A knee that both buckles and will not bend all the way is often sitting on two ratings, not one. Many veterans assume one joint means one number, so the instability points or the motion-loss points quietly go unclaimed. VA's own General Counsel opinions treat those as different problems that can be rated separately in the same knee.
A knee that both buckles and won't bend all the way is often sitting on two ratings, not one. Many veterans assume one joint means one number, so the instability points or the motion-loss points quietly go unclaimed. VA's own General Counsel opinions treat those as different problems that can be rated separately in the same knee.
How VA rates the knee
The knee is one of the most commonly rated joints, and it has a quirk that earns veterans real points when they understand it: two different problems in the same knee can be rated separately. The knee codes live in 38 CFR 4.71a. The two main ones are:
- Instability or recurrent subluxation (DC 5257): slight is 10 percent, moderate is 20 percent, severe is 30 percent. This covers the knee buckling, giving way, or needing a brace.
- Limitation of motion (DC 5260 and 5261): based on how far the knee bends (flexion) and straightens (extension), measured in degrees.
Limitation of flexion (DC 5260)
- Flexion limited to 45 degrees: 10 percent
- Flexion limited to 30 degrees: 20 percent
- Flexion limited to 15 degrees: 30 percent
Limitation of extension (DC 5261)
- Extension limited to 10 degrees: 10 percent
- Extension limited to 15 degrees: 20 percent
- Extension limited to 20 degrees: 30 percent
- Extension limited to 30 degrees: 40 percent
- Extension limited to 45 degrees: 50 percent
There are also codes for meniscus problems (DC 5258 for a dislocated cartilage with locking and effusion at 20 percent, DC 5259 for symptomatic removal at 10 percent), ankylosis, and tibia or fibula impairment.
The separate-ratings rule
VA General Counsel opinions allow a knee to carry more than one rating at the same time, because the codes measure different functions:
- You can be rated for instability (5257) and separately for arthritis or limitation of motion (5003, 5260, or 5261) in the same knee. Buckling and a stiff, painful bend are different problems.
- You can also be rated separately for limited flexion (5260) and limited extension (5261) in the same knee.
Because these address distinct disabling effects, stacking them is not pyramiding under 38 CFR 4.14, and the separate ratings combine.
Functional loss and painful motion
Range of motion is measured after repetitive use, and pain, weakness, and fatigue count (38 CFR 4.40 and 4.45, the DeLuca rule). Arthritis confirmed by X-ray with painful motion warrants at least a 10 percent rating even when the degrees alone would be noncompensable. Make sure your C&P exam captures a flare and the after-repetition measurement.
Common rating gaps to watch for
- Instability plus motion loss is two ratings, not one. A knee rated only for buckling may be leaving the motion-loss points on the table.
- Flexion and extension can each be rated in the same knee under the General Counsel guidance.
- X-ray arthritis with painful motion is at least 10 percent, even if your degrees look normal.
- Both knees trigger the bilateral factor, which adds an extra 10 percent of the combined knee value before the rest of your ratings are combined.
- Instability evidence is broader than one document. Clinical observations of buckling or giving way, provider notes, a prescribed brace or other stabilizing device, and your own credible lay statements describing the knee giving out can all support a rating under 5257.
Related on this site
- How VA rates ankle conditions (DC 5270 to 5274)
- How VA rates knee replacement (DC 5055)
- How VA rates arthritis (DC 5003)
- How VA rates hip conditions (DC 5250 to 5255)
- How VA rates the spine (38 CFR 4.71a)
- The bilateral factor, explained
- Combined VA ratings and the 10 percent rule
- When a C&P exam is inadequate, and what to do
Common questions
Can one knee carry more than one VA rating?
Yes, and this is the point most veterans miss. VA General Counsel opinions allow instability under DC 5257 and arthritis or limitation of motion under DC 5003, 5260, or 5261 to be rated separately in the same knee, because buckling and a stiff, painful bend are different problems. You can even receive separate ratings for limited flexion and limited extension in the same knee. The separate ratings combine, and stacking them is not pyramiding.
How is knee instability rated?
Under DC 5257: slight instability or recurrent subluxation is 10 percent, moderate is 20 percent, and severe is 30 percent. Evidence is broader than one document: clinical observations of buckling or giving way, provider notes, a prescribed brace or other stabilizing device, and your own credible lay statements describing the knee giving out can all support the rating.
What motion loss gets a compensable knee rating?
Under DC 5260, flexion limited to 45 degrees is 10 percent, to 30 degrees is 20 percent, and to 15 degrees is 30 percent. Under DC 5261, extension limited to 10 degrees is 10 percent, rising step by step to 50 percent when extension is limited to 45 degrees. Meniscus problems have their own codes: a dislocated cartilage with locking and effusion is 20 percent under DC 5258, and symptomatic removal is 10 percent under DC 5259.
My knee degrees look normal. Can arthritis still be rated?
Yes. Arthritis confirmed by X-ray with painful motion warrants at least a 10 percent rating even when the degrees alone would be noncompensable. And under 38 CFR 4.40 and 4.45 and the DeLuca rule, motion is measured after repetitive use with pain, weakness, and fatigue counted, so make sure the exam captures a flare and the after repetition measurement.
Do both knees together get extra?
Yes. When both knees are rated, the bilateral factor adds an extra 10 percent of the combined knee value before the rest of your ratings are combined. It is a small but real boost that a rater applies automatically when both lower extremities carry ratings.