Reference: 38 CFR 4.71a

Sources & Related Guides

What is the VA rating for Knee / Lower Leg?

Review knee and lower-leg guidance around flexion, extension, painful motion, instability, meniscus findings, replacement history, tibia or fibula impairment, and shin splints routing.

What is Knee / Lower Leg?

The published schedule uses several separate knee and lower-leg pathways. RatingScope's current deterministic comparison covers prosthetic replacement or resurfacing, ankylosis, measured flexion and extension, recurrent instability or subluxation, meniscus findings, tibia or fibula nonunion, and medial tibial stress syndrome. The relevant medical finding matters more than the diagnosis name alone.

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Start AssessmentAnswer condition-scoped questions using documented findings from your records or exam notes.ContinuePercentage GuideSee the published percentage tiers and what changes between them.ContinueSecondary ConditionsSee conditions commonly connected to this one in VA claims.Continue

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What are you trying to understand about knee / lower leg?

Overview

How VA describes knee and lower-leg severity

The published schedule uses several separate knee and lower-leg pathways. RatingScope's current deterministic comparison covers prosthetic replacement or resurfacing, ankylosis, measured flexion and extension, recurrent instability or subluxation, meniscus findings, tibia or fibula nonunion, and medial tibial stress syndrome. The relevant medical finding matters more than the diagnosis name alone.

This guide explains published educational criteria. It does not diagnose a knee condition, infer missing measurements, determine service connection, or predict a VA decision. RatingScope does not combine same-knee routes or create a painful motion percentage when the current deterministic comparison requires more detail.

Percentage Guides

Understanding Your Percentage

Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.

0%

Next: 10%

Several knee and lower-leg routes include a 0% level, including flexion limited to 60 degrees, extension limited to 5 degrees, and certain MTSS treatment histories shorter than 12 consecutive months.

What separates the next level: The 10% motion boundaries are flexion limited to 45 degrees and extension limited to 10 degrees. Other 10% routes use their own instability, meniscus-removal, or MTSS findings.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5260 lists flexion limited to 60 degrees at 0 percent. DC 5261 lists extension limited to 5 degrees at 0 percent. DC 5262 lists MTSS treatment for less than 12 consecutive months at 0 percent.
Qualification explanation
A route-specific 0% level requires enough information to identify that route. Missing flexion, extension, treatment duration, side, or other required facts belongs in a needs-more-detail state and must not be converted into 0%.
Examples
Measured flexion is limited to 60 degrees under the DC 5260 route.; Measured extension is limited to 5 degrees under the DC 5261 route.; Documented MTSS treatment has continued for less than 12 consecutive months.
Medical evidence
Knee and Lower Leg DBQ; Clinician-recorded flexion and extension measurements; MTSS treatment-duration records
Functional impact examples
Pain or activity limits may still be present even when a route is noncompensable.; A 0% criteria pathway does not mean the knee condition is unimportant.
Common misconceptions
0% is not a denial prediction.; Missing measurements are not proof of a 0% pathway.; Pain alone does not identify which 0% or compensable route applies.
Related topics
noncompensable pathway; flexion 60 degrees; extension 5 degrees; MTSS duration
Source context
38 CFR 4.71a; 5260, 5261, and 5262; Current knee and lower-leg educational pathways.

10%

Next: 20%

The 10% level can appear through several distinct routes: flexion limited to 45 degrees, extension limited to 10 degrees, qualifying recurrent instability or subluxation, symptomatic removal of semilunar cartilage, qualifying MTSS treatment history, or documented genu recurvatum.

