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VA Disability for Arthritis

READ the blog post here: https://cck-law.com/blog/how-va-rates-arthritis/

  1. Degenerative arthritis (Osteoarthritis) vs. Rheumatoid arthritis
  2. In-service causes of arthritis
  3. Presumption of service connection for arthritis
  4. How VA rates arthritis
  5. Viewer Question: Is gout rated as arthritis by VA?
  6. Limitation of Motion
  7. VA Exam (C&P Exam) for Arthritis
  8. X-rays and arthritis diagnosis
  9. Diagnostic Code 5003 for Degenerative arthritis
  10. Painful Motion Rule
  11. Secondary Service Connection for arthritis
  12. Joint replacement surgery
  13. VA Unemployability for arthritis (TDIU)
  14. Special Monthly Compensation (SMC) for arthritis

Video Transcription:

Maura: Good Afternoon, everyone! Thank you for joining us today for our Facebook Live discussion. , we are here at Chisholm Chisholm and Kilpatrick. My name is Maura Clancy. I’m an attorney here at CCK and I’m joined today by Lindy Nash and Mike Lostritto, also attorneys here at CCK. Today, we’re talking about arthritis. We have some material prepared to talk about how VA rates arthritis, what arthritis is generally, some of the different, you know, nuance VA issues that come up when dealing with arthritis conditions. Before we get started, a quick note that we will be looking at the comments feed next to this video throughout the discussion today. So, if there are any questions that you have, please feel free to leave them there. We will, in turn, post any helpful material that we think is responsive to your question in the comments feed. And then, we also might be able to take a couple of questions while we discuss these issues today. So, that’s there for your  reference and for additional resources. We also have additional resources about some of the things that will come up today on our website at cck-law.com. So, please feel free to visit there at any time. And without further ado, we’ll go ahead and get started.  first, Lindy, tell us what arthritis is just so that we have an understanding of what the condition is that we’re talking about.

Lindy: Sure. So, there’s really two main types of arthritis, that we’ll be talking about today. One kind of more in specificity. So, the first one Degenerative Arthritis, also known as Osteoarthritis.  and basically, Degenerative Arthritis is the breaking down of cartilage between the joints. So, eventually, it leads to a kind of bone-on-bone contact and this can lead to a lot of pain, limited mobility, stiffness, and other really uncomfortable symptoms. Usually, it happens I’d say mostly in the weight-bearing joints. So, from the back, hips, knees, feet, particularly in those areas. , but we also see Rheumatoid arthritis and that occurs when your immune system malfunctions and it actually attacks the membrane that lines your joints, which leads to inflammation. And so, that also causes pain, limited mobility, and stiffness as well.

Maura: Okay, great. And I think for today’s purposes, we’re gonna be focusing on, as Lindy said, degenerative and osteoarthritis. So, this is probably the thing that comes to mind more often when you talk about arthritis. Rheumatoid arthritis is definitely its own distinct condition. And as Lindy said, it does manifest in symptoms similar to degenerative and osteoarthritis, including stiffness, swelling, and pain in the joints.

Lindy: Yeah.

Maura: We’ll know now though that VA does have their own different rating criteria for rating Rheumatoid arthritis conditions.

Maura: So, it can be similar. Sometimes, if it’s just about pain and joint involvement, then they use the codes that they use for the other type of arthritis? But there are other things that come into play.

Maura:  So, we probably won’t be getting too much further into that.

Lindy: Right.

Maura: We should have some details on our website, previous blog posts, and things like that if Rheumatoid arthritis is what you’re looking for information about. But for today’s purposes, we’re mostly talking about the osteopathic issues.

Lindy: Yes.

Maura: So, what are some causes of arthritis? What are some things that might have prompted a veteran who served to develop arthritis later in life? Either one of you.

Mike: So, really what we’re looking for here are in-service injuries or overuse of the joints. As Lindy mentioned, a lot of these conditions involve the weight-bearing joints.

