Key Takeaways
- VA knee ratings depend on the symptoms and diagnostic codes that apply to your condition. Ratings may be based on limited flexion or extension, instability, meniscus damage, arthritis, surgical residuals, or knee replacement.
- Range-of-motion measurements during a C&P exam can directly affect your rating. The examiner measures how far you can bend and straighten your knee and may also assess pain, repetitive use, and flare-ups.
- You may receive separate ratings for limited motion and instability.
- Meniscus tears, ACL injuries, arthritis, and knee replacements are rated differently.
- Back, hip, or ankle problems caused or aggravated by an altered gait may qualify for secondary service connection when the evidence links them to the knee disability.
Knee injuries sustained during military service can affect you for years afterward. Symptoms like pain, reduced motion, and instability can prevent you from working and even carrying out basic functions like standing and walking. If that happens to you, you may be eligible for Veterans Affairs (VA) disability benefits.
When the VA grants service connection for a knee condition, the next question is how much compensation that disability warrants. The VA uses several diagnostic codes for knee conditions, and the percentage can depend on criteria like how far you can bend or straighten your knee, whether the joint is unstable, and whether you’ve undergone a knee replacement.
At Perkins Studdard LLC, we help military veterans like you win VA disability benefits for knee injuries. In this guide, we’ll outline how the Department of Veterans Affairs rates knee conditions, how range-of-motion testing at a C&P exam affects your knee rating, and when you may be able to file a secondary claim for hip, back, or ankle problems.
How Does the VA Rate Knee Disabilities?
The VA rates knee disabilities under the musculoskeletal section of the VA Schedule for Rating Disabilities. The diagnostic code or codes it applies depend on your service-connected knee condition and the symptoms shown in your medical records, C&P exam, and other evidence.
Common knee diagnostic codes include:
- Diagnostic Code 5260: Rates limitation of flexion, or how far you can bend your knee.
- Diagnostic Code 5261: Rates limitation of extension, or how fully you can straighten your knee.
- Diagnostic Code 5257: Rates recurrent subluxation, ligament instability, and patellar instability.
- Diagnostic Code 5258: Rates dislocated semilunar cartilage, including certain meniscus injuries involving frequent locking, pain, and joint effusion.
- Diagnostic Code 5259: Rates symptoms that remain after removal of semilunar cartilage.
- Diagnostic Code 5055: Rates knee resurfacing and knee replacement.
- Diagnostic Code 5003: Applies to degenerative arthritis in qualifying cases.
Other codes may apply to conditions such as ankylosis or impairment of the tibia and fibula. In many knee claims, however, the rating depends on loss of motion, instability, cartilage damage, arthritis, or the effects of surgery.
VA Rating for Limitation of Knee Flexion
The VA uses Diagnostic Code 5260 to rate limited knee flexion. Flexion is the movement you use to bend your knee, such as when sitting down, climbing stairs, or squatting.
Under DC 5260, the VA assigns:
- 0% when flexion is limited to 60 degrees
- 10% when flexion is limited to 45 degrees
- 20% when flexion is limited to 30 degrees
- 30% when flexion is limited to 15 degrees
The lower the flexion measurement, the greater the loss of motion. For example, if you can bend your knee only to 30 degrees, the rating schedule provides a 20% evaluation under DC 5260. If flexion is limited to 15 degrees, the maximum schedular rating under this code is 30%.
VA Rating for Limitation of Knee Extension
The VA uses Diagnostic Code 5261 to rate limited knee extension. Extension refers to how fully you can straighten your knee. Full extension is 0 degrees. If you can’t fully straighten your knee, the number of degrees remaining before you reach 0 determines the rating under DC 5261.
The VA assigns:
- 0% when extension is limited to 5 degrees
- 10% when extension is limited to 10 degrees
- 20% when extension is limited to 15 degrees
- 30% when extension is limited to 20 degrees
- 40% when extension is limited to 30 degrees
- 50% when extension is limited to 45 degrees
For example, if your knee stops 20 degrees short of full extension, the rating schedule provides a 30% evaluation. If it stops 45 degrees short, the maximum schedular rating under DC 5261 is 50%.