What separates the next level: The 20% motion boundaries are flexion limited to 30 degrees and extension limited to 15 degrees. Instability, meniscus, and MTSS use their own additional findings. DC 5263 genu recurvatum does not have an adjacent higher or lower level within its own diagnostic code.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5260 lists flexion limited to 45 degrees; DC 5261 lists extension limited to 10 degrees; DC 5257 provides lower recurrent instability or subluxation routes; DC 5259 covers symptomatic removal of semilunar cartilage; DC 5262 includes an MTSS 10 percent route; and DC 5263 lists genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) as a single flat 10 percent route.
Qualification explanation
Each route has different required findings. A measured motion value cannot be substituted for instability, and a brace, pain report, or surgery history cannot be treated as a stand-alone route. The DC 5263 genu recurvatum route has no higher or lower tier of its own; it requires acquired, traumatic weakness and insecurity in weight-bearing that is objectively demonstrated, not merely reported.
Examples
Knee flexion is measured at 45 degrees.; Extension limitation is measured at 10 degrees.; The record documents a qualifying lower instability route or current symptoms after meniscus removal.; Acquired, traumatic genu recurvatum with objectively demonstrated weight-bearing weakness and insecurity is documented.
Medical evidence
Knee DBQ range-of-motion section; Ligament or patellar-instability findings; Operative and follow-up records for meniscus removal; MTSS treatment records; Orthopedic examination documenting genu recurvatum and objective weight-bearing findings
Functional impact examples
Difficulty bending the knee documented with a 45-degree endpoint; Difficulty fully straightening the knee documented with a 10-degree extension limitation; Giving-way effects explained with the required clinical route facts; Insecurity in weight-bearing documented through objective examination findings rather than a symptom report alone
Common misconceptions
A brace does not automatically establish 10%.; Knee pain alone does not identify a motion endpoint.; Every 10% route does not use the same evidence.; A hyperextended knee posture alone does not establish DC 5263; the weakness and insecurity in weight-bearing must be objectively demonstrated.
Related topics
flexion; extension; instability; meniscus removal; MTSS; genu recurvatum
Source context
38 CFR 4.71a; 5257, 5259, 5260, 5261, 5262, and 5263; Current route-specific knee and lower-leg educational pathways.

20%

Next: 30%

The 20% level can describe flexion limited to 30 degrees, extension limited to 15 degrees, a qualifying middle instability route, dislocated semilunar cartilage with frequent locking, pain, and effusion, or a qualifying one-extremity MTSS route.

What separates the next level: The 30% motion boundaries are flexion limited to 15 degrees and extension limited to 20 degrees. Other 30% routes require their own ankylosis, instability, replacement, or bilateral MTSS findings.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5260 lists flexion limited to 30 degrees; DC 5261 lists extension limited to 15 degrees; DC 5257 provides middle instability routes; DC 5258 lists dislocated semilunar cartilage with frequent locking, pain, and joint effusion; and DC 5262 includes a one-extremity MTSS route.
Qualification explanation
These routes are alternatives, not one blended checklist. The explanation should identify the actual motion, instability, meniscus, or MTSS pathway documented in the record.
Examples
Knee flexion is measured at 30 degrees.; Extension limitation is measured at 15 degrees.; A dislocated meniscus is documented with frequent locking, pain, and effusion.
Medical evidence
Measured flexion or extension; Knee stability examination and prescription records; MRI or operative records plus current locking, pain, and effusion findings; MTSS treatment and side documentation
Functional impact examples
Limited ability to bend or straighten the knee documented with a qualifying measurement; Frequent locking and effusion affecting ordinary movement; Persistent instability described with the applicable clinical and prescription findings
Common misconceptions
A meniscus tear alone does not establish the DC 5258 route.; Self-reported giving way does not automatically establish an instability level.; MRI language does not replace current examination findings.
Related topics
30-degree flexion; 15-degree extension; meniscus; instability; MTSS
Source context
38 CFR 4.71a; 5257, 5258, 5260, 5261, and 5262; Current route-specific knee and lower-leg educational pathways.

30%

Next: 40%

The 30% level can appear through flexion limited to 15 degrees, extension limited to 20 degrees, the highest qualifying instability route, favorable knee ankylosis, the minimum after total knee replacement, or qualifying bilateral MTSS.

What separates the next level: Higher levels begin with route-specific findings such as extension limited to 30 degrees, ankylosis at a higher fixed angle, tibia or fibula nonunion with loose motion requiring a brace, or severe replacement residuals.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5260 lists flexion limited to 15 degrees; DC 5261 lists extension limited to 20 degrees; DC 5257 provides the highest recurrent instability or subluxation routes; DC 5256 lists favorable ankylosis; DC 5055 provides a minimum for total replacement; and DC 5262 includes bilateral MTSS under its specified treatment conditions.
Qualification explanation
The record must identify the route and all of its required facts. The total-replacement minimum does not apply to resurfacing, and bilateral MTSS requires explicit treatment response and side count.
Examples
Knee flexion is measured at 15 degrees.; Extension limitation is measured at 20 degrees.; A total knee replacement is beyond the post-procedure period and the minimum replacement route is documented.
Medical evidence
Knee DBQ motion or ankylosis findings; Instability route findings and prescribed-device records; Knee replacement operative history and timing; MTSS treatment response and bilateral documentation
Functional impact examples
Marked bending or straightening limits tied to measured degrees; A fixed knee position within the favorable ankylosis route; Persistent instability effects documented with the required route facts
Common misconceptions
A knee replacement does not remain at the temporary 100% level indefinitely.; Resurfacing does not receive the total-replacement minimum after the temporary period.; Bilateral symptoms should not be inferred from a general shin-splints diagnosis.; Once a DC 5055 rating applies, 38 CFR 4.71a's Prosthetic Implants and Resurfacing table Note (1) bars an additional, separate rating under 4.71a for that same knee -- disclosed here, not stacked.
Related topics
15-degree flexion; 20-degree extension; favorable ankylosis; total replacement; bilateral MTSS
Source context
38 CFR 4.71a; 5055, 5256, 5257, 5260, 5261, and 5262; Current route-specific knee and lower-leg educational pathways.

