VA knee ratings: arthritis, instability and range of motion

The knee is unusual in the rating schedule: motion, instability, and cartilage damage are rated under different codes, and VA's General Counsel has said some of them can be rated separately in the same knee.

Last reviewed October 2026 · Not legal advice, VA.gov always controls

VA rates a service-connected knee on the impairment the evidence shows: limited bending (flexion) or straightening (extension), instability, cartilage damage, arthritis, or the residuals of a replacement. Each has its own code and thresholds in degrees or findings. Distinct impairments in the same knee can be rated separately, but the same symptom cannot be paid twice, and two knees combine under VA's combined ratings math rather than adding up (38 CFR § 4.71a).

Knee conditions are rated in 38 CFR § 4.71a under the knee-and-leg codes, DC 5256 through DC 5263, with DC 5055 for a replacement. Which code applies depends on what is wrong, and a knee with a torn meniscus, arthritis, and a loose ligament has three things wrong. The schedule was revised in February 2021, so guidance older than that may describe criteria that no longer exist; check the current text at eCFR.

Limitation of motion: two codes, two directions

A normal knee bends (flexes) to 140° and straightens (extends) fully to 0°, the standard range shown in Plate II of 38 CFR § 4.71. The schedule rates loss in each direction separately.

Read those flexion numbers again. A knee that only bends to 45° has lost more than two thirds of its normal 140° of flexion, and it rates 10%. Compensable motion loss in the knee requires serious restriction, which is why a painful knee that stays short of those thresholds is rated on painful motion instead.

The VA General Counsel held in VAOPGCPREC 9-2004 that limitation of flexion and limitation of extension in the same knee may be rated separately, because they are different disabilities. A knee with flexion to 45° and extension stuck at 10° can be two 10% ratings, not one.

The painful-motion floor

A knee that does not meet the compensable thresholds above can still get 10%, because § 4.59 says a joint that is painful on motion is entitled to at least the minimum compensable rating for that joint. Arthritis shown on X-ray with painful or limited motion is rated the same way under DC 5003. This 10% is the floor, not the ceiling.

The same rules that govern spine exams govern knees: under DeLuca, the examiner must account for additional motion lost during flare-ups and after repeated use, and under Correia, must test active and passive motion, weight-bearing and not. Say where the pain starts, stop where pain or weakness actually stops you, and describe your flare-ups in degrees of lost function if you can ("after a full day of standing, the knee will not bend far enough to climb into a truck"). Read the spine guide for the full treatment of these rules; they transfer directly.

Instability: DC 5257

A knee that gives way, buckles, or slips out of joint is rated under DC 5257, "recurrent subluxation or instability," and this is a separate rating from motion loss. General Counsel opinion VAOPGCPREC 23-97, reinforced by VAOPGCPREC 9-98, established that a veteran with both arthritis (rated on motion or painful motion) and instability in the same knee can be rated separately under DC 5003 and DC 5257. It is not pyramiding, because instability and limited motion are distinct impairments.

The 2021 revision rewrote the 5257 criteria. The old "slight, moderate, severe" tiers are gone. Every ligament-tear level now requires persistent instability. The 10%, 20%, and 30% levels turn on the kind of ligament damage (a sprain, a partial tear, or a repaired complete tear, versus a complete tear that was never repaired or whose repair failed) and on whether a medical provider has prescribed a brace, an assistive device such as a cane or crutches, or both for walking. The 30% tier is reserved for an unrepaired or failed-repair complete tear with a prescription for both. Kneecap (patellar) instability has its own 10% to 30% ladder under the same code, and its upper two levels also require a prior surgical repair. The schedule counts a brace or assistive device only when a medical provider prescribes it for walking, so a brace you bought on your own does not meet those criteria. If your knee gives way, tell the treating provider, so the instability and any device the provider prescribes are in the record.

