Veterans Disability Info Blog

Fighting for Orthopedic Claims: Legal Strategies for Veterans

Suffering orthopedic injuries as a result of military service can negatively impact your personal and professional life. When your current disability is a result of an in-service injury, illness, or other event you generally qualify for free medical coverage from the VA. When your VA disability rating exceeds 0 percent, you are entitled to receive tax-free monthly VA compensation payments meant to compensate for any lost earnings linked to your disability. 

There is free help available from the VA and VA-accredited representatives when filing your initial VA disability application. If your claim has been denied, then a VA disability lawyer can help with your appeal or advise you about a secondary service connection claim. 

What are Orthopedic Claims? 

Orthopedic claims involve all claims linked to the muscles or joints, with one of the most common areas of litigation concerning orthopedic injuries being for the lower-back disability claims.  This is also referred to as the lumbar spine.  Orthopedic claims also include disabilities involving the ankles, elbows, knees, shoulders, and feet. A broad variety of injuries or incidents can result in orthopedic injuries, including explosions, repetitive stress injuries, overexertion, heavy lifting, parachute jumps, and many others. 

Eligibility for orthopedic claims under the VA is the same as for other VA disability claims, namely that you have a current diagnosis of a disability, an event during qualifying active service, and evidence connecting your current condition to the event in service. Gathering the proper evidence for your initial claim will determine whether you receive an approval, and how accurate your disability rating is concerning your condition and its impact on your day-to-day life and ability to work. 

The Most Common VA Orthopedic Disability Claims

While there are a broad variety of injuries that can impact the bones and joints, there are some that are more common than others. Some of the most common VA disability claims related to orthopedic disabilities include:

  • Spine injuries 
  • Ankles injuries 
  • Knee injuries 

The VA disability ratings for spine injuries revolve around the range of motion within portions of your spine. For example, when you are capable of forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees, your disability falls within the 10 percent rating range. Should your range of motion drop below 15 percent or lower, then you are generally eligible to receive a disability rating of 30 percent. When a veteran has unfavorable ankylosis, which is rigidity and stiffness (frozen spine), of the entire spine, you may receive a disability rating of 100 percent. 

Prosthetics Result in Varying Disability Ratings

Other orthopedic injuries are evaluated by the VA in different ways. In terms of wrist replacement (prosthesis), the condition is rated at 100 percent disability in the year following implantation. After the year following implantation, the condition of your prosthetic and the level of chronic pain and limited motion or weakness may result in a 30 or 40 percent disability rating. 

If you experience intermediate weakness, pain, or limited motion at the same level as wrist ankylosis, then you may receive a minimum rating of 20 percent. In cases of extremely unfavorable ankylosis or stiffness and rigidity, you could be eligible to receive a permanent 100 percent disability rating. 

The rating that you receive for your orthopedic condition is accomplished by the VA by comparing the severity of the condition with detailed charts that are provided through federal regulations. Your service records, medical records, and the outcome of any Compensation and Pension examinations (C&P Exams) will also be taken into account when your application is reviewed. 

Special Claims Linked to Orthopedic Disabilities 

The significant degree to which orthopedic disabilities can impact a veteran’s life can entitle you to additional benefits through special claims. These claims are meant to provide disabled veterans with additional coverage for costs linked to their service-connected injuries or illnesses. 

Automobile Allowance

When your service-connected disability prevents you from being able to drive, you could be eligible to receive compensation from the VA through an automobile allowance meant to help provide you with the opportunity to drive. The purpose of the funding is to either purchase a specially-equipped vehicle that takes into account your disability or to make changes to your existing vehicle through the installation of adaptive equipment. 

To be eligible for the automobile allowance you must be a veteran with a service-connected disability, that includes at least one of the following conditions:

  • You have experienced the loss, or permanent loss of use, of 1 or both feet, or
  • You’ve experienced the loss or permanent loss of use of 1 or both hands, or
  • Permanent decreased vision in both eyes, with 20/200 vision or less in your better eye with glasses, or greater than 20/200 vision although with a visual defect that reduces your peripheral vision to 20 degrees or lower in your better eye, or
  • You have experienced a severe burn injury, or
  • You are suffering from amyotrophic lateral sclerosis (ALS), or
  • You have ankylosis in 1 or both of your knees, although this particular condition only qualifies you for an adaptive equipment grant, not a vehicle allowance 

When you have these conditions, many of which are orthopedic in nature, you are eligible for additional benefits, and as with your initial claim, the evidence provided with your claim will determine whether or not your benefits are approved or denied. Given that a one-time automobile allowance is $24,115.12, being approved can provide you with a substantial source of support and transportation. 

Replacing Clothing Damaged by Orthopedic Devices 

If your clothing has been damaged by a prosthetic or orthopedic device such as a wheelchair, you may be eligible for a VA clothing allowance. The VA clothing allowance is a disability compensation benefit that provides you with an annual clothing allowance. 

To be eligible for a VA clothing allowance, you must meet the following two requirements: 

  • Your prosthetic device, orthopedic device, or skin medicine is causing damage to your clothing, and
  • You require this device or medicine due to a service-connected condition 

The amount in clothing allowance that you are entitled to could be a one-time payment of $968.52, or an annual payment of that same amount, depending on the circumstances of your condition and situation. 

Making Your Claim as Soon as Possible Supports Success

We understand that it can be difficult to get around to filing your VA disability claim when you are adapting to life following your active service. Gaining access to the VA disability benefits that your orthopedic claim might entitle you to, however, is supported by filing as soon as possible following your service. Waiting to file can also result in a greater likelihood that your initial claim is denied. 