40%

Next: 50%

The 40% level can describe extension limited to 30 degrees, knee ankylosis in the next fixed-angle band, or tibia and fibula nonunion with loose motion requiring a brace.

What separates the next level: The 50% routes use extension limited to 45 degrees or knee ankylosis in a higher flexion-angle band.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5261 lists extension limited to 30 degrees. DC 5256 lists ankylosis in flexion between 10 and 20 degrees. DC 5262 lists nonunion of the tibia and fibula with loose motion requiring a brace.
Qualification explanation
Each route must remain traceable to its own finding. A brace alone is not the DC 5262 route; nonunion and loose motion must also be documented. Restricted motion should not be converted into ankylosis unless the knee is fixed.
Examples
Extension limitation is measured at 30 degrees.; The knee is fixed in flexion within the 40% ankylosis band.; Tibia and fibula nonunion is documented with loose motion and a required brace.
Medical evidence
Knee DBQ extension measurement; Ankylosis finding with fixed angle; Imaging and orthopedic findings for tibia or fibula nonunion; Brace requirement documentation
Functional impact examples
Major difficulty straightening the knee documented with a 30-degree extension limitation; The knee is fixed rather than merely stiff or painful; Loose motion and brace dependence documented with nonunion
Common misconceptions
Wearing a brace does not automatically establish 40%.; Very limited motion is not automatically ankylosis.; A fracture history does not automatically establish current nonunion with loose motion.
Related topics
30-degree extension; knee ankylosis; tibia and fibula nonunion; brace requirement
Source context
38 CFR 4.71a; 5256, 5261, and 5262; Current route-specific knee and lower-leg educational pathways.

50%

Next: 60%

The 50% level can describe extension limited to 45 degrees or knee ankylosis fixed in flexion within the corresponding higher angle band.

What separates the next level: The 60% level includes ankylosis at 45 degrees or more and severe chronic painful motion or weakness after total knee replacement.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5261 lists extension limited to 45 degrees. DC 5256 lists ankylosis in flexion between 20 and 45 degrees at 50 percent, with the higher 60 percent band beginning at 45 degrees or more.
Qualification explanation
The record should distinguish a measured extension limitation from a knee fixed by ankylosis. RatingScope follows the active registry boundary and keeps the 45-degree ankylosis endpoint in the higher 60% route.
Examples
Extension limitation is measured at 45 degrees.; The knee is fixed by ankylosis above 20 degrees but below the 60% boundary.; The explanation identifies whether the route is measured extension or fixed-position ankylosis.
Medical evidence
Knee DBQ extension endpoint; Ankylosis section identifying the fixed angle; Orthopedic examination describing whether motion exists
Functional impact examples
Very limited ability to straighten the knee documented at the measured endpoint; The knee remains fixed in a substantial flexed position; Standing and walking effects described alongside the route-specific finding
Common misconceptions
Severe pain does not automatically establish a 45-degree extension limitation.; A flexed resting posture is not automatically ankylosis.; The measurement and fixed-position routes should not be blended.
Related topics
45-degree extension; ankylosis angle; fixed knee position
Source context
38 CFR 4.71a; 5256 and 5261; Current route-specific knee educational pathways.

60%

Next: 100% during the qualifying temporary post-procedure period

The 60% level can describe knee ankylosis in flexion at 45 degrees or more, or chronic severe painful motion or weakness after total knee replacement and after the temporary post-procedure period.

What separates the next level: The 100% DC 5055 route applies for the four-month period following qualifying prosthesis implantation or resurfacing, not as a permanent severity level.