Cartilage, replacement, and the rest

• DC 5258, dislocated semilunar cartilage (meniscus) with frequent episodes of locking, pain, and effusion into the joint: 20%. This is a single-tier code, and the 2021 revision left it unchanged. It can sit alongside a motion or instability rating only for symptoms those ratings do not already cover, such as locking and effusion; the anti-pyramiding rule in § 4.14 bars rating the same symptom twice.
• DC 5259, removal of semilunar cartilage, symptomatic: 10%. It needs both the removal and continuing symptoms, and like DC 5258 it cannot pay again for symptoms another knee rating already covers.
• DC 5055, knee resurfacing or replacement: 100% for four months after the implant (the period was one year until the 2021 revision), starting once the one-month § 4.30 convalescence rating that follows hospital discharge ends. After that, a total replacement rates 60% for chronic residuals of severe painful motion or weakness, is rated by analogy to DC 5256, 5261, or 5262 for intermediate residuals, and carries a 30% minimum. Resurfacing has no minimum once the 100% period ends.
• DC 5256, ankylosis (a knee frozen in place): 30% to 60% depending on the angle.
• DC 5262, tibia and fibula impairment: 40% for nonunion with loose motion requiring a brace. Since 2021, malunion is rated under the knee codes (5256, 5257, 5260, 5261) or the ankle codes, whichever gives the higher rating. DC 5262 also covers shin splints (medial tibial stress syndrome), rated 0% to 30% depending on how long treatment has lasted, whether it has worked, and whether one or both legs are affected.

Service connection for knees

A knee injury can show up in the service treatment records in many forms: a twist on a ruck, a parachute landing, a fall off a vehicle, a profile for "knee pain," physical therapy, an MRI. Pull every one. Arthritis that becomes manifest to a degree of 10% or more within one year of separation is also a chronic-disease presumptive under §§ 3.307(a)(3) and 3.309(a), for a veteran with at least 90 days of continuous service. For a knee that went bad years later, the common theories are direct connection through documented in-service injury or the cumulative load of the job, or secondary connection to another service-connected lower-extremity condition: an ankle, a foot, a hip, or the other knee, through altered gait. The secondary conditions guide covers what that opinion needs to say.

The knee is also a common primary for secondaries. A service-connected knee that changes how you walk is the standard basis for later hip, back, and opposite-knee claims. If you have one service-connected knee and the other one is starting to hurt, a medical opinion on whether the first caused or worsened it is what a secondary claim needs.

The checklist

1. Current imaging (X-ray for arthritis, MRI for ligament or meniscus), with the diagnosis in words.
2. Range-of-motion measurements in both directions, flexion and extension, with where pain begins and where motion ends both recorded.
3. Documentation of instability: the provider's note that the knee gives way, any positive Lachman or drawer test, and a prescription for a brace or cane.
4. Surgical history: meniscectomy, ACL repair, replacement, with dates.
5. A flare-up log and lay statements on what the knee stops you from doing: stairs, kneeling, standing through a shift, getting out of a car.
6. The symptoms of each impairment described on the 21-526EZ or in a statement, such as "left knee gives way" as well as "left knee pain," so the exam covers each one. VA rates what the evidence shows either way.

Sources

• 38 CFR § 4.71a, Diagnostic Codes 5055 and 5256 through 5263: the current knee criteria, including the flexion and extension tables, the DC 5257 instability tiers, and the replacement ratings.
• 38 CFR § 4.71, Plate II: normal knee motion of 0 degrees extension to 140 degrees flexion.
• 38 CFR § 4.59, Painful motion: the minimum compensable rating for a painful joint, and the active, passive, weight-bearing testing rule.
• 38 CFR § 4.14, Avoidance of pyramiding: the bar on rating the same symptom twice under different codes.
• VA, Knee and Lower Leg Conditions Disability Benefits Questionnaire: the exam's flexion and extension endpoints, pain, repeated-use and flare-up findings, joint stability and prescribed-device questions, meniscus symptoms, and surgical history.
• 38 CFR § 4.25, Combined ratings table: how separate ratings combine and how the result rounds to the nearest 10.
• 38 CFR § 4.26, Bilateral factor: the extra 10% added when both legs have compensable disabilities.
• VAOPGCPREC 9-2004: separate ratings under DC 5260 and DC 5261 for the same knee.
• VAOPGCPREC 23-97: separate ratings for arthritis under DC 5003 and instability under DC 5257.
• 38 CFR § 3.307(a)(3): the one-year, 10% window for chronic diseases listed in § 3.309(a), which include arthritis.
• 85 FR 76453 (Nov. 30, 2020): the musculoskeletal revision effective February 7, 2021, which rewrote DC 5257 and cut the knee replacement 100% period from 12 months to 4.