What Is The Current State Of The Law On Rating Total And Partial Knee Replacements
In May 2016, the Federal Circuit Court of Appeals affirmed the rating process explained in this post. You can read the Courts decision here it begins with a jurisdictional question which it narrowly resolved in this Veterans favor.
Whats interesting about the decision is that the Fed Circuit called out the CAVC for what it very politely called a stretch in logic. Heres how.
The CAVC decided that the VA could not rate a Partial Knee Replacement using the same diagnostic code as a Total Knee Replacement because every part of the knee was not replaced, and the rating criteria DC 5055 excluded a less than total knee replacement.
The Fed Circuit didnt buy the VAs arguments, finding them light on support in the facts the Court pointed out that the majority of BVA decisions actually concluded exactly the oppositea fact conveniently overlooked by the CAVC and the VA. .
The Fed Circuit also caught the VA red-handed playing silly red-tape games.
The VA argued that DC 5055 was unambiguous in excluding Partial Knee Replacements from its rating criteria.
However, while on appeal, the VA published Interpretative Guidance explaining this point and seeking to clarify that DC 5055 did not apply to partial knee replacements.
The Fed Circuit said Not so fast, VAyou cant argue something is clear while releasing guidance that purports to clear up an ambiguity on the same issue you argue is unambiguous.
38 CFR 4.71, DC 5256
Common Causes Of Service
Back pain is a very common ailment that veterans face during and after military service. Because servicemembers frequently carry and lift heavy equipment, hold uncomfortable positions for long periods, practice their skills in combatives and in evacuating casualties, and even parachute out of airplanes, the physical demands of military service can take a toll on the spine. In addition to the daily strain, military accidents such as explosions and vehicle crashes commonly result in temporary or permanent damage to the spine.
After leaving military service, you may find that the lingering pain in your back has made it difficult to conduct your day-to-day activities or to perform well at work. If a doctor is able to identify the source of your back pain, spinal fusion surgery may be recommended for treatment.
Spinal fusion permanently joins at least two vertebrae in your spine to improve strength and stability, fix a distortion, and/or relieve discomfort. The following conditions are a few examples of diagnoses that may necessitate spinal fusion:
Addendum Added November 28 2016
On November 21, 2016, the VA revised its Manual M21-1MR to allegedly reflect changes in processing of Partial Knee Replacements post-Hudgens.
In short, heres what they did they are basically only going to re-rate claims that were filed before the effective date of the new regulation and that are still pending.
For those that were filed and finally adjudicated before this date, they are likely going to reject CUE claims because the Fed Circuit found that the old reg was ambiguous, and therefore not clear and unmistakeable error
Take a look at the text added to the VAs M21 Manual on November 21, 2016:
|III.iv.4.A.3.e. Evaluations for Knee Replacement|
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What You Should Know Before Getting A Knee Replacement
The disability rating for a knee replacement is 100 percent, according to the text, after one year of wearing the prosthesis. After that, a minimum disability rating of 30% may be assigned for post-knee replacement. In 2020, the cost of a knee replacement in the United States is expected to be between $30,000 and $50,000. If you can no longer work as a result of knee replacement surgery, you may be eligible for SSD and SSI benefits. For those who have chronic pain and are unable to work for more than 12 months, pain relief is especially important. According to Social Security, many knee replacement claims are denied because they do not meet the 12-month duration requirement.
The Top Ssd Attorneys Want To Help You After Your Knee Replacement Surgery
We will use our legal skills to help you through the Social Security benefits process. It is our goal to win your case and to make it easier for you. We offer a free review of your case. And, there is no obligation to become a client. You can simply ask questions. We will try to help you, even if you dont become our client.
It also doesnt cost you money upfront to hire us. Why? Because we work on a contingency fee. It means if we win, you pay us out of your back benefits. If you do not win, you do not pay an attorney fee. But, how much is the fee? The fee is 25% of your back benefit. However, the fee is capped at $7200. You pay whatever amount is less. And, the 25% fee is the more likely fee. Because 25% of your back benefit is usually less than the $7200 cap on fees. Again, you pay the lesser of the two amounts.
If there are costs in your case, then you pay for those costs. Costs are minimal. They are usually less than $100. Typically, the only cost you will pay for is a copy of your medical records. And, we only charge you what the doctor charges us. You will owe costs whether we win or lose. In order to hire most lawyers, you have to pay an upfront fee. We dont work like that. You dont have a job. So how can we expect you to pay? We cant. That is why we work on a contingency fee basis. Contact us today if you need help with your benefits after knee replacement surgery.