Mike: So, whether that’s a knee, perhaps an ankle, ah–your back, you know, if there’s an in-service injury to one of those conditions, it’s potentially — it– it’s possible that a veteran will eventually develop arthritis – degenerative arthritis. Because it only progresses over time usually.

Mike: And you know as you said, the cartilage between the joints continues to wear down.

Mike: So like I said, overuse or injury to those specific joints is what we’re really looking at here.

Maura: We’re seeing people with histories of jumping and even just the heavy gear that’s required during training–

Mike: Ankle rolls–

Maura: Yeah.

Mike: You know back strain, anything –any injury really that over time can develop further into an– you know arthritis.

Maura: Yeah. Okay, great. And that poses a separate medical question, too. So, we want to be clear–

Maura: –that not every single incident of overuse or every single strain in-service is necessarily gonna be linked to ah– the arthritis that comes later but since it can be a little bit elusive or tricky to pin down what the cause of it actually is and since these things that happen in-service could be potentially related. Sometimes, it’s necessary to have a doctor look at those facts and figure out what the relationship is but those are– those are good examples. And, it’s pretty clear that you don’t need a traumatic injury also, — which can be helpful. Sometimes, to be able to say, well there was no big in-service event that caused or that could have caused the arthritis now, but there doesn’t need to be something of that magnitude necessarily.

Lindy: Exactly.

Maura: And Mike, what about the presumption of service connection for arthritis? So, are there any — are there any regulations or laws in place that VA follows where they recognize that arthritis will be caused due to service under certain conditions? In other words, they will look at the facts and decide that there is a way to say that the arthritis is related to service no matter how much time has passed or things like that?

Mike: Yeah. This is a– This is an important point I think, under CFR Section 3.309, arthritis is characterized as a chronic disease.

Mike: And under that presumption, under that specific regulation,  if a veteran can show that he or she had symptoms  within a one-year period from the date of discharge from the military  and that the condition manifested to a 10% disability rating in terms of severity, then the presumption will apply to the veteran’s condition. As you said, this is important because this allows a veteran to establish service connection for this condition even if he may not otherwise have medical evidence that links his currently diagnosed arthritis of a particular joint to some incident or accident or injury that occurred in service.

Maura: Okay. So that is important, and it can be helpful if there is evidence within that requisite time period to highlight that. Because that takes out a lot of the work that needs to be done in proving service connection. Specifically, you don’t really need medical evidence, to substantiate that. You just need to show the onset within that certain time so.

Mike: Yup, it’s a shortcut in a way. So it’s something you know, to definitely look out for within that one-year period post—discharge.

Maura: Great. And so in terms of ratings, how VA rates arthritis? There is one diagnostic code or one code that set aside in VA’s regulations that’s used — that specifically contemplates arthritis. And so, it provides at least some criteria as to how VA will assign compensation or monthly benefits to arthritis. So, the code for arthritis from what I understand Lindy is 5003?

Lindy: Yes.

Maura: But there are other codes that contemplate arthritis symptoms. So, can you tell us how VA goes about rating arthritis given that there’s– there can be many codes involved?

Lindy: Yes. So, under 38 CFR 4.71A is where you’ll find DC, Diagnostic Code 5003, like Maura just said, and that contemplates degenerative arthritis. However, if you read that diagnostic code, you’ll see that the first part there describes how it is to be looked at first.  so basically, depending on where your arthritis is located, they’re going to try to rate you first under the limitation of motion diagnostic code, so this can get a little bit complicated so bear with me and ask any questions that you have.  so basically, you start with the joint that is affected. So say, it’s arthritis at the knee. The VA or the rater will first look to the limitation of motion ah– for the knee diagnostic code and see if they can rate you based on your limitation of motion for your knee, assuming that they can, they will give you whatever rating that you fall under based purely on limitation of motion in that diagnostic code. , so I think they do that mostly to — they’re supposed to maximize the benefit for the veteran, that’s a duty that VA has. , and so I believe that under 5003, you can only really get a 10% or a 20% rating. So, if you look at those other diagnostic codes that are more limitation of motion, you can get much higher. You can get a 50%, a 60%, and so on. , so that I think is VA’s attempt to kind of maximize the benefit for the veteran,  it also kind of forces the rater to look a little more in-depth into what is going on. , so during the exam, they’ll test you know more deeply about what you’re– you know dealing with, how severe your limitation of motion is, and go from there. , and the only reason that you would actually go to 5003 is if, under limitation of motion, you would get a 0% rating. So otherwise, a non-compensable rating.

