, with ratings from 10% to 100%.

• Favorable ankylosis is fixation in a functional position; unfavorable ankylosis is fixation in a non-functional position.

• Spinal ankylosis ratings: 100% for entire spine, 50% for thoracolumbar spine, 40% for favorable ankylosis.

• Knee ankylosis ratings range from 30% (favorable) to 60% (45° or more).

• Ankylosis can be service-connected directly or secondary to another service-connected condition.

• A nexus letter using “at least as likely as not” language is critical for secondary claims.

• File VA Form 21-526EZ and explicitly list ankylosis as a claimed condition with the specific joint and diagnostic code.

• Secondary conditions caused by ankylosis (e.g., knee arthritis from ankle ankylosis) should also be claimed.

• Appeals must be filed within one year of a denial to preserve the effective date.

Official Resources

• VA Disability Compensation: va.gov/disability

• VA Form 21-526EZ: va.gov/find-forms/about-form-21-526ez

• VA Form 20-0995 (Supplemental Claim): va.gov/find-forms/about-form-20-0995

• VA Form 20-0996 (Higher-Level Review): va.gov/find-forms/about-form-20-0996

• Board of Veterans’ Appeals: va.gov/decision-reviews

• 38 C.F.R. § 4.71a (Musculoskeletal Ratings): ecfr.gov

• 38 C.F.R. § 3.310 (Secondary Service Connection): ecfr.gov

• VA PACT Act Information: va.gov/pact