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 previous posts, we discussed ratings for limitation of flexion and extension and instability. Today we are going to discuss the ratings available for injuries involving the meniscus.
Why are there multiple ratings for knee problems and meniscus?
Before we get into meniscus injuries specifically, it is important to understand why exactly it is that multiple ratings are allowed for the knee. As explained in the previous posts, 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.
The VA Rating Schedule for Meniscus and Similar Knee Issues
Meniscus injuries are evaluated under DC 5258 and DC 5259. On the VA rating schedule, you will see the term “semilunar cartilage.” Semilunar Cartilage is, basically, another word for “meniscus.”
Under DC 5258, a 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion (swelling) into the joint. The term “dislocated” includes “torn,” so a torn meniscus will be evaluated under DC 5258. Also, the term “frequent” is not defined. As such, you should argue that more than one incidence of “locking,” pain, and effusion is “frequent.” In addition, all three elements are required to be eligible for a rating under DC 5258. That means that if a veteran has episodes of locking and pain, but no swelling, he will not be rated under DC 5258.
Under DC 5259, a 10 percent rating is warranted for the removal of semilunar cartilage, symptomatic. “Removal of semilunar cartilage” is another way to say “meniscectomy,” which is the term you will likely see in medical records. Another term to look for is “debridement.” Debridement is the removal of damaged tissue, but is not a complete meniscectomy. However, if a veteran suffers residuals from a debridement, he should still argue for a rating under DC 5259.
If the veteran has had a meniscectomy, he or she should argue that any and all symptoms that are not rated under other diagnostic codes should be rated under DC 5259. This includes symptoms such as pain, weakness, locking, swelling, and tenderness to palpation. A veteran can receive separate ratings under DC 5258 and 5259 and DC 5260/5261 (limitation of motion) as long as there are symptoms related to the meniscectomy other than the limitation of motion. For example, if a veteran had a meniscectomy and now has pain, swelling, and flexion limited to 45 degrees, he is entitled to a 10% rating under DC 5260 for limitation of flexion and 10% under DC 5259 for pain and swelling.
However, the VA Adjudication Manual instructs VA adjudicators to not assign separate ratings for limitation of motion under DC 5260/5261 (or instability under DC 5257) and meniscus conditions under DC 5258/5259. However, this reading of the rating schedule is inconsistent with the plain text of the regulation and memorandum decisions from the Court of Appeals for Veterans Claims. Therefore, if you are not awarded separate ratings for these conditions at the RO, you should argue that you are entitled to separate ratings at the Board of Veterans Appeals.
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