Maura: Okay, great. That’s really helpful because it can be a little counter-intuitive–

Lindy: Right.

Maura: –to realize that VA has a code for arthritis but then the default is that they look to other codes for limitation of motion. But as Lindy was saying since arthritis manifests as limitation of motion and since those other limitations of motion codes can get you a higher rating for the individual joints,

Maura: And they’re more specific to the individual joints, and what impairments might arise due to arthritis in those different joints and areas of the body, then that’s the way that they handle it. And we actually have a question that I think fits into this discussion.  Sherwin, thanks for asking a question today, Sherwin. He wants to know whether gout would be qualifying — would be a qualifying disability under arthritis. And I assume that that means whether service connection and an arthritis rating could be a sign for gout? I believe that it can and I think that this makes the point that Lindy was making. That ah– VA will rate your condition that they grant service connection for assuming that service connection is granted based on the code that best approximates the symptoms that you have coming from that disability. So, I’ve– we’ve seen a couple of cases at least in recent times about gouty arthritis–

Maura: -or gout that affects joints the way that arthritis does, or even the way that rheumatoid arthritis does. So in that instance, even though it’s not technically the type of arthritis that we’ve been talking about today if service connection has been granted, then VA will look at the code that best approximates the symptoms that are resulting and assign the rating based on that. Does that sound good to you both?

Mike: Yes and we’ll get into this a little bit further on but, it’s also — it will be important to take a look at what specific joints are affected and,

Maura: Right.

Mike: Like I said, we’ll get into this but you know, it really ah– there’s the possibility to have separate ratings–

Mike: -for different joints and so, you know, I think it’s important to know which joints are affected by the condition which would potentially lead to a higher rating.

Maura: That’s a really good point, and so Mike, we kind of already covered this but limitation of motion just to be clear, eh–there’s not one code for limitation of motion, right?

Mike: Correct. So, limitation of motion in it of itself is not it’s own diagnostic code. It–basically, you want to take a look at all the different conditions separately and individually, and there’ll be various range of motion testing based on each individual condition. And so, you know, for instance, you take a–a knee condition and the first stop for VA rater is to determine whether the range of motion for the veteran’s knee warrants a compensable rating.

Mike: And if it does not, then VA will turn or should turn to Diagnostic Code 5003 and if there’s evidence of arthritis, degenerative arthritis, the veteran could be entitled to an award under that specific diagnostic code. Ah, so just to answer your question, no, there isn’t one specific diagnostic code for limitation of range of motion, you know each condition is tested based on limitation of range of motion in it of itself.

Maura: Okay. And so, eh I think it follows then that you can’t get a rating under both the diagnostic code for arthritis 5003 and a limitation of motion code at the same time?

Mike: For the same condition.

Maura: Okay.

Mike: So- for instance, taking the knee example again, a veteran wouldn’t be able to receive a rating based on limitation of motion for their knee  and also receive a separate rating based on Diagnostic Code 5003 for degenerative arthritis for that condition. , a veteran could receive a rating for the knee under the– you know the diagnostic code for limitation of motion and also receive a rating under 5003 for a separate condition. Say, you know, back or something else, where degenerative arthritis is shown to that separate condition.

Maura: Great. And, you mentioned examinations for joint conditions or arthritis.

