Due to the high physical 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.
Many Veterans suffer from aches and pains in the years and decades after their military service. The physical stress and strain of active military duty can have long-term effects on a soldier’s body. Sometimes, this strain can end up leading to severely disabling conditions. However, in many cases, the aches and pains that Veterans suffer from in the years after they serve in the military may be less severe. Depending on a Veteran’s experiences, injuries, and the environment that they served in, they may retire from the military with milder or more severe disabilities, including knee pain.
Veterans with chronic knee pain have often had to carry heavy loads, walk long distances, or work in uncomfortable conditions for long periods. These factors can all lead to joint problems, persistent swelling, and other issues that can be chronically painful for many Veterans. Most Veterans who suffer from service-connected knee pain are still able to walk, albeit with some discomfort.
However, for some, service-related knee problems are much more severe, requiring intensive medical treatment and, at times, the use of a wheelchair. If a Veteran is suffering from knee pain that is severely disabling, they may qualify for disability benefits from the VA.
The VA’s disability benefits for knee pain can vary depending on several factors. If a Veteran is suffering from knee pain in addition to other service-connected conditions, they are more likely to receive a higher disability score than a Veteran who is dealing with knee problems alone. The disability rating that the VA gives to a Veteran can be cumulative, accounting for the combined severity of multiple disabilities. In other cases, a Veteran may be approved for benefits on account of only one service-connected condition. Since knee pain can range from mild to severe, the compensation a Veteran can receive for the condition — and their ability to qualify for benefits — can vary.
If a Veteran suffers from knee pain that is so disabling that they have trouble moving, their condition is much more likely to warrant a high disability rating in the eyes of the VA. Sometimes, service-connected knee pain can even qualify a Veteran for a 100% disability rating, leading to the highest possible benefits. In order to receive this rating, a Veteran will need to prove to the VA that their condition is so severe that it significantly inhibits them from functioning in work and everyday life.
Veterans can still receive disability benefits for milder cases of knee pain as well. If a Veteran’s knee problems negatively affect their quality of life but do not cause the Veteran to be severely disabled, the VA may still recognize their condition as warranting disability benefits. However, Veterans with milder knee problems are more likely to get a lower disability rating from the VA, leading to less monthly compensation overall.
To start the process of applying for VA disability benefits, you will need to fill out a claim and submit it to your local VA office. You can submit a claim online, in person, or by mail. Once the VA has your claim, they will start reviewing the information and medical evidence that you submitted. After evaluating your condition with an in-house Compensation and Pension Examination, the VA will determine whether you should be approved for benefits. If your claim is approved, you will receive a specific disability rating that corresponds to the amount of monthly compensation you can receive.
In order to receive disability benefits from the VA for knee pain, you will need to receive at least a 10 percent disability rating after filing your claim. A 0 percent rating indicates that the VA did not find your condition to be severely disabling enough to warrant monthly compensation. In some cases, a Veteran might suffer from mild flare-ups or brief struggles with walking due to knee pain, but these symptoms may still not be enough to convince the VA to grant approval for benefits.
Veterans can find their disability claims for knee pain denied for several reasons. If the VA has rejected your claim, it most likely means one of two things — either the VA was unable to establish a verifiable connection between your knee pain and your time in the military, or your disability was not assessed as being severe enough to qualify you for benefits.
Other factors can lead to a Veteran’s claim getting denied or deferred as well. Sometimes, a Veteran’s claim will be deferred — neither approved nor denied — because the Veteran has not provided the information that the VA needs to make a decision. If your claim has been deferred, make sure to submit any additional documentation or evidence that the VA has asked for — that way, you can work towards receiving the benefits you deserve.
Sometimes, the VA allows conditions that are not directly service-connected to affect a Veteran’s disability score. These disabilities are called secondary conditions, and they can increase a Veteran’s disability rating by adding to the score given for a primary disability. If a Veteran has a service-connected disability that has caused or worsened other conditions, these issues may be listed as secondary conditions on a Veteran’s disability claim. Knee pain can often develop or be exacerbated as a result of service-connected disabilities, and the VA recognizes knee problems as grounds for increasing a Veteran’s disability rating in some cases, even if a service-related experience or injury did not directly cause the pain.
