NOVA - On November 30, 2020, VA issued its final rule updating its Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries. 85 FR 76455. The rule is effective February 7, 2021.
NOVA commented on the proposed rule, focusing its comments on the following DCs. We have provided the updated status below per the final rule. Please see the entire published final rule for additional limited changes.
- DC 5054 – Hip resurfacing or replacement (prothesis) and DC 5055 – Knee, resurfacing or replacement (prosthesis). VA proposed to reduce the initial 100-percent convalescent evaluation for hip/knee resurfacing or replacement from the current one year to four months. NOVA argued for retention of this one-year period: VA did not make any changes and the four-month period will remain in the final rule. VA made some changes to the introductory notes to include a statement that claims processors only evaluate revision procedures in the same manner as the original procedure if the revision completely replaces the original components. VA also stated it “will consider adding criteria specific to subtotal joint replacement in a future rulemaking, once sufficient evidence is received and reviewed to provide adequate evaluation criteria.”85 FR 76455.
- DC 5257 – Knee, other impairment of.VA proposed replacing the current ratings for recurrent subluxation or lateral instability of 30-percent (severe), 20-percent (moderate), and 10-percent (slight), with a grading system of 1, 2, or 3. All grades had some requirement for physician-prescribed assistive devices. NOVA argued requiring physician-prescribed assistive devices at all levels is too restrictive and, even if the use of assistive devices is appropriate for this DC, requiring both bracing and an assistive device for both the 20- and 30-percent ratings is too restrictive. VA replaced the term “physician” with “medical provider.” VA has significantly rewritten this DC, see 85 FR 76463, and changed the “and” to an “or” for the 20-percent ratings.
- DC 5285 – Plantar fasciitis. VA proposed a separate rating for plantar fasciitis, with a 30-percent rating for bilateral symptoms not relieved by both non-surgical and surgical treatment; a 20-percent rating for unilateral symptoms not relieved by both non-surgical and surgical treatment; or a 10-percent rating for symptoms relieved by either non-surgical or surgical treatment, unilateral or bilateral. NOVA agreed with VA’s proposal of a distinct rating for this condition, but maintained the 30-percent and 20-percent ratings were too restrictive; a veteran who has symptoms that have not been relieved by either non-surgical or surgical treatment should be provided a 30-percent rating for bilateral symptoms and a 20-percent rating for unilateral symptoms. In response, VA inserted the following note: “If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable.”85 FR 76464.