Veterans may wait to file an orthopedic claim until the pain has reached a significant level, and not when it first emerged. Waiting until this point can increase the likelihood of a denied claim as it becomes more difficult to establish the essential connection between your current diagnosis and your active service to qualify to collect VA disability benefits. 

Many veterans develop orthopedic conditions that cause only occasional pain following their discharge and may not believe that filing a claim is necessary. Even if you are experiencing only minor and occasional pain, it is helpful to file with the VA, as even if you get a 0 percent disability rating for your injury, you will be eligible to receive cost-free healthcare coverage from the VA. Should your condition worsen in time and result in greater disability, you are able to file an increased rating claim to adjust your VA disability rating to accurately reflect your current orthopedic or other disability. 

In our experience, back disabilities are ones that veterans often have a hard time with.  The typical scenario is one where an injury will happen during service, and after some initial pain, it heals.  So, at the time of discharge the veteran reports nothing wrong with his spine.  Once out of the service, many years pass without any problems.  But gradually, over the passing years, a veteran’s back begins to bother him.  It continues to worsen to the point that he finally considers filing for VA benefits.  However, by this time, 30 years have passed.  And so when he does file his claim, the VA denies it on the grounds that the separation exam was normal and there were no complaints of back problems for 30 years.  These cases can be hard to win unless you retain a medical expert.  Often, the most cost-effective way to hire an expert is by retaining a veterans disability attorney who will pay for the expert up front, and only charge you at the end if you win.  Some veterans find their own expert to write a nexus letter, but this option exists only for veterans that have the money to pay up front.  

Has Your Orthopedic Claim Been Denied? 

When you have submitted a claim to the VA for coverage of your disability and it has been denied, it is important to know that you still have options. When your initial VA disability claim has been denied, you can appeal the decision of the VA. During the period between your denial and appeal, you may still be able to take advantage of healthcare provided by the VA. 

As noted above, lower back pain disability claims can be particularly complicated given that they are often underreported during service, or can take time to emerge following active service. A common reason for denying lower back pain is the lack of in-service evidence or the lapse of time before filing, but this does not mean that your claim isn’t valid. The VA may not have been provided with sufficient evidence with your initial application to be able to approve your lower back pain orthopedic VA disability rating. On appeal, you are able to submit new evidence through some pathways, as your VA disability attorney can advise you. 

If your appeal is successful, you also collect the benefits that you are rated to receive retroactively from the time of your initial application. Given that the appeals process can take many months or even years, the amount of compensation you receive upon a successful appeal can be substantial. 

Working With an Experienced VA Disability Lawyer Supports Your Appeal 

There are a number of companies out there actively marketing towards veterans who may have disability claims or denials. If these companies are not VA-accredited VSOs or attorneys, they do not have the knowledge, experience, and accreditation necessary to help you through the process. Despite a lack of qualifications, these companies are actively scamming veterans, oftentimes charging for “education” or “coaching” throughout the process. They prey upon some veterans’ skepticism of lawyers and the legal system, and imply that they have special inside knowledge.  In the end, you get what you pay for.  If you have a difficult case, and where losing is not an option, we would not recommend taking a chance on a non-accredited consultant.

Working with a VA-accredited disability attorney provides you with an advocate looking out for your best interests. Veterans benefits lawyers have years of training, education, and experience to back them up.  Additionally, your VA disability lawyer provides the support of an experienced professional who completes as much of the process on your behalf as legally allowed. Your VA disability lawyer will gather evidence, draft and file your appeal with the VA, and appear on your behalf at any hearings that the VA might require throughout the process. 

If Your Condition Has Changed, You May Be Able to File an Increased Rating Claim 

When you have already filed a successful VA orthopedic claim and are receiving a rating, but it no longer accurately reflects the disability caused by your condition (i.e. it has worsened), you can file an increased rating claim. Alternatively, if you have a different condition that is related to an existing service-connected condition, you need to file a new secondary service connection claim.  An example would be that you are service-connected for the low back, and you then develop numbness and radiating pain into the lower extremities.  You are diagnosed with neuropathy or radiculopathy due to the pinched nerves in your lower back.  This would be a new claim for secondary service connection, i.e. the cause of the new condition is the service-connected lower back condition. 

By increasing your rating or adding service connection for another condition, you can raise your combined rating.  In some instances, this can bring your total disability rating to 70 percent or greater. Under some situations, this can entitle you to disability compensation at the 100 percent rate.  This is done using TDIU or total disability individual unemployability.   

Discuss Your Orthopedic VA Disability Appeal or Supplemental Claim with a Lawyer Now

If you have not yet filed your VA disability claim, the VA-accredited disability appeals attorneys are not available to provide you with paid assistance. However, you can seek out free assistance and guidance from your local VA office or a veterans service officer with one of the State or Congressionally-chartered service organizations.  Or, learn how to file a claim by visiting the VA online. 

The time to contact a VA disability lawyer is: 

  • When your initial orthopedic disability claim has been rejected, or 
  • You need to file an appeal because VA granted service connection but granted a rating that is too low.

Our experienced VA disability lawyer team is standing by to provide you with guidance on how we can help in this situation. Your initial case review is free, and if we take your case we only get paid if we win. Call us today at 1-888-878-9350

We are Here to Help

If you are having trouble obtaining benefits, contact us online or at 888.878.9350 to discuss your case.