One of the more common medical conditions that military veterans seek to have service-connected is arthritis of the knees.
It should come as no surprise, then, that one of the most common errors that the VA makes is failing to properly rate arthritis of the knees.
Here is a general summary of how you can double-check the VA’s rating to make sure that they properly evaluated and rated your service-connected arthritis of the knee.
Before getting started, it is important to understand that, generally, the VA is not permitted to “pyramid” ratings. A “pyramid rating” happens when the VA rates the same disability under multiple – and sometimes different – diagnoses. Read the regulation at 38 C.F.R. § 4.14 to learn more about pyramid ratings.
Arthritis is different. If a military veteran is service-connected with arthritis of the knees, that Veteran might be entitled to up to 3 ratings for the same condition. They key word is “might” – what is important is that the VA evaluate and rate the unique way that arthritis manifests in your knees.
Here are three (3) factors that the VA should look at to see how to rate arthritis of the knees for any military veterans.
1) Functional Loss. Functional Loss is a limitation to the range of motion of the knee. The VA Rater should focus on what the military veteran’s medical records say about his/her ability to perform the normal working movements of the knee with “excursion, speed, strength, coordination and endurance”. This aspect of arthritis of the knee is typically rated under the Diagnostic Codes 5000-5010 – (Diagnostic Codes and their criteria are found at 38 C.F.R. Part 4.)
2) Instability. Instability is the inability of the knee to play the “support” role it plays – an inability to keep you standing and balanced. If this limitation is present in your knee arthritis, the VA examiner should rate it using three (3) criteria under Diagnostic Code 5257:
a) slight (which equates to an additional 10% rating)
b) moderate (which equates to an additional 20% rating)
c) severe (which equates to an additional 30% rating)
3. Pain. The most common and recognizable manifestation of arthritis is pain. The VA typically does not consider pain in determining the proper rating for a disease or condition. Arthritis is a little different; even if there is no Functional Loss, the VA Examiner can grant a rating for pain if there is evidence that the military veteran is impacted by pain when he or she uses the knee in normal, daily, repetitive use and/or when pain limits the Range of Motion.
Confused? Don’t worry. The VA Examiner probably is, too.
I have seen a lot of improper and bizarre ratings and evaluations of pain for service-connected arthritis of the knee.
In fact, I recently looked at a claim where the VA examiner rated arthritis as sciatica. Sciatica is a condition that relates to the nerves of the spinal cord; while pain may refer down the legs to the knees in sciatica, there was no diagnosis for the condition in the C-File – the examiner simply never figured out that arthritis and sciatica are two totally different conditions.
One caveat – the explanation above is simplified, and under the facts of your case, it may not be the right analysis. Ever case is different, every military veteran’s medical situation is unique.
If you are a military veteran with service-connected arthritis of the knee, it is highly recommended that you bring your arthritis rating decision – and the code sheet – to an attorney or VSO representative that is familiar with the proper way to rate arthritis.
If you don’t know what the VA Code Sheet is, it is even more important that you get it in to have someone review your rating to make sure you are getting all the compensation you are entitled to.
Source by Christopher Attig