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VA Secondary Conditions to Knee Pain: Claims & Appeals

VA Secondary Conditions to Knee Pain: Claims & Appeals

Knee pain is one of the most common service-related conditions that Veterans receive benefits for. However, knee pain is often accompanied by other illnesses or chronic conditions. These secondary conditions may entitle you to additional disability benefits.

Many Veterans already know that the claims and appeals process for getting those extra benefits can be complex, unintuitive, and downright frustrating. Today, let’s break down how claims and appeals work for VA secondary conditions to knee pain and how you can maximize your benefits with the help of legal professionals.

What Are VA Secondary Conditions?

In a nutshell, secondary conditions are physical or mental health conditions caused by a Veteran’s primary service-connected condition. 

VA secondary conditions are not directly caused by one’s military service. Instead, they are caused by a Veteran’s service-related injuries or illnesses. 

Example of a Secondary Condition

Here’s an example to illustrate what a secondary condition might look like for a Veteran who experiences a major injury during their service.

First, they return home and get treatment for the injury. However, it still causes massive pain and discomfort for the Veteran. The Veteran ultimately goes through the VA claims process and receives disability benefits for their injury.

Despite all this, the Veteran develops depressive symptoms because of the discomfort and lower quality of life caused by the injury.

This depression is an example of a secondary condition. Without the primary service-connected condition, the Veteran may not have developed depression at all.

In many cases, Veterans may be entitled to additional disability benefits for secondary conditions. However, filing a claim for secondary conditions can be tricky, just like navigating the appeals process.

Common Secondary Conditions to Knee Pain

Knee pain is incredibly common among servicemembers. Knee pain can be caused due to a wide range of VA recognized conditions and injuries, including but not limited to:

  • Limitation of flexion or extension of the knee, which have diagnostic codes 5260 and 5261, respectively
  • Instability of the knee, diagnostic code 5257
  • Ankylosis of the knee, diagnostic code 5256
  • Total knee replacements, diagnostic code 5055

Many Veterans develop knee pain and injuries because of combat duty, the heavy physical requirements of their work, and other reasons. However, your knees are important body parts that affect other systems and areas throughout your body, such as your legs, your feet, your waist, and even your back.

Knee pain, therefore, is also frequently linked to many secondary conditions, including but not limited to:

  • Foot injuries and pain
  • Ankle injuries and pain
  • Hip injuries and pain
  • Back conditions
  • GERD (gastroesophageal reflux disease)
  • Arthritis
  • Mental health conditions like depression

These secondary conditions may appear because your knee affects how you walk, whether you experience pain when moving around, and the kind of work or activities you can complete. 

For example, if your knee pain prevents you from running, you may not be able to participate in a sport you enjoyed prior to developing your knee condition.

Can You Get Disability Benefits for Secondary Conditions?

Yes. The VA allows Veterans to receive disability benefits for secondary conditions, provided they can tie those secondary conditions to their service-connected injury or illness. In this example, a Veteran would have to prove that their secondary condition was caused because of their knee pain or injury.

Can You Receive TDIU for Secondary Conditions to Knee Pain?

TDIU, or total disability based on individual unemployability, is a unique monthly VA benefit. This compensates any Veterans at the 100% disability rating level if they cannot find and/or maintain substantially gainful employment due to their condition(s).

Secondary conditions may contribute to a Veteran’s total disability rating and, therefore, their ability to qualify for TDIU. To qualify for TIDU, Veterans must:

  • Have at least one condition rated at the 60% disability level, or
  • Have at least two conditions that, when combined, reach the 70% disability level. One of those conditions must be rated at 40% disability.

Therefore, a secondary service connection may increase a Veteran’s total disability rating to 70% or above. Fortunately, secondary service-connected conditions carry the same disability weight as primary service connections. But keep in mind that adding your disability ratings together can be complex.

The VA usually calculates a secondary condition’s disability percentage based on your existing disability percentage. For example, if you have a current disability rating of 30% and your secondary claim receives a separate disability rating of 20%, you’ll end up with a full disability rating of 44%. The VA would round down to 40% in total.

