If you suffer from a service-related knee condition that causes you to stumble or fall, then you should file a VA disability claim for instability benefits.
How do you know if you are eligible for service-connected instability benefits?
First, your knee(s) condition(s) must be related to service.
Service-connected knee conditions are different than many other service-connected conditions because you may receive several separately compensable claims arising from one knee injury. For example, if your knee injury hinders your movement (i.e. flexion and extension) while also causing instability, then the VA will grant service-connected benefits for flexion, extension, and instability separately, which can impact your VA benefits in significant ways.
Second, your knee condition must cause instability.
Importantly, though, instability does not have to be medically diagnosed using objective testing to warrant VA benefits. Lay evidence, or evidence from non-medical experts, can establish instability. Therefore, to prove that you suffer from instability, you should submit a statement and/or statements from your friends, family, coworkers, and anyone else who can speak to your instability. The statements should detail your instability symptoms and how instability impacts your daily life and ability to work.
What benefits can you receive for service-connected instability?
Once the VA has acknowledged that you have instability related to military service, the VA will provide a rating based on the severity of the instability. Because medical evidence is not required to grant benefits for instability, you must detail your instability and frequent falls to the VA so all veterans benefits tied to the true impact of your condition are fully recognized.
The VA rates Knee instability based on 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5257.
Prior to February 7, 2021, DC 5257 provided the following ratings for recurrent subluxation or lateral instability of a knee:
| Slight | 10 |
|---|---|
| Moderate | 20 |
| Severe | 30 |
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The VA failed to provide a definition for “slight,” “moderate,” and “severe,” so the VA adjudicators were required to articulate the standard that they used. Many veterans appealed instability ratings under this framework usually because the VA either failed to articulate the definition of these terms and/or failed to provide an adequate rationale regarding which rating applied. This remains an important factor in VA disability benefits, and if your appeal period dates back to before February 7, 2021, the VA must consider the severity of your condition based on these criteria.
Since February 7, 2021, the VA has rated instability based on the following criteria:
For recurrent subluxation (dislocation) or instability:
| Condition | Rating |
|---|---|
| Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation | 30 |
| One of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation | 20 |
| Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation | 10 |
| For patellar instability: A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker | 30 |
| A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker | 20 |
| A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker | 10 |
Can instability cause secondary conditions?
Yes, and those should be service connected as well. For example, if your service-connected knee instability causes you to fall and break your hip, then the resulting broken hip may be service-connected on a secondary basis. Veterans should be sure to include all secondary conditions when filing a VA disability claim for instability since doing so can directly increase benefits for veterans who experience long term consequences from their knee injury.
Contact us to appeal now!
Have you been denied benefits for service-connected instability? We are here to help you appeal! Contact us to reach our advocates today, or call (877) 777-4021 to take the first step in obtaining the VA disability benefits you deserve.