Maura: And, I think that anyone who has attended compensation and pension, or a C&P exam for a joint has probably gone through what Mike referred to earlier which is range of motion testing. Obviously, they’re looking at some other things when they do those exams. They are looking at a — they’re supposed to take your medical history and get some pertinent facts and review your file. But, one of the critical things that we see all the time is their range of motion of tests. Can you tell us what that’s like? Either of you or?

Mike: Yes, so it’s literally, you know, a veteran will go in and say, they’re testing the elbow, there’s a device that the rater will use, and  you know both test how far the veteran can extend their arm, how far the veteran can flex their arm,

Mike: -the same goes for the knee and other joints. , and based on the criteria that’s outlined in this specific diagnostic code, VA will assign a rating based on the limitation of the veteran’s motion.

Lindy: Okay. I was just going to say that there’s no true way for you to prepare for these exams. I would just suggest being  as open and honest as you can in terms of if they’re going to ask you any questions about pain you experienced or any functional limitations you may have. , now is not the time to be stoic and I would just say be honest with them about your experiencing and how limiting your  knee condition is or whatever you’re experiencing.

Maura: I think that’s a really good point. , especially the point that you made about functional loss?

Lindy: Yeah.

Maura: Orthopedic conditions are not always done right at the VA. [Lindy &Mike laugh] Yes, so we’ll limit that to orthopedic conditions for today but if VA often forgets the fact that the limitation of motion codes are of course based on how far you’re able to move the joints. So, when Mike talks about how the examiner will administer a range of motion test, they’re literally tracking how many degrees the joint can move and they’re assessing whether that constitutes a full range of motion so such that it’s normal for the joint or whether it’s limited and then, they’re not able to extend beyond a certain point. And that data is what they use to assign a rating under the limitation of motion. But, there are so many other considerations that are relevant in rating orthopedic conditions like arthritis and those involve how often the joint swells, instability, stiffness –tenderness about the joints, anything that would impede your ability to perform the daily working movement of the body, I think that’s the language that the reg uses, the regulation. So impairments just sitting, standing, walking, running, all those things are really critical.

Lindy: Yup.

Maura: But sometimes when you walk into the exam, the examiner’s focused solely or mostly on the range of motion test and that’s certainly something that they need to do but if like as Lindy said, if you’re asked about what kind of issues you’re having with the joint, don’t forget that it is relevant to bring up any other issues you might be having about how your joint condition affects your ability to move around,  affects your ability to perform daily activities, to sit or stand for long periods of time, all of that is relevant. And I think that as Lindy said, there really is no true way to prepare but those facts are helpful.

Mike: Yeah, and those are great points. And don’t be afraid to tell the examiner if you’re experiencing pain while you’re doing the range of motion testing.

Maura: Yes.

Mike: So you know, don’t just try to tough it out. If you are experiencing pain–they’re supposed to note that.

Maura: Right. And so, it’s important for you to relay that information to the examiner, you may be able to do the full range of motion but only with extreme pain throughout. So that’s just an important consideration that the VA is supposed to note and consider when rating your condition.

Maura: Great. Thank you both other things that will come up at an exam sometimes are x-rays. Lindy, why are x-rays important in arthritis cases?

Lindy: Sure. So you actually, to get a– arthritis diagnosis, you need it on an x-ray. So that is what the VA will look to, that is what the VA provider or examiner to look to–to actually confirm that you have a diagnosis of arthritis. So you really need that x-ray evidence to confirm that first element of service connection.

Maura: Okay. Great, and I think we’re backtracking here a little bit. Mike, I might have skipped over you before, but going back to the arthritis diagnostic code. So, if the limitation of motion codes are not applicable in your case for whatever reason, and VA is going to assign a rating under the arthritis code which is 5003 and as Lindy mentioned before it’s at 38 CFR 4.71A.

Lindy: Yup.

Maura: How does that code work in terms of how they get to the rating assigned?

