VA Disability Rating for Knee Replacement (Prosthetic)
Diagnostic Code 5055 · 38 CFR §4.71a
What Is It?
Knee replacement surgery replaces the damaged surfaces of the knee joint with metal and plastic components. Total knee replacement replaces the entire joint, while partial knee replacement replaces only the most damaged portion. Veterans may need knee replacements because of degenerative arthritis from decades of running, rucking, and physical training, traumatic injuries from service, or meniscal tears that led to progressive joint deterioration. Even after a successful surgery, some stiffness, pain, and limitation can remain. Intermediate degrees of residual weakness, pain or limitation of motion are rated by analogy to DC 5256, DC 5261 or DC 5262.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Knee resurfacing or replacement, for four months following implantation of the prosthesis or resurfacing. Under Note (5) to the prosthetic implants table, this four-month period commences after the initial grant of the one-month total rating assigned under 38 CFR 4.30 following hospital discharge. |
| 60% | Chronic residuals consisting of severe painful motion or weakness in the affected extremity. |
| 30% | Minimum evaluation, total replacement only. At the conclusion of the 100 percent evaluation period, resurfacing is evaluated under DC 5256 through DC 5262, for which the schedule sets no minimum evaluation. |
Evidence Needed
- Surgical records for the knee replacement
- Service connection evidence for the underlying knee condition
- Post-surgical range of motion measurements for both flexion and extension
- Documentation of any instability, pain, or weakness remaining after surgery
- Records of physical therapy and ongoing treatment
C&P Exam Tips
- Demonstrate your knee flexion and extension range of motion
- Describe any ongoing pain, especially with stairs, kneeling, or prolonged standing
- Show any swelling or warmth in the replaced knee
- Mention clicking, catching, or instability if present
- Explain how the replacement has changed your daily activities compared to before surgery
How to File
File under DC 5055 for knee replacement. File as soon as possible after surgery to start the 100 percent rating, which runs for four months and, under Note (5), commences after the initial grant of the one-month total rating assigned under 38 CFR 4.30 following hospital discharge. The minimum rating of 30 percent afterwards applies to a total replacement only; the schedule sets no minimum evaluation for resurfacing. DC 5055 assigns 60 percent for chronic residuals consisting of severe painful motion or weakness in the affected extremity, and rates intermediate degrees of residual weakness, pain or limitation of motion by analogy to DC 5256, DC 5261 or DC 5262. Document all residual symptoms thoroughly.
Common Mistakes
- Not filing promptly after surgery.
- Not preparing for the re-evaluation at the end of the four-month period with documented residual symptoms.
- Failing to file for secondary conditions in the opposite knee and back.
- Accepting the minimum 30 percent when residual symptoms warrant 60 percent.
- Expecting a second 38 CFR 4.71a rating for the same joint: under Note (1) to the prosthetic implants table, when an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under DCs 5051 through 5056, an additional rating under 38 CFR 4.71a may not also be assigned for that joint, unless otherwise directed.
Frequently Asked Questions
What rating will I get after the 100 percent period?
After the 100 percent period, DC 5055 assigns 60 percent for chronic residuals consisting of severe painful motion or weakness in the affected extremity. The minimum of 30 percent applies to a total replacement only; resurfacing is evaluated under DC 5256 through DC 5262 with no minimum. Your rating depends on how well the replacement functions after recovery.
Can I get rated for both knees if both are replaced?
Yes, each knee replacement is rated individually. If both knees are replaced, you receive a separate rating for each, plus the four-month 100 percent period for each surgery.