On May 18, 2016, in Hudgens v. McDonald, the Federal Circuit ruled that partial knee joint replacements qualify for ratings under Diagnostic Code (DC) 5055, which is the diagnostic code that grants a temporary 100% rating for the year following a knee joint replacement, and then a minimum 30% rating thereafter. This is a great outcome for veterans undergoing partial knee replacement surgery, because prior to this ruling, the Court of Appeals for Veterans Claims had ruled that DC 5055 applied only to total knee joint replacements.
The veteran in this case, Mr. Hudgens, applied for a temporary 100 percent rating under DC 5055 after he underwent a partial knee replacement on his service-connected knee. The VA denied his claim stating that DC 5055 applied only to total knee replacements, not partial knee replacements.
Mr. Hudgens appealed the denial to the Board of Veterans’ Appeals, which also ruled that DC 5055 did not apply to partial knee replacements. The Board stated Mr. Hudgens was not entitled to a rating under DC 5055 because he “underwent only a ‘partial’ knee replacement, and not the total prosthetic replacement of the knee joint.”
Mr. Hudgens appealed the Board’s decision to the Court of Appeals for Veterans Claims, and in 2014, the Court agreed with the Board and also ruled that DC 5055 applied only to total knee joint replacements. The Court relied upon a definition of “knee joint” from a medical dictionary to reason that DC 5055 only applied when all three components of the knee joint were replaced with prosthetics.
Thankfully, Mr. Hudgens continued his fight and appealed the Court’s decision to the U.S. Court of Appeals for the Federal Circuit, and this time won his case. The Federal Circuit started its opinion by agreeing with Mr. Hudgens that DC 5055 did not unambiguously exclude partial knee replacements. It then highlighted the fact that this issue had come up before the Board in 14 prior cases, and in 11 of those cases, the Board found that DC 5055 did apply to partial knee joint replacements. The Court then resolved any doubt in the interpretation of DC 5055 in favor of Mr. Hudgens, and ruled that he could be compensated for a 100 percent rating under DC 5055 based on his partial knee replacement.
Interestingly, you’ll notice the current version of DC 5055 has a note at the bottom that reads: “The term ‘prosthetic replacement’ in diagnostic codes 5051 through 5056 means a total replacement of the named joint.” This note is the result of the VA amending its own regulations through an informal process 12 days before its written argument was due in Mr. Hudgens’ appeal. Despite the VA’s sly attempt to bolster its position and limit DC 5055 to full knee joint replacements, the Court rejected the VA’s regulation change and declined to give any weight to the note still contained in DC 5055.
If you have been denied a temporary total rating under DC 5055 because the VA said your partial knee replacement did not qualify, you may be able to win an appeal of that denial with this case. It’s also highly probable that it will take years before the VA regional offices consistently and correctly apply DC 5055 to partial knee joint replacements, so if you have been denied a temporary 100% rating under DC 5055 because you had a partial knee replacement, send me an email or call me and I’m happy to discuss your case.
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Gregory Rada is an Air Force veteran that helps veterans nationwide receive the benefits to which they are entitled. He works with all his clients one-on-one from the start of their case to the end and never hands them off to case managers or paralegals. Learn more about his experience by clicking here.