Can You Get VA Benefits for Knee Pain?
Pain is one of the most common causes of disability in the United States. However, it is often difficult to prove that pain is the cause of a person’s service-connected disability. This is because pain is not in itself a diagnosis.
So, can you get VA disability benefits for knee pain?
Fortunately, knee pain is often an indicator of an underlying illness or chronic condition that will qualify for a disability rating through the United States Department of Veterans Affairs.
If you are experiencing knee pain, a knee injury, or functional loss of the knee relating to your military service, you may be eligible for disability compensation based on a variety of factors. This guide will outline which knee conditions might qualify for VA disability compensation and how veterans can best prove service connection.
Which Conditions Might Qualify a Veteran For VA Disability Benefits?
As mentioned above, getting VA disability for knee pain can be challenging. However, while reported knee pain may not be enough to qualify a veteran for benefits, there are some knee conditions that can. These conditions include:
- Tuberculosis of the knee
- Rheumatoid arthritis that affects the knees
- Degenerative arthritis
- Knee Instability
- Limited range of motion
If you have a condition that leads to knee pain, the next step is to prove that the issue resulted from military service.
Service Connection for Knee Pain
The first step in receiving a VA disability rating for knee pain is to establish a direct service connection. The stronger the connection between your military service and the injury you sustained, the more likely you are to have a successful disability claim. However, this process is often easier said than done. One of the most common reasons claims fail is that they fail to include three essential factors:
1. A current diagnosis that includes the disability that is being claimed
In this case, you will need a diagnosis that accounts for the knee pain you are experiencing. If your diagnosis loosely explains your knee pain, it is unlikely that it will apply to your disability claim. It is important to persist until you receive a diagnosis that directly connects your knee pain to the illness or knee condition.
2. Documentation of an in-service occurrence or incident that caused the disability, or at the very least, aggravated the condition
If you had a singular incident that caused your knee pain, it is important that you gather all of the possible documentation relative to that incident. Be sure your documentation includes the date and time the incident happened, any medical attention you received, whether your condition improved or deteriorated from there, and how the incident impacted your pain. Documentation is more difficult to obtain if knee pain is related to a chronic condition like degenerative osteoarthritis that developed over time. This is why service members are encouraged to have their pain and disability documented prior to leaving the military.
3. A medical nexus that connects the current, diagnosed disability to the in-service occurrence, incident, or exposure
The medical nexus can make or break a disability claim. A medical nexus letter can establish strong ties between the condition and military service. This evidence can be critical when the condition developed over time.
Secondary Service Connection for Knee Pain
If a new disability appears secondary to a service-connected injury or condition, former military service members may be able to prove a secondary service connection. Secondary service connection can also be an aggravation of a non-service connected disability that is caused by a service-connected condition or incidence. In other words, your knee pain may not have happened while you were in the service, but it could be a symptom that shows up much later that is the result of a service-connected incident.
Knee pain can appear as a secondary service connection related to:
- Back injuries
- Injury to the opposite knee
- Foot injuries
- Hip injuries
- Partial or total joint replacements of either knee
Service Connection by Aggravation
What if you were diagnosed with knee pain before service?
It is possible that you entered the service with a previous injury that resulted in knee pain. Even if that pain was not service-connected, it is possible that your military service aggravated that condition. For example, you might have had knee arthritis prior to service that worsened during active duty. Mild discomfort may have turned into severe pain due to the physical demands of service.
In this case, you will need to provide documentation that you had knee pain or a knee disability prior to your military service and then documentation that your military service made that knee pain worse. This documentation includes:
- A current diagnosis of your condition
- Documentation of your condition prior to military service, including x-rays, imaging scans, chart notes, surgical documentation, etc.
- Documentation of your condition after military service, including comparable x-rays, imaging scans, chart notes, surgical documentation, etc.
- A medical nexus connecting your aggravated knee pain to your military service.
This evidence can help prove that your knee pain is connected to aggravation during service, which can help support your VA disability claim.
Compensation & Pension (C&P) Exams for Knee Pain
When you don’t have sufficient medical evidence to support your veteran’s disability claim, the VA may require a Compensation & Pension (C&P) exam for your knee pain. This exam generally happens at a VA hospital or clinic and is conducted by VA medical staff. The purpose of the C&P exam is to support or refute your claim. You will need to submit all medical records to the VA prior to the exam, as your provider will not be able to review any new information once you are there.
