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VA Knee Claims: How to Get Rated for Knee Conditions and What You'll Earn

Knee conditions are a top-5 most-granted VA disability and the volume leader in musculoskeletal claims after the lumbar spine. Eight diagnostic codes cover everything from ROM limitation to instability to meniscus damage — and unlike most body parts, the VA explicitly lets you combine instability (DC 5257) with ROM codes without pyramiding. This guide covers every rating path, the goniometer measurements you need your C&P exam to capture, and how to fight the denials veterans face most.

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Top 5 Most-granted VA disability category
38 CFR 4.71a Federal regulation governing knee ratings
DC 5256–5263 Eight diagnostic codes for knee conditions
+30% Instability combinable with ROM rating
38 CFR 4.71a — Eight diagnostic codes for the knee

The knee diagnostic code map: DC 5256–5263 in plain language.

The VA rates knee conditions under eight diagnostic codes in 38 CFR 4.71a. Each code targets a specific type of functional impairment. Most veterans are rated under DC 5260 (flexion limitation) or DC 5261 (extension limitation), but instability, meniscus damage, and structural deformity each have their own code — and many veterans qualify for multiple codes simultaneously. Understanding which codes apply to your knee is step one.

DC Condition Max Rating Key Test / Evidence
5256 Ankylosis of the knee — unfavorable (extension beyond 10°, or in flexion greater than 15°) OR favorable (at 10° or less) 60% / 30% X-ray or clinical confirmation of joint fusion; unfavorable position (leg bent in non-functional angle) = 60%
5257 Recurrent subluxation or lateral instability — slight / moderate / severe 30% Stress testing (varus/valgus), Lachman's test, pivot-shift; veteran-reported episodes of the knee "giving way"
5258 Dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion 20% MRI showing meniscal tear/displacement; documented locking episodes with swelling in treatment records
5259 Symptomatic removal of semilunar cartilage 10% Surgical records showing meniscectomy (partial or total); residual pain or mechanical symptoms post-removal
5260 Limitation of flexion — knee cannot bend beyond threshold 30% Goniometer measurement of maximum knee bend; thresholds at 60°, 45°, 30°, 15°
5261 Limitation of extension — knee cannot fully straighten 50% Goniometer measurement of extension deficit from full extension (0°); thresholds at 5°, 10°, 15°, 20°, 30°, 45°
5262 Impairment of the tibia and fibula — malunion or nonunion with slight, moderate, or marked knee disability 40% X-ray confirming malunion or nonunion; functional impairment assessment
5263 Genu recurvatum — traumatic arthritis with marked knee disability 10% Hyperextension of the knee (bows backwards); traumatic arthritis documented on imaging
Which code does the VA choose?

The VA rates under whichever single diagnostic code — or combination of codes — produces the highest rating without pyramiding. For most veterans, that means evaluating both DC 5260 and DC 5261 to determine which produces the higher rating for the same limitation, then separately adding DC 5257 instability if present (because instability and ROM measure different functions). You do not have to choose — file a complete claim, get a thorough C&P exam, and let the rater apply the most favorable code.

Important: the VA is prohibited from combining DC 5260 and DC 5261 for the same knee in most cases — these both rate motion and would overlap. But DC 5257 (instability) can stack with either.

DC 5260 and DC 5261 — the goniometer measurements that determine your rating

Flexion vs. extension: the ROM thresholds your C&P exam must capture.

For most knee claims, your rating comes down to degrees — how far you can bend (flexion, DC 5260) and how straight you can extend (extension, DC 5261). The examiner uses a goniometer at the C&P exam to capture both measurements. Normal knee flexion is approximately 140°. Normal knee extension is 0° (fully straight). Any deficit from normal is the impairment being rated.

DC 5260 — Limitation of Flexion:

Rating Flexion Limited To What This Looks Like
10%
60°
Knee bends to about half of normal. You can walk stairs but with difficulty. Sitting in a car or low chair is uncomfortable. This is the most commonly granted flexion rating.
20%
45°
Knee bends to roughly one-third of normal — about the angle when sitting at a table. Squatting, kneeling, and climbing stairs are severely limited. Getting up from low seats requires arm support.
30%
30° or 15°
Severe restriction — knee barely bends past the neutral position. Standing from seated positions requires significant assistance. Running and stair-climbing are not possible. This is the maximum rating under DC 5260.

