VA disability claims involving knee disabilities are very common, and the mistakes the VA can make when evaluating knee claims are even more common. Knee ratings can be tricky because there are so many different factors to consider, and there are multiple different ratings available. It is important to be aware of all of the available ratings for knee disabilities in order to ensure that you are getting the highest rating possible. The general rule regarding multiple ratings for the same disability is, “the evaluation of the same disability under various diagnoses is to be avoided.” However, VA regulations specifically provide that the knee joint can be evaluated under multiple diagnostic codes where there are different manifestations of the same disability. So, as long as the knee disability affects you in separate and distinct ways, you can receive multiple ratings.
Ratings to be Aware of
The knee can be rating under many different diagnostic codes depending on the specific problem, or problems, caused by a knee condition. For example, there are ratings available for instability of the knee, limitation of extension, knee replacements, etc. It is important to be aware of all the different ratings, and whether you are entitled to compensation for multiple ratings in order to make sure the VA is giving you all of the compensation you’re entitled to for your knee disability. Below is a list of ratings that can potentially be assigned to the same underlying disability:
- Limitation of Flexion: The diagnostic code for limitation of flexion is 5260. According to the rating criteria, if the knee can straighten, but can’t bend all the way, it is rated under 5260. The different percentages available are 0%, 10%, 20%, and 30%. These ratings are assigned based on how much the knee can bend. So, the less the knee can bend, the higher the rating will be. There are specific range of motion measurements that correspond with each percentage which can be found here.
- Limitation of Extension: The diagnostic code for limitation of extension is 5261. This diagnostic code is used when the knee’s mobility isn’t frozen, but it can’t straighten all the way. The different percentages available are: 0%, 10%, 20%, 30%, 40%, and 50%. These ratings are assigned based on the knee’s ability to straighten. The more the knee disability prevents the leg from straightening, the high the rating will be. Again, there are specific range of motion measurements that correspond with each percentage, and can be found here.
- Instability of the Knee: The diagnostic code for instability of the knee is 5257. This diagnostic code is used with the knee has too much motion from side to side, or dislocates regularly. Instability of the knee can occur when damaged tendons and cartilage can no longer support the knee joint properly. The different percentages available are: 10%, 20%, and 30%. The more instability present in the knee, the higher the rating. In order to get the highest rating of 30%, the knee must be so unstable that it gives out or dislocates regularly.
- Total Knee Replacements: If your knee disability becomes so severe that a total knee replacement is required you will automatically receive a temporary 100% rating for one year post surgery. After that one year period, the knee will be rated according to the severity of any remaining problems. The highest rating available for residuals of the total knee replacement (rated under diagnostic code is 60%. A 60% rating will be assigned when there is weakness and severe pain with motion. If the pain is not severe, but you have limited range of motion in your knee, your knee will be rated according to the criteria set forth for limitation of flexion and/or limitation of extension.
- Partial Knee Replacements: Unlike total knee replacements, partial knee replacements do not have their own diagnostic code. Instead, partial knee replacements are rated according to any symptoms that are caused by the replacement such as limited motion.
Knowing these different ratings allows you to be aware of whether you’re entitled to receive more compensation from the VA. Yes, bending and straightening your knee both involve your ability to move your knee, but they involve different movements. Therefore, you can receive ratings for both limitation of flexion and limitation of extension for the same knee. If the knee can move, but is limited in its ability to bend or straighten it should be rated under diagnostic code 5260 and 5261. Also, instability of the knee is a rating that is often overlooked. However, if you have problems with your knee dislocating or giving out because of a service-connected disability, then it is important to be aware of this rating because instability of the knee can be rated in addition to other ratings for the same knee. For example, if you have trouble bending your knee, straightening your leg, and your knee gives out on you, then you are entitled to 3 separate ratings (limitation of flexion, limitation of extension, and instability of the knee). All of these different rating combinations also come into play when evaluating residuals from total and partial knee replacements.
Evaluating a Knee Disability – Keep in Mind
The VA likes to use Disability Benefits Questionnaires (DBQs) to evaluate a veteran’s disability. These can be completed by your private doctor and submitted to the VA as evidence for your claim. The VA may also schedule you for a Compensation & Pension examination (C&P Exam) where the C&P examiner will complete a DBQ. Regardless of who is completing the DBQ form, it is important to remember that many knee ratings are based on range of motion measurements, and all range of motion measurements must be performed with a goniometer in order for the VA to accept them.