Due to the high psychical demands of military service, many veterans experience knee injuries or dysfunction. When they leave the service, they apply for disability compensation for their knee problems through the VA, only to find their debilitating condition rated at 10 percent or lower. If the object of disability compensation is to make up for functional loss suffered by the veteran due to military service, why would a daily struggle with knee dysfunction be given a low rating?
Oftentimes, the VA overlooks a special qualification given to knee dysfunction. Namely, multiple knee problems may be evaluated separately, unlike most other disabilities. In order to understand what that means for the knee evaluation, we must first explore the treatment of most other disabilities with separate possible ratings.
The VA has a rule against “pyramiding,” which means that multiple diagnoses may not be used to evaluate a single disability. The rule exists to prevent the VA from compensating a veteran multiple times for the same manifestation of their disability. The reasoning for this is that the disability is not more disabling simply because it could be caused by more than one diagnosed problem. A common example of this comes up when a veteran suffers from multiple diagnosed mental health disorders. If a veteran suffers from both major depressive disorder and post-traumatic stress disorder, the manifestations might be very similar. In order to avoid pyramiding, the VA evaluates the claims as one disorder and provides a single rating as though the veteran only suffered from one mental health disorder.
In addition to the general rule against pyramiding, there are multiple places in the VA’s rating schedule which prohibit separate evaluations of specific disabilities. Some examples include the forbidding of separate evaluations for respiratory conditions and the instruction to evaluate hypertension due to aortic insufficiency or hyperthyroidism as part of the underlying condition. Knee dysfunction operates differently.
The regulations do not include a prohibition against a separate evaluation for manifestations of a knee disability. That means that different parts of the same knee problem may be evaluated separately.
When looking at the rating of a knee condition to decide whether to pursue a higher rating, it’s important to consider the multiple diagnostic codes available. Conditions of the knee and leg are listed under 38 C.F.R. § 4.71a. In that section, there are eight diagnostic codes covering the various malfunctions of the knee.
Let’s say our veteran experiences pain when she’s walking, as well as stiffness, clicking, weakness, and a wobbly sensation which sometimes results in falling. Her one knee condition would probably qualify for rating under multiple diagnostic codes. First, under DC 5257, the veteran could be rated for “recurrent subluxation or lateral instability.” Subluxation is a misalignment of the knee. Lateral instability would be movement side to side. Because the veteran experiences a wobbly sensation in her knee, she probably qualifies for a rating under the diagnostic code.
Since the veteran also experiences stiffness in her knee, she may also qualify for ratings for either (or both) limitation of extension and limitation of flexion under DC 5260 and 5262. A doctor will be able to test the range of motion of the knee and determine whether she qualifies. If the flexion is limited to 60 degrees or more, the veteran will qualify to receive compensation. The same applies for extension if it is limited to 10 degrees or more. If the veteran has days that the stiffness is considerably worse, the examiner will also need to estimate the degree of additional functional loss as a result.
In the above example, the veteran could qualify for compensation under three different diagnostic codes, which is permitted under the regulations. When deciding whether to appeal a knee condition, it’s important to make sure all symptoms have been accounted for to see if the veteran qualifies for additional compensation under an alternative diagnostic code.
Sometimes the process of filing and being granted disability compensation is more difficult than it should be. Oftentimes, a veteran has an apparent disability that the VA rates to low or declines altogether. Add in the fact that knee injuries can have separate evaluations because of their different diagnostic codes, and it is easy to see why they struggle to get the compensation they deserve. If you or somebody you know would like to appeal a VA rating decision, contact our team today at (888) 883-2483 for a free, confidential consultation.
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