VA Diagnostic Code 5055Knee, resurfacing or replacement (prosthesis)
Rated from 30% to 100% under § 4.71a. Here is what the VA requires at each level.
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Summary
Prosthetic replacement of knee joint. With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
What each rating requires
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- 100%
For 4 months following implantation of prosthesis or resurfacing
- 60%
With chronic residuals consisting of severe painful motion or weakness in the affected extremity
- 30%
Minimum evaluation, total replacement only
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- Note (1): When an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under diagnostic codes 5051-5056, an additional rating under § 4.71a may not also be assigned for that joint, unless otherwise directed.
- Note (2): Only evaluate a revision procedure in the same manner as the original procedure under diagnostic codes 5051-5056 if all the original components are replaced.
- Note (3): The term âprosthetic replacementâ in diagnostic codes 5051-5053 and 5055-5056 means a total replacement of the named joint. However, in DC 5054, âprosthetic replacementâ means a total replacement of the head of the femur or of the acetabulum.
- Note (4): The 100 percent rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge.
- Note (5): The 100 percent rating for 4 months following implantation of prosthesis or resurfacing under DCs 5054 and 5055 will commence after initial grant of the 1-month total rating assigned under § 4.30 following hospital discharge.
- Note (6): Special monthly compensation is assignable during the 100 percent rating period the earliest date permanent use of crutches is established.
- Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5256 through 5262; there is no minimum evaluation for resurfacing.
Knee Replacement or Resurfacing (Prosthesis) — VA Diagnostic Code 5055
Musculoskeletal System · 38 CFR § 4.71a
Understanding This Condition
Diagnostic Code 5055 covers the prosthetic replacement of the knee joint. Under the VA rating schedule, the term "prosthetic replacement" for this code means a total replacement of the knee joint (Note 3).
If you have had a knee replacement or resurfacing procedure, the VA assigns your disability rating based on where you are in the recovery timeline and, later, on the residual effects the procedure leaves behind.
Available Rating Levels
The VA uses the following rating "ladder" for Diagnostic Code 5055:
| Rating | What It Reflects |
|---|---|
| 100% | For 4 months following implantation of the prosthesis or resurfacing |
| 60% | Chronic residuals consisting of severe painful motion or weakness in the affected extremity |
| 30% | Minimum evaluation — total replacement only |
For intermediate degrees of residual weakness, pain, or limitation of motion, the VA rates the condition by analogy to Diagnostic Codes 5256, 5261, or 5262.
How the Rating Timeline Works
- 100% for 4 months: The 100 percent rating following implantation of a prosthesis or resurfacing begins after the initial 1-month total rating assigned under § 4.30 following hospital discharge (Note 5).
- Special monthly compensation: During the 100 percent rating period, special monthly compensation may be assignable from the earliest date that permanent use of crutches is established (Note 6).
- After the 100% period: For resurfacing, the VA evaluates the condition under Diagnostic Codes 5256 through 5262 once the 100 percent evaluation period ends, and there is no minimum evaluation for resurfacing. (The 30% minimum evaluation applies to total replacement only.)
What the VA Looks For
When rating under Diagnostic Code 5055, the VA considers:
- The type of procedure — whether it was a total joint replacement or a resurfacing, and (for revisions) whether all original components were replaced. A revision procedure is only evaluated the same way as the original procedure if all the original components are replaced (Note 2).
- Your position in the recovery timeline — the 100 percent rating applies for the defined post-implantation period.
- Chronic residuals — such as severe painful motion or weakness in the affected extremity, which supports the 60% level.
- Intermediate residuals — degrees of weakness, pain, or limitation of motion that are rated by analogy to Diagnostic Codes 5256, 5261, or 5262.
Important Notes
- When an evaluation is assigned for joint resurfacing or prosthetic replacement of a joint under Diagnostic Codes 5051–5056, an additional rating under § 4.71a may not also be assigned for that same joint, unless otherwise directed (Note 1).
These criteria are a rendering of § 4.71a, diagnostic code 5055. The official version is the one that governs your rating.
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