DC 5261 — Limitation of Extension:

Rating Extension Limited To What This Looks Like
10%
5° (can't fully straighten by 5°)
Minimal extension deficit. Walking appears mostly normal but the knee never fully locks out. Often caused by post-surgical scar tissue or mild arthritic changes.
20%
10°
Noticeable extension loss. Gait is affected — the knee stays slightly bent during the stance phase. Prolonged standing causes pain and fatigue faster than normal.
30%
15°
Significant extension deficit. The leg appears bent even at rest. Climbing stairs requires compensatory hip and ankle mechanics. Common after ACL reconstructions or severe arthritis.
40%
20°
Major functional impairment. The knee is functionally in a semi-crouched position during ambulation. Running and sustained walking are not possible without compensatory mechanisms.
50%
30° or 45°
Severe extension loss. The knee is permanently bent and cannot bear normal load through the joint. Full-time mobility assistance may be required. This is the maximum rating under DC 5261 and represents serious functional disability.
Extension limitation often outrates flexion limitation — do the math before your exam

A 20° extension deficit (cannot fully straighten the knee) = 40% under DC 5261. A 45° flexion deficit (cannot bend past 45°) = 20% under DC 5260. The same knee produces a dramatically different rating depending on which measurement is worse. If your knee won't straighten fully, DC 5261 is your primary code — and a 40% rating from extension limitation is one of the most common higher-tier knee ratings veterans don't know to file for. Bring a goniometer to a pre-exam appointment with your own doctor to get a baseline measurement of your extension deficit.

DeLuca / Mitchell — flare-up measurements apply to knee ROM too

The same DeLuca v. Brown (1995) and Mitchell v. Shinseki (2012) standards that apply to back pain apply to knee ROM: the VA must consider how pain, weakness, and fatigability affect range of motion — not just the baseline measurement at rest. If your knee is more limited after walking, after repetitive use, or during a flare-up, document it. The examiner should perform repetitive-use testing (measure after 3 repetitions) and ask about flare-up severity. An examiner who only takes one static measurement is using an inadequate protocol.

DC 5257 — recurrent subluxation and lateral instability

Instability claims under DC 5257: the one knee code you can combine with ROM ratings.

DC 5257 covers recurrent subluxation (partial dislocation of the kneecap or tibiofemoral joint) and lateral instability (the knee shifting side-to-side or giving way). The rating levels are straightforward:

Instability Level Rating 2026 Monthly Pay (single veteran, no dependents)
Slight — occasional giving way on uneven surfaces, no episodes requiring brace 10% ~$175/mo
Moderate — frequent giving way, brace helpful, limits prolonged standing or walking 20% ~$346/mo
Severe — constant instability, requires assistive device, significant functional impairment 30% ~$524/mo
The no-pyramiding exception — why DC 5257 can be combined with DC 5260 or 5261

VA's anti-pyramiding rule (38 CFR 4.14) prohibits rating the same disability twice. But the Board of Veterans' Appeals and the Court of Appeals for Veterans Claims have consistently held that DC 5257 (instability) and DC 5260/5261 (ROM limitation) rate different functional deficits — a stiff knee and an unstable knee are distinct impairments, even if they coexist in the same joint. This means a veteran with 20% for limitation of flexion (DC 5260) and 20% for moderate instability (DC 5257) combines those two ratings: approximately 36%, which rounds to 40%.

This is one of the most consistently missed combination opportunities in knee claims. If you have both a stiff knee and a knee that gives way, you should be evaluated under both sets of codes. File for both. Get both documented at the C&P exam.

How to document instability for the C&P exam

Instability is subjective from the veteran's report and objective from clinical testing. At the exam: (1) Tell the examiner exactly how often your knee gives way — per week, per day, under what circumstances (stairs, uneven ground, pivoting). (2) Ask if the examiner performed lateral stress testing (varus and valgus stress tests) and Lachman's test. If the examiner doesn't perform these tests, the instability assessment is incomplete. (3) If you wear a knee brace, bring it — and note whether the instability is present even with the brace. Brace dependence for daily ambulation is evidence of moderate-to-severe instability.

DC 5258 and 5259 — meniscal damage, locking, effusion

Meniscus claims: the C&P exam miss that costs veterans 20%.

Two diagnostic codes cover meniscal (cartilage) damage in the knee. These are frequently missed at C&P exams because examiners don't always ask about the specific symptom pattern the codes require — particularly the "locking, pain, and effusion" triad for DC 5258.

