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The median retirement savings for Americans aged 55 to 64 is $185,000, according to the most recent Federal Reserve Survey of Consumer Finances. The average is $537,560. The space between those figures shows how a small number of high-balance households pull the average far above what most people actually have saved.
The difference between $185,000 and $537,560 can make these numbers feel alienating, like you’re either far behind the average or invisible in the data. Neither reaction is the whole story.
How you fit into this picture depends on your age, income, and account type. Below you’ll find retirement savings benchmarks broken down by age group and generation, covering 401(k)s, IRAs, and total balances, drawn from Federal Reserve data, Vanguard, Fidelity, and the Transamerica Center for Retirement Studies.
Key figures at a glance:
| Savings Type | Median / Average | Source |
| Retirement savings, ages 55–64 | $185,000 median / $537,560 average | Federal Reserve 2022 |
| Middle-class retirement savings (not yet retired) | $67,000 median | Transamerica 2025 |
| Middle-class total savings (retirees) | $253,000 median | Transamerica 2025 |
| Average 401(k) balance | $167,970 | Vanguard How America Saves 2026 |
| Average IRA balance | $137,095 | Fidelity Q4 2025 |
A note on average vs. median: Averages are usually higher than medians because a small number of very wealthy households pull the number up. The median is simply the midpoint in a set of numbers. Example: The average of 1, 5, and 10 is 5.33. The median is 5.
Use the Boldin Planner to see your own totals and projections. Try different scenarios to see how adjustments affect your long-term picture.
Retirement accounts are tax-advantaged and typically off-limits until retirement. Take money out before age 59½ and you’ll face significant tax penalties in most cases.
The Transamerica Center for Retirement Studies 2025 research, covering data through late 2024, puts the median total household retirement savings for not-yet-retired middle-class households at $67,000. That $67,000 figure sounds modest, and it is, relative to what a 26-year retirement requires. But it’s also a median, not a ceiling.
The Federal Reserve data below shows how much those numbers shift depending on where someone is in their working years. The spread between median and average above age 45 reflects how concentrated retirement wealth becomes as balances grow.
| Age Group | Median Retirement Savings | Average Retirement Savings |
| Under 35 | $18,880 | $49,130 |
| 35–44 | $45,000 | $141,520 |
| 45–54 | $115,000 | $313,200 |
| 55–64 | $185,000 | $537,560 |
| 65–74 | $200,000 | $609,230 |
| 75+ | $130,000 | $462,410 |
Source: Federal Reserve Survey of Consumer Finances (2022)
The drop after age 74 reflects drawdowns in retirement rather than a savings shortfall. Those households are spending what they accumulated over decades. The more telling pattern is the space between median and average at every age group above 45, which reflects how much the top of the distribution pulls the average up.
Retirement accounts are only part of the picture. For a fuller view that includes home equity and other assets, see average net worth by age.
Transamerica’s 2025 research puts total household savings for middle-class retirees at $253,000 (estimated median), up from $186,000 in their prior survey. Some 17% of retirees have reportedly saved at least a million dollars, while 5% of them are estimated to lack household savings entirely.
If you’re wondering where the top of the distribution actually starts, see what it takes to be among the wealthiest retirees. For more on what households hold outside retirement accounts, see how much the average household has in savings.
It’s worth noting that the $253,000 figure covers total household savings excluding home equity, which is a broader measure than retirement accounts alone. The 401(k) and IRA data below shows where those balances specifically sit.
Some 45% of workers participate in a workplace retirement plan, according to the Pension Rights Center. Vanguard’s How America Saves 2026, covering 4.6 million 401(k) accounts through year-end 2025, puts the average 401(k) balance at $167,970 and the median at $44,115. Both are new records.
The spread between those figures follows the same pattern as the Federal Reserve data above: a small number of large accounts pull the mean well above what most holders carry. For a full breakdown by age bracket and income level, see average 401(k) balance by age.
If you’re not sure how your 401(k) fits into your broader retirement picture, the Boldin Planner lets you model your balance alongside Social Security, other income sources, and projected expenses to get a clearer read on your timeline.
The Investment Company Institute reports that 36% of Americans have an IRA, with most in traditional accounts. Roth IRAs are gaining popularity, and in the right situation a Roth conversion can meaningfully cut your long-term tax bill.
Fidelity’s Q4 2025 retirement analysis puts the average IRA balance at $137,095, up 7% year over year. EBRI previously reported an average of $123,973, with accounts held 20 years or longer averaging $283,200. Time in the market explains most of that difference.
Fidelity’s generational breakdown from Q4 2024 shows where different age groups stand.
| Generation | Average IRA Balance |
| Gen Z | $6,672 |
| Millennials | $25,109 |
| Gen X | $103,952 |
| Baby Boomers | $257,002 |
| All participants (population-weighted average) |
$137,095 |
Generational figures: Fidelity Q4 2024. All-participants figure: Fidelity Q4 2025.
