Many veterans who served in the military develop pain in their knees and lower legs due to their time in active service. The U.S. Department of Veteran’s Affairs (VA) handles compensation and military disability rating for knee pain. If you developed knee problems due to military service, you may be entitled to financial compensation from VA. Consult a legal representative to determine whether or not you are eligible for VA disability benefits.
How Common is Knee Pain in Veterans?
The fifth most commonly-claimed disability in 2018 was the limitation of flexion to the knee according to VA’s Annual Benefits Report. Over 80,000 veterans received service-connected compensation for this condition. A variety of other knee conditions can be evaluated for VA disability ratings as well.
What Factors Does VA Consider When Determining VA Disability for Knee Pain?
A VA rating for knee pain or joint pain is determined based on multiple factors such as instability, reduced range of motion, movement without pain, and knee replacements. The less you can move or bend your knee, the higher your VA rating will likely be. Ratings for knee conditions abide by a diagnostic code and are usually based on range of motion and a C&P examination.
Knee Conditions Recognized by VA
Knee pain is rated under different diagnostic criteria according to 38 CFR § 4.71a, Schedular Ratings, Musculoskeletal System. Some of the common knee conditions covered by diagnostic codes are as follows:
5256 – Ankylosis of the knee: Abnormal stiffening of the knee that can be assigned a rating between 30 and 60 percent. The higher the limitation of the knee, the higher the disability rating.
5257 – VA disability rating for knee instability: Excessive side to side motion or frequent dislocation of the knee. Occurs when tendons and cartilage cannot properly support the knee joint. Based on the level of instability, VA will assign a rating between 0 and 30 percent for this condition.
5260 – Limitation of flexion of the knee: The most common knee condition that veterans receive VA disability benefits for. Limitation of flexion refers to a range of motion as the veteran curls or moves the knee towards the body. The highest rating available for this condition is 30 percent, but the most common is 10 percent. VA has strict rating criteria for knee conditions that involve a range of motion. Disability ratings are determined explicitly from set measurement parameters.
5261 – Limitation of extension of the knee: The knee is not frozen, but cannot straighten all the way. This condition is rated between 0 and 50 percent based on the extension limitation. Similar to flexion, VA has a specific range of motion measurements for each disability percentage.
Other VA Knee Conditions
Other knee conditions that may be eligible for benefits include:
Shin splints VA rating: Yes, you can get a VA disability rating for shin splints. However, it can be difficult to prove a service connection for this disability because it is so common.
Runner’s knee (chondromalacia): Cartilage under the kneecap softens and deteriorates, this is more common among athletic individuals.
Runner’s Knee (Patellofemoral pain syndrome) VA rating: Pain on the front of the knee and around the back of the kneecap. 10 percent VA disability rating for each leg.
VA disability for bursitis: Bursitis occurs when small fluid sacs that protect joints become inflamed, causing pain and stiffness. In the knee, the disability rating will be assigned based on the range of motion limitation.
VA disability rating for Osgood Schlatter disease: This condition occurs from inflammation below the knee from repeated stress to the patellar tendon. Ratings will typically fall around 10 percent per leg.
VA disability rating for knee tendonitis & VA disability rating for patellar tendonitis: Swelling of tendons in the knees, including the patellar tendons. 10 percent VA rating for each leg.
VA rating for partial knee replacement: While full knee replacement ratings cannot fall below 30 percent, a partial knee replacement has no minimum rating and is based on the symptoms a patient experiences after surgery.
If you or someone you know has a condition that causes or leads to knee pain, the next step in the process is to prove that condition is service-connected to time in the military.
Proving Service Connection for Knee Pain
The most common option to obtain a VA rating for knee pain is by establishing a direct service connection. Proving direct connection for knee pain relies on three main factors
First, you will need a current diagnosis for the disability being claimed. This diagnosis must come from a medical professional and cover the condition you are trying to win compensation for. If the diagnosis only partially explains your knee pain, VA will not accept it. It’s important to have a diagnosis that connects your knee pain directly to an illness or knee condition.
Second, VA will expect documentation of an in-service event that caused or aggravated the knee condition. If your knee pain is related to a chronic condition that has been developing for a long time, it can be difficult to collect adequate documentation. Many veterans will begin keeping records of their pain before they leave the military for this reason. If your knee pain was caused by a singular incident, VA will want to see as much relevant information as possible about the occurrence. When it happened, how it impacted your pain, whether the condition got worse or better following the incident, and any medical attention you got should be included in these documents.