What You Need for a Successful Claim

Filling a benefits claim for a secondary condition follows largely the same process as filing a benefits claim for a primary condition. Any Veteran wishing to receive benefits for secondary conditions to knee pain needs three main things:

  • A service-connected injury/illness
  • Proof of pain, injury, or illness
  • A nexus opinion

Below, we’ll discuss each of these requirements in more detail.

Service-Connected Injury/Illness

First, a Veteran must have a service-connected injury or illness they already receive benefits for. It is not possible for a Veteran to receive secondary benefits if they aren’t already receiving primary disability benefits.

Therefore, a Veteran must file a claim for disability benefits for a primary and direct service-connected condition. In this case, it would be knee pain. Veterans can file either for general knee pain and immobility or for a knee injury categorized under the VA’s diagnostic code system described above.

Knowledgeable Veterans law attorneys can assist with this aspect of the process, guiding you through the primary claims process.

Proof of Pain/Injury/Illness

After receiving benefits for a service-connected injury or condition, a Veteran must provide medically backed proof of the secondary condition itself. For example, if a Veteran experiences hip pain because of their knee injury, they need:

  • Medical notes or doctor recommendations that clearly show the hip pain is real and has a tangible effect on the Veteran’s livelihood and quality of life
  • An official diagnosis (if applicable) from a VA approved medical practitioner

For most secondary connection claims, the VA will request a Compensation and Pension Exam or C&P Exam. This official examination explores the Veteran’s secondary condition and its symptoms to obtain information about the link between it and the Veteran’s current knee pain.

C&P Exams are always carried out by VA examiners or contracted examiners. The exam may include a physical examination or an interview if the secondary connection is related to mental health.

Even if the VA requests two separate exams, you should do your best to attend them promptly. The exams are not redundant. They allow the VA to thoroughly analyze your condition and determine whether there are enough grounds to qualify you for additional benefits.

If the VA does not receive satisfactory exam results, your claim could be denied.

Nexus Opinion

Like a service-connected condition, a secondary condition requires a nexus opinion clearly outlining the link between a Veteran’s primary illness or injury and their secondary condition(s). 

Remember, a secondary condition does not require the Veteran to connect that condition to their time in the military. They need to connect the secondary condition to their primary condition instead.

Lawyers can help Veterans explain more effectively to the VA how their secondary pain or symptoms are directly related to their service-connected condition.

What if Your Benefits Claim Is Denied?

If your benefits claim is denied, knowledgeable Veterans law attorneys may be able to help. Sometimes, secondary condition claims are denied because:

  • There’s a problem with paperwork
  • The VA doesn’t consider there to be enough evidence to warrant an increase in benefits 
  • The Veteran has trouble proving the connection between their secondary condition and their service-connected condition

In any of these cases, lawyers may be your best bet to see a denial reversed. The right legal team can help you by:

  • Gathering additional evidence on your behalf
  • Helping you file your disability benefits claim and/or appeals paperwork properly
  • More thoroughly documenting the exact connection between your secondary condition and your service-connected condition 
  • And more

Contact Berry Law Today

Getting the benefits you deserve for secondary conditions can be tough, but Berry Law can help you file a successful claim no matter what. As skilled and experienced Veteran law attorneys, we’re more than able to assist when you file a benefits claim for secondary conditions to knee pain, including foot pain, back pain, and more.

In addition, Berry Law can help if you’ve already filed a claim for secondary condition benefits but have been turned down. We’re experts at navigating the VA appeals process and can potentially help you overcome a denial so you get the higher benefits you deserve.

Don’t wait. Instead, contact Berry Law today and get a free case evaluation.

Sources:

What is Secondary Service Connection for VA Disability Compensation? | Veteransaidbenefit.org

38 CFR § 4.71a – Schedule of Ratings – Musculoskeletal System | Cornell Law School

VA Individual Unemployability if You Can’t Work | Veterans Affairs

Berry Law

The attorneys at Berry Law Firm 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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