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?

[Louie]

Thank you for your help.

Concerning Deluca, during the C&P I discussed fatigability with the doctor. Unfortunately, that discussion was not reflected in the C&P report. ( I have requested a copy of my C-file to see everything.) I discussed that I had frequent buckling in the knees due to the severe instability causing fatigue in the knee after a short time on my feet. The "severe instability" was included in the C&P report. I have no extension or significant limitations of motion. The left knee does extend past 0 degrees and is a bit painful when it buckles in. I wear a brace to help.

Concerning the proper comp and convalesence period, I was 100% with housebound for 13 months. I do have a question on this. Do I get an SMC code in addition to being housebound? This was bilateral knee replacement. As such, each knee was rated 100% for that time period.

[Berta]

Bilateral- yow!

Are you saying they gave you the "S" Housebound award during your convalesence-

I would think that they should have considered you for a temporary "loss of use of" SMC "L" award for each extremity-at least the "L" level of SMC-during the convalenscence period.

Does this make sense to anyone else- would the 100% temp hospitalization be due to the fact that the veteran was not employable due to convalescence for whatever reason-yet-

would it not also involve eligibility for "loss of use of" under SMC "L"?

"This was bilateral knee replacement. As such, each knee was rated 100% for that time period." do you still have their exact wording on the rating of this?

[Louie]

The decision states, "Service connection for osteoarthritis, right and left knee, status post total knee replacement, is granted with an evaluation of 100 percent for each knee..."

I think I got the S rate for housebound..it was 2813 per month.

Edited June 7, 2006 by Louie

[Berta]

That was the convalescent rating?

Louie- I hope our SMC expert Rich comes on board-

I dont know how many dependents you have or what year this was- but the historic comp charts at VA web site sure can help a lot to figure this stuff out.

I sure would think that you suffered temporary loss of use of both extremities under SMC "K".

Here are the rates- hard for me to say what comp they gave you-

http://www.vba.va.gov/bln/21/Rates/

[Louie]

I found in UCAV 04-554 a order that "Board decision is REVERSED to the extent that it concluded separate ratings under DC 5055 and 5257 would violate 38 C.F.R. 4.14, and the matter is REMANDED for further proceedings consistent with this order."

The document says that "this action not be cited as precedent." Nevertheless, it seems that the court would have based their decision on solid law.

How can I, and what method do I use this information when forming a NOD?

Thanks in advance.UCAV 04-554

[Louie]

Sorry folks, The link below doesn't work. But if you go to the UCAV site and search for 5055, document 4-0554 comes up at the top. Sorry for the inconvenience.

Louie