Mike: Sure. So this is slightly complicated, but I think really it’s important to know that VA breaks the joints down into 2 groups – subgroups, what they consider the major joints and what they consider the minor joints. And, so for instance, the major joints that VA considers are shoulder, wrist, elbow, hip, knee, and ankle. While the minor joints are fingers, toes, even the spine, and so, knowing that then it’s important to know that 5003 further breaks it down to how many of those joints are affected. And, based on how many of those joints are affected, the VA will determine what the appropriate rating is. So for instance, you know, a 10% rating is affected where the veteran can show that two or more major joints or two or more groups of the minor joints are impacted. The next highest rating under 5003 is a 20% rating and a 20% rating is warranted where the veteran can show that again two or major joints and two or more of the minor subgrouping joints are affected. But also, the veteran must show, to receive a 70%, sorry a 20% rating, that the– degenerative arthritis produces occasional incapacitating episodes. So, that’s just an additional hurdle that the veteran has to show in order to warrant that 20% rating under that diagnostic code.

Maura: Okay. That makes sense. So that’s a little bit trickier.

Mike: It’s tricky. It’s kind of a mouthful, but you know there’s a 10% rating, there’s a 20% rating under 5003 and, it’s important to know that, you know, VA breaks it down into these two groups

Mike: Major joints, minor joints. And, depending on up–up–upon how many of those groupings are impacted, VA will assign a rating, either a 10% or 20%

Lindy: And based on how trick– how tricky that sounds, I think we’re all glad that they default to the limitation of motion codes. [laughs] ‘Cause those are a little more straightforward. They have their own different criteria, the knee is rated different than the shoulder, and the feet are rated different than the hands, but it’s better to get that individualized assessment I think. It makes more sense.

Mike: Yeah. And there’s the potential also for the veteran ah–I think to receive increased compensation or a higher rating due to a rating based on limitation of motion under a separate diagnostic code. So, while 5003 is certainly there, it’s ah–I consider it almost a default option.

Mike: But nevertheless, it’s there to provide a rating for a veteran to have degenerative arthritis but otherwise don’t need the limitation of motion requirements under the other specific diagnostic codes.

Maura: Okay. And Lindy, can you tell us about the painful motion roll and why this is something that is important for people who are service-connected for arthritis to be aware of?

Lindy: Sure. So 4.59 or 38 CFR 4.59 is also known as the painful motion roll. , so that basically means that if you have arthritis  in any which joint, if you have pain on motion there or if that hurts when you move it, anything like that, you can get a separate 10% rating for that. , I usually think about it when maybe you have arthritis in one area but as Mike said, you need it in two major joints. But say you only have one joint that has arthritis in it, you can get that 10% rating based on pain on motion for that one arthritis joint. So you don’t need two. , like it says under 5003. Under 4.59, you can get a 10% rating for just one area of arthritis or one joint of arthritis. , and so, that would include  like I said, painful motion so if it hurts to move it, and also under 4.59, during an examination, the examiners are supposed to test  and indicate really specific things which we also kind of noted before. , but that would include testing for both pain on active and passive motion, weight-bearing, non-weight-bearing, and if possible, within the range of the opposite undamaged joint. , and I know I can speak for Mike and Maura where we see this all the time. That the ortho examinations that veterans go through are really inadequate. They don’t do all of the testings that I just mentioned, so if you notice that maybe your exam didn’t test for weight-bearing and non-weight-bearing, that is a violation of the duty to assist and we often bring that up all the time. So be on the lookout for that, and under 4.59, you are entitled to that kind of testing.

Maura: And, another cool thing about 4.59 and the rule that you can get a 10% rating if you have painful motion in a joint is that you can get separate 10% ratings–

Lindy: Right.

Maura: -for different joints as long as Mike had said before, you’re not getting the same rating twice for the same joint. But if you have one wrist that has arthritis and is painful lift movement, a knee, a shoulder, an elbow, an ankle whatever. Those can all be potentially 10% ratings.