Review CFR criteria, examples, and evidence
Official CFR language
DC 5256 lists extremely unfavorable knee ankylosis in flexion at an angle of 45 degrees or more. DC 5055 lists chronic residuals after total knee replacement consisting of severe painful motion or weakness in the affected extremity.
Qualification explanation
The replacement route requires a total replacement, completed temporary period, and severe chronic residual finding. The ankylosis route requires a fixed knee at the listed angle. RatingScope does not infer either from severe symptoms alone.
Examples
The knee is fixed in flexion at 45 degrees or more.; After total knee replacement and the temporary period, severe chronic painful motion is documented.; After total knee replacement and the temporary period, severe chronic weakness is documented.
Medical evidence
Knee DBQ ankylosis findings; Total knee replacement operative report and procedure date; Postoperative examination documenting chronic severe painful motion or weakness
Functional impact examples
The knee is fixed in an extremely unfavorable flexed position; Severe chronic weakness affects standing or walking after total replacement; Severe painful motion persists after the postoperative period
Common misconceptions
A painful knee replacement does not automatically establish severe chronic residuals.; Knee resurfacing does not receive the post-period total-replacement minimum or residual route.; Severe limitation is not automatically ankylosis.; Once a DC 5055 rating applies, 38 CFR 4.71a's Prosthetic Implants and Resurfacing table Note (1) bars an additional, separate rating under 4.71a for that same knee -- disclosed here, not stacked.
Related topics
total knee replacement; severe chronic residuals; 45-degree ankylosis
Source context
38 CFR 4.71a; 5055 and 5256; Current route-specific knee educational pathways.

100%

Highest listed pathway

DC 5055 provides a temporary 100% level for four months following implantation of a qualifying knee prosthesis or knee resurfacing.

What separates the next level: After the temporary period, total replacement may follow the severe-residual, intermediate-analogy, or 30% minimum instructions. Resurfacing is evaluated under the applicable knee codes without the total-replacement minimum.

Review CFR criteria, examples, and evidence
Official CFR language
The schedule provides 100 percent for four months following implantation of a prosthesis or resurfacing under DC 5055.
Qualification explanation
The procedure type and timing must be explicit. After the temporary period, total replacement and resurfacing follow different instructions. This pathway is based on the post-procedure period, not an estimate of permanent severity.
Examples
A total knee prosthesis was implanted three months ago.; Qualifying knee resurfacing occurred within the four-month period.; The procedure date and procedure type are both documented.
Medical evidence
Operative report; Procedure date; Records distinguishing total replacement from resurfacing; Postoperative follow-up records
Functional impact examples
Postoperative recovery occurs during the schedule's defined temporary period; Mobility and rehabilitation needs are documented as treatment context; Later residual function is evaluated after the temporary period
Common misconceptions
The 100% route is not permanent by default.; A general knee surgery does not automatically qualify as prosthesis implantation or resurfacing.; Procedure timing must not be guessed.
Related topics
DC 5055; knee prosthesis; resurfacing; temporary post-procedure period
Source context
38 CFR 4.71a; 5055; Current temporary post-procedure educational pathway.

Diagnostic Code 5262 comparison tool

Compare tibia and fibula malunion evaluation routes

Malunion of the tibia and fibula (DC 5262) does not have its own percentage table. The schedule instead directs evaluation under whichever knee route (DC 5256, 5257, 5260, or 5261) or ankle route (DC 5270 or 5271) results in the highest evaluation. Enter documented findings for each route below to see them side by side. This is an informational comparison, not a submission. Nothing entered here is saved or sent anywhere.

Knee routes

Ankle routes

Full detail on these routes lives in the Ankle condition hub.

Knee ankylosis (DC 5256)

–

No documented knee ankylosis entered.

Knee flexion (DC 5260)

–

No measured flexion entered.

Knee extension (DC 5261)

–

No measured extension entered.

Knee instability (DC 5257)

–

No documented knee instability route entered.

Ankle ankylosis (DC 5270)

–

No documented ankle ankylosis entered.

Ankle limitation of motion (DC 5271)

–

No documented ankle limitation of motion entered.

Enter at least one documented route above to see a comparison. This comparison covers only the DC 5256, 5257, 5260, 5261, 5270, and 5271 routes listed in the DC 5262 malunion instruction; it does not include DC 5258, 5259, 5263, other DC 5262 findings, combined ratings math, or any other disability.

Compare your full knee recordsReview the Ankle condition hub

Learn

Understand the details behind the criteria

Use these short guides to connect published terms with the records and observations that may clarify them.