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Final Thoughts On Your Va Disability For Knee Replacement
Keep in mind that if pain is occurring in both knees simultaneously, the VA will bestow further compensation according to the disability ratings assigned.
So, whether youre experiencing knee pain, instability, or swelling in the knee, you can take steps to get the rating you need to qualify for a VA disability for knee replacement. Many Veterans benefit from this common orthopedic procedure and get the compensation they deserve.
Indicators That You May Benefit From Knee Replacement Survey Include:
- Your knees are swollen and stiff
- Painful motion or weakness in your knees most of the day, even when you are resting
- Climbing stairs, walking, and getting out of a chair can be consisting of severe painful results
- Physical therapy and medicine are not providing enough relief
- Your knee cartilage is damaged to the point that your bones are rubbing together in your knee
Knee Replacement Surgeryhas been perfected through the years and is now one of the most common procedures performed in the United States.
There are two types of surgeries partial knee replacement and full knee replacement. Knee replacements last around 25 years, but if youre especially hard on your knees it could be more like 15 or 20 years.
If youre a Veteran in your forties and contemplating knee replacements surgery, consider that if youre hard on your knees, you may need a second procedure in your sixties, which is sometimes harder to recover from.
During the procedure, the surgeon will remove the diseased compartments in the knee and replace them with a metal implant. You can anticipate spending a few days in the hospital following the surgery, where youll be recovering and working with physical therapy.
Within a few weeks, patients usually experience more mobility and less pain in their knees.
How Long Does A Claim Take To Be Rated For Compensation In Veteran
The repercussions of service-related disabilities may echo for decades, and former members of the armed services may require surgery or hospitalization years after the original disability. If eligible, you may receive a 100 percent temporary disability rating and benefits if your medical situation warrants it.
Many veterans with service-related disabilities already have a permanent disability rating of under 100 percent. For example, if a veteran has a 40 percent permanent disability rating, he may receive a temporary 100 percent disability for the time allowed.
Once the time period for the 100 percent temporary disability is over, the permanent disability rating reverts back to 40 percent. In most cases, veterans may apply online at eBenefits for 100 percent temporary disability benefits, but there are other application options.
Va Rating For Knee Conditions That May Lead To A Knee Replacement
The rating needed for a VA disability for knee replacement can be a little confusing due to 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. You can receive different ratings depending on the movement involved in the knee.
For example, a Veteran may have trouble bending and straightening their knee. In this case, they would receive a rating for both Limited Flexion of the Knee and Limited Extension of the Knee. Any of the below conditions may lead to a knee replacement.
Limited Flexion of the Knee: One of the most common knee conditions among Veterans, this refers to the motion of the knee moving in toward the body. It is important to note that the VA measures the motion for the knee, not pain, to determine the rating.
Limited flexion of the knee is most commonly assigned a 10 percent rating, although the highest rating a Veteran can receive is 30 percent. It is rated under diagnostic code 5260.
Limited Extension of the Knee: This motion refers to how the knee moves outward, away from the body, unable to completely straighten. It is rated under diagnostic code 5261 and ranges from 0 to 50 percent rating according to how much the knee can or cannot straighten.
Instability of the Knee: Too much side-to-side motion or frequent dislocation of the joint can indicate weakness in the affected knee.
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Winning Ssd Under Listing 117 After Knee Replacement Surgery
At Cannon Disability Law, we see clients who did not recover after knee surgery. Knee surgery results in being paid SSD benefits if you suffer from chronic pain and you need two canes or a walker to walk. The SSA applies Listing 1.17, to figure out if you should be paid SSD or SSI benefits. Listing 1.17 refers to reconstructive surgery of a major weight bearing joint. In other words, it applies to you if you have knee replacement surgery. Because, the knee is a major weight bearing joint.
Contact Cannon Disability Law After Knee Replacement Surgery
It is always our goal to win benefits for our clients. Your future ability to pay your bills, for yourself and your family, relies upon the results of your SSD case. Additionally, your ability to receive Medicaid and also Medicare depends upon whether you win your case. Learn more about Medicaid benefits here. Medicare benefits are a form of health insurance that helps pay your medical bills. You can learn more information about Medicare benefits here.
You need to hire an SSD attorney with experience. We bring 30 years of legal experience to your benefit case. For example, Dianna Cannon has been helping people win their benefits for over thirty years. Brett Bunkall and Andria Summers also have many years of litigation experience. Additionally, our legal staff also has years of experience helping clients collect their records and win their benefits.
