How Much VA Disability is Available for a Knee Replacement?

How Much VA Disability is Available for a Knee Replacement?

VA disability compensation is a tax-free monetary benefit paid to Veterans who have a service-connected disability. The Department of Veterans Affairs (VA) determines the level of disability and assigns a rating based on the severity of the condition. These ratings directly impact the amount of monthly compensation a Veteran receives.

It is important that Veterans who have undergone or are considering a knee replacement understand the VA disability ratings for this procedure. Knee replacements can significantly impact a Veteran’s quality of life, mobility, and overall well-being. By familiarizing themselves with the rating criteria and the potential benefits available, Veterans can ensure they receive the appropriate level of compensation and support for their service-connected knee replacement.

VA Disability Ratings for Knee Replacements

VA disability ratings are assigned to Veterans with service-connected disabilities to compensate them for the impact their conditions have on their daily lives and earning capacity. These ratings are based on the severity of the disability and are expressed as percentages, ranging from 0% to 100%.

When it comes to knee replacements, the VA rates the condition under Diagnostic Code 5055: Knee, resurfacing or replacement (prosthesis):. This diagnostic code outlines the specific criteria used to determine the appropriate disability rating for a Veteran who has undergone a knee replacement surgery.

Under Diagnostic Code 5055, a Veteran is eligible for a temporary 100% rating for four months following the implantation of the prosthesis. This temporary total disability rating is granted to provide the Veteran adequate time to recover from the surgery and undergo necessary rehabilitation.

To be eligible for the temporary 100% rating, the Veteran must have undergone a replacement surgery or resurfacing. The temporary total evaluation period begins on the date of the Veteran’s hospital admission for the surgery and for 4 months following the implantation of the prosthesis or resurfacing.

Reevaluating After Recovery

After the temporary 100% rating period has ended, the Veteran’s knee replacement is re-evaluated, and a new disability rating is assigned based on the residual symptoms and impairment. The minimum rating following the temporary 100% period is 30% for replacement, there is no minimum for resurfacing.

This 30% minimum rating applies when the Veteran’s knee replacement has resulted in intermediate degrees of residual weakness, pain, or limitation of motion. These residual symptoms are rated by analogy to Diagnostic Codes 5256 (ankylosis of the knee), 5261 (limitation of extension), or 5262 (impairment of the tibia and fibula).

If the Veteran experiences chronic residuals consisting of severe painful motion or weakness in the affected extremity, a higher 60% rating may be assigned. This 60% rating is the maximum schedular rating available for a knee replacement under Diagnostic Code 5055.

What is Involved in a Knee Replacement?

Knee replacement surgery is a procedure that replaces damaged or worn-out parts of the knee joint with artificial components made of metal and plastic. The goal of the surgery is to alleviate pain and improve knee function. Surgeons evaluate a patient’s knee range of motion, stability, and strength, and use X-rays to determine the extent of the damage before deciding if a knee replacement is the best course of action.

The type of artificial joint and surgical technique used depends on various factors, including the patient’s age, weight, activity level, knee size and shape, and overall health. Knee replacement surgery is most commonly performed to relieve pain caused by arthritis, which often leads to difficulty walking, climbing stairs, and getting up from chairs.

Recovery time after knee replacement surgery varies from person to person, but it typically involves a combination of rest, physical therapy, and a gradual return to activities. Most patients experience significant pain relief, improved mobility, and a better quality of life following the surgery.

With proper care and rehabilitation, knee replacements can last 15 to 20 years or more, providing long-term benefits for those suffering from chronic knee pain and reduced mobility.

Knee Injuries Among Veterans

Knee replacements can also be performed because of injuries to the knee. While arthritis is the most common reason for knee replacement surgery, other conditions and injuries that cause damage to the knee joint may necessitate the procedure. These can include:

  • Fractures: Severe fractures in the knee joint, particularly those that damage the joint surface.
  • Ligament injuries: Serious ligament injuries, such as anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears, can cause instability and damage to the knee joint over time.
  • Meniscus tears: Severe or chronic meniscus tears can lead to the breakdown of cartilage in the knee joint, which may eventually necessitate a knee replacement.