The savings numbers above get more useful when you think about how long they need to last. Transamerica’s 2025 research found that the middle class plans to spend 26 years in retirement (median), based on a median planned lifespan of 89. People in their 20s and 30s are planning for about three full decades of retirement.
Put that alongside the savings figures. A household retiring at 62 with the median $185,000 in retirement accounts and $1,900 a month in Social Security has a meaningful income gap to fill across 26 or more years. That gap is what retirement planning is designed to close, with drawdown strategy, account sequencing, and decisions about when to claim Social Security.
The median retirement age among middle-class retirees in their 60s is 62. That’s earlier than most people plan for. The Transamerica report found that a significant number of retirees left the workforce ahead of schedule, usually because of health or job loss rather than choice. Counting on extra working years to shore up savings is a reasonable assumption, but it isn’t guaranteed. For many households, the space between planned and actual retirement date is where savings shortfalls begin.
Social Security timing compounds this. Claiming at 62 rather than waiting until 67 or 70 means a permanently reduced monthly benefit. For the four in 10 people in their 60s who expect Social Security to be their primary income source, that decision carries real long-term weight. The average benefit at full retirement age runs about $1,900 a month. That’s enough to cover basic expenses for some households, but not a full income for most.
The Boldin Planner lets you run your specific accounts, Social Security estimate, and expected expenses together to see whether your savings are on pace for the retirement you’re actually planning.
The figures above tell you where most middle-class households stand. They can’t tell you whether you’re on track, because that depends on your retirement date, what you plan to spend, how your accounts are set up, and what Social Security will contribute to your income.
If your balances are behind the averages, that’s useful to know but it’s not the whole picture. Someone retiring at 67 with modest expenses and a pension needs a very different number than someone retiring at 60 with no defined benefit income. An informed plan accounts for that.
The Boldin Planner lets you build around your specific numbers so you can see what your retirement outlook looks like, not what the typical household’s looks like. That’s where the comparison starts being useful.
Median retirement savings in the U.S. range from $18,880 for households under 35 to $185,000 for those aged 55 to 64, according to the Federal Reserve’s 2022 Survey of Consumer Finances. The median drops to $130,000 for households 75 and older, which reflects spending down in retirement rather than lower lifetime savings. Averages run significantly higher at every age group because a small number of high-balance households pull the mean up.
The average 401(k) balance was $167,970 at year-end 2025, with a median of $44,115, according to Vanguard’s How America Saves 2026 report. For a full breakdown by age bracket and income level, see average 401(k) balance by age.
The average IRA balance reached $137,095 in Q4 2025, up 7% year over year, according to Fidelity. Accounts held for 20 years or longer average $283,200, according to EBRI, a figure that reflects the compounding effect of sustained long-term saving.
Middle-class households not yet retired have saved a median of $67,000 in total household retirement accounts, according to 2025 Transamerica Center for Retirement Studies research covering data through late 2024. Middle-class retirees report a median of $253,000 in total household savings excluding home equity, a figure that reflects a full working lifetime of accumulation.
Middle-class households plan to spend 26 years in retirement (median), based on a median planned lifespan of 89, according to 2025 Transamerica Center for Retirement Studies research. The median actual retirement age among middle-class retirees in their 60s is 62. That’s earlier than most people plan for, often due to health or job loss rather than choice.
The right retirement savings target depends on when you plan to retire, what you expect to spend, how your accounts are structured, and what role Social Security will play in your income. Modeling your own numbers against your own retirement timeline gives a far more accurate picture than any national average can.
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Authentic Mexican recipes inspired by family traditions
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Most people think financial success comes down to income, investments, taxes, or spending habits.
Those things matter. But beneath every financial decision is something even more powerful: your beliefs.
Beliefs shape what you notice, what you ignore, what opportunities you pursue, and what risks you’re willing to take. They influence whether you save, invest, retire, work longer, spend more, spend less, seek advice, or avoid planning altogether.
In many ways, your financial future is built not just on your money, but on the stories you tell yourself about money.
Most self-help books focus on two things:
Nir Eyal, author of Beyond Belief: The Science-Backed Way to Stop Limiting Yourself and Achieve Breakthrough Results, argues that there is a third ingredient that is often missing: belief (will this work for me). Without belief, people don’t follow through, even when they know exactly what to do.
Eyal’s book is about how the beliefs we hold shape what we perceive, attempt, and ultimately achieve. And, how changing our beliefs can change our lives. The central idea is simple. Beliefs are not truths, they’re tools.
Throughout the book, Eyal argues that beliefs influence us in three major ways:
Our brains don’t passively record reality. They filter it. If you believe opportunities are scarce, you’ll notice obstacles. If you believe opportunities exist, you’ll notice possibilities. The same environment can look completely different depending on your beliefs.
Expectations affect performance, health, pain, motivation, and even aging.
Eyal draws on research around placebo effects and expectancy effects to show that what we anticipate influences what we actually experience.
People who believe they can influence outcomes persist longer, recover faster from setbacks, and take more action.
People who see themselves as powerless often stop trying before they’ve truly tested their limits.