If you have developed knee pain due to a service-connected injury, you may be able to receive higher disability compensation than what you are already getting. In addition, if a service-related disability made your pre-existing knee problems worse, your disability benefits may be able to increase as well. As long as you can establish that your knee pain was caused or worsened by factors related to your military service, the VA will most likely grant an increased disability rating as a result of your condition.
If you want to file a disability claim for knee pain or a knee injury, it’s also important to understand the pyramiding rule. In a nutshell, the practice of pyramiding involves using multiple diagnoses for one disability or disabling condition. The VA does not allow pyramiding when diagnosing a disability.
The pyramiding rule is important because it prevents the VA from accidentally compensating a claimant several times for the same manifestation of their disability. Furthermore, a disability is not “more” disabling just because it may be caused or aggravated by more than a single diagnosed issue or condition.
For example, if a Veteran has major depressive disorder and post-traumatic stress disorder, the manifestations of those symptoms could be very similar.
To prevent pyramiding, the VA evaluates both claims as a single disorder and gives the Veteran one rating. For example, the VA would not give benefits for both lack of concentration as associated with PTSD and lack of concentration as associated with depressive disorder. Instead, the VA would compensate the Veteran based on the single symptom.
In addition to the general rule against pyramiding, there are multiple places in the VA’s rating schedule that 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.
It’s also important to understand how knee injuries are evaluated relative to separate medical evaluations. The VA’s rating schedule has several areas that don’t allow separate evaluations for specific disabilities.
For instance, you cannot pursue a separate evaluation for both respiratory conditions and hypertension from aortic insufficiency or hyperthyroidism.
On the other hand, knee injuries do not have this prohibition against separate evaluations. In other words, different parts of your knee problem, condition, or injury can be evaluated separately. That’s partially because there are several diagnostic codes available that can affect knee and leg conditions. There are eight total diagnostic codes that cover different malfunctions of the knee.
To learn more about how separate evaluations and knee injuries work, let’s look at an example:
Given the potential for maximizing compensation, it’s important to work with knowledgeable Veterans law attorneys, so you gather the right evidence and demonstrate your qualifying knee injury symptoms under multiple diagnostic codes.
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 when 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.
Because knee pain is often a chronic condition, it usually does not get better over time. However, the VA sometimes assumes that a Veteran suffering from knee problems may no longer require disability compensation after a few years. If the VA presumes that you have made a full recovery from your knee problems because a certain amount of time has passed, they may lower your disability rating or cease your benefits. To do this, though, the VA must first send a letter explaining that they plan on reducing your benefits.
However, in many cases, the VA will lower a Veteran’s rating even when they are still suffering from knee pain and other service-connected disabilities. To ensure that your rating does not get lowered when it should remain the same, there are several essential steps to take.
To keep your disability rating for knee pain from changing, make sure to continue seeking treatment for your condition. Going to your doctor, taking prescribed pain medications, and attending physical therapy sessions are all practices that can indicate to the VA that you are still needing and getting treatment for knee pain. If the VA recognizes that your treatment is ongoing, they will not have grounds to lower your disability rating, nor will they assume that you have made a full recovery over time.
In addition, if the VA does default to lowering your disability rating, you can request to have your condition re-evaluated. Getting a re-evaluation can help you maintain your current disability rating, and in some cases, a re-evaluation from the VA can even lead to increased benefits. The VA requires Veterans to come in for routine evaluations multiple times after they qualify for benefits, but you can also schedule your own re-evaluation if necessary.
If your knee pain gets worse, make sure to let the VA know. The symptoms of knee problems can often get more severe over time, and you may be able to qualify for higher disability benefits if you start experiencing more frequent and more severe pain. Make sure to get your condition re-evaluated by the VA if you notice more severe symptoms, especially if these symptoms hinder you from effectively working and functioning in everyday life.
If the VA denies your disability claim for knee pain, we can help. The Berry Law team is made up of Veterans of numerous branches of the military, and we’re ready and willing to do what it takes to help you get the benefits you deserve. As a team of Veterans helping Veterans, we know what the VA looks for in disability claims, and we can help you appeal a VA decision to get the compensation you need to help support yourself and your loved ones.
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