Lastly, VA will want to see a medical nexus letter for knee pain. A medical nexus is a document or statement from a medical provider that clarifies the relationship between your condition and military service. This can be from the same doctor that diagnosed your condition or a separate VA-approved medical professional. The presence of a medical nexus can make or break a VA disability claim for knee pain.
Buddy and Lay Statements
There are also additional documents that can help prove service connection and increase disability rating. Buddy statements and lay statements can be very influential in receiving more compensation for knee injuries or knee joint pain. A buddy statement is written by another service member, while a lay statement is from a family member or peer.
These statements help communicate to the C&P examiner how your service-connected knee condition affects your daily activities. If you’re missing the necessary medical evidence or your service records have been lost, buddy and lay statements can help push your case through. Depending on the severity described in statements, these documents can be helpful in getting an increase to ratings above 50%. Buddy and lay statements should be submitted to the C&P doctor to strengthen your claim.
VA Secondary Conditions to Knee Pain
When a primary condition causes or aggravates another disability or condition, that secondary condition can be service-connected for VA compensation. Because the knees are so vital to movement, knee joint injuries can have an impact on many other parts of the body. It’s not uncommon for veterans to develop VA disability hip pain secondary to knee pain, because they must move or sit in uncomfortable ways to keep their knees from hurting.
When one knee is hurt, the other knee is also at an increased risk of developing problems because it overcompensates to make up for the injured one. For this reason, right knee secondary to left knee and left knee secondary to right knee are common secondary conditions that result in a bilateral VA rating.
Service Connection by Aggravation
Individuals who were diagnosed with knee pain before their time in service are also eligible for VA compensation if their condition is worsened by their time in the military. To prove service connection by aggravation, you must present evidence that proves your disability worsened. For disabilities that naturally worsen, such as arthritis getting more severe over time, you must prove that the deterioration was accelerated beyond a natural level as a result of military service.
VA Disability Knee Exam: C&P and DBQs
To properly assess your knee pain and the effects it has on your life, VA uses compensation and pension (C&P) exams and disability benefits questionnaires (DBQs).
VA DBQ: Knee and Lower Leg Conditions
You will be expected to fill out a DBQ before attending a C&P exam. The DBQ gathers basic information about your condition, how it developed, and how it has impacted your ability to live and work. When you attend your C&P exam the doctor will ask you questions about your DBQ, so it’s important that you fill it out completely and honestly. The more information you can provide on a DBQ, the less time you need to spend discussing it at the C&P exam.
Knee Pain Compensation and Pension (C&P) Examination
During the C&P exam, you will have time to explain your knee injury and how your life has changed as a result of it. You can take this time to discuss flare-ups and episodes or spend time describing why the condition is service-connected. At some point, the doctor is expected to perform a range of motion VA C&P exam based on the VA knee rating chart. These include the measurements of flexion and extension from VA Diagnostic Code 5260 and 5261. The doctor will use a device called a goniometer to measure range of motion. All of this information will be included in a report with the examiner’s opinion and sent to VA for the decision-making process.
AMA-Accepted Evidence for Knee Pain Claims and Appeals
Without an underlying condition, claims based on pain are some of the most difficult to prove. Knee pain is typically connected with another diagnosis that can be discovered through testing. Under the Appeals Modernization Act (AMA) of 2017, the accepted forms of evidence for knee pain include the following:
Range of motion testing
Documentation of surgeries, injuries, or other conditions with a secondary symptom of knee pain
The AMA also allows you to appeal your claim in three separate ways without having to perform a lengthy appeals process.
VA Rating for Knee Pain
A VA disability rating for knee joint pain is primarily based on a range of motion and C&P exams. However, there are a multitude of situations where additional rules may apply.