Every day, people make financial decisions based on beliefs they rarely stop to examine. Some common examples:
These beliefs often feel like facts. But many are assumptions, interpretations, or conclusions drawn from past experiences. And because they feel true, they influence behavior.
Someone who believes they’re bad with money may avoid looking at their finances altogether. If you think retirement is impossible, you may never build a plan. And, if you presume that investing involves too much risk, you might leave too much cash on the sidelines for decades.
Beliefs often shape the future more than we realize.
One of the most powerful benefits of financial planning isn’t that it tells you what to do. It’s that it helps you test your beliefs.
We see thousands of people every month who come to Boldin thinking that retirement will be a challenge and years away. Most find that they are better prepared than they think and that an earlier retirement is possible.
Great discoveries are made possible because they took the time to build and test a financial plan.
Many people approach retirement carrying beliefs that have never been challenged. Some of those concerns may be valid. But many aren’t.
A financial plan turns assumptions into questions.
Planning allows you to replace fear, hope, and guesswork with evidence.
At Boldin, we’ve seen thousands of people discover that their biggest obstacle wasn’t a lack of money.
It was a limiting belief.
People often compare themselves to headlines, friends, or arbitrary retirement targets.
But retirement readiness isn’t determined by a single number. It’s determined by the relationship between your resources, your spending, your goals, and your time horizon.
Many people are in far better shape than they think. Others discover opportunities to improve their outlook that they never knew existed.
Either way, the answer starts with understanding reality, not assuming the worst.
The truth is that certainty doesn’t exist.
Nobody knows how long they’ll live, what markets will do, or what future legislation may bring.
Successful retirement isn’t about eliminating uncertainty. It’s about building resilience. The most confident retirees aren’t those with perfect forecasts. They’re the ones with flexible plans that evolve with their life.
This may be one of the most expensive beliefs of all. Financial planning is not a talent reserved for experts.
It’s a skill, a skill that anyone can learn.
Nobody is born understanding withdrawal strategies, Roth conversions, or Social Security claiming decisions.
And the good news is that the Boldin Planner makes it easier than ever to understand the decisions that matter most. The tool enables you to model your own life with ease. And, every change you make to your plan reveals a shift to your financial future.
The goal isn’t blind optimism or manifestation. It’s not replacing every concern with positive thinking. The goal is to adopt beliefs that are both realistic and useful.
One of the biggest misconceptions about financial planning is that it’s about predicting the future. It isn’t.
Planning is about exploring possibilities.
It’s a way to test assumptions, understand tradeoffs, and make decisions with greater confidence. The most valuable thing a financial plan can give you isn’t a number. It’s a new perspective.
Sometimes that perspective reveals a problem you need to address. Other times it reveals an opportunity you didn’t know existed. And, it can also challenge a belief you’ve carried for years.
Because the biggest breakthroughs in financial planning often don’t happen when your numbers change. They happen when your beliefs do.
Imagine that two people enter the planner with exactly the same finances.
The second person almost always gets more value from planning because they see planning as a tool for agency rather than prediction.
That’s really the connection between Eyal’s ideas and financial planning: beliefs don’t just shape how people think about money. They shape whether people believe they can do anything about their future at all.
Money matters. But the beliefs that drive your financial decisions matter too.
The stories you tell yourself influence what actions you take, what opportunities you pursue, and how confidently you navigate uncertainty.
A good financial plan doesn’t just help you understand your money. It helps you understand what’s possible. That’s exactly what Boldin is built for. Find your possibilities today with the Boldin Planner.
Limiting beliefs about money tend to cluster around capability and timing. Common examples: “I’m not good with money,” “it’s too late to catch up,” “investing is too risky for someone like me,” or “I’ll never be able to retire.” What gives them staying power is that they go unexamined. They form from past experience, financial setbacks, or patterns absorbed from family long before anyone had reason to test them.
A realistic concern is specific: your savings rate looks low for the retirement age you have in mind, so you make a change. A limiting belief tends to be categorical, something like “I’ll never retire” rather than “retiring at 62 looks difficult at my current rate.” Specific concerns invite a response. Categorical beliefs tend to foreclose planning before any numbers get examined.
The connection between money beliefs and retirement outcomes runs through behavior. Someone who believes retirement is out of reach tends to skip the modeling and put off decisions. Someone who sees the future as influenceable tends to engage with scenarios and adjust when things look off. What the beliefs do is shape behavior. The behavior produces the outcome.
Positive thinking swaps a worse-feeling belief for a better one. Testing your money beliefs is different: it treats them as questions worth examining rather than fixed truths. “I probably don’t have enough to retire” becomes something to check against your numbers. The shift is from assumption toward inquiry.
Running retirement scenarios is the most direct way to test the assumptions underneath a money belief. A planning tool lets you put numbers behind what you’ve been taking for granted: what does retiring at 62 look like given your savings, spending, and income sources? Most people find the distance between their assumed outcome and their modeled outcome is wider than they expected, and the modeled picture tends to be more encouraging than the assumption was.
