I have been getting calls from veterans who have had knee and/or hip replacements for their service-connected disabilities. Unfortunately, many of them are unaware that they are entitled to a 100 percent disability rating. This blog explains why veterans are entitled to a rating increase after a joint replacement and how they can ensure that they receive that increase.
Why Veterans are Entitled to a 100% Disability Rating After Joint Replacements
VA regulation 38 C.F.R. sec. 4.71a states that a veteran shall receive a 100 percent rating for four months after a knee replacement, though this is essentially extended to five. This is a big change from prior to February 2021, where a knee replacement was rated at 100 percent disabling for one year after the surgery. VA indicated that they made this change because studies showed that individuals could return to work within this time frame. However, they also suggested that a veteran that is in need of more than four months of a temporary 100 percent rating should apply for an extension of the rating based on a need for convalescence. Furthermore, the regulations essentially provide for a five-month period of a 100 percent rating following discharge. That is because the four-month period begins after a one-month period of convalescence at the 100 percent rate.
One hundred percent rating also applies to shoulder, elbow, wrist, hip, and ankle replacements. The VA has retained, at the current time, the one year of 100 percent benefits for most of these disabilities, except for the hip, which has also had a reduction to four months. When service-connected joint conditions affect both knees or another pair of extremities, our VA disability calculator (with bilateral factor) can help estimate the overall disability percentage.
How to Get a Rating Increase After a Joint Replacement
Many veterans assume that if the joint replacement is performed at a VA hospital and the joint is already service-connected, the 100 percent rating is awarded automatically. That is not always the case. Even when the surgery is performed at a VA hospital, the VA does not always award the temporary 100 percent rating on its own. In most cases, the veteran should still file a claim for a temporary 100 percent rating (often called a convalescent rating under 38 C.F.R. sec. 4.30) or otherwise notify the VA that the surgery occurred.
This is even more important when the replacement is performed at a private hospital. The 100 percent rating is not acknowledged until the VA knows of the surgery, so the veteran should inform the VA as soon as possible. A veteran who waits until after one year following a private-hospital surgery is no longer eligible for the 100 percent disability rating.
Note VA does not seem to be always paying for a partial replacement. The term “prosthetic replacement” in diagnostic codes 5051-5053 and 5055-5056 means a total replacement of the named joint.