How Range-of-Motion Testing at a C&P Exam Affects Your Knee Rating
During a C&P exam, the examiner measures how far you can bend and straighten your knee in degrees. The Knee and Lower Leg Disability Benefits Questionnaire lists normal flexion as 140 degrees and normal extension as 0 degrees. The examiner records these measurements for each affected knee. They also evaluate how pain and repeated movement affect your knee. Testing can include:
- Active and Passive Motion: The examiner evaluates pain when you move the knee yourself and when the joint is moved for you.
- Weight-Bearing and Nonweight-Bearing: They evaluate pain while the knee bears weight and while it doesn’t.
- Repetitive-Use Testing: The examiner performs at least three repetitions when possible and records any additional loss of motion afterward.
- Repeated Use Over Time: The examiner estimates how repeated use limits your flexion or extension based on your statements, medical records, examination findings, and medical judgment.
- Flare-Ups: If you report flare-ups, the examiner estimates additional loss of flexion or extension during those periods when the available evidence allows an estimate.
These measurements can directly affect your rating. For example, flexion limited to 45 degrees meets the criteria for a 10% rating under Diagnostic Code 5260, while flexion limited to 30 degrees meets the criteria for 20%. A difference of several degrees can therefore change the percentage the VA assigns.
How Does the VA Rate Knee Instability?
The VA uses Diagnostic Code 5257 to rate recurrent subluxation or instability and patellar instability. These problems can occur when ligament damage or a condition involving the patellofemoral joint causes the knee to give way or become unstable.
For ligament-related instability, the VA assigns:
- 10% for a sprain, incomplete ligament tear, or complete ligament tear that causes persistent instability when a medical provider hasn’t prescribed a brace or assistive device.
- 20% for certain ligament injuries that cause persistent instability when a medical provider prescribes a brace or an assistive device such as a cane, crutches, or a walker.
- 30% for an unrepaired or unsuccessfully repaired complete ligament tear that causes persistent instability when a medical provider prescribes both bracing and an assistive device.
DC 5257 also contains separate criteria for patellar instability. Ratings range from 10% to 30% depending on recurrent instability, surgical repair, and the use of prescribed braces or walking aids.
Note: Instability is different from loss of motion. You may be able to bend and straighten your knee while still experiencing recurrent giving way or instability.
Can You Receive Ratings for Both Limited Motion and Knee Instability?
Yes. The VA can assign separate ratings for limitation of motion and instability when each causes different symptoms, and the evidence meets the criteria for both.
For example, arthritis may restrict how far you can bend or straighten your knee, while an ACL injury may cause the joint to give way. In that situation, the VA may assign one rating for limitation of motion and another for instability under Diagnostic Code 5257. Under the VA’s anti-pyramiding rule, the same manifestation can’t be compensated twice under different diagnostic codes. Each rating must compensate a different manifestation of the knee disability.
How Does the VA Rate a Meniscus Tear?
The VA may rate a meniscus injury under Diagnostic Code 5258 or 5259, depending on its symptoms and treatment history. The rating schedule refers to the meniscus as semilunar cartilage.
- Under Diagnostic Code 5258, the VA assigns a 20% rating for dislocated semilunar cartilage with frequent episodes of locking, pain, and joint effusion. A meniscus tear may qualify under this code when the evidence shows these symptoms.
- Under Diagnostic Code 5259, the VA assigns a 10% rating for symptomatic removal of semilunar cartilage. This may apply after a meniscectomy when symptoms remain following surgery.
A meniscus injury can also cause restricted motion, instability, or other knee symptoms. Separate ratings may apply when those manifestations meet another diagnostic code and haven’t already been compensated under the meniscus rating.
How Does the VA Rate an ACL Injury?
An ACL injury is a ligament injury, so the VA may rate it under Diagnostic Code 5257 when it causes persistent knee instability. The percentage depends on whether the injury is a sprain, incomplete tear, repaired complete tear, or unrepaired or unsuccessfully repaired complete tear. The VA also considers whether a medical provider has prescribed a brace or an assistive device such as a cane, crutches, or a walker.