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The final phase of a U.S. Coast Guard initiative at Base Kodiak will inject more than $140 million in funding to construct 30 additional housing units, a child development center, and other infrastructure improvements in Alaska.
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There are places that look better in person than in photos, and places that look exactly as advertised. Wadi Rum somehow does both. The desert is larger and more impressive than you would imagine, changing color throughout the day as the light shifts across the landscape. Of all the places we visited in Jordan, the …
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If you’ve spent time convincing yourself you’re behind financially, that you’ll never feel ready to retire, or that everyone else has figured out something you haven’t, you’re not alone. That experience has a name: money dysmorphia.
The term borrows from body dysmorphia, a condition where people perceive flaws in their appearance that aren’t visible to others. The financial version works the same way: a mismatch between what’s real and what feels real about your finances.
Money dysmorphia isn’t a formal clinical diagnosis in the DSM. But it describes a pattern that shows up across every income level, age group, and balance sheet size — and it’s worth understanding, because it can drive financial decisions that cost you.
Money dysmorphia is a distorted perception of your financial situation. You might feel broke when you’re stable, or feel insecure even when you’re objectively secure. It can show up as constant anxiety about money, chronic feelings of being behind, or avoiding financial decisions because they feel overwhelming, regardless of what your balance sheet says.
The core issue is the distance between what’s true and what feels true about your finances.
The distortion shows up in what you do: avoiding your accounts, checking them multiple times a day, making financial decisions from fear or shame rather than facts.
Over time, those patterns carry real consequences. Over-saving and under-spending. Taking on unnecessary risk. Staying stuck in stress even when the numbers say you’re okay.
Because money dysmorphia is a behavioral term, not a clinical diagnosis, there’s no single checklist for it. But recognizing that your financial feelings may not match your actual situation is where change starts.
Money dysmorphia is common across age groups, but it hits younger adults hardest. A 2024 Credit Karma survey put the overall prevalence at 29% of Americans, with rates nearly double that among Gen Z and millennials.
| Group | Experience Money Dysmorphia |
| All Americans | 29% |
| Gen Z | 43% |
| Millennials | 41% |
| Gen X | 25% |
| Age 59+ | 14% |
Source: Intuit Credit Karma, 2024
The same survey found a striking difference in how people with and without money dysmorphia experience their own finances.
| Feel Behind Financially | |
| Experience money dysmorphia | 82% |
| Do not experience money dysmorphia | 29% |
Source: Intuit Credit Karma, 2024
The distress is often less about the actual numbers and more about comparison. People measure themselves against others, or against their own expectations of where they should be, and that space between perception and reality is where the anxiety lives.
You don’t need a diagnosis to notice these patterns in yourself. Ask:
If several of these sound familiar, you may be experiencing money dysmorphia. It doesn’t matter what your income or net worth is.
The term tends to get associated with younger adults who feel stuck or stretched. But for people approaching or in retirement, money dysmorphia often runs the other direction. You’ve built substantial savings, and you still feel like it’s not enough.
That pattern is common among high savers and careful planners. You might have a seven-figure portfolio and still worry constantly about running out of money. You might delay retirement by years to be safe, even when your projections say you’re likely fine. You might spend well below what your plan can support because drawing down your savings feels like a threat.
Research on retirees and pre-retirees shows that this kind of persistent fear can reduce quality of life even when actual shortfall risk is low. The problem isn’t the balance — it’s how you’re reading it.
A structured retirement income plan that shows how your spending holds up across real scenarios closes that loop better than a higher account balance does. When you can see the numbers play out, the fear has less to work with — and you’re freer to spend in ways that actually improve your life.
Money dysmorphia doesn’t arise on its own. It’s fed by a mix of social, economic, and psychological forces, including the way social media compresses other people’s financial milestones into a constant highlight reel.
The same Credit Karma study found that 27% of Americans say they’re obsessed with the idea of being rich, including 44% of Gen Z and 46% of millennials. A feed full of promotions, home purchases, and investment wins makes it feel like everyone else is racing ahead while you stand still.
Economic uncertainty compounds it. Homeownership, debt-free degrees, early retirement: traditional markers of financial success have gotten harder to reach. Against that backdrop, the belief that you’re behind can feel like fact, even when your day-to-day situation is reasonably stable.
The Consumer Financial Protection Bureau’s research on financial well-being cuts through those comparisons with something simpler. Their work identifies four elements of genuine financial well-being:
Measured against that standard, money dysmorphia is a sign that your internal yardstick is misaligned — not that you’re failing with money.
Addressing money dysmorphia starts with separating what you feel from what you can measure. These five steps help do that.
Start with a clear picture of where you stand today. List your accounts, debts, monthly expenses, and savings rate so you can see your finances in one place rather than relying on impressions.
A structured tool makes this easier. The Boldin Planner brings your income, savings, investments, and goals into a single plan so you can see whether you’re on track for retirement and other priorities. When the numbers are in front of you, the story that says “it’s never enough” gets harder to sustain.
