VA Disability Benefits for Knee Pain
Prevalence of Knee Pain Among Veterans
Knee pain problems are commonly-claimed conditions for VA disability benefits. According to VA’s Annual Benefits Report for Fiscal Year 2018, limitation of flexion of the knee was the fifth most commonly-claimed disability, with over 80,000 veterans receiving service-connected compensation for this issue. In total, nearly 650,000 veterans receive benefits for limited knee flexion. However, limitation of flexion of the knee is just one type of knee condition that can receive service-connected compensation. 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.
Common Types of Knee Conditions and How They Are Rated
Knee pain can be rated under several different diagnostic codes (see below), but overall, they are rated under 38 CFR § 4.71a.
Limitation of Flexion of the Knee – Diagnostic Code 5260
Limitation of flexion of the knee is the most common knee condition for which veterans receive VA disability benefits. This condition refers to the range of motion of the knee as the veteran moves it or curls it inward towards the body. Generally speaking, VA rates this condition based on the range of motion that exists as the veteran moves their knee in that direction. The most common rating VA assigns for limitation of flexion of the knee is 10 percent. This low evaluation speaks to how VA rates knee conditions. Namely, there are strict rating criteria and specifications veterans must meet to have their knee conditions rated at certain levels. It is not just about how painful it is or how much it hurts. Instead, VA will literally measure the range of motion and assign a rating based largely off that alone.
Within VA’s regulations, veterans should be afforded a 10 percent rating even if they do not necessarily meet the specific diagnostic code criteria for limited range of motion, but can otherwise show they have painful motion. However, VA often makes mistakes when it comes to this. VA should pay attention to other indicators of functional loss such as weakness, interference with sitting and standing, pain on motion, and fatigability. If VA does not take such factors into consideration, veterans should consider appealing for a higher disability rating.
Limitation of Extension of the Knee – Diagnostic Code 5261
Limitation of extension of the knee refers to when the knee is not frozen, but is limited in extension and cannot straighten all the way. This knee pain condition is rated under diagnostic code 5261 and the disability ratings available are 0, 10, 20, 30, 40, and 50 percent. Typically, the greater limitation of extension (or the harder it is to straighten the knee), the higher the disability rating will be. Similar to limitation of flexion of the knee, there are specific range of motion measurements that correspond with each disability evaluation. For example, if the leg can only straighten to within 45 degrees of being completely straight, then it is rated at 50 percent, whereas if it can only straighten to 10 degrees it is rated at 10 percent.
Instability of the Knee – Diagnostic Code 5257
Instability of the knee refers to when the knee has too much motion from side to side, or dislocates regularly. This condition can occur when damaged tendons and cartilage can no longer support the knee joint properly. VA assigns a 0, 10, 20, or 30 percent disability rating for this knee pain condition based on the amount of instability present in the knee. In order to get the highest evaluation, the knee must be so unstable that it gives out or dislocates on a regular basis.
Ankylosis of the Knee – Diagnostic Code 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. Again, the more limitation of the knee the veteran experiences, the higher the disability rating should be.
Total Knee Replacements – Diagnostic Code 5055
If the entire knee joint has been replaced by a prosthesis, then the condition is rated 100 percent for the first year following surgery. After this one-year period, the veteran will attend a Compensation & Pension examination to determine the severity of their knee pain condition. Following the examination, the veteran will be assigned a new rating, based on the rating criteria outlined below. If there is weakness and severe pain with motion, then the veteran’s knee condition is rated at 60 percent. If the pain is not severe, but does limit the veteran’s range of motion, then it is rated under diagnostic code 5256, 5261, or 5262 based on the residual symptomology. Importantly, the minimum rating for a total knee replacement is 30 percent regardless of how much motion it has.
Partial Knee Replacements
Unlike total knee replacements, partial knee replacements do not have their own diagnostic code. Instead, partial knee replacements are rated according to any symptoms that are caused by the replacement such as limitation of motion.
Can Veterans Receive More Than One Disability Rating for Knee Pain?
It is important to note that veterans can receive more than one disability rating for knee conditions as long as each condition involves different movements. For example, if a veteran experiences difficulty in both bending and straightening their knee, they might be able to receive service-connected compensation for limitation of flexion and extension. 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).
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