As you know from your time serving in any of the military branches, intense training, heavy gear, and other strenuous activities puts all parts of your body under severe strain. As a result, chronic knee problems that lead to ongoing pain, lost mobility, and replacement surgery are common among Veterans. Sometimes service-related damage to this joint is not apparent right away, but worsens over time. If you have chronic knee pain or need a knee replacement due to a service-related injury, you may qualify for VA disability benefits.
VA Diagnostic Codes for Knee Problems and Replacements
The VA uses diagnostic codes to classify service-connected injuries or illnesses. Your diagnostic code is the key to understanding exactly how the VA chose to categorize your condition and its severity. It is, therefore, the key to the level of compensation the VA will award you. The diagnostic codes can be especially important if you disagree with the VA’s evaluation, and you wish to appeal the agency’s decision.
The VA uses these diagnostic codes to classify knee problems:
- 5260: Limitation of leg flexion
- 5261: Limitation of extension of the knee
- 5257: Instability of the knee
- 5256: Ankylosis of the knee
- 5002: Arthritis
- 5259: Removal of the semilunar cartilage
Total knee replacements are classified under diagnostic code 5055. Partial knee replacements do not have their own diagnostic code. They are rated according to any symptoms that are caused by the replacement, such as limited range of motion.
If you can establish a service-connection for your knee pain or lack of mobility, the VA rating will assign a rating from 0% to100%. The less you can move or bend your knee, the higher your VA rating will likely be. Overall, VA ratings for knee pain depend on these factors:
- The type of knee injury
- The severity of the diagnosed knee condition
- The knee’s range of motion
- The pain it causes
VA regulations stipulate that Veterans should be granted a 10 percent rating even if they do not meet a specific diagnostic code criteria for limited range of motion but can otherwise demonstrate their knee motion causes them pain.
Knee Replacement Ratings
For knee replacements the VA rates them at 30%, 60%, and 100%. Eligible Veterans will receive a temporary 100% VA disability for the first four months after knee replacement surgery. After this postoperative period, the VA will reassess your condition and assign a new rating. The VA will likely schedule you for a Compensation and Pension (C&P) exam after the post-operative period to determine your new rating. It is essential that you show up for your C&P exam.
Knee Pain and Secondary Disability
Chronic knee pain can lead to other additional medical conditions like back pain, arthritis, nerve damage, hip pain and even anxiety or depression. If this has happened to you, you can apply for a secondary disability rating. A secondary disability may increase your overall VA rating and provide additional monthly compensation.
TDIU for Knee Problems
Many Veterans who return from military duty have a service-connected condition, illness, or disability that may interfere with some aspect of their lives. Additionally, these conditions can make it impossible for them to function in society or sustain gainful employment. If you are a Veteran who can prove you unable to work at any job due to a service-connected impairment, you may qualify for higher level disability benefits under a classification known as Total Disability Individual Unemployability—or TDIU for short. Under TDIU you may be eligible for a 100 percent disability rating even though your individual disability ratings do not add up to 100 percent. On its own, knee pain will not qualify you for TDIU. However, if you already have been approved for VA disability and have at least one service-connected disability rated at 60% or more, or two or more disabilities for a combined total rating of 70% or more, and your knee pain prevents you from holding down a job, you may qualify for TDIU. (For more about TDIU including insider tips on qualifying download our free book “The Road Map to a 100% VA Disability Rating - What Veterans Need to Know About TDIU”.)
If you suffer from knee problems caused or made worse by your time in uniform, you may be eligible for a monthly tax-free disability payment from the VA. Contact the VA accredited attorneys at Cuddigan for help in filing for compensation. We offer a free, no-strings- attached evaluation of your case, and we only get paid when you win your case, so call or email us today.
