VA Disability Ratings for Knee Tendonitis
What is Knee Tendonitis?
Knee tendonitis, also known as patellar tendonitis, is an injury to the tendon connecting an individual’s kneecap (i.e., patella) to their shinbone. The patella tendon works in conjunction with certain thigh muscles to allow for motions such as kicking, running, and jumping. It is most common in athletes or individuals who are frequently jumping or bending at the knees (e.g., squatting) while using all of their bodyweight. Generally speaking, pain is the first symptom of knee tendonitis. Such pain is typically located between the kneecap and where the tendon attaches to the shinbone (i.e., tibia). At first, the pain may be limited to when the individual is engaging in physical activity or after exercising; however, the pain tends to linger and worsen over time. Eventually, knee tendonitis may interfere with daily movements such as climbing stairs or rising from a chair.
Knee tendonitis is a common overuse injury, caused by repeated stress on the patellar tendon. In some cases, the repeated stress may result in small tears to the tendon, which further complicate the healing process. As the tears in the tendon multiply, they cause pain from inflammation and weakening. If tendon damage persists for more than a few weeks, then it becomes “tendinopathy.” Several factors may increase the risk of developing knee tendonitis, including the following:
- Physical activity – running and jumping are most commonly associated with knee tendonitis
- Tight leg muscles – tight quadriceps (i.e., thigh muscles) and hamstrings (i.e., back thigh muscles) can increase strain on the patellar tendon
- Muscular imbalance – if some muscles in the legs are stronger than others, the stronger muscles can pull harder on the patellar tendon thereby causing knee tendonitis
- Chronic illness – some illnesses (e.g., kidney failure, lupus, rheumatoid arthritis) disrupt blood flow to the knee, which weakens the patellar tendon
To diagnose this knee condition, the examining doctor may apply pressure to different parts of the knee to determine where the pain is coming from. Again, most often the pain is located on the front part of the knee, just below the kneecap. One of the following imaging tests may also help the examining doctor diagnose knee tendonitis: X-rays, ultrasound, or magnetic resonance imaging (MRI).
Knee tendonitis is typically treated with non-invasive approaches, including the following:
- Stretching exercises
- Strengthening exercises
- Ice/heat
- Pain relievers (e.g., Advil, Motrin, etc.)
However, if the individual’s knee tendonitis is severe, other approaches may be warranted. Specifically, doctors may recommend corticosteroid injections, oscillating needle procedures, or surgery.
Service Connection for Knee Tendonitis
Veterans can receive service connection for knee tendonitis in a number of different ways, including: direct service connection, secondary service connection, and service connection by aggravation.
Direct Service Connection
To establish direct service connection, veterans must provide the following: (1) a current diagnosis of knee tendonitis; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current, diagnosed knee tendonitis to the in-service occurrence. For example, you experienced multiple rough landings while parachuting on active duty. Following discharge from service, you are diagnosed with knee tendonitis. If your knee tendonitis can be traced back to your in-service parachuting accidents, then direct service connection may be warranted. Importantly, a doctor must opine that your knee tendonitis is “at least as likely as not” caused by your parachuting accidents.
Secondary Service Connection
A secondary service-connected condition is one that resulted from a separate condition that is already service-connected. For example, a veteran is service-connected for a knee condition and later develops tendonitis in that knee. Then the veteran’s tendonitis may warrant secondary service connection if it is the result of their primary service-connected knee condition.
Service Connection by Aggravation
VA will also compensate veterans for medical conditions that existed at the time of entry into service that were made worse or “aggravated” by service. According to 38 CFR § 3.306, “a preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease”.
For example, a veteran has pre-existing (i.e., prior to service) knee tendonitis. Following service, their knee tendonitis worsens and becomes severe, now impacting activities of daily living. In this case, the veteran’s active duty service aggravated their pre-existing condition beyond the natural progression of the disability. In this case, the veteran may be eligible for service connection based on aggravation.
How VA Rates Knee Tendonitis
Although there are several different diagnostic codes under 38 CFR § 4.71a that are used to rate knee conditions, the most common ones for knee tendonitis include the following:
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, although the highest rating a veteran can receive is 30 percent.
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 that they experience painful motion. VA is also required to pay attention to other indicators of functional loss such as weakness, interference with sitting and standing, and fatigability. If VA does not take such factors into consideration, veterans should consider filing an appeal 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 (i.e., 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 45 degrees, with 100 degrees being completely straight, then it is rated at 50 percent; whereas if it can only straighten to 90 degrees, meaning the veteran is only 10 degrees limited, it is rated at 10 percent.
