Avascular Necrosis (Osteonecrosis)

DC 5250Musculoskeletal38 CFR 4.71a, DC 5250

Death of bone tissue due to loss of blood supply, most commonly affecting the hip. Avascular necrosis can lead to joint collapse and severe arthritis. When the hip joint is severely damaged, the VA may rate based on ankylosis of the hip if the joint becomes functionally immobile.

How the VA rates this condition

The VA rates this condition based on objective clinical measurements and test results. The examiner will use standardized tests or lab values to determine the severity of your condition rather than relying primarily on subjective symptom reports.

Diagnostic code

DC 5250

Rating range

60% – 90%

Rating levels

Rating criteria are defined in 38 CFR 4.71a, DC 5250. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

You have avascular necrosis resulting in extremely unfavorable ankylosis of the hip. The hip is fixed in a position that makes sitting, standing, and walking extremely difficult or impossible, such as extreme abduction, flexion beyond 45 degrees, or any combination with other unfavorable positions.

What the VA looks for

Complete femoral head collapse on imaging
Hip ankylosed in extremely unfavorable position
Flexion fixed at 45 degrees or more
Near-total disability in ambulation and daily function

Common Pitfalls

⚠Not getting early MRI imaging — avascular necrosis is often invisible on X-rays in early stages but clearly visible on MRI, and early documentation strengthens the service connection claim.
⚠Not documenting the progressive nature of the condition — avascular necrosis typically worsens over time, and serial imaging showing progression supports increased compensation.
⚠Not considering whether total hip replacement has occurred or is planned — if a joint replacement is performed, the rating may change to DC 5054 (hip replacement) with different criteria.
⚠Failing to file for secondary conditions — avascular necrosis of one hip frequently causes compensatory problems in the opposite hip, knees, and lumbar spine.

Related DBQ Forms

DBQ Hip and Thigh Conditions

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

Avascular Necrosis (Osteonecrosis)

How the VA rates this condition

Diagnostic code

DC 5250

Rating range

60% – 90%

Rating levels

Rating Levels

What the VA looks for

Complete femoral head collapse on imaging
Hip ankylosed in extremely unfavorable position
Flexion fixed at 45 degrees or more
Near-total disability in ambulation and daily function

Common Pitfalls

⚠Not getting early MRI imaging — avascular necrosis is often invisible on X-rays in early stages but clearly visible on MRI, and early documentation strengthens the service connection claim.

⚠Not documenting the progressive nature of the condition — avascular necrosis typically worsens over time, and serial imaging showing progression supports increased compensation.

⚠Not considering whether total hip replacement has occurred or is planned — if a joint replacement is performed, the rating may change to DC 5054 (hip replacement) with different criteria.

⚠Failing to file for secondary conditions — avascular necrosis of one hip frequently causes compensatory problems in the opposite hip, knees, and lumbar spine.