How knee range of motion is recorded

A clinician records flexion and extension in degrees, usually with a goniometer, for each knee being examined.

  • Flexion describes bending the knee.
  • Extension describes how fully the knee straightens.
  • The published reference shown on the DBQ is 140 degrees of flexion and 0 degrees of extension.
  • RatingScope uses documented degree values and does not convert words such as stiff or limited into measurements.

Records to review: Knee and Lower Leg DBQ; orthopedic examination; physical therapy measurements.

Why flexion and extension are separate

DC 5260 and DC 5261 use different measurements and different percentage boundaries.

  • A flexion endpoint records how far the knee bends.
  • An extension limitation records how far the knee remains from full straightening.
  • One measurement should not be substituted for the other.
  • When both routes or other same-knee routes conflict, the current comparison asks for more detail instead of silently combining them.

Records to review: Knee DBQ flexion endpoint; Knee DBQ extension endpoint.

What painful motion means

Pain is important when it affects documented motion or function, but it is not a private score that RatingScope converts into a percentage.

  • The DBQ records whether pain appears in active, passive, weight-bearing, or nonweight-bearing motion.
  • The examiner may identify the degree where pain contributes to limitation.
  • 38 CFR 4.40, 4.45, and 4.59 provide functional context for painful joints.
  • 38 CFR 4.59's own text states: 'It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint' -- this is genuine CFR text, not case law. The current deterministic comparison preserves painful-motion uncertainty as needs more detail rather than computing this minimum automatically.

Records to review: Knee DBQ pain findings; range-of-motion examination; treatment notes.

How instability and recurrent subluxation are described

DC 5257 distinguishes ligament-related and patellar-instability routes using diagnosis or ligament status, persistent or recurrent instability, surgical history, and prescribed devices.

  • A report that the knee gives way is useful history but does not provide every route fact.
  • Ligament routes distinguish sprain, incomplete tear, repaired complete tear, and unrepaired or failed complete tear.
  • Patellar routes use a diagnosed patellofemoral condition and recurrent instability, with surgical history where applicable.
  • A provider-prescribed brace, cane, walker, or other assistive device matters only within the specific route that asks for it.

Records to review: Knee DBQ instability section; orthopedic stability testing; brace or assistive-device prescription.

How meniscus conditions use separate findings

The schedule distinguishes dislocated semilunar cartilage from symptomatic removal of semilunar cartilage.

  • The DC 5258 route requires dislocation with frequent locking, pain, and joint effusion.
  • The DC 5259 route concerns current symptoms after removal.
  • An MRI showing a tear does not by itself document every DC 5258 element.
  • Pain alone should not be expanded into locking, effusion, dislocation, or symptomatic removal.

Records to review: MRI; operative report; Knee DBQ meniscus section; orthopedic notes.

What functional loss adds to the record

Functional loss describes how pain, weakness, fatigability, incoordination, or other factors affect normal knee movement and ordinary activity.

  • The DBQ asks the veteran to describe functional loss in their own words.
  • The examiner connects reported limits to examination findings and available evidence.
  • Standing, walking, stairs, kneeling, squatting, and work tasks may provide concrete context.
  • Functional impact does not authorize RatingScope to infer an undocumented motion value or route.

Records to review: Knee DBQ functional-loss sections; physical therapy records; firsthand statements.

How flare-ups are documented

The useful flare-up record describes frequency, duration, characteristics, triggers, relief, severity, and functional impairment.

  • The examiner asks whether flare-ups occur and what changes during them.
  • The DBQ requests estimated flexion and extension during flare-ups when supported by procurable information.
  • A veteran can accurately describe observable limits without inventing degree values.
  • When a supported estimate is unavailable, RatingScope keeps the measurement missing rather than guessing.

Records to review: Knee DBQ flare-up section; treatment notes; personal statement.

How to read the Knee and Lower Leg DBQ

The DBQ organizes diagnosis, history, motion, repeated use, flare-ups, atrophy, ankylosis, instability, meniscus, lower-leg findings, procedures, assistive devices, testing, and functional impact.

  • Start with the affected side and diagnosis section.
  • Review initial, repeated-use, and flare-up motion separately.
  • Keep instability and meniscus sections distinct from ordinary motion.
  • Check procedure type, timing, and residual findings when replacement or resurfacing is involved.

Records to review: Knee and Lower Leg DBQ; C&P examination report.

Common Knee C&P examination misunderstandings

A C&P examination gathers medical