One thing you may not know is that we are able to help you with your case no matter where you live. For example, we represent clients in Utah and Nevada. If you need to know more about winning Utah SSDI benefits, then read here. Likewise, if you need to know more about Nevada disability benefits, then read here. We also have clients in Idaho, Colorado, and California. You can trust that our lawyers will do the job to win your SSD and SSI benefits. We want to be your legal team. Contact us today.
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How To Apply For Disability Benefits For A Knee Replacement
Knee replacements are as common as they are difficult to deal with. Caused by anything from trauma to arthritis to the natural wear and tear of aging, knees are especially susceptible to damage. The resulting pain, surgery, medical costs, and recovery time can also be an added strain.
Luckily, if you or a loved one is currently coping with a knee replacement, disability benefits may be an option. Millions of Americans in need receive monthly Social Security benefits for severe medical conditions, including severe cases that result in surgery and elongated healing times. Continue below to see if your case may fit the requirements.
Va Disability And Knee Pain: Getting Help With Your Claim
If your knee disability claim has been denied, or you disagree with the VAs 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.
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Do Benefits For Knee Pain Ever Decrease
Sadly, knee pain does not usually improve over time. Most doctors will consider a Veterans knee pain chronic. Even the best treatment usually only helps decrease the severity of the symptoms rather than healing the problem.
Still, the VA can decrease a Veterans rating for knee pain over time even if it follows a partial or total knee replacement surgery. After a few years, they may presume that a Veterans knee condition has improved or healed over time.
To avoid a reduction in their disability rating, Veterans will have to indicate to the VA that they are continuing treatment for their knee. This can include showing that they are still attending physical therapy or that they are still taking medication for their knee pain.
Getting The Highest Rating
Veterans who have a disability should seek the highest disability rating they can. This is important. The VA will often give a Veteran a lower rating than they deserve, leading to a loss of benefits.
It can be difficult to get a high rating from the VA due to mistakes within the claims process. However, there are some ways that a Veteran can get the most out of their claim. If a Veteran has other service-connected disabilities in addition to their knee pain or knee replacement, they will likely get a higher rating.
The VA will account for every service-connected disability and give the Veteran a cumulative rating that depends on the disabilitys severity.
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Knee Replacement Surgery: The Risks And Rewards
A common way to relieve chronic pain is to have a knee replacement surgery. Complications, on the other hand, can make it more difficult to return to work. If you had knee replacement surgery on a knee with degenerative joint disease, or if you sustained a bad knee injury and the surgery failed, you may be entitled to Social Security disability benefits. All applicants for Social Security disability benefits must have major joint dysfunction due to any underlying cause, as well as gross anatomical deformity . Furthermore, you must have chronic joint pain and stiffness and demonstrate significant functional impairment. Although most people consider knee replacement surgery to be a successful procedure, it is common for permanent work restrictions to occur. For example, crutches are commonly used by most employees for three to six weeks following surgery. While most daily activities are resumed, it is not uncommon for a person to be placed on temporary leave. If youre considering knee replacement surgery, you should consult with your doctor to see if this is the right procedure for you. Furthermore, if you are considering the surgery, discuss any potential benefits or risks with your insurance company. If you are eligible for Social Security disability benefits, you must apply as soon as possible.
Common Reasons For Knee Replacement Surgery
Several factors can play a role in needing a partial or full knee replacement. To get a VA disability rating for a knee replacement, youll want to have a clear understanding from your doctor regarding what caused and/or contributed to your knee pain, ultimately leading to your need for knee replacement surgery. This will help establish your service connection .
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Staged Ratings Tied To Condition Severity
If your condition either gets worse or improves after you file your initial claim, the VA may choose to change your disability rating throughout the process. For example, if you apply for a 10% disability rating for a condition that then worsens over a two-year period, the VA may update your rating to 25%.
The Veterans Affairs Department Knee Brace Coverage
Veterans who meet certain criteria may be eligible for free knee braces from the Veterans Affairs Department. As part of the Veterans Health Care Systems reimbursement policy, veterans who are prescribed a knee brace and used it to treat a service-connected condition will be reimbursed for its cost. The VA will rate your condition based on how severe of your pain and how well you can move your knee if you have pain and limited range of motion. You may be eligible for a 60 percent rating in some cases. If your knee is injured as a result of your military service or an event that occurred during that service, you must have a doctor examine your knee to determine whether it is service connected.
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