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Osteoporosis

A condition where your bones become weak and brittle, making them more likely to break. 38 CFR 4.71a directs that DC 5013 be evaluated AS DEGENERATIVE ARTHRITIS, based on limitation of motion of the affected parts — so bone density alone does not produce a rating. What produces a rating is what the weakened bone has DONE: painful or limited motion of a joint, or a pathological fracture whose residuals limit motion. Vertebral compression fractures, the most common osteoporotic fracture, are rated on the General Rating Formula for Diseases and Injuries of the Spine.

Code: 5013
Criteria: 38 CFR 4.71a, DC 5013 (evaluated as degenerative arthritis on limitation of motion); General Rating Formula for Diseases and Injuries of the Spine; 38 CFR 4.59
Exam length: ~30 minutes
Form: Bone Conditions DBQ

Rating steps

0%
10%
20%
30%
40%
50%
100%

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will review your DEXA scan results (T-scores), fracture history, and risk factors including military-related causes such as prolonged corticosteroid use or physical demands.
You will be asked about any fragility fractures (fractures from minimal trauma) you have experienced and their impact on your function.
The examiner will assess your posture, noting any height loss, thoracic kyphosis (dowager's hump), or other skeletal deformity from vertebral compression fractures.
Range of motion of the spine and other affected areas may be tested if compression fractures or deformity are present.
You will be asked about your current medications, calcium/vitamin D supplementation, activity modifications, and fall risk.

What the examiner is actually filling in

01DEXA scan T-scores at the spine, hip, and forearm — values at or below -2.5 confirm osteoporosis diagnosis.
02History and documentation of fragility fractures, their locations, and residual functional impairment from each.
03Spinal examination for kyphotic deformity, vertebral body height loss, and resulting limitation of spinal motion.
04Current medication regimen and whether the condition requires continuous treatment to prevent fractures.
05Activity restrictions including weight-bearing limitations, fall risk assessment, and impact on occupational functioning.

Rated under 38 CFR 4.71a, DC 5013 (evaluated as degenerative arthritis on limitation of motion); General Rating Formula for Diseases and Injuries of the Spine; 38 CFR 4.59. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

If you have lost height over the years, report this with specific measurements — "I was 5 foot 10 when I enlisted and I am now 5 foot 8" indicates vertebral compression.
Describe your physician-imposed restrictions in detail: "I cannot lift more than 15 pounds, cannot do sit-ups or crunches, and must avoid any activity with fall risk."
If you have had fragility fractures, describe each one including how it happened — "I fractured my wrist just from catching myself on a countertop" shows the severity of bone loss.
Report medication side effects — bisphosphonates can cause GI problems, musculoskeletal pain, and osteonecrosis of the jaw, all of which add to your disability burden.
Mention the psychological impact: fear of fracture affecting daily activities, avoidance of stairs, reluctance to walk in icy conditions, and social withdrawal from physical activities.

What costs veterans points

Not understanding that osteoporosis alone (without fractures) may rate lower — the VA primarily rates the functional consequences such as fractures, deformity, and activity restrictions.
Failing to report vertebral compression fractures, which may have occurred silently without a specific injury — these can cause height loss and chronic back pain.
Not connecting osteoporosis to a service-related cause like prolonged corticosteroid prescriptions, hormonal changes from service-related conditions, or extreme physical training.
Minimizing activity restrictions by saying "I just have to be careful" instead of describing specific permanent limitations imposed by your physician.
Not mentioning the psychological impact of living with brittle bones — fear of falling and activity avoidance are real functional limitations.

