LOADING
Knee injuries and conditions are among the most frequently claimed disabilities in the VA system, and for good reason. Military service places enormous stress on the knees through running, marching, jumping, carrying heavy loads, and operating in environments that accelerate joint wear. Despite how common knee claims are, the rating criteria can be surprisingly complex. Multiple diagnostic codes may apply to a single knee, and understanding how they interact, including when you can receive separate ratings for different manifestations of the same knee condition, can significantly affect your overall disability percentage.
The VA rates knee conditions under Diagnostic Codes 5256 through 5263, each covering a different type of knee impairment. DC 5256 covers ankylosis (complete immobility of the knee joint), which is rated from 30% to 60% depending on the angle at which the knee is fixed. DC 5257 covers recurrent subluxation or lateral instability, rated at 10% for slight, 20% for moderate, and 30% for severe. DC 5258 covers dislocated semilunar cartilage (meniscus) with frequent episodes of locking, pain, and effusion into the joint, rated at 20%. DC 5259 covers removal of semilunar cartilage when symptomatic, rated at 10%. DC 5260 covers limitation of flexion, and DC 5261 covers limitation of extension. DC 5262 covers impairment of the tibia and fibula, and DC 5263 covers genu recurvatum (hyperextension of the knee).
Limitation of flexion under DC 5260 is one of the most commonly applied knee codes. Normal knee flexion is 140 degrees. Under this code, flexion limited to 60 degrees warrants a 0% (noncompensable) rating. Flexion limited to 45 degrees warrants 10%. Flexion limited to 30 degrees warrants 20%. Flexion limited to 15 degrees warrants 30%, which is the maximum under this code. Many veterans are frustrated to learn that their knee flexion must be fairly significantly limited before a compensable rating is assigned; a veteran with flexion of 100 degrees, which is noticeably restricted, would still receive a 0% rating under the strict numerical criteria.
Limitation of extension under DC 5261 uses a separate set of thresholds. Normal knee extension is 0 degrees (fully straight). Extension limited to 5 degrees warrants a 0% rating. Extension limited to 10 degrees warrants 10%. Extension limited to 15 degrees warrants 20%. Extension limited to 20 degrees warrants 30%. Extension limited to 30 degrees warrants 40%, and extension limited to 45 degrees warrants 50%. Importantly, limitation of flexion and limitation of extension can be rated separately for the same knee. This principle was established in VA General Counsel Precedent Opinion 9-2004 (VAOPGCPREC 9-2004), which held that separate ratings under DC 5260 and DC 5261 may be assigned when both flexion and extension are compensably limited.
Knee instability under DC 5257 is rated differently from ROM limitation because it measures a different type of impairment. Instability refers to the knee giving way or feeling unstable, often due to ligament damage (ACL, MCL, LCL, or PCL injuries). The rating is based on the examiner's clinical assessment of severity: slight (10%), moderate (20%), or severe (30%). Crucially, instability can be rated separately from limitation of motion. This principle was established in VAOPGCPREC 23-97, which held that a veteran who has both arthritis with limitation of motion and instability in the same knee can receive separate ratings for each. This means a single knee could potentially receive three separate ratings: one for limited flexion, one for limited extension, and one for instability.
Meniscal conditions have their own diagnostic codes. DC 5258 applies when there is dislocated semilunar cartilage (a torn meniscus that has not been removed) with frequent episodes of locking, pain, and effusion (swelling) into the joint. This code provides a single rating of 20%. DC 5259 applies after surgical removal of the semilunar cartilage (meniscectomy) when the knee remains symptomatic. This code provides a single rating of 10%. Veterans who have had meniscal surgery should be aware that if their knee also has limitation of motion or instability, those conditions can potentially be rated under their respective codes in addition to the meniscal code, depending on the specific symptoms and how they overlap.
The bilateral factor is an additional calculation that applies when a veteran has service-connected disabilities affecting both paired extremities. Under 38 CFR 4.26, when both knees are service-connected, the combined rating for both knees is increased by 10% of that combined value before being incorporated into the overall combined rating. For example, if the left knee is rated at 20% and the right knee is rated at 10%, the combined value of the bilateral group is calculated, and then 10% of that value is added. While the bilateral factor does not dramatically change the combined rating, it provides a small but meaningful increase that veterans should be aware of.
During a C&P examination for a knee condition, the examiner will measure range of motion using a goniometer, recording initial flexion and extension and then measuring again after repetitive use (typically three to five repetitions). The examiner will perform stability testing, including the Lachman test, anterior and posterior drawer tests, and valgus/varus stress tests. They will check for meniscal conditions, note any swelling or effusion, and assess your gait. As with spine exams, the examiner must address DeLuca factors: pain on motion, weakness, fatigability, incoordination, and functional loss during flare-ups. If you experience flare-ups where your knee is significantly worse than on the day of the exam, describe those episodes in detail.
Common secondary conditions from knee injuries include hip conditions (caused by altered gait), lower back conditions (caused by compensatory movement patterns), ankle conditions, and mental health conditions related to chronic pain and reduced mobility. If your service-connected knee condition has caused or aggravated another condition, you may be able to claim that secondary condition. The nexus for secondary service connection requires medical evidence showing that the secondary condition was caused by or permanently worsened by the service-connected knee disability. A medical opinion from your treating physician addressing this connection can be valuable evidence.
One of the most common errors in knee ratings is failing to assign separate ratings when they are warranted. If you have both limited ROM and instability in the same knee, review your rating decision to ensure you received separate evaluations for each. Similarly, if both flexion and extension are compensably limited, each should be rated under its own diagnostic code. If your decision only assigns a single rating for a knee that has multiple types of impairment, that may be an error worth challenging through a Higher-Level Review or Supplemental Claim.
Veterans with knee replacements (total or partial) should be aware of DC 5055, which provides a 100% rating for one year following the implantation of a knee prosthesis. After that one-year period, the knee is re-evaluated and rated based on residual symptoms, with a minimum rating of 30%. The one-year 100% rating is automatic and begins on the date of the surgery, so veterans who undergo knee replacement should ensure the VA is notified and the temporary 100% rating is properly assigned.
Disclaimer: This article is for educational and informational purposes only. It does not constitute legal, medical, or VA claims advice. VA regulations, fee structures, and enforcement actions are subject to change. Always verify current requirements at VA.gov or consult with an accredited VSO, attorney, or claims agent before making decisions about your benefits.
Written by Claim Recon Editorial