Notice when money anxiety spikes. Is it after scrolling social media, talking with certain people, or reading about someone who retired early or built wealth fast?
Write down the specific situations that set off comparison spirals and the thoughts that follow. “Everyone my age owns a home.” “We’ll never catch up.” Naming those patterns helps you treat them as assumptions to examine, not facts to accept.
A written plan translates your values and goals into concrete targets for saving, investing, and spending. It also gives you a framework for decisions: does this move me closer to or farther from the life I actually want?
With the Boldin Planner, you can set retirement, saving, and lifestyle goals; model different retirement ages, spending levels, and Social Security strategies; and see how changes to contributions or spending affect your long-term projections. Vague fears are harder to hold onto when you’ve run the actual numbers.
If money dysmorphia is causing serious distress or driving you to avoid important decisions, working with a financial planner, coach, or therapist who understands financial anxiety can help.
A planner can stress-test your retirement plan and give you an outside perspective when your internal voice is catastrophizing. For some people, pairing financial planning with therapy — particularly approaches that address anxiety, perfectionism, or scarcity thinking — delivers the most durable reset.
Decide what financial success looks like for you, in your current season of life. Maybe it’s a six-month emergency fund, a paid-off high-interest debt, retiring at a specific age, or having enough flexibility to work less and spend more time with people who matter.
Then measure against those benchmarks, not against friends, influencers, or viral success stories. Checking in on your savings rate, debt payoff, and retirement readiness on a regular schedule keeps you grounded in your own reality instead of chasing a moving external target.
If you recognize yourself in these patterns and want to go further:
Money dysmorphia is a distorted view of your financial situation. People who experience it often feel behind, unsafe, or bad with money even when their numbers say otherwise. It can also show up as unwarranted confidence or overspending when finances are strained. The defining feature is a mismatch between financial perception and financial reality, and it can affect anyone regardless of income or net worth.
People who experience money dysmorphia often feel behind financially despite having savings, avoid checking their accounts because it triggers anxiety, or compare their finances to others and consistently come up short in their own minds. Another sign is refusing to spend on things they can afford, or delaying retirement indefinitely because it never feels safe enough. These patterns can show up at any income level.
Money dysmorphia comes from a mix of social comparison, economic uncertainty, and internal beliefs about what financial security should look like. Social media and cultural fixation on extreme wealth can make ordinary financial progress feel inadequate. Past experiences with money, family messages about scarcity or wealth, and perfectionism can all intensify the distortion over time.
Money dysmorphia is most common among younger adults, but it affects all age groups. A Credit Karma study found that 43% of Gen Z and 41% of millennials experience it, compared with 25% of Gen X and 14% of people 59 and older.
Start by getting your actual numbers in one place so you can separate what you feel from what’s measurable. From there, identifying comparison triggers and building a written plan around your real goals helps close the distance between perception and reality. Working with a planner or coach, and tracking your own benchmarks rather than other people’s, supports that shift over time. Most people who engage with the process make real progress — and a clearer picture of your finances is usually less scary than the one your anxiety has been filling in.
Wealthy people and retirees with substantial savings can experience money dysmorphia as a persistent fear of not having enough, which often leads to chronic under-spending and delayed life decisions. A retiree with a seven-figure portfolio may still feel one bad market year away from disaster. That fear is real, but it often isn’t an accurate read of actual shortfall risk. A clear, evidence-based retirement plan that models real spending scenarios is what typically brings that fear into proportion.
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Patellofemoral pain syndrome is typically rated from 0% to 50%, under the knee rating criteria, based on the symptoms and functional limitations you experience.
Dealing with chronic knee pain is a daily struggle. It hurts to climb stairs, squatting feels impossible, and your knees ache after sitting for long periods. If that sounds familiar, you may have patellofemoral pain syndrome (PFPS), sometimes called “runner’s knee,” and you may qualify for a VA rating and compensation.
Understanding your patellofemoral pain syndrome VA rating is important because the VA doesn’t assign ratings based on your diagnosis alone. Instead, your rating depends on how much the condition limits your function, range of motion, stability, and daily activities.
The good news is that even if imaging looks normal, you can still qualify for VA disability compensation if your symptoms are service-connected and properly documented.
Patellofemoral pain syndrome is a condition that causes pain around or behind the kneecap (patella). Medical experts describe it as one of the most common causes of anterior knee pain. Symptoms typically worsen during activities that place stress on a bent knee, including squatting, climbing stairs, running, kneeling, or prolonged sitting.
Some veterans also experience grinding, clicking, or popping sensations in the knee. While symptoms vary from person to person, the condition often interferes with daily activities that require bending or weight-bearing.
For many veterans, PFPS develops from years of:
The VA does not assign a disability rating based solely on a diagnosis of patellofemoral pain syndrome.
Instead, the condition is generally rated under the knee rating criteria found in 38 CFR § 4.71a, based on the symptoms and functional limitations you experience.
