Knee Conditions VA Rating

Overview

Range of motion: limitation of flexion is evaluated under DC 5260 and limitation of extension under DC 5261. These are separate codes, so a knee that is limited in both directions may be evaluated under both.

Instability: recurrent subluxation or lateral instability is evaluated under DC 5257 (slight / moderate / severe), independent of range of motion.

Cartilage: dislocated semilunar cartilage with episodes of locking, pain, and effusion into the joint is evaluated under DC 5258; symptomatic removal of semilunar cartilage under DC 5259.

Arthritis: degenerative arthritis (DC 5003) and traumatic arthritis (DC 5010) apply where X-ray findings are present and motion loss is not compensable under the motion codes.

Ankylosis: a knee fused or fixed in one position is evaluated under DC 5256 by the angle of fixation.

Tibia and fibula: malunion or nonunion of the tibia and fibula is evaluated under DC 5262, graded by the degree of resulting knee or ankle disability.

Genu recurvatum: acquired, traumatic hyperextension with weakness and insecurity in weight-bearing is evaluated under DC 5263.

Prosthetic replacement: total knee replacement is evaluated under DC 5055 — 100% for the year following implantation, then a minimum evaluation with higher levels for chronic residuals.

Other pathways: tenosynovitis and bursitis about the knee (DC 5024, DC 5019) are rated on limitation of motion; painful or unstable surgical scars may be evaluated under DC 7804; and amputation codes (DC 5164/5165) set the ceiling for the overall level of the extremity under the amputation rule at 38 CFR § 4.68.

In Depth

VA General Counsel Precedent Opinions 23-97 and 9-98 address separate evaluations for arthritis with limitation of motion and for instability under DC 5257 in the same knee, and VAOPGCPREC 9-2004 addresses separate evaluations for limitation of flexion and limitation of extension. The practical effect is that one knee can carry more than one evaluation when the record documents distinct disability, and § 4.14 (pyramiding) is the limit — the same functional impairment cannot be paid twice under different labels.

Painful motion matters even when the goniometer reading looks normal. Under 38 CFR §§ 4.40, 4.45, and 4.59 and the DeLuca line of cases, functional loss from pain, weakness, fatigability, and incoordination — including after repetitive use and during flare-ups — is part of the evaluation. Correia v. McDonald (2016) requires joint testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing conditions where applicable; Sharp v. Shulkin (2017) requires the examiner to estimate additional loss during flare-ups or explain why that cannot be done.

Bilateral knees are evaluated one knee at a time. When both knees are service connected, the bilateral factor at 38 CFR § 4.26 adds 10% of the combined value of the bilateral disabilities before combining with other ratings — which is why each knee needs its own evaluation on the rating sheet.

38 CFR § 4.68, the amputation rule, caps the combined evaluation for disabilities of one extremity at the level that would be assigned for amputation at the elective level. It rarely binds in knee cases, but it is the ceiling when several knee codes stack.

Secondary pathways are common: a service-connected knee that changes gait is a documented route to opposite-knee, hip, ankle, and low-back claims under 38 CFR § 3.310, and the medical opinion has to address causation or aggravation rather than simply noting the conditions coexist.

How to Establish Service Connection

• In-service injury, jump school records, or repetitive-strain MOSs (infantry, airborne, mechanic) are common bases.
• Secondary: knee conditions caused by an altered gait from a service-connected ankle, hip, or back.

Rating Criteria

Paraphrased from 38 CFR § 4.71a, DC 5260 (flexion), 5261 (extension), 5257 (instability), 5258/5259 (meniscus)

See what each percentage pays in 2026 and how it combines with your current rating →

Knee Range of Motion Chart

38 CFR § 4.71, Plate II · rated under DCs 5256–5263

• Limitation of flexion (DC 5260) and limitation of extension (DC 5261) can be rated separately for the same knee when both are compensable — this is not pyramiding under 38 CFR § 4.14 (VAOPGCPREC 9-2004).
• Instability or recurrent subluxation is rated separately under DC 5257 (10%/20%/30%) in addition to a limitation-of-motion rating.
• Painful motion that does not meet a compensable limitation still supports a 10% rating under 38 CFR § 4.59 when there is arthritis or joint pathology.
• Measurements are taken with a goniometer, both actively and passively, and VA must consider additional loss of function from pain, weakness, fatigability, and incoordination (38 CFR §§ 4.40 and 4.45, DeLuca v. Brown).
• If flare-ups reduce motion below the measured range, the examiner is expected to estimate that additional loss — describe frequency, duration, and severity of flare-ups at the exam (Sharp v. Shulkin).

Evidence Checklist

• MRI or X-ray imaging.
• Goniometer measurements of flexion and extension.
• Documentation of giving way / instability — brace use is strong evidence.

Evidence Templates

Common formats of evidence the VA looks for in this type of claim. These describe what the documents typically include — they are not legal forms or medical opinions, and Oakridge Claims does not draft them.

Evidence VA Commonly Cites in These Claims

Descriptive summary of evidence types frequently referenced in rating decisions for this condition. Not a checklist of actions to take — every claim is decided on its own facts.

• ★Ask that the exam report state flexion and extension separately, in degrees, including where pain begins.
• ★Instability findings carry more weight when they are objective — Lachman, anterior drawer, and varus/valgus stress testing, plus prescribed brace use — rather than reported giving-way alone.
• ★Imaging or operative reports that identify the specific pathology (meniscal tear, chondral defect, ligament rupture, degenerative change) support evaluation under the correct code.
• ★Flare-up frequency, duration, and functional effect are part of the record; a contemporaneous symptom log is more useful than recall at the exam.
• ★Where both knees are involved, confirm each knee appears separately on the rating decision code sheet.

Illustrative Scenarios

These are hypothetical educational examples — not actual case results, predictions, or guarantees of outcomes.

Common pitfalls VA sees

• Treating a single knee evaluation as the whole answer when the record documents instability, meniscal pathology, or both directions of motion loss.
• Not reporting post-repetitive-use limitation and flare-ups to the examiner.
• Assuming a surgical scar or a tibia/fibula malunion is folded into the knee rating automatically.
• Overlooking the effective-date question when a knee has worsened over several years of treatment records.

Common Secondary Conditions

Conditions frequently service-connected as secondary to Knee Conditions:

What the C&P Exam Documents

General information about how this condition is typically evaluated. This is not coaching on what to say and is not a substitute for medical or legal advice.

• →Expect separate measurements of flexion and extension; note for the examiner exactly where pain limits further motion.
• →Mention any instability, buckling, or use of a brace — this points the exam toward assessing DC 5257 in addition to range-of-motion codes.
• →Describe any locking, catching, or swelling episodes if a meniscus tear is suspected or diagnosed.
• →If you had a total knee replacement, bring the operative report so the examiner has the surgical date and details relevant to the DC 5055 timeline.

Frequently Asked Questions