Evidence checklist

Osteoporosis

DC 501338 CFR § 4.71aMusculoskeletal

Evidence strength

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Target

Saved locally

Specialist opinion

Highest value

DEXA scan (dual-energy X-ray absorptiometry) with T-score resultsCritical

Bone mineral density results from DEXA scan documenting T-scores at the lumbar spine, femoral neck, and/or total hip. T-score of -2.5 or below confirms osteoporosis; -1.0 to -2.5 indicates osteopenia.

Private provider · independent opinion

Nexus opinion linking osteoporosis to service-connected condition or medication ("at least as likely as not")Critical

A medical opinion connecting osteoporosis to a service-connected condition (e.g., hypogonadism from TBI, malnutrition, PTSD medications such as long-term steroids) or establishing it as secondary to a primary service-connected disease.

Private provider · independent opinion

Treating physician

Laboratory workup (calcium, vitamin D, PTH, testosterone/estradiol)

Lab results evaluating secondary causes of osteoporosis including calcium, 25-OH vitamin D, parathyroid hormone, and sex hormone levels.

Your treating provider · written request

Treatment records

Documentation of osteoporotic fractures (vertebral, hip, wrist)Critical

Records of fragility fractures attributable to osteoporosis, including vertebral compression fractures on spine imaging, hip fractures, or distal radius fractures that occurred with minimal trauma.

VA or private records · written request

Documentation of bone-active medications (bisphosphonates, teriparatide)

Records showing prescription of bone-strengthening medications and the rationale for treatment, reflecting the severity of the condition.

VA or private records · written request

Lay statements

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →

Benefits questionnaire

Completed DBQ Musculoskeletal ConditionsCritical

Standardized form capturing bone density findings, fracture history, and functional limitations. Rate under the most limiting fracture or musculoskeletal manifestation.

Provider-completed · VA DBQ formHow to get this →

Service records

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180

Condition guideRating criteria and what VA looks for C&P exam prepWhat the examiner will ask Buddy statement builderGuided VA Form 21-10210

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