The VA commonly evaluates PFPS using:
Because every claim is different, two veterans with the same diagnosis can receive different ratings.
>> Learn more about the VA Knee Rating Chart
| VA Rating | Typical Findings |
| 0% | Service-connected but symptoms do not meet compensable criteria |
| 10% | Painful motion or mild limitation of motion |
| 20% | More significant limitation of flexion, extension, or instability |
| 30%+ | Severe limitation of motion, instability, or other qualifying knee impairment |
A 10% evaluation is often assigned when patellofemoral pain syndrome causes painful motion but does not result in compensable limitation of flexion or extension under the knee rating criteria.
The VA pays close attention to range-of-motion measurements during your C&P examination.
Flexion refers to bending your knee.
The more limited your ability to bend the knee, the higher your potential rating.
Your examiner will measure:
Extension refers to straightening your leg.
Veterans with significant extension limitations may qualify for ratings higher than those available solely for flexion loss.
Because PFPS symptoms often worsen during repetitive use, it’s important to accurately describe flare-ups, functional loss, daily limitations, and activity restrictions.
Never push through pain during range-of-motion testing simply to “look tough.”
Sometimes, yes.
Depending on the evidence, the VA may assign separate ratings for the different ways knee conditions present themselves.
In some situations, the VA can assign multiple ratings for the same knee when different symptoms are being compensated.
For example, a veteran may receive one rating for limited motion and another for instability if each condition creates a separate functional impairment. Additional ratings may also be available for certain meniscus injuries or painful surgical scars.
However, VA rules prohibit compensating the same symptom twice, a practice known as pyramiding.
This is one reason why a thorough review of your medical evidence can make a significant difference in your overall disability rating.
Like most VA disability claims, a claim for patellofemoral pain syndrome generally requires three elements:
The diagnosis may be provided by a VA provider, a private physician, an orthopedic specialist, or a physical therapist.
Evidence of an in-service event could include documented knee injuries, physically demanding military duties, airborne operations, or years of stress from training and occupational activities.
Finally, the VA must see evidence showing that your current condition is “at least as likely as not” related to your military service.
To learn more, visit the Service Connection Guide for Veterans.
>> Learn more about a Range of Motion VA C&P Exam: What to Expect and How to Prepare!
The knee C&P exam is often the most important part of your claim.
The examiner may evaluate:
Before your exam, think about how your knee condition affects daily tasks such as walking, standing, climbing stairs, squatting, and work or home activities.
Be specific and accurate. The VA is evaluating functional impairment, not simply whether you have knee pain.
Absolutely.
Chronic knee pain rarely exists in isolation. When one knee becomes painful, many people unconsciously change the way they walk, stand, and distribute weight. Over time, these compensatory movements place additional stress on other joints and body systems.
Common secondary conditions include:
If a service-connected knee condition causes or aggravates another disability, you may qualify for secondary service connection.
The strongest claims typically include the strongest medical evidence.
In addition to a current diagnosis, in-service event, and a nexus connecting the two, consider submitting:
Your lay evidence should clearly explain:
Specific examples are usually more persuasive than general statements.
You may want to seek an increased rating if:
A patellofemoral pain syndrome VA rating can range from 0% to 50% or higher, depending on how the condition affects your knee function, stability, and daily life.
The diagnosis itself doesn’t determine your rating; the severity of your symptoms does.
If your knee pain affects your ability to walk, squat, climb stairs, work, or stay active, make sure those limitations are clearly documented in your medical records and during your C&P exam.
The stronger your evidence, the stronger your claim.
Many veterans receive a 10% rating because painful motion can qualify for compensation even when range-of-motion limitations are relatively mild.
Yes. If PFPS is service-connected and causes functional impairment, it may qualify for VA disability compensation.
Yes. If both knees are service connected, each knee is evaluated separately. The VA may also apply the bilateral factor when appropriate.
Yes. Patellofemoral pain syndrome does not require an arthritis diagnosis. Functional loss and painful motion can support a compensable rating.
Yes. In some cases, PFPS may be caused or aggravated by service-connected foot, ankle, hip, or gait-related conditions.
Strong evidence may include updated medical or physical therapy records, a credible nexus letter and DBQ, lay statements, independent medical opinions (IMOs), or documentation of flare-ups and functional loss.
Yes. Bilateral patellofemoral pain syndrome is common, and each knee may be rated separately if service connection is established. To calculate the bilator factor for VA disability compensation, see the VA Disability Calculator.
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Katie McCarthy is a writer and editor with experience in daily news and digital and print magazine publishing. She honed her editorial (and firearms) skills at Guns & Ammo before helping launch Black Rifle Coffee Company’s Coffee or Die Magazine as the managing editor. She holds degrees in English (BA) and public administration (MPA). Katie is a military spouse and word nerd who enjoys reading, hiking, camping, gardening, and spending time with her family.
Have you been told that you — or an older person you care about — has kidney disease?