During your exam, the doctor will not treat you, provide referrals, or write prescriptions. They are simply there to gather information. They may do any of the following:
- Review your file with you
- Ask questions based on the medical records you have previously provided.
- Do a basic physical exam
- Ask you to have other tests done, like x-rays or blood draws, if necessary
The doctor that does your C&P exam is there to make an evaluation, not provide information about your claim. It is possible they may not even examine you if the documentation you have provided is sufficient for them to evaluate your condition. Once they have finished the C&P exam, they will write a report and send it to the VA claims processor in charge of your case.
If you are unhappy with any part of your C&P process, you are urged to share that feedback with the C&P exam supervisor at the VA medical center immediately. You can also reach out to the VA patient advocate or call the number on your appointment letter. Be sure to write a statement that details your concerns and submit it as a part of your claim file. If you have any concerns, do not wait until the results of your exam are submitted to share them. This will ensure your concerns are addressed prior to a final decision.
Evidence for Knee Pain Claims and Appealing Under The AMA System
In general, pain claims are among the most difficult to prove without an underlying condition. Fortunately, knee pain is often connected to another diagnosis that can be established with diagnostic testing. Be sure your knee pain claim includes:
- Ultrasound Images
- Range of Motion testing
- Stability testing
- Documentation of injuries, surgeries, or other conditions with knee pain as a secondary symptom
If your claim is initially denied for any reason, hope is not lost. The Appeals Modernization Act (AMA) System gives you three options to have your claim reviewed if you disagree with the decision. It also allows you to submit additional documentation that will support your claim without having to wade through a lengthy, step-by-step appeals process.
You can read more about these three review options here.
VA Disability Ratings For Knee Pain
The VA rating of your knee pain will determine how much disability compensation you receive. The VA typically applies separate ratings for knee pain relative to one of five areas. Each of the areas on the rating schedule for knee pain uses a different diagnostic code, as listed below.
- Limitation of Flexion: If the knee can be straightened but not bent all the way, this is considered a limitation of flexion (Diagnostic Code 5260). Ratings of 0%, 10%, 20%, and 30% are based on how far the knee can bend. The less flexion, the greater the disability.
- Limitation of Extension: When the knee is not frozen, but cannot straighten all the way, it is considered to have a limitation of extension (Diagnostic Code 5261). Ratings of 0% through 50% are based on how far the knee can straighten. The less the knee can straighten, the higher the disability rating.
- Instability: If the knee has too much side-to-side motion or regularly dislocates, it is considered unstable. The VA assesses knee instability under diagnostic code 5257. Often, knee instability is related to damage to the tendons, ligaments, and cartilage that support the knee joint. Disability percentages range from 10% to 30%. The more instability present, the greater the disability rating.
- Total Knee Replacement: If your knee requires a total knee replacement, you will receive a 100% disability rating for one year after surgery. After that, the knee disability can be rated based on any remaining problems. After a total knee replacement, it is possible to have a disability rating of up to 60% if there are weakness and pain with any motion. Any additional disability ratings will be based on instability, limited flexion, or limited extension.
- Partial Knee Replacement: There is not a separate diagnostic code or rating criteria for a partial knee replacement. They are actually rated based on the residual symptoms such as limited extension, limited flexion, or instability.
Hospitalization for Knee Pain and Temporary Ratings
The only time a temporary rating for knee pain is given is when a total knee replacement is performed. After total knee replacement surgery, there is an automatic 100% disability rating for one year. After that year has elapsed, veterans will require additional tests for knee flexion, extension, and instability. The results of these tests will determine the ongoing rating. If there are any additional problems, it is possible to receive a disability rating of up to 60%.
TDIU for Knee Pain
TDIU stands for Total Disability Rating based on Individual Unemployability. On its own, knee pain will not qualify you for TDIU. In fact, the only time knee pain qualifies for a 100% disability rating is following total knee replacement surgery. However, if you already 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 you can’t hold down a job due to knee pain, you may qualify for TDIU.
If your knee disability claim has been denied, or you disagree with the VA’s rating decision, the team at Hill & Ponton is available to help. Our team of knowledgeable attorneys specialize in social security and veterans disability law, helping former military service members obtain appropriate compensation for their injuries and illnesses. We value attorney-client relationships, treating each veteran as an individual. Contact our law firm today for a free case evaluation.