On Thursday, July 16, 2015, the VA
published a final rule regarding how to apply the ratings for joint
replacements.
Previously, the VASRD codes 5051 – 5056
gave the rating requirements for prosthetic implants used for joint
replacements, but did not specify whether the ratings applied only to total
joint replacements or included partial joint replacements.
Under these codes, a 100% rating is given
for 1 year following the date of surgery for joint replacements in order to
cover the long period of recovery usually required by such significant and
invasive surgery.
The VA’s standard practice when applying
these codes has always been to include just total joint replacements, not
partial joint replacements, but without the language specifying this in the
VASRD, questions soon arose. The United States Court of Appeals for Veterans
Claims finally determined in Hudgens v.
Gibson that the VA’s practice was justified.
With the many medical advances that have
occurred, partial joint replacements are now far less invasive and require far
less recovery time than a total joint replacement. Thus, they do not need the
1-year 100% rating necessary for total joint replacements.
To solidify this decision, the VA changed
the VASRD to include the following note:
“The term ‘prosthetic replacement’ in
diagnostic codes 5051 through 5056 means a total replacement of the named
joint. However, in DC 5054, ‘prosthetic replacement’ means a total replacement
of the head of the femur or of the acetabulum.”
As mentioned in the note, the only
exception to this rule is for code 5054, joint replacement of the hip, which
specifies that either the total replacement of the head of the femur or
the total replacement of the acetabulum qualifies. The hip is the only
exception to this rule. For every other joint, the full joint must be replaced.
This change was finalized and made
affective July 16, 2015.
All partial joint replacements are rated on
any symptoms that they cause, like limited motion of the joint.
I think it is fair
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