DC 5258 — "Dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion" — rated 20%

All three elements must be documented: (1) Locking — the knee mechanically catches or locks in a position during movement, requiring manipulation or rest to release. This is distinct from pain-limited motion or stiffness. (2) Pain — present with or during locking episodes. (3) Effusion — fluid buildup in the joint (visible swelling or diagnosed by physician). The episodes must be "frequent" — documented recurrently in treatment records, not just once. If your knee locks up, swells, and causes pain — and this happens repeatedly — DC 5258 applies. Make sure your treatment records use this exact language. If your doctor's notes say "knee catches with activity and swelling noted," that language supports DC 5258. If the notes only say "knee pain," it does not.

DC 5258 is rated at 20% — and it can be assigned alongside DC 5257 (instability) if the knee is also unstable, because instability and meniscal locking are different functional deficits.

DC 5259 — "Symptomatic removal of semilunar cartilage" — rated 10%

If you had a meniscectomy (partial or total removal of the meniscus) and continue to have symptoms — pain, swelling, instability, or limited motion — DC 5259 applies at 10%. The surgical records confirming the meniscectomy are the core evidence. Residual symptoms must be present for service connection; an asymptomatic post-meniscectomy knee does not qualify. If your symptoms after surgery are severe enough to meet DC 5258 criteria (locking + pain + effusion), rate under 5258 instead — it pays more.

Tell the examiner about every locking episode — the word "locking" matters

C&P examiners use the language on the DBQ form when writing their reports. The DBQ for the knee asks specifically about "locking, pain, and effusion." If you don't say the word "locking," the examiner may document your symptoms as "catching" or "clicking" — and that language does not satisfy DC 5258. Before the exam, write down every time your knee has locked and what you had to do to release it. Use the word "lock" explicitly. Say: "My knee locks during [activity] approximately [X] times per month and requires me to [stop, straighten, or manipulate] it to release."

Secondary conditions — 38 CFR 3.310

Secondary conditions from a service-connected knee: back, opposite knee, hip, and more.

Under 38 CFR 3.310, any condition caused or materially aggravated by your service-connected knee condition can be claimed as a secondary disability. Knee pathology affects biomechanics throughout the entire lower kinetic chain. Every secondary rated adds to your combined rating independently. Full guide: Secondary Conditions →

Lumbar Spine
An altered gait caused by knee pain or instability creates asymmetric loading on the lumbar spine, accelerating disc disease and facet arthritis. The nexus is biomechanical — antalgic gait documented in records ties the back condition to the knee. File under DC 5237 or the appropriate spinal code.
10%–40% (38 CFR 4.71a)
Contralateral Knee
Favoring a bad knee offloads weight to the opposite knee, causing or accelerating arthritis, meniscal wear, and patellofemoral syndrome. The gait-biomechanical nexus is well-established in orthopedic literature. File the opposite knee as a secondary condition — it gets its own separate rating.
10%–30% (DC 5260/5261/5257)
Hip Conditions
Knee pathology alters gait mechanics and load distribution in the hip joint. Ipsilateral hip bears abnormal stress from knee compensation. Contralateral hip is also affected by altered pelvic mechanics. Rated under DC 5250–5255 depending on specific hip impairment.
10%–40% per hip
Ankle / Foot
Knee instability changes foot strike patterns — veterans often overpronate or supinate to compensate, causing plantar fasciitis, Achilles tendinopathy, and ankle instability. Document the gait alteration with your treating physician before filing.
10%–20% per foot/ankle
Depression / Anxiety
Chronic knee pain, functional limitations, and inability to maintain pre-service activities (sports, hiking, active duty) are well-documented causes of major depressive disorder and anxiety. A psychiatrist or psychologist's nexus opinion linking knee-related limitations to onset of depression is routinely accepted.
Up to 100% (38 CFR 4.130)
Peripheral Neuropathy
Peroneal nerve compression from chronic knee swelling, scar tissue from surgery, or direct injury can cause foot drop or lateral leg numbness. Rated under 38 CFR 4.124a as common peroneal nerve impairment — separate from the knee rating itself.
10%–40% (38 CFR 4.124a)
The gait-alteration nexus — how to document it before filing

The most powerful secondary-condition nexus for knee claims is altered gait: your service-connected knee causes you to walk abnormally, and that abnormal walking causes the secondary condition. To document this: (1) Ask your treating physician to record your gait abnormality explicitly — "antalgic gait," "Trendelenburg gait," "decreased stride length on right," or similar observations. (2) If you've had physical therapy for the knee, those therapy notes often record gait deviations — obtain and preserve them. (3) A private physician's nexus letter linking the documented gait alteration to the onset or worsening of your back, opposite knee, or hip condition is the strongest evidence for secondary claims in this category.

Evidence checklist — what you need to win a knee claim

What evidence to gather before and after filing.

