The Three Separate Knee Ratings
Under VA General Counsel precedent opinions, a single knee can receive up to THREE separate ratings without pyramiding: limitation of flexion (DC 5260), limitation of extension (DC 5261), and instability/subluxation (DC 5257). Most veterans only receive one. Understanding these separate rating pathways is the difference between a 10% knee rating and a 30%+ knee rating - per knee.
Limitation of Flexion (DC 5260)
Normal knee flexion is 0-140 degrees. The VA rates based on where flexion is limited TO (not from).
Limitation of Extension (DC 5261)
Normal extension is 0 degrees (fully straight). Any inability to fully straighten the knee is rated under DC 5261 - separately from flexion under VAOPGCPREC 9-04.
Instability (DC 5257)
Under VAOPGCPREC 23-97, knee instability (recurrent subluxation or lateral instability) is rated SEPARATELY from limitation of motion. This is rated on severity, not ROM: 10% (slight), 20% (moderate), 30% (severe). A veteran can receive a ROM-based rating AND an instability rating simultaneously. This is one of the most commonly missed separate ratings.
Meniscal Conditions (DC 5258-5259)
Dislocated semilunar cartilage (torn meniscus) with frequent episodes of locking, pain, and effusion rates 20% under DC 5258. Removal of semilunar cartilage (meniscectomy) rates 10% under DC 5259. These may be rated in addition to ROM limitations depending on the specific symptoms.
The Bilateral Factor
If both knees are service-connected, the bilateral factor under 38 C.F.R. 4.26 adds approximately 10% to the combined value of both knee ratings before combining with other disabilities. This is automatic but only applies if both extremities are rated.
Secondary Conditions
Common secondaries from knee conditions: hip conditions (altered gait), lumbar spine (compensatory movement), ankle conditions, radiculopathy (if gait changes affect nerve compression), depression/anxiety (chronic pain, mobility loss). Each secondary is rated under its own DC and combined using VA math.