The rating criteria, in plain language

Rating levels for Osteoporosis under 38 CFR 4.71a, DC 5013 (evaluated as degenerative arthritis on limitation of motion); General Rating Formula for Diseases and Injuries of the Spine; 38 CFR 4.59
Rating	Rating criteria	What that means for you
0%	§ 4.31 Zero percent evaluations. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.	Osteoporosis is established on DEXA and service connected, but there is no vertebral fracture and no limitation of motion of the spine or any other affected joint that reaches a compensable level. The lowest compensable rung on this ladder is 10 percent. A zero percent rating pays nothing now, but it establishes service connection and fixes the effective date any later increase runs from.
0%	What supports this level DEXA scan establishing the osteoporosis diagnosis Imaging showing no vertebral fracture Spinal and joint range of motion measured and recorded, even when normal Repeat DEXA and imaging over time, so progression has a documented history
10%	Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height.	Osteoporosis has left a joint with objectively painful motion, or with limitation of motion that is not compensable under that joint's own code. 38 CFR 4.59 makes 10 percent the minimum for the joint. A vertebral body fracture with loss of 50 percent or more of the height also reaches 10 percent on its own under the spine formula.
10%	What supports this level DEXA scan showing osteoporosis (T-score of -2.5 or below) Objective evidence of painful motion at the affected joint Imaging showing a vertebral body fracture, with percentage height loss stated Range of motion measured for every affected joint or spinal segment
20%	Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.	Osteoporotic fracture residuals have left forward flexion of the thoracolumbar spine between 30 and 60 degrees, or muscle spasm or guarding severe enough to produce an abnormal gait or abnormal spinal contour such as scoliosis or abnormal kyphosis — the kyphosis of multiple vertebral compression fractures often qualifies here.
20%	What supports this level DEXA scan confirming osteoporosis Forward flexion measured and recorded Abnormal spinal contour or gait documented on examination Imaging showing one or more vertebral compression fractures
30%	Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine.	Osteoporotic fractures in the CERVICAL spine have left forward flexion of the neck at 15 degrees or less, or favorable ankylosis of the entire cervical spine. This step exists only for the cervical segment — the thoracolumbar spine has no 30 percent rung on this formula.
30%	What supports this level Imaging showing one or more cervical vertebral compression fractures Cervical forward flexion measured at 15 degrees or less Favorable ankylosis of the entire cervical spine documented Cervical and thoracolumbar segments measured separately at the same examination
40%	Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.	Osteoporotic vertebral fractures have left forward flexion of the thoracolumbar spine at 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine.
40%	What supports this level Vertebral compression fractures documented on imaging Forward flexion of 30 degrees or less measured Ankylosis of the thoracolumbar spine documented Significant functional limitation from bone fragility
50%	Unfavorable ankylosis of the entire thoracolumbar spine.	Osteoporotic fractures have produced unfavorable ankylosis of the entire thoracolumbar spine. There is no 60 percent rung on this formula — the next and last step is 100 percent.
50%	What supports this level Multiple pathological fractures documented Unfavorable ankylosis of the entire thoracolumbar spine documented Significant height loss from vertebral fractures Severe functional impairment requiring assistive devices
100%	Unfavorable ankylosis of the entire spine. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.	Osteoporotic fractures have produced unfavorable ankylosis of the ENTIRE spine — cervical and thoracolumbar together. This is the only 100 percent rung the spine formula prints, and Note (6) says the two segments are rated separately except in exactly this case, where they are rated as a single disability.
100%	What supports this level Imaging showing fusion of both the cervical and thoracolumbar segments Unfavorable ankylosis of the entire spine documented on examination Spine fixed in flexion or extension with one or more of the Note (5) consequences (difficulty walking from a limited line of vision, restricted mouth opening and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms from costal-margin pressure, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms from nerve root stretching) Both spine segments evaluated at the same examination

The middle column is our transcription of the criteria at 38 CFR 4.71a, DC 5013 (evaluated as degenerative arthritis on limitation of motion); General Rating Formula for Diseases and Injuries of the Spine; 38 CFR 4.59, condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Expecting the DEXA score itself to set the rating. It does not. DC 5013 is evaluated as degenerative arthritis on limitation of motion, so a severe T-score with full painless range of motion is a 0 percent finding. Get the DEXA scan — it establishes the diagnosis and the fracture risk — but the compensable rating comes from measured motion and from fracture residuals.

Not documenting pathological fractures — fractures caused by osteoporosis (from minimal trauma) support higher ratings. Every fracture should be on imaging.

Not connecting osteoporosis to service — osteoporosis can be secondary to medications (steroids), hormonal changes, or other service-connected conditions.

Not filing for each affected body part separately — if osteoporosis causes fractures in multiple areas (spine, hip, wrist), each area may warrant its own rating.

Not reporting the impact on daily activities — describe difficulty standing, walking, lifting, and the fear of falling that affects your quality of life.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

Tick these off as you gather them. Nothing here is required — the exam happens either way — but each one is something the examiner cannot record if it is not in front of them.

Saved in this browser only.

Take it with you

Print the whole guide — what the examiner records, the folder list with your ticks, the criteria table and the mistakes to avoid — and bring it to the appointment.

Frequently paired

Documented secondary or co-occurring conditions. Each is examined separately and has its own guide.

Free tool · 282 guides · DBQ-aligned

C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

Osteoporosis

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

Osteoporosis

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam