5055 And 5257

[Louie]

Can 5055 (knee replacement) and 5257 (lateral instability in the knee) be assigned as separate disabilities without pyramiding?

It is my understanding that 5055 and 5257 do not have overlapping manifistations. 5055 rating is affected by severe pain or weakness (30% vs. 60%). 5256, 5261, and 5262 seem to have overlapping disibility traits with 5055, but 5257 does not seem to overlap with 5055.

Your thoughts/references?

[JR Reihs]

Louie

I doubt you will get anywhere with this. The most the VA will give you for your knee would be 30%, and an extra 10% if you have arthritis.

I have contimplated a knee replacement for years but due to other problems it is no longer possible at this time , but it would not have changed my rating of 30% and could in fact lower it due to the 10% for arthritis.

[Louie]

Can 5055 (knee replacement) and 5257 (lateral instability in the knee) be assigned as separate disabilities without pyramiding?

It is my understanding that 5055 and 5257 do not have overlapping manifistations. 5055 rating is affected by severe pain or weakness (30% vs. 60%). 5256, 5261, and 5262 seem to have overlapping disibility traits with 5055, but 5257 does not seem to overlap with 5055.

Your thoughts/references?

I had a knee replacement. During my C&P the doctor wrote that I had severe lateral instability in the knee. Does this qualify as a 60% rating, or is lateral instability (5257) a separate rating?

Can 5055 (knee replacement) and 5257 (lateral instability in the knee) be assigned as separate disabilities without pyramiding?

It is my understanding that 5055 and 5257 do not have overlapping manifistations. 5055 rating is affected by severe pain or weakness (30% vs. 60%). 5256, 5261, and 5262 seem to have overlapping disibility traits with 5055, but 5257 does not seem to overlap with 5055.

Your thoughts/references?

I had a knee replacement. During my C&P the doctor wrote that I had severe lateral instability in the knee. Does this qualify as a 60% rating, or is lateral instability (5257) a separate rating?

[Louie]

Does VA General

Councel (VAOPGPREC 23-97) support separate possible ratings for 5257 and 5055?

[Louie]

It is my understanding that pyramiding means rating the same manifestation of a condition under two separate DC. I am having difficulty finding manifestation of lateral instability (5257) within the the knee replacement DC (5055).

Does anyone here see what I see, or am I missing something?

[Berta]

Louis I get your point-

That OGC Pres op seems to show that arthritis , in the questioned presented to counsel, was separate DC thus separate rating.

However the first BVA decision I found gives more info:

http://www.va.gov/vetapp01/files01/0100144.txt

Did you get proper comp for the replacement surgery and convalesence period? if applicable to your situation?

That BVA decision states:

The evaluation of the same "disability" or the same

"manifestations" under various diagnoses is prohibited. 38

C.F.R. § 4.14 . The United States Court of Appeals for

Veterans Claims (Court) has held that a claimant may not be

compensated twice for the same symptomatology as "such a

result would overcompensate the claimant for the actual

impairment of his earning capacity." Brady v. Brown, 4 Vet.

App. 203, 206 (1993). This would result in pyramiding,

contrary to the provisions of 38 C.F.R. § 4.14. The Court

has acknowledged, however, that when a veteran has separate

and distinct manifestations attributable to the same injury,

he should be compensated under different diagnostic codes.

Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4

Vet. App. 225 (1993).

I will see what else I can find on this-

[Berta]

This decision might help more-

http://www.va.gov/vetapp01/files01/0106863.txt

Is it possible that- although they seem to say that 5055 and 5257 are 'overlapping' disabilities in this case and thus not separate- could you possibly fit into the 5260 or 5261 criteria as they state it here?

Was Deluca considered in your claim?

Also there is another Pres op referenced in this case-

I get your point- I think if they used the wrong diagnostic code- and your medical evidence shows they sure have used 5260 or 5261 , that could make a difference-

http://www.va.gov/vetapp05/files2/0513799.txt-

"VAOPGCPREC 9-98 (August 14, 1998);

VAOPGCPREC 23-97 (July 1, 1997). Where the medical evidence

demonstrates at least a noncompensable rating assignment

based on limitation of motion, a separate 10 percent rating

for arthritis is warranted under either Diagnostic Code 5260

or Diagnostic Code 5261. Where the evidence does not reveal

limitation of motion sufficient to satisfy the criteria for

at least a noncompensable evaluation under those Code

sections, a separate rating may nonetheless be assigned for

arthritis under Diagnostic Code 5003 and 38 C.F.R. § 4.59 if

range of motion is inhibited by pain. VAOPGCPREC 9-98."