VA Rating for Femur Impairment, Fractures, and Malunion: DC 5255

Diagnostic Code 5255 addresses severe structural failure of the thigh bone following traumatic fracture of the shaft or anatomical neck. Nonunion occurs when fractured bone fragments fail to heal together. Under current 38 CFR 4.71a criteria, nonunion of the shaft or anatomical neck with loose motion (spiral or oblique fracture) is assigned an 80% evaluation. Nonunion without loose motion, where weight bearing is preserved with the aid of a brace, is assigned a 60% evaluation. Fracture of the surgical neck of the femur with a false joint (pseudoarthrosis) is also assigned a 60% evaluation.

Malunion occurs when a fractured femur heals in an abnormal alignment, causing rotational deformity, angulation, or altered joint biomechanics. The current rating schedule does not assign a single static percentage to malunion. Instead, DC 5255 explicitly instructs that malunion of the femur be evaluated under the applicable knee or hip diagnostic codes, whichever yields the highest evaluation. Rating specialists review whether the altered femur alignment limits hip flexion (DC 5252), knee flexion (DC 5260), or knee extension (DC 5261), selecting the most favorable rating.

Diagnostic Code 5275 is frequently misunderstood. It is not an arthritis code. DC 5275 specifically evaluates shortening of the bones of the lower extremity based on measured physical shortening. Ratings are assigned on a calibrated scale: 1 1/4 to less than 2 inches receives 10%, 2 to less than 2 1/2 inches receives 20%, 2 1/2 to less than 3 inches receives 30%, 3 to less than 3 1/2 inches receives 40%, 3 1/2 to 4 inches receives 50%, and over 4 inches receives 60%. Hip arthritis must be rated under arthritis codes (DC 5002 or 5003) or joint motion codes, not DC 5275.

Because the femur links the pelvis to the lower leg, malunion or nonunion creates substantial abnormal stresses along the kinetic chain. Angulation or limb shortening disrupts normal gait, forcing compensatory pelvic tilt and lateral spinal curvature. These mechanics frequently cause secondary osteoarthritis in the ipsilateral or contralateral knee, lumbar disc disease, or trochanteric bursitis, which may be claimed as secondary conditions under 38 CFR 3.310.

Claims under DC 5255 require definitive orthopedic documentation. Serial radiographs or CT scans confirming failure of bony bridging, pseudoarthrosis, or mechanical axis deviation are critical. Operative reports detailing internal fixation, intramedullary rodding, or bone grafting establish surgical history. For shortening claims, the record must contain calibrated scanogram measurements or tape measurements from the anterior superior iliac spine to the medial malleolus.