If so, you’re not alone: kidney disease is very common in older adults. Almost everyone’s kidney function declines at least a little with aging, with actual chronic kidney disease affecting an estimated 35% of people over age 65.
It’s also fairly common for older adults to develop an “acute kidney injury,” which means the kidneys suddenly start working less well. This often happens during an illness, dehydration, infection, or hospitalization.
Fortunately, in most cases, acute kidney injuries improve, and chronic kidney disease remains fairly manageable, with only a minority of older adults progressing to needing dialysis.
But kidney disease is still important to recognize and monitor, because it can affect medication safety, blood pressure, fluid balance, and overall health.
In this article, I’ll cover what older adults and families should know about kidney disease in aging.
Most people are born with two kidneys, located in the back of the body, just below the rib cage. Their main job is to continuously filter the blood and produce urine.
But the kidneys do much more than make urine. They are involved in many important body functions, including:
Each kidney contains millions of tiny filtering units called nephrons. Each nephron includes a glomerulus, which starts the filtering process, and a tubule, which reabsorbs needed substances and helps remove waste.
Normally, healthy kidneys keep important things like blood cells, large proteins, and glucose in the body. That’s why, under normal circumstances, those substances should not be found in significant amounts in the urine.
Kidney function is usually checked with blood tests that are part of a basic metabolic panel.
One of the most important numbers is the eGFR, or estimated glomerular filtration rate. This estimates how well the kidneys are filtering the blood.
A normal adult filtration rate is usually around 90 to 120 mL/min. This reflects the function of both kidneys together.
Other common kidney-related blood test results include:
It’s important to know that creatinine is affected by muscle mass. For instance, a petite older woman with low muscle mass may normally have a creatinine of 0.6. If it rises to 1.1, that may represent a meaningful decline in kidney function, even though 1.1 might look “normal” on many lab reports. (This is why it’s always useful to look at past lab results!)
If kidney dysfunction becomes more significant, other abnormalities may appear, such as high potassium levels or excess acidity in the blood.
There are three main kidney issues that commonly arise in medical care.
Chronic kidney disease (CKD) means there is long-term, ongoing evidence of kidney damage or reduced kidney function.
CKD is usually defined as either:
Chronic kidney disease is often caused by long-term damage from conditions such as high blood pressure or diabetes.
Acute kidney injury means kidney function suddenly worsens over hours or days.
This can happen because of:
Acute kidney injury is often reversible if the underlying problem is found and corrected.
Sometimes an older adult already has chronic kidney disease and then develops an acute kidney injury on top of it. This is called acute-on-chronic kidney disease.
For example, someone may have mild chronic kidney disease for years, then become dehydrated during an illness and have their kidney function suddenly worsen.
One important thing to know is that mild to moderate kidney dysfunction usually causes no symptoms.
Many older adults with chronic kidney disease feel completely normal. Their kidney disease may only be noticed because of routine blood tests.
Even a GFR in the 50s often causes no symptoms. Kidney function can sometimes get significantly lower before a person feels unwell.
However, more severe kidney dysfunction can cause symptoms and complications, including:
Significant uremia tends to cause symptoms. Symptoms of uremia can include:
In older adults, new or worsening confusion is especially important to evaluate. This is often called delirium, and kidney dysfunction can be one possible cause or contributor.
Chronic kidney disease is often described in stages based on eGFR.
The general kidney function stages are:
| Stage | eGFR | Description |
| G1 | 90 or higher | Normal or high kidney function |
| G2 | 60 to 89 | Mildly decreased kidney function |
| G3a | 45 to 59 | Mildly to moderately decreased kidney function |
| G3b | 30 to 44 | Moderately to severely decreased kidney function |
| G4 | 15 to 29 | Severely decreased kidney function |
| G5 | Less than 15 | Kidney failure |
It’s important to understand that most older adults with chronic kidney disease do not progress to stage 5 kidney failure, which may require dialysis to control fluids and electrolytes.
Many people remain in the mild or moderate stages for a long time. In these cases, the main focus is usually monitoring kidney function, protecting the kidneys, avoiding medication-related harm, and managing contributing conditions.
The most common causes of chronic kidney disease in older adults are long-term damage from:
These conditions can gradually damage the small blood vessels and filtering structures in the kidneys.
Other causes or contributors include:
Aging itself is also associated with a gradual decrease in kidney function. One estimate is that GFR declines by about 1% per year with age, or about 8 mL/min per decade starting in midlife.
This doesn’t mean kidney disease should be ignored or dismissed as “just aging.” But it does mean that some decline in kidney filtration is common in later life.
Because chronic kidney disease (CKD) often causes no symptoms, it may not seem urgent. But it’s still important to know about it.
If you have CKD, you and your health providers may need to take steps to:
One common medication group to be careful with is NSAIDs, or non-steroidal anti-inflammatory drugs. These include medications such as ibuprofen and naproxen.
NSAIDs can be useful in some situations, but they can stress the kidneys, especially in older adults who already have CKD, dehydration, heart failure, or are taking certain blood pressure medications.
