A Veteran’s Guide to VA Disability for Knee Replacement

Knee injuries and chronic knee problems are all too common for veterans. The physical stress of military action can lead to knee issues that plague veterans years after their active service. Veterans can experience a traumatic injury to the knee that leads to lasting pain or lost mobility. Alternatively, veterans may incur repetitive motion strain to the knee joint that leads to joint damage, which only worsens over time.

Knee replacement is one treatment option for severe, chronic knee problems. If you need a knee replacement due to a service-related injury, you may be eligible for long-term benefits from the VA.

What is a Knee Replacement?

Knee replacement is a surgical procedure to repair or resurface a damaged knee joint. The bones that meet at the knee joint are typically covered with a protective layer of cartilage that prevents the bones from making direct contact when you bend your leg. Loss of that cartilage leads to bone grinding on bone, which is painful and damaging to the bone.

In a knee replacement procedure, doctors cap the ends of the bones in the knee joint with metal or plastic components. These form a new protective layer around the bones, allowing the joint to move more easily and with less pain.

Doctors recommend knee replacement when more conservative treatments such as pain medication, physical therapy, cortisone injections, and knee braces are no longer effective.

Reasons for Knee Replacement

Knee damage can be a result of several conditions. The most common is osteoarthritis, a degenerative joint condition that destroys cartilage. Rheumatoid arthritis, an autoimmune condition affecting joint tissue, can also lead to knee damage.

Traumatic arthritis is also a cause of knee joint problems. This is the loss of cartilage because of an injury to the joint. Traumatic arthritis can happen due to a single injury or develop over time due to repetitive strain on the joint.

Can I Get VA Disability for Knee Replacement?

The VA considers knee replacement resulting from service-related causes as a disability. If you are service connected for a knee condition, and need a knee replacement, you will receive a disability rating of 100% for the four months immediately following the operation.

After the postoperative period, the VA will reassess your condition and assign a new rating. If you have had a total knee replacement procedure, you will receive a minimum rating of 30%. Your rating may be higher if you have pain or reduced function in the knee following surgery. According to the VA Schedule of Ratings, knee replacement disability ratings are as follows:¹

• 5055 Knee, resurfacing or replacement (prosthesis): For 4 months following implantation of the prosthesis or resurfacing 100% Prosthetic replacement of knee joint: With chronic residuals consisting of severe painful motion or weakness in the affected extremity, 60% With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262. Minimum evaluation, total replacement only 30%.

If you have a partial knee replacement, your rating will be determined by any residual pain or reduced function you have after surgery.

The VA rates knee conditions according to the amount of movement you have in the joint and if your overall mobility is compromised. According to the VA Schedule of Ratings, disability ratings for knee joint disabilities are as follows:¹

• 5256 Knee, ankylosis of:
  • Extremely unfavorable, in flexion at an angle of 45° or more 60%
  • In flexion between 20° and 45°, 50%
  • In flexion between 10° and 20°, 40%
  • Favorable angle in full extension, or slight flexion between 0° and 10°, 30%
• 5261 Leg, limitation of extension of:
  • Extension limited to 45°, 50%
  • Extension limited to 30°, 40%
  • Extension limited to 20°, 30%
  • Extension limited to 15°, 20% Extension limited to 10°, 10% Extension limited to 5°, 0%
• 5262 Tibia and fibula, impairment of:
  • Nonunion of, with loose motion, requiring a brace, 40%
  • Malunion of: Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.
• 5257 Knee, other impairment of:
  • Recurrent subluxation or instability: Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation, 30%.
  • One of the following: Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation, 30%
  • Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation, 10%.
  • Patellar instability: A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker, 30%.
  • A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker, 20% A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without a history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker, 10%.

Disability ratings for knee replacement can be combined with additional disabilities. The overall rating would be based on the Combined Disability Rating Scale, which assesses the cumulative effects of all your service-related health conditions.

Proving a Service Connection for Knee Condition

To qualify for VA disability benefits, you must be able to prove that your knee problems are directly connected to your military service. Whether or not you have a knee replacement does not matter unless the underlying condition is service-connected.

To do this, you must satisfy three essential criteria:

1. Evidence of a current disability
2. Evidence of in-service injury or disease
3. Evidence of a connection between in-service injury or disease and the present disability (medical nexus)

If your knee problems stem from an injury incurred during service, evidence of the injury should be in your medical records. If the injury didn’t cause problems for the remainder of your service, you might need to prove that it has gotten worse after you left active duty. For example, your injury may have started due to repetitive strain during service, but problems with the joint only emerged later. In that case, you will need to prove that your service was a cause of later problems with your knee.

Usually, a medical expert will be needed to connect the in-service events to the current condition. Sometimes, your knee problems could be secondary to a service-connected foot or ankle problem that causes an altered gait which, in time, can throw off body mechanics and put abnormal stress on a proximal joint like a knee.

We have won many cases that required complicated evidence. Give us a call at 888.878.9350 to discuss your claim and how we can get you the VA disability payments you deserve.

References:

1. Legal Information Institute, Electronic Code of Federal Regulations (e-CFR) Title 38 – Pensions, Bonuses, and Veterans’ Relief CHAPTER I – DEPARTMENT OF VETERANS AFFAIRS PART 4 – SCHEDULE FOR RATING DISABILITIES Subpart B – Disability Ratings The Musculoskeletal System § 4.71a Schedule of ratings – musculoskeletal system