Lindy: Right.

Mike: Yes and that’s a great point. The cordless exam and section 4.59 and really has held that it’s there to allow a, you know, the baseline compensable rating.

Mike: Usually, a 10% rating for situations just as you described, where you know a veteran has arthritis in the joint, otherwise, does not meet the rating criteria for a higher rating under a separate diagnostic code due to limitation of range of motion. 4.59 is there and a veteran should receive a separate rating, a minimally compensable rating but a separate rating nonetheless for each joint that’s affected by arthritis.

Maura: And another thing that Lindy mentioned earlier that I think brings up another good point is about how, as we mentioned, the exams that are done for these conditions are often not adequate ‘coz they don’t do all the testing that’s required and they don’t provide all the information to the VA that’s required. So in addition to the certain testing that needs to be done, they are also supposed to provide opinions about functional loss. As we were talking about earlier, functional loss is very important in trying to figure out what rating should be assigned to a joint condition because the inability to do daily activities, the interference at work, those are all things that the–that VA is rating schedule is intended to compensate. So, if you notice that an exam is– or if you think that the examiner isn’t doing a thorough enough job, we have other videos about how to challenge an exam, a C&P exam or how to respond to a bad C&P exam. All of those would be helpful if you have had one of those exams recently and you’re not sure that all the proper testing was done, or that all of the information made it into the report. So we would highly recommend taking a close look at those. Those are really rife with issues, in terms of the one that we see.

Mike: Yes and particularly applicable in cases like this.

Mike: Just because it’s so difficult for examiners, admittedly so difficult for examiners to go through all the hoops that are necessary for them to provide an adequate examination for these types of conditions.

Mike: So you know, that’s a great point.

Maura: But they still should. [laughs] It’s nonetheless. Ah, so once again, we’re here today at Chisholm Chisholm and Kilpatrick. My name is Maura Clancy. I’m here with Lindy Nash and Mike Lostritto, and we’re talking about arthritis. We have a few more things but please don’t feel free — I mean do feel free. [Laughs] I’m sorry. Please don’t hesitate to use the comments feed next to this video if you have any questions or if you want to see additional resources. , so secondary service connection. Most of our discussion today has been about rating–

Maura: -arthritis, assuming that VA has already granted service connection.

Maura: But the concept of secondary service connection is also relevant. , so if arthritis is caused by a service-connected disability, then arthritis itself can be service-connected even if it didn’t arise in service, would you both agree?

Lindy: Yes.

Mike: Yes.

Maura: Okay. So there’s one regulation that we were talking about earlier today, that we don’t see a lot but it does kind of illustrate how it might occur that your arthritis is maybe not related to service but is related to a service-connected condition such that VA should grant you service connection. It’s 4.58 in the code of federal regulations. This rule basically says that if in service or if you have a service-connected amputation or a leg shortening. Leg shortening issues can be seen if there was an in-service–lower extremity issue that wasn’t properly treated or that didn’t resolve fully.  sometimes, people have actual discrepancies in the length of their lower limbs, which can cause a lot of issues. , so if arthritis comes up later in life and it can be attributed to those service-connected either amputation or leg shortening, then it will be secondarily service-connected so to speak. So that’s one example of when a service-connected condition might cause arthritis later, just because of the problems with amputation and leg shortening issues that can come up with weight-bearing and ambulating, and things like that. But what are some examples either of you, of an instance where service-connected arthritis might cause something else for which secondary service connection could be granted?

Lindy: I usually think of arthritis or any kind of ortho condition causing maybe a psychiatric disability. Or something like depression, you know, maybe your used to playing basketball, and going fishing, and being with your grandkids and playing with your children. And all of a sudden, your arthritis really doesn’t allow you to do any of those things, oftentimes, we see veterans who become depressed over situations like that. So, arthritis I think could lead to ah– psychiatric disability and so that would be an example of being secondarily service-connected from your arthritis.