Knee claims live or die on documentation. The rating is driven by functional measurements, but service connection requires a clear nexus to military service. Build this file before you file.

C&P exam failures — the three most common protocol gaps in knee exams

Common C&P exam failures for knee claims — and how to challenge a bad exam.

The knee C&P exam follows the Knee and Lower Leg DBQ. Not all examiners follow it correctly. Knowing what a complete, legally adequate exam requires lets you identify when your exam was inadequate — and challenge it through an HLR or Supplemental Claim before the rating becomes final.

1
Examiner doesn't perform repetitive-use testing (DeLuca violation)
The examiner should measure your ROM, then ask you to perform the motion three times and re-measure. If your knee stiffens after repetitive bending — which is common with arthritis and post-surgical changes — the post-repetition measurement is the one the VA should use for rating. If the examiner only measures once, documents only one set of ROM numbers, and doesn't address flare-up ROM, the exam is inadequate under DeLuca/Mitchell. Write down immediately after the exam whether repetitive-use testing was performed. If it wasn't, note it in your rebuttal statement.
2
ROM tested non-weight-bearing only — the table exam problem
Many examiners measure knee flexion and extension with the veteran lying on an exam table. The knee under no body weight load often moves better than when bearing full body weight. A knee with arthritis may have 80° of flexion when lying down but lock up at 50° when standing and walking down stairs. Weight-bearing ROM assessment is more functionally relevant. If your exam was entirely non-weight-bearing and your real-world limitation is worse than what the table test showed, document this discrepancy in a statement in support of claim and request that any future exam include weight-bearing ROM assessment.
3
Instability never tested — DC 5257 never evaluated
Many veterans leave a knee C&P exam rated only for ROM because the examiner never assessed instability. If the examiner didn't perform lateral stress testing (varus/valgus), Lachman's test, or an anterior/posterior drawer test, the instability evaluation was incomplete. Before your exam, explicitly tell the examiner: "My knee also gives way when I walk on uneven ground — I'd like instability assessed." After the exam, request your DBQ immediately. If the instability section is blank or marked "not evaluated," file a Supplemental Claim requesting a new exam with instability assessment, citing the incomplete evaluation as the new and relevant evidence.
Request your Knee DBQ immediately after the exam

You're entitled to the C&P exam report and Knee and Lower Leg DBQ. Request it through MyHealtheVet or your regional office within days of the exam. Compare what the examiner documented against what you actually experienced and reported during the exam. If the findings are inconsistent with what you told the examiner — or if required elements (repetitive-use testing, instability assessment, flare-up inquiry) are missing — submit a written rebuttal to your claim file before the rating decision is issued. A timely rebuttal can prevent a bad rating from becoming the starting point for your appeal. Full exam prep: C&P Exam Guide →

Common denial reasons and how to fight them

Knee claim denied? Three most common reasons and the rebuttal for each.

Knee claims are denied at rates that don't reflect the underlying medical reality. The three patterns below account for the majority of knee denials. Each has a documented strategy. You have one year from the denial date to file an appeal — don't let the clock run.

1
Denial: "No in-service event documented"
The VA says there's no record of knee injury or knee complaints during service. Rebuttal: STRs are frequently incomplete. File buddy statements from fellow servicemembers who witnessed your injury or physical demands. Request complete military personnel records through the NPRC. If your MOS involved documented physical demands — airborne operations, infantry/combat arms, deck plates, heavy equipment — a private orthopedic nexus letter tying those demands to your current knee diagnosis can establish service connection without a specific incident report. Many knee conditions are caused by cumulative stress, not a single traumatic event, and the VA must consider MOS-based exposure.
2
Denial: "Degenerative — age-related, not service-connected"
The examiner concluded osteoarthritis or degenerative changes are due to normal aging. Rebuttal: The VA cannot deny service connection solely because a condition is degenerative. Under 38 CFR 3.303, if service aggravated a pre-existing condition beyond natural progression, service connection applies. A private nexus letter stating that your in-service physical demands (repetitive impact, parachute landings, vehicle vibration) accelerated degenerative changes beyond normal aging directly rebuts this denial. Early-onset knee arthritis in a veteran in their 30s or 40s is not "normal aging" — present that argument explicitly in the nexus letter.
3
Denial: Low rating — 10% when the impairment clearly supports 20% or higher
Service connection was established but the rating is too low. This is an underrating, not a denial — and the dollar difference is significant. Rebuttal: If the C&P exam was on a good day, the ROM measurement may be better than your average functional state. File a Supplemental Claim with a private Knee DBQ documenting your ROM after repetitive use and during flare-ups, a written statement describing your worst functional state, and any treatment records showing ROM worse than the C&P exam found. Alternatively, file for a Higher Level Review if the examiner failed DeLuca/Mitchell requirements. The difference between 10% (~$175/mo) and 30% (~$524/mo) is over $4,200/year, tax-free — and it compounds indefinitely.
Start here VA Claim Denied Guide What the denial letter means and your first decision after receiving it. Pick your lane VA Appeals Guide HLR, Supplemental Claim, or BVA? The three AMA lanes for knee denials. Prep the exam C&P Exam Guide What to expect, what gets measured, and what to say about instability and flare-ups. Add to your rating Secondary Conditions Back, opposite knee, hip — each secondary adds to your combined rating independently. Related claim VA Back Pain Claims Guide Knee gait alteration often causes or worsens lumbar conditions — file both together. Run the numbers VA Combined Ratings Calculator See how your knee rating plus instability and secondaries combine into your total monthly pay.
Ask on the HadIt Forum — 26,000 veterans who've been through the same C&P exam →
Frequently asked questions