Kidney dysfunction is often first noticed on routine bloodwork, especially a basic metabolic panel.
If kidney function looks abnormal, the next steps depend on several factors:
Health providers usually try to determine:
A medication review is especially important. Sometimes a medication is contributing to the kidney problem, or a medication dose may need to be adjusted because kidney function has declined.
Hydration status also matters, especially in frail older adults or those who have recently been ill.
In some cases, the best next step may simply be to repeat the blood test in one to two weeks, especially if the abnormality is mild or if dehydration or illness may have been involved.
Additional tests may include:
Kidney specialists are called nephrologists.
Much of the evaluation and management of mild-to-moderate chronic kidney disease can be handled in primary care. But a nephrology referral may be especially important if:
A primary care clinician can help determine when a nephrology referral is appropriate.
The main goals of chronic kidney disease management are to protect remaining kidney function, reduce progression, and prevent complications.
Common management steps include:
High blood pressure can damage the kidneys over time. Blood pressure control is one of the most important parts of protecting kidney function. (See below for more on which BP medications are especially good for the kidneys.)
NSAIDs such as ibuprofen and naproxen can worsen kidney function in some people, especially when used regularly or during dehydration or illness.
Other medications may also need caution or dose adjustment, depending on kidney function.
If diabetes, high blood pressure, urinary obstruction, infection, or another condition is contributing, managing that condition is key.
High blood sugar can damage the kidneys over time. For people with diabetes, glucose management is an important part of kidney protection.
Albumin in the urine can be a sign of kidney damage. It also helps health providers estimate the risk of kidney disease progression and decide which treatments may be helpful.
For people with CKD and albuminuria, certain medications have been shown to slow progression in many cases.
These may include:
ACE inhibitors and ARBs are commonly used for blood pressure control. SGLT2 inhibitors were originally developed for diabetes, but they have also been found to have kidney-protective effects in certain people with chronic kidney disease.
As always, whether these medications are appropriate depends on the person’s overall health, lab results, blood pressure, medication list, and goals of care.
Kidney failure generally refers to very advanced kidney dysfunction, often when eGFR is around 15 mL/min or lower.
At that stage, the kidneys may no longer be able to adequately remove fluid, waste products, and excess electrolytes from the body. Severe kidney failure can eventually lead to death unless kidney function is replaced or managed in another way.
The main treatment options for end-stage kidney disease include:
Dialysis is a medical treatment that filters the blood to remove excess fluid and waste products.
There are two main forms:
Dialysis can be used temporarily in the hospital for severe acute kidney injury. It can also be used long-term for advanced chronic kidney disease.
Most people with chronic kidney disease do not progress to needing dialysis. But for those who do, planning often starts when eGFR is around 20 – 25 mL/min.
This early planning matters because long-term dialysis usually requires special preparation, such as creating a vascular access point for hemodialysis.
Kidney transplant can be an option for some older adults with end-stage kidney disease, especially if they are otherwise in reasonably good health.
However, transplant is a major procedure and requires significant ongoing medical care afterward, including medications to prevent rejection.
Whether transplant is a realistic option depends on the person’s overall health, frailty, other medical conditions, and preferences.
Another option for advanced kidney disease is conservative kidney management, which is a palliative approach.
This means focusing on comfort, symptom management, and quality of life rather than dialysis or transplant.
This option can be especially worth considering when someone is much older, frail, has advanced dementia, or has multiple serious medical conditions.
Dialysis can be burdensome. It often involves frequent appointments, procedures, dietary restrictions, and medical complications. For some older adults, especially those with significant frailty or limited life expectancy, dialysis may not improve quality of life in a meaningful way.
A conservative approach does not mean “doing nothing.” It means actively managing symptoms and supporting the person in a way that fits their health situation and goals.
In geriatrics, kidney disease is very common, and it often interacts with other health problems.
Here are a few important points for older adults and families:
The best approach depends not only on the kidney function numbers, but also on the person’s overall health, function, preferences, and goals.
If you or your older relative has abnormal kidney test results, consider asking:
It’s also a good idea to keep copies of lab results and track kidney function over time. This can help you and your health providers notice important changes sooner.
Kidney disease is common in older adults, and it often causes no symptoms in the early or moderate stages.
The key number to know is usually the eGFR, which estimates how well the kidneys are filtering the blood. Chronic kidney disease is often defined as an eGFR below 60 mL/min for at least three months, or evidence of kidney damage such as albumin in the urine.
The most common causes of chronic kidney disease are high blood pressure and diabetes. Other contributors can include certain medications, infections, blocked urine flow, autoimmune disease, smoking, obesity, and age-related decline.
For most older adults with CKD, treatment focuses on monitoring kidney function, controlling blood pressure and blood sugar, avoiding kidney-stressing medications, adjusting medication doses when needed, and slowing progression.
And for those who develop advanced kidney disease, it’s important to understand all the options, including dialysis, transplant, and conservative kidney management.
I hope this article has helped you better understand any kidney disease affecting your life or that of someone you care about.
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