For example, an unrepaired or unsuccessfully repaired complete ACL tear that causes persistent instability may qualify for a 20% or 30% rating depending on the prescribed devices you need for walking. A sprain, incomplete tear, or repaired complete tear can also receive a rating when persistent instability remains.
An ACL injury may also cause restricted flexion or extension. If those symptoms meet separate rating criteria, the VA may assign additional ratings as long as it doesn’t compensate the same manifestation twice.
How Does the VA Rate Arthritis and Chronic Knee Pain?
The VA may rate degenerative arthritis of the knee under Diagnostic Code 5003. When arthritis causes limited motion, the VA generally rates it under the code for the affected movement, such as DC 5260 for flexion or DC 5261 for extension.
If the limitation of motion doesn’t reach a compensable level under those codes, DC 5003 provides a 10% rating for the affected knee when degenerative arthritis is established by X-ray findings and the limitation of motion is objectively confirmed. The knee is considered a major joint for VA rating purposes.
VA regulations also recognize painful motion under 38 C.F.R. § 4.59. A painful, unstable, or malaligned joint due to healed injury may qualify for at least the minimum compensable rating for that joint.
It’s important to note that chronic knee pain doesn’t have a fixed VA percentage. The rating you may receive depends on the symptoms, loss of motion, functional impairment, and diagnostic code that applies.
How Does the VA Rate a Knee Replacement?
The VA rates knee replacement and resurfacing under Diagnostic Code 5055. After surgery, the VA assigns a 100% rating for four months following implantation of the prosthesis or resurfacing. This period begins after the initial one-month temporary total rating under 38 C.F.R. § 4.30 following hospital discharge.
For a total knee replacement, the VA assigns:
- 60% for chronic residuals consisting of severe painful motion or weakness in the affected leg.
- Intermediate ratings when residual weakness, pain, or limitation of motion falls between the 30% and 60% levels. The VA rates these residuals by analogy under DC 5256, 5261, or 5262.
- 30% as the minimum rating after a total knee replacement.
Knee resurfacing is also rated under DC 5055, but there is no minimum 30% rating after the temporary 100% period. The VA then evaluates resurfacing residuals under DC 5256 through 5262.
Can a Service-Connected Knee Injury Cause Secondary Disabilities?
Yes. A service-connected knee injury can lead to another compensable condition if it causes or aggravates a separate disability. One common example is an altered gait. If knee pain, weakness, or instability changes the way you walk, the added stress on other areas may contribute to problems in your back, hips, or ankles.
Secondary conditions can include:
- Low Back Conditions: An altered gait can place added stress on your lower back and may cause or aggravate a diagnosed back condition.
- Hip Conditions: Favoring one leg or shifting your weight can affect your hips and may cause or aggravate arthritis or another diagnosed condition.
- Ankle Conditions: Compensating for an injured knee can change how you bear weight and may cause or aggravate an ankle condition.
Under 38 C.F.R. § 3.310, the VA can grant secondary service connection when a disability is caused or aggravated by an already service-connected condition. VA gives the example of a veteran whose service-connected knee injury causes a limp that later contributes to hip arthritis.
A secondary condition isn’t automatically service-connected because you already have a knee rating. You need evidence showing that you have the additional condition and that it is linked to your service-connected knee disability. Medical records, medical opinions, and lay evidence may help establish that connection.
Talk to a Veterans Benefits Attorney Today
A few degrees of lost motion can change a knee rating. If the VA overlooked those findings or your knee has worsened since your last decision, you may have grounds to seek a higher rating or another form of review.
At Perkins Studdard, we represent veterans in VA disability claims and appeals. We can review your rating decision, C&P exam findings, medical records, and other evidence to identify the basis for the percentage the VA assigned and determine which option may apply. To schedule a confidential consultation with a VA disability benefits lawyer, call our law firm at (770) 285-0548.
