A prosthesis is an artificial substitute for the replacement of a part. An ankle prosthesis is placed between the leg and the foot where the tibia, fibula and talus join together.

The usual causes for ankle joint replacement surgery are advanced osteoarthritis or rheumatoid arthritis.

Prior to surgery, there may be signs and symptoms common to arthritis (see Diagnostic Code: 5003 Arthritis, degenerative, other than post-traumatic). These manifestations include: pain, swelling, limited motion and structural changes. In the immediate postoperative phase, surgical pain, swelling, and limitation of motion may occur until healing brings about improvement or chronic residuals.

Preoperatively, tests most often include: complete blood count (CBC), erythrocyte sedimentation rate (ESR), x-rays, electrocardiogram, stress test, cltting profiles, urine sample, and other tests based on the type of arthritis.

The ankle prosthesis is the treatment of choice when medical management has not been successful.

Early postoperative complications are avoided by having the patient move frequently, do breathing exercises, receive adequate fluids, and participate actively in rehabilitation. Ankle joint replacement has been effective in relieving pain and increasing mobility.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1)  – Special Monthly Compensation (SMC).

• Only total joint with both parts of the joint replaced by prosthesis qualifies for the 100% rating for 1 year following prosthesis implantation under 38 CFR 4.30 [Convalescent ratings]. Half of the joint replaced by prosthesis, joint reshaping, bone or cartilage removal, or the insertion of a substance, such as plastic or metal between the two parts of a reconstructed joint do not qualify for the 100% rating for 1 year following prosthesis implantation under 38 CFR 4.30. There are important similarities between joint resurfacing and prosthetic joint replacement.  Joint resurfacing (permitted under DC 5053 and DC 5054) takes about the same time to perform and the recovery/rehabilitation periods are similar to comparable prosthetic joint replacement.

• Special monthly compensation is assignable during the 100 percent rating period the earliest date permanent use of crutches is established. Consider entitlement to SMC under 38 CFR 3.350 as an issue in every case where there is a severe degree of disability involving the loss or loss of use of an extremity or sensory organ or any other functional loss providing entitlement to SMC.

• Generally, unless required by the diagnostic code, reexamination is not required following a period in which a temporary total rating was assigned under 38 CFR 4.30.  The rating activity must review the evidence of record and assign a new post-convalescence evaluation based on the residual disability following the convalescence period.

• Only request a VA examination before the end of the total disability period when the evidence is inadequate to determine the residual disability and assign a schedular evaluation after the convalescence period.  Exercise prudent judgment and refer to 38 CFR 3.327(b) in determining the need for review examination.

• RVSR Effective Dates Content Tables: Compensation

• RVSR Assistant – RVSR Effective Dates

• Minimum rating is 20%. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]

• The term “prosthetic replacement” in diagnostic codes 5051-5053 and 5055-5056 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.

• Special monthly compensation is assignable during the 100 pct rating period the earliest date permanent use of crutches is established. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]

• When an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under diagnostic codes 5051-5056, an additional rating under 38 CFR 4.71a may not also be assigned for that joint, unless otherwise directed.

• 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.

• Special monthly compensation is assignable during the 100 percent rating period the earliest date permanent use of crutches is established.