VA Knee Claims FAQ — 7 questions veterans ask most.

How does the VA rate knee conditions?
Under 38 CFR 4.71a using eight diagnostic codes (DC 5256–5263). The most common paths: limitation of flexion (DC 5260) rated 10–30% by how far you can bend; limitation of extension (DC 5261) rated 10–50% by how straight you can extend; instability (DC 5257) rated 10–30% and uniquely combinable with flexion/extension codes. Meniscus damage (DC 5258/5259) at 20% or 10%. Use the combined ratings calculator to see how your codes stack.
What are the flexion rating thresholds under DC 5260?
Flexion limited to 60° = 10%; to 45° = 20%; to 30° or 15° = 30% (maximum). Normal flexion is ~140°. These measurements must be taken with a goniometer at the C&P exam. The examiner should also measure after repetitive use and ask about flare-up severity. If your knee stiffens significantly during flare-ups, document that — the post-flare ROM may meet a higher threshold.
What are the extension rating thresholds under DC 5261?
Extension limited to 5° = 10%; to 10° = 20%; to 15° = 30%; to 20° = 40%; to 30° or 45° = 50% (maximum). Extension limitation often produces higher ratings than flexion limitation — a 20° extension deficit is 40%, which is a significant rating. If your knee won't straighten fully after surgery or due to arthritis, DC 5261 may be your primary code. Get your extension measured by your own doctor before the exam so you know your baseline.
Can I combine DC 5257 (instability) with DC 5260 or 5261?
Yes. The VA's anti-pyramiding rule prohibits rating the same disability twice, but instability (DC 5257) and ROM limitation (DC 5260/5261) rate different functional deficits. The BVA and CAVC have consistently allowed this combination. A veteran with 20% for flexion limitation and 20% for moderate instability combines to approximately 36%, rounding to 40%. File for both if your knee is stiff and unstable — they are separate ratings.
What is DC 5258 and how is it different from DC 5259?
DC 5258 (dislocated semilunar cartilage with frequent locking, pain, and effusion) = 20%. All three elements must be documented: mechanical locking, pain, and swelling — repeatedly. DC 5259 (symptomatic removal of semilunar cartilage — meniscectomy) = 10%. If you've had a meniscectomy but still have locking, pain, and effusion, file under 5258 instead — it pays more. The key language for 5258 is "locking" — use that word explicitly with the examiner and in your treatment records.
What secondary conditions can I claim from a service-connected knee?
Under 38 CFR 3.310: lumbar spine (altered gait from knee pain causes abnormal spinal loading — often worth 10–20% secondary); contralateral knee (overloading the good knee causes arthritis — file it as a separate claim); hip conditions (knee biomechanics alter hip loading); ankle/foot conditions (knee instability alters foot strike); depression or anxiety (chronic pain secondary to service-connected condition). Each secondary adds to your combined rating. The gait-alteration nexus ties most of these together — document your gait abnormality with your treating physician.
My knee claim was denied because there's no in-service incident documented. What do I do?
This is the most common knee denial. STRs are routinely incomplete. Rebuttal strategy: (1) File buddy statements from servicemembers who witnessed your injury or duty limitations. (2) Request complete military personnel records through NPRC. (3) If your MOS involved repetitive physical demands, get a private orthopedic nexus letter tying those demands to your current diagnosis — cumulative stress is a valid service connection theory. File a Supplemental Claim with the nexus letter and buddy statements as new and relevant evidence. See the Denied Claim Guide and Appeals Guide for next steps.

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