Veterans who served in the military may be at a higher risk of developing knee problems that could lead to the need for a knee replacement. Some factors that contribute to this increased risk include:

  • Physical demands: Military service often involves high levels of physical activity, such as running, marching, and carrying heavy equipment, which can put significant stress on the knees.
  • Injuries during service: Veterans may sustain knee injuries during training exercises, combat situations, or other military-related activities, which can cause long-term damage to the knee joint.
  • Overuse: Repetitive motions and prolonged periods of standing or walking can lead to overuse injuries in the knees, such as tendinitis or bursitis, which can contribute to the development of knee problems over time.

As a result, Veterans may be more likely to experience knee strain, injuries, or conditions that could eventually require a knee replacement.

When evaluating a Veteran’s disability claim, the VA considers not only the primary disability condition (in this case, the knee replacement) but also any secondary conditions that are determined to be related to the primary condition. 

Secondary conditions can develop as a result of the knee replacement surgery or the recovery process. Scars related to the surgery are service connectable and might include issues such as pain, tenderness, or limitation of moment. Other conditions might include instability of the knee joint, and/or peripheral nerve damage caused by surgery, resulting in numbness, tingling, or weakness in the leg or foot.

The presence of secondary conditions can impact a Veteran’s overall disability rating for a knee replacement. the primary condition. 

If found to be related to the primary disability and thus, service connectable,  the VA will assess the severity of the secondary condition and assign a separate rating, which is then combined with the rating for the primary condition. All ratings together determine a Veteran’s total disability rating.

Applying for VA Disability Benefits for a Knee Replacement

To apply for VA disability benefits for a knee replacement, Veterans must meet certain eligibility requirements. First, they must have served on active duty, active duty for training, or inactive duty training. Second, they must have a current disability related to their knee replacement that is connected to an injury, disease, or event that occurred during their military service.

When applying for VA disability benefits, Veterans must provide various documentation to support the claim. This documentation can include: medical records detailing the diagnosis, treatment, and severity of the knee condition, statements, and personnel or service treatment records.

A nexus letter from a medical professional can also be submitted to provide a crucial link between the Veteran’s current knee condition and their military service.

To increase the chances of a successful claim, Veterans should work closely with their healthcare providers and gather all relevant medical evidence. They should also provide a detailed account/statement of how their knee condition impacts their daily life and ability to work.

An experienced VA disability benefits lawyer can help guide Veterans in navigating the application process. They will help ensure all necessary documentation is submitted and assist in building the strongest case possible for the Veteran.

Appealing a VA Disability Rating Decision

If a Veteran disagrees with the VA’s decision regarding their disability rating for a knee replacement, they have the right to appeal. Veteran’s have three options when they disagree with a rating decision,

  1. Supplemental Claim: submit a VAF 20-0995 with new and relevant evidence
  2. Higher-Level Review: request the VA review the file and evidence already of record again
  3. Board of Veterans’ Appeals: file a notice of disagreement (NOD)

A Veteran has one year from the date of the notification letter to continuously pursue their claim. Should one year lapse, the Veteran will either need to file to reopen the claim (if denied) or file for an increase (to adjust the evaluation).

The BVA will review the case and issue a decision. If the Veteran still disagrees with the BVA’s decision, they may appeal to the Court of Appeals for Veterans Claims (CAVC). This is an independent federal court that has the authority to review BVA decisions.

Throughout the appeals process, an experienced VA disability benefits lawyer can provide guidance and representation. They can represent Veterans before the Agency (regional offices, BVA,  and US Court of Appeals for Veterans Claims (CAVC), advocating for their rights and working to secure the benefits they deserve for their service-connected knee replacement.

Contact Berry Law to File a VA Disability Claim for Knee Replacement

Veterans seeking VA disability benefits for a knee replacement should consider contacting Berry Law for legal guidance and representation. As a law firm dedicated to serving Veterans, Berry Law understands the complex VA system and the unique challenges service members face when pursuing disability claims.

Many of the attorneys and legal professionals at Berry Law are Veterans themselves, giving them firsthand knowledge of the military experience and the impact of service-connected injuries on a Veteran’s life. This personal understanding allows the team at Berry Law to provide compassionate, effective advocacy throughout the disability claims process.

Contact Berry Law today to talk to a lawyer and take the first step toward securing the benefits earned through service and sacrifice. We represent Veterans in all 50 states and our legal team is available 24/7. Call Berry Law at (888) 883-2483 or contact us online today to schedule a free and confidential legal consultation. We know the way forward.

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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