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Veterans Law

Knee Problems and Your VA Disability Claim

June 15, 2017
Knee Problems and Your VA Disability Claim

Knee problems are commonly-claimed conditions for VA benefits.  According to the VA 2015 Annual Benefits Report, limitation of knee flexion was the fourth most commonly-claimed disability during that fiscal year, with over 80,000 veterans receiving disability benefits for this issue.  In total, nearly 658,000 veterans receive service-connected compensation for limited knee flexion.  Importantly, there are many different ways that knee conditions can be evaluated under the Veterans Affairs Schedule for Rating Disabilities.  Veterans filing a claim or appealing a claim denial for a knee condition should be aware of the various ways that knee conditions can be rated.

Knee problems can be rated under several different diagnostic codes (DC), but overall, they are rated under 38 CFR § 4.71a.  Some of the diagnostic codes are based on range of motion measurements.  Generally speaking, greater restrictions in the knee joint’s range of motion lead to higher disability ratings.

Common Knee Conditions Rated by VA

Ankylosis of the Knee – DC 5256

Ankylosis (i.e. abnormal stiffening and immobility) of the knee can be assigned a 30, 40, 50, or 60 percent disability rating depending on the limitation of flexion.  The rating criteria is as follows:

  • 60% – extremely unfavorable, in flexion at an angle of 45 degrees or more
  • 50% – in flexion between 20 and 45 degrees
  • 40% – in flexion between 10 and 20 degrees
  • 30% – favorable angle in full extension, or in slight flexion between 0 and 10 degrees

Other Impairment of the Knee – DC 5257

Here, the rating criteria are based on the extent of “recurrent subluxation or lateral instability” a veteran experiences with their knee condition.  Subluxation refers to the dislocation of the kneecap while lateral instability refers to your knee giving out.  Below are the rating criteria for recurring subluxation or instability of the knee:

  • 30% – unrepaired or failed repair of complete ligament tear causing persistent instability
    • Additionally, a medical provider must prescribe both an assistive device, such as a cane, crutch, or walker, as well as bracing for ambulation
  • 20% – one of the following criteria must be met:
    • Sprain, incomplete ligament tear, or complete ligament tear causing persistent instability
      • A medical provider must also prescribe a brace and/or assistive devices such as a cane, crutch, or walker, or bracing for ambulation
    • Unrepaired or failed repair of complete ligament tear causing persistent instability
      •  A medical provider must also prescribe assistive devices such as a cane, crutch, or walker, and/or bracing for ambulation
  • 10% – Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability
    • A medical provider does not need to proscribe assistive devices such as a cane, crutch, or walker, or bracing for ambulation to receive this rating

Another impairment of the knee rated under this diagnostic code is patellar instability.  Patellar instability occurs when the kneecap, or the patella, is moved or displaced from its intended resting place.  A kneecap without impairment typically rests in a groove called the trochlea near the end of the thigh bone, or femur.  When the patella is pushed completely out of this groove, the patella becomes dislocated.  When the patella is pushed partially out of the groove, it is referred to as subluxation.  Below are the rating criteria for patellar instability:

  • 30% – A diagnosed condition involving the patellofemoral complex with recurrent instability
    • A medical provider must prescribe both an assistive device, such as a cane, crutch, or walker, as well as bracing for ambulation
  • 20% – A diagnosed condition involving the patellofemoral complex with recurrent instability
    • A medical provider must prescribe one of the following: a brace, cane, or walker.
  • 10% – A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair)
    • A medical provider does not need to proscribe assistive devices such as a cane, crutch, or walker, or bracing for ambulation to receive this rating

It is important to note that the patellofemoral complex refers to the quadriceps tendon, the patella and the patellar tendon.  For the purposes of the rating criteria, a surgical procedure that does not involve one of these (quadriceps tendon, patella or patellar tendon) cannot qualify as surgical repair for patellar instability.  For example, arthroscopy to remove loose bodies and joint aspiration does not qualify as surgical repair for patellar instability.

Limitation of Extension of the Knee – DC 5261

Limitation of extension of the knee refers to an individual’s ability to straighten his or her knee.  VA evaluates this condition as follows:

  • 50% – extension limited to 45 degrees
  • 40% – extension limited to 30 degrees
  • 30% – extension limited to 20 degrees
  • 20% – extension limited to 15 degrees
  • 10% – extension limited to 10 degrees
  • 0% – extension limited to 5 degrees

How Does VA Rate Knee Replacements?

Knee Replacement (Prosthesis)

If a veteran’s knee condition progresses, he or she may need to undergo a knee replacement.  Knee replacements can be total or partial.  Importantly, both total and partial knee replacements are rated the same by VA under DC 5055.  Specifically, total and partial knee replacements are evaluated as follows:

  • 100% – For four months following implantation of prosthesis or resurfacing. After the four-month period, the knee will be re-evaluated for a permanent rating.
  • 60% – with chronic residuals consisting of severe painful motion or weakness
  • 30% – with intermediate degrees of residual weakness, motion, or limitation of motion

For the minimum 30 percent disability rating, VA should look to other diagnostic codes related to knee conditions, such as the ones mentioned above, to see if the veteran is entitled to a higher evaluation.

Some knee problems may seem to fit under the rating criteria of multiple diagnostic codes.  However, in these cases it is important to avoid pyramiding – the VA term for rating the same disability, or same manifestation (i.e., symptom) of a disability, twice.  Therefore, it may be beneficial to talk to a representative to learn more about which disability ratings are appropriate for your knee condition(s).

Knee Disability Compensation and Pension (C&P) Exams

To evaluate a knee disability, the VA may schedule Compensation & Pension exam.  The exam will typically be conducted by a VA healthcare provider, or a VA contracted provider.  The purpose of the exam is to determine whether your knee disability is linked to your service.  To do this, the examiner may ask you questions regarding your service or knee disability, review your file, or perform a physical exam.

Many knee conditions are rated on range of motion.  To measure this, VA examiners use a tool called a goniometer to obtain an official measurement of range of motion for VA to accept.  In some instances, the examiner may determine that they do not need to conduct a physical exam in order to issue an opinion, usually if there is enough documentation to evaluate the condition.

After the examination, the VA examiner will issue an opinion.  A favorable opinion will support the notion that your knee disability is connected to your service.  An unfavorable opinion will not support service connection.  If you receive an opinion you disagree with, you can acquire a private physician or doctor’s opinion from outside the VA to refute the findings.  The VA does not provide copies of the exam report unless specifically asked, so veterans will want to be sure to request a copy.

Obtaining TDIU with a Knee Disability

If you are unable to work because of your knee disability, you may be entitled to total disability based on individual unemployability.  In order to receive TDIU, or total disability based on individual unemployability, you must indicate that your knee disability prohibits you from obtaining gainful employment.  VA generally deems gainful employment as the ability to support oneself and their family.

If you are granted TDIU, you will be paid at the one hundred percent level from VA.  This rating indicates that VA acknowledges your knee disability is caused by service and inhibits you from supporting yourself and your family financially. The one hundred percent rating is the highest form of compensation from VA.

Was Your VA Disability Claim for a Knee Condition Denied?

If you need assistance with a disability compensation appeal, contact Chisholm Chisholm & Kilpatrick LTD.  Our veterans’ law practitioners have over 25 years of experience working with veterans.  Call us at 800-544-9144 for a free case evaluation.