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Veterans Law

VA Secondary Conditions Related to Knee Pain

Lisa Ioannilli

October 7, 2021

Updated: November 20, 2023

VA Secondary Conditions Related to Knee Pain

Knee pain is a very common condition that affects many veterans.  Knee pain can be measured by the limitation of flexion, limitation of extension of the knee, instability of the knee, and knee replacements.  Continue reading to find out more about the various knee conditions categorized as knee pain, and the secondary conditions that can be associated with knee pain.

Prevalence of Knee Pain Among Veterans

As mentioned above, knee pain is extremely prominent among veterans.  According to VA’s Annual Benefits Report for Fiscal Year 2020, the limitation of flexion of the knee was the second most prevalent service-connected disability among new compensation recipients (meaning those who became service-connected during the 2020 fiscal year.)

In total, roughly 98,000 veterans newly became service-connected for limitation of flexion of the knee in 2020.  This increased from just over 80,000 veterans in 2018, when the condition was the fifth most common among new recipients.

How Does VA Rate Knee Pain?

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.  Typically, VA rates this condition based on the range of motion that exists as the veteran moves their knee in that direction.

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.  Typically, the greater limitation of extension (or the harder it is to straighten the knee), the higher the disability rating.  As with limitation of flexion of the knee, there are specific range of motion measurements that correspond with each disability evaluation.

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.  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 is categorized by abnormal stiffening and immobility.  Again, the more limitation of the knee the veteran experiences, the higher the disability rating VA should award.

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 4 months following surgery.

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.

VA Disability for Knee Conditions & Pain

Establishing Service Connection for Knee Pain in Veterans

As discussed, there are many ways that knee conditions can be evaluated under the Veterans Affairs Schedule for Rating Disabilities.  Veterans filing a claim or appealing a denial for a knee condition should be aware of the various ways that knee conditions can become service-connected.

Direct Service Connection

To establish direct service connection, veterans must provide the following:

  • A current, diagnosed knee condition;
  • An in-service event, injury, or illness; and
  • A medical nexus linking the current, diagnosed knee condition to the in-service incurrence

Veterans can submit a claim for VA disability benefits on VA Form 21-526EZ.  This can be submitted via mail to the Evidence Intake Center or electronically through VA’s website.

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 arthritis in that knee.  The veteran’s arthritis may warrant secondary service connection if it is the result of their service-connected knee condition.

Service Connection by Aggravation

VA will compensate veterans for medical conditions that existed at the time of entry into service and 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.”

5 Ways to Establish VA Service Connection

Common Secondary Conditions to Knee Pain

As knee pain is one of the most common conditions, it can also be linked to a variety of secondary conditions.  Below are some examples of conditions secondary to knee pain.  However, this list is not exhaustive, meaning there are other ways that conditions can be linked to knee pain.

Secondary Conditions to Knee Pain Common secondary conditions to knee pain include: -Foot Injuries -Hip Injuries -Ankle Injuries -Back Conditions -Arthritis -GERD -Depression

Other Orthopedic Conditions

Other orthopedic conditions can frequently arise as the result of knee pain.  For example, knee pain may cause you to favor one leg over the other.  The extra stress on the favored leg can then lead to new issues such as hip injuries, foot injuries, or ankle injuries.  Because knee conditions can affect a person’s posture and the way they walk, back conditions may also develop as secondary to knee conditions.

Arthritis Secondary to Knee Pain

Knee conditions can cause a person to develop arthritis, And vice versa.  As such, some veterans may be eligible to become secondary service-connected for arthritis if it develops as the result of a knee condition OR secondary service connection for a knee condition if it develops as the result of arthritis.

GERD Secondary to Knee Pain

A veteran may be prescribed medication to help alleviate symptoms and treat their knee pain.  Often, veterans are prescribed NSAIDs like ibuprofen for their knee pain.  Taking these medications consistently can cause gastrointestinal problems such as GERD.

GERD, or Gastroesophageal reflux disease, is a condition that occurs when stomach acid flows back up the esophagus, which connects the mouth to the stomach.  Even though GERD may not relate physically to the veteran’s knee, the fact that the medication they were prescribed for their knee pain causes GERD is enough to establish service connection on a secondary basis.

Depression Secondary to Knee Pain

Knee pain can be extremely debilitating and limit a person’s mobility.  As such, veterans may experience depression as a result of the pain and physical limitations.  If a veteran develops depression due to their knee pain and the impact it has on their day-to-day life, they may be eligible for secondary service connection.

Compensation and Pension (C&P) Exams for Secondary Conditions

Becoming secondary service-connected follows much of the same process it takes to becomes primary service-connected.  As such, VA may request a Compensation and Pension exam (C&P) to examine the veteran and obtain more information about the link between the veteran’s knee pain and the secondary condition.

The C&P exam will be performed by a VA examiner or a VA-contracted examiner.  They may physically examine the veteran, if the secondary condition is physically examinable, or they may interview the veteran regarding the condition.

It is important to attend any C&P exams that VA requests, even if they request two exams: one for knee pain and one for the secondary condition.  Though the exams may seem redundant, it is crucial that the veteran attends because VA may deny the claim if they do not.

TDIU and Conditions Secondary to Knee Pain

Total disability based on individual unemployability, or TDIU,

TDIU, is a monthly VA benefit that compensates veterans at the 100 percent level if they are prevented from finding or maintaining substantially gainful employment because of their conditions.

In order to be eligible for Schedular TDIU, veterans must have one condition rated at 60 percent minimum OR two conditions that can be combined to reach 70 percent, where one condition is at a minimum of 40 percent.  As such, secondary service connection can be extremely helpful in boosting veterans to the 70 percent minimum needed for multiple conditions to achieve TDIU.  The criteria for schedular TDIU is outlined under 38 CFR § 4.16a. 

It should be noted that ratings for secondary service-connected conditions carry the same weight as primary service-connected conditions.

Veterans who do not meet the necessary criteria for schedular TDIU may be eligible for extraschedular TDIU.  For this form of TDIU, veterans must prove that their condition(s) uniquely hinder their ability to maintain substantially gainful employment.  Extraschedular TDIU is rated under 38 CFR § 4.16b.

Total Disability based on Individual Unemployability TDIU Infographic

Need Help with Your VA Disability Benefits for a Condition Secondary to Knee Pain?

If your claim for service connection for a knee condition, or secondary service connection for a condition secondary to knee pain, has been denied, Chisholm Chisholm & Kilpatrick may be able to help.  Our team has helped thousands of veterans with their appeals for service connection for knee pain, increased ratings for knee pain, and conditions secondary to knee pain.  Contact us today for a free case review at 800-544-9144.

About the Author

Bio photo of Lisa Ioannilli

Lisa joined CCK in March 2012. Lisa is a Senior Attorney focusing on representing disabled veterans in claims pending before the U.S. Department of Veterans Affairs and the United States Court of Appeals for Veterans Claims.

See more about Lisa