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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 his or her knee condition.  Subluxation refers to the dislocation of the knee cap while lateral instability refers to your knee giving out.  A minimum 10 percent rating is assigned for slight recurrent subluxation or lateral instability and a maximum 30 percent rating is assigned for severe recurrent subluxation or lateral 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 one year following the knee replacement and implantation of prosthesis, after which the veteran will undergo a re-evaluation and receive one of the ratings listed below
  • 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% 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).

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.

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