VA Disability for Bilateral Knee Condition
VA understands that disability that affects both knees limit your day-to-day ability to function more than single-knee conditions. This means VA will assign additional compensation for a bilateral knee pain VA rating. The amount of compensation is based on the combination of respective disability ratings. For example, if a veteran has a 20 percent rating in their left knee for instability and a 30 percent rating in their right knee for limitation of extension, VA will combine those ratings to get a 44 percent disability rating. Then, because the rating affects both sides of your body, VA will take 10 percent of the 44 (4.4) and add it on. The new bilateral rating would be 48.4, which rounds up to a 50 percent combined disability rating. Sometimes the rating will not change, but in this example the disability rating goes from 40 percent to 50 percent, earning the veteran additional compensation for the bilateral factor.
VA’s Painful Motion Rule
VA has regulations that state that any veteran who can show they have painful motion should be afforded a 10 percent rating, even if their condition does not meet the specific criteria for a limited range of motion.
VA’s Functional Loss or Functional Impairment Rule
VA also is expected to look at the veteran’s functional loss due to knee pain as well. Functional loss or impairment refers to the effect of a knee condition on the veteran’s everyday life. Even when a veteran experiences full range of motion, severe pain that prevents them from functioning normally should be taken into account when determining a VA rating for knee pain.
VA Disability for Arthritis in Knee and the Major Joint Rule
The major joint rule states that when a veteran has arthritis of the knees, VA will perform the normal range of motion tests and determine a rating based on Diagnostic Codes 5260 or 5261. If VA discovers that the veteran has a normal range of motion but experiences pain, VA will then refer to Diagnostic Code 5003 for arthritis.
Under Diagnostic Code 5003, if a veteran has arthritis that is confirmed through X-ray evidence they should be assigned a 10 or 20 percent disability rating. This percentage will be based on arthritis severity and whether it affects only a single knee or is bilateral. VA will only look past the range of motion tests to arthritis criteria in the case of arthritis in the knees.
Total Knee Replacement Disability Rating
Diagnostic Code 5055 covers individuals who receive a total knee replacement. Any veteran who gets a total knee replacement will automatically receive a temporary 100 percent VA disability rating for surgery. This is the only time a veteran can receive a temporary rating. After one year passes, the knee will be reevaluated based on the remaining conditions. The highest rating available for post-surgery symptoms after one year is 60 percent.
A bilateral VA disability rating for both knee replacements is treated the same way. After one year, however, the post-surgery symptom rating can be bilateral, which might increase the maximum compensation available. VA knee replacement compensation allows veterans to recover without having to work and damage their knees during the healing process after surgery.
Knee Pain TDIU
There are circumstances when your knee injury doesn’t qualify for a 100 percent VA rating in which you may still receive full compensation. If you meet the requirements for Total Disability based on Individual Unemployability (TDIU) between one or multiple disabilities, you can receive maximum benefits.
TDIU is based on your employability — you only qualify if you are unable to find and keep substantially gainful employment as a result of your service-connected knee condition. The specific criteria for TDIU include:
Having at least one disability rated at 60 percent or more, or having two or more disabilities where at least one is rated at 40 percent or more and they add up to a combined total of 70% or more.
You cannot keep a job that financially supports you due to your disability. Instances of marginal employment (odd jobs) do not count.
If you have one or more highly rated knee disabilities that prevent you from working, you may be eligible for TDIU.
Is it Possible to Increase Your VA Disability Rating for Knee Pain?
If you have received your disability rating and believe it should be higher, VA allows you to submit an appeal to earn higher VA compensation for knee pain. Within one year of the VA decision, you must file a Notice of Disagreement (NOD), supplemental claim, or take the higher review lane. Each of these are viable options under the AMA legislation.
You can file for an increase if your condition worsens and you are not yet receiving maximum compensation. You can submit a new claim for a secondary condition that will result in a new VA rating. You can increase your VA rating for knee pain by combining multiple disabilities. You can also increase your VA disability knee pain rating by filing it as bilateral if it is affecting both sides of the body. It may be beneficial to hire a legal representative who understands what your condition will qualify for.
Can Veterans Receive Multiple Disability Ratings for Knee Pain?
Depending on the nature of a veteran’s knee issues, it may be possible for them to receive multiple VA ratings for knee pain. If there are two separate conditions that involve different movements of the knee, both conditions may be eligible for their own VA rating.
Many veterans will consult a legal representative for help determining whether their disabilities can both be rated or if they would be pyramiding. Pyramiding occurs when the same symptom or disability is rated twice, and is not allowed by VA.
#appeals #Evidence #VAClaims #Tips #VADisability #Veterans #VARating #vadecision