Knee Conditions: VA Rating Criteria

Plain-language guide

What this rating actually turns on

A knee is one of the few joints VA will rate more than once at the same time: instability, limited flexion, and limited extension can each carry their own percentage on the same leg. Under 38 CFR 4.71a, the main pathways are: limitation of flexion (DC 5260) and extension (DC 5261) measured in degrees; instability (DC 5257); ankylosis, a knee frozen in place (DC 5256); meniscus problems (DCs 5258–5259); and knee replacement or resurfacing (DC 5055).

The instability criteria changed on February 7, 2021, when VA rewrote the musculoskeletal schedule (85 FR 76453). DC 5257 no longer uses “slight/moderate/severe.” It now turns on two documented facts: the status of the ligament (sprain, incomplete tear, or complete tear, repaired, unrepaired, or failed repair) and whether a medical provider has prescribed a brace and/or an assistive device (cane, crutches, walker) for walking. The top 30 percent level requires an unrepaired or failed-repair complete tear plus prescriptions for both bracing and an assistive device.

Two rules work in your favor. Painful motion: 38 CFR 4.59 entitles an actually painful, unstable, or malaligned joint to at least the minimum compensable rating even if your measured motion wouldn’t qualify. Separate ratings: VA General Counsel has held that instability under DC 5257 and arthritis with limited motion may be rated separately on the same knee (VAOPGCPREC 23-97), and that limited flexion and limited extension of the same leg get separate ratings (VAOPGCPREC 9-2004).

A worked example

Say a soldier tears the ACL in the left knee during a field exercise, has it surgically reconstructed, and the graft later fails, so the knee keeps giving way. At the C&P exam the Lachman and pivot-shift tests confirm the instability, and the orthopedist has prescribed a hinged knee brace for walking but no cane or crutches. The examiner documents the three facts DC 5257 turns on: a complete ligament tear, a failed repair with persistent instability, and a provider’s prescription for bracing but not for an assistive device. That is a failed-repair complete tear with a prescription for either a brace or an assistive device, which is the 20 percent level of DC 5257, the amount shown in the pay table below. Because instability under DC 5257 is rated separately from limitation of motion, if that same knee also held flexion to 30 degrees on the goniometer, the 20 percent flexion rating under DC 5260 would stand on its own and combine with the instability rating rather than disappear into it.

What the C&P exam measures

The examiner completes the Knee and Lower Leg DBQ. It requires range of motion in degrees, active and passive, weight-bearing and nonweight-bearing, with the other knee tested for comparison, plus at least three repetitions to check for additional loss. It records your own description of flare-ups (frequency, duration, severity) and instability, and the examiner must estimate your range of motion in degrees during flare-ups based on your statements, even if no flare-up is observed at the exam. The stability section asks specifically whether a ligament is torn, whether repair succeeded or failed, and whether a provider has prescribed canes, crutches, a walker, or braces.

What to have in your file

Per VA’s evidence requirements: service treatment records, surgical and operative reports (they establish repair status under DC 5257), imaging, and the prescription record for any brace or assistive device, under the current criteria, that prescription is what separates 10 from 20 or 30 percent. Lay statements (VA Form 21-10210) describing flare-ups and giving-way episodes feed directly into DBQ questions the examiner must answer.

Common mistakes

• Buying a brace yourself. VA stated in the final rule that self-purchased devices don’t count; the criteria require a medical provider’s prescription (85 FR 76453).
• Underreporting flare-ups at the exam. The DBQ instructs the examiner to estimate degrees lost during flares from your description, silence gets recorded as no functional loss.
• Assuming one knee equals one rating. Instability, limited flexion, and limited extension can each be rated separately where supported.

Worth knowing

After a total knee replacement, DC 5055 assigns 100 percent for four months following implantation, then a minimum of 30 percent, but the regulation says the minimum applies to total replacement only; resurfacing has no minimum. If both knees are compensable, the bilateral factor adds 10 percent of their combined value, the calculator on this site handles that.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.