Maura: And at that instance, VA would have to assess whether your psychiatric disability, as Lindy said, should be service-connected and whether you should get benefits for that. Even if your theory is not that it started while you were on active duty–

Lindy: Right.

Maura: – but instead that it arose from a service-connected condition.

Mike: We could see, and we have seen arthritis in a particularly– particular joint leading to service connection for arthritis in another joint.

Maura: Okay.

Mike: So you know, the situation could arise where say a veteran has an ankle condition that’s already been service-connected, and due to the ankle condition over many years, the veteran’s gait is altered. So they walk slightly differently than they did before and over many many years,  you know, of walking differently and with the altered gait, they now have maybe hip problems, maybe they have a knee problem, or a back problem. , and again, over time, those joints in and on themselves develop arthritis. , so because the– you know the original condition, the ankle condition led to the other conditions basically, you can get secondary service connection for those other newer conditions.

Maura: Yeah. That’s a good example. Those can be trickier medically but —

Mike: Yeah.

Mike: We have to get medical evidence to show it but assuming you can do that, that’s a perfectly acceptable theory of secondary service connection.

Maura: Definitely. And I think it’s common, I think it’s common in the real world that if there are arthritic changes or arthritis in your feet, and ankles, and knees that it can, in theory, sort of travel up. It can affect the way you walk, which can affect your other weight-bearing joints.

Mike: Sure.

Maura: With also on the flipside scene, a lot of VA opinions where they don’t recognize that to be medically possible that can be unfortunate in cases and it can be an extra hurdle that you have to go through. , sometimes, they say that there needs to be evidence of you know, chronic issues over the years or all kinds of things like that. So, just be aware that it can be a little bit tough at the VA but  medical evidence can be really helpful if you think that that’s a circumstance that applies to you.

Mike: Yeah.

Maura: There are some benefits that arise other than just the monthly compensation benefits we were talking about earlier when we discussed ratings. Other benefits that can come into play if you have service-connected arthritis. So, what happens if a veteran has to undergo a joint replacement surgery? I think knee is an obvious,  example but what will VA adjust your compensation if that happens?

 

Lindy: Yeah. So, in some situations where you would need surgery due to a service-connected condition, you can get what’s known as a temporary total rating. , we often call it temp total. And so, that means you have a 100% rating for a–temporary period of time. And basically, it can be assigned in a couple of different situations. , but the first one that comes to mind is hospitalization. So, if you need to be in the hospital due to a service-connected condition for over 21 days, you can get a temp total in that way. You can also get it under what’s known as convalescence. So that means, say you had surgery like a knee replacement and you needed you know serious recovery time, they usually look for about a month in terms of convalescence. So, that recovery period should be about a month. You can get a 100% for that or if you have really serious residuals  from your knee replacement. Maybe something,  you know, knock on wood, went wrong,  or you really needed a longer period of time for recovery, you can get a 100% for that as well. , and I believe if there’s an immobilization due to a cast or something like that, you would get a temp total for that as well.

Maura: Okay, great. And then, what about–

Lindy: Yup. Or, did you have anything to add, Mike?

Mike: Nope.

Lindy: I’m sorry. No. Just making sure I got all of them. [laughs]

Mike: No. You know, I was going to say, you know, as the name temp total indicates during that period, the veteran receives a 100% rating–

Maura: Yup.

Mike: – but after the period is up, then VA will have to determine what the rating is oftentimes,

Lindy: Right.

Mike: They’ll continue with the previous ratings was but they really are required to consider what the rating going forward should be at that point.

Mike: And you’re allowed to submit evidence and argent to suggest that an increase trading is warranted.

Maura: That’s a great point because I’m sure you both have seen cases where VA will assess that the surgery fixed everything.

Maura: Or the joint replacement means that the condition can’t be as bad as it was before the surgery because before, it needed surgical treatment and now, it’s fine, it’s resolved. So, Mike’s point is a good one if things really haven’t changed, if you’re kind of just having to live with certain symptoms due to the arthritis both before and after surgery, it can be important to make VA aware of that. , they do often go back to the rating that was in place before depending on what it is and every case is different but definitely something to be on the lookout for, with those.

