Of all the disabilities listed on the VA’s Schedule for Rating Disabilities, the ratings involving the knee are one of the most difficult for veterans to understand – and for the VA to get right. Much of the confusion stems from the fact that a veteran may be able to receive multiple ratings for the same knee, depending on the severity of his or her condition. In a previous post, we discussed ratings for limitation of flexion and extension. Today we are going to discuss another rating that a veteran may be entitled to for a knee condition – instability.
Why are there multiple ratings for the knee?
Before we get into instability specifically, it is important to understand why exactly it is that multiple ratings are allowed for the knee. As explained in the previous post, the “Rule against Pyramiding” and the rule that the VA must maximize benefits for a veteran work together. This means that separate disability ratings may be assigned for different conditions where none of the symptomatology for the separately rated conditions is duplicative or overlapping. This is particularly important for the knee, where one injury may cause many different issues, and these separate manifestations of that injury may all be entitled to separate ratings.
Today we are going to discuss knee instability. Instability is rated under Diagnostic Code 5257. That diagnostic code refers to “recurrent subluxation or lateral instability” and ratings are available for severe (30 percent), moderate (20 percent), and slight (10 percent). Subluxation means dislocation of the patella, or knee cap. Lateral instability means a feeling of “giving way,” generally caused by damage to the knee ligaments. You may also see the term “medial instability” in your medical records. Medial instability is a direction of lateral instability and is also rated under DC 5257.
The “feeling of giving way” is something that the veteran is competent to report and attest to. As is often the case, a medical diagnosis of ligament diagnosis is going to be the most persuasive evidence when it comes to instability, but the VA is supposed to consider a veteran’s self-report of instability. It is important to note, however, that if testing is done during a C&P examination (such as Lachman’s test) and no instability is found, the VA will likely consider that medical evidence to be the most persuasive.
Level of Instability for Rating
As noted above, instability is rated as severe, moderate, or slight. The VA does not define these terms. For example, a C&P examiner performs the Lachman’s test and notes that a veteran does have instability and indicates that it is “slight.” The use of the term “slight,” “moderate,” or “severe” by a C&P examiner is not supposed to be controlling, but practically speaking, it is. The VA will most likely give the veteran a 10 percent rating under DC 5257. However, the veteran should attempt to argue the full disability picture in an effort to get a higher rating. The veteran should submit statements detailing his struggles with instability, buddy statements from people who have witnessed his knee giving way, and any medical records that support the finding that his instability is more than “slight.” He may also want to get an independent medical opinion from an outside doctor to support the argument that he is entitled to a higher rating for his instability.