Maura: What about if arthritis prevents a person from being able to work or even impacts their work performance? Are there any other ways for compensation under those circumstances?

Mike: Yeah, absolutely. So, if you are a service-connected, whatever the condition may be. Service-connected condition leads to in a–in an– inability–

Mike: -to obtain or maintain substantially gain from employment, then there’s a benefit out there called TDIU, which is a Total Disability Rating Based on Individual Unemployability that a veteran can  I guess apply for or raise to VA, and if VA does find that the condition that service-connected leads to a veteran’s inability to work, then they would receive payment at the 100% maxim rate.

Maura: Okay, good to know.

Lindy: Can I add one thing really quick?

Maura: Of course!

Lindy: So, I know we touched on this before but going back to your exam, when you’re in the exam and if your arthritis causes an inability to work or causes you trouble while you’re working, like Mike said, you can get TDIU. So, it’s really important during that exam to say, you know, my arthritis is so painful, it affects my concentration at work. Or maybe, it causes me to call out of work, or I can’t lift boxes at work, or you know, whatever way it impacts you, you should really note that in your exam to help you with TDIU later on.

Mike: That’s a great point. Yeah. Because, you know, it’s much more helpful to have that documented at the time than years later when you’re going to apply for TDIU, you have to suggest that that’s the case.

Maura: Right.

Mike: So that–that’s a great point

Maura: And what about instances where the arthritis is so severe that it might cause loss of use of a joint. In other words, it’s sort of immobilizes the joint, it makes it so that the person really functionally cannot use it. Are there additional special types of benefits for those circumstances?

Lindy: Yeah. So there’s something known as special monthly compensation, otherwise SMC. And if you have loss of use of a,  particular body part  or part of yeah, part of the body. ,  you can apply for SMC and get that extra payment. , so an SMCK is about an extra, I believe a $100 a month,  and you can get multiple case from multiple losses of use. So if multiple, you know, left-hand, right-hand, and then the more loss of use you have, you can kind of climb the SMC ladder and get more and more compensation depending on what you are unable to use.

Maura: Okay great! Anything else Mike?

Mike: In addition to special monthly compensation due to loss of use, there is something called special multi-compensation due to attendance which you know just means that if a veteran has service-connected disability, say a risk condition, a back condition,  knee conditions due to their degenerative arthritis, if those service-connected disabilities result in a veteran needing regular aid and attendance to perform just, you know, daily activities of living,  perhaps they can’t cook for themselves, they can’t drive themselves places, they need somebody to come in and, you know, help with things around the house. Then, you may be entitled to what’s called SMC aid and attendance. And again, as Lindy said, that’s a benefit above and beyond whatever the maxim rating is allowed under the law.

Maura: Right. Great. I don’t have anything else. Does anyone have anything they want to add? Closing thoughts?

Lindy: I guess I would add really quick from– in the beginning  of this Facebook Live, we touched on presumptive service-connection and Mike mentioned how if you have arthritis within a year of service, that can qualify as presumptive service-connection? So, I would just say that if you are, you know freshly out of service and you think that you may have arthritis, I would suggest going and  checking it out with your doctor, whether that’s someone at the VA or a private physician. , because as we said, it’s often difficult to kind of look back in time and try to prove that your arthritis–

Lindy: -started within that first year after service. If you have it documented and the date clearly shows it was right after service, then that’s great and kind of one less hoop you have to through. So, I would say just keep in mind that one year time period goes by quickly and two, get it checked out even if you’re not sure.

Mike: Yeah, that’s great! I don’t have anything else to add. [laughs]

Maura: Perfect. Any other questions? Excellent! Thank you both so much for, attending today and we hope that this was informative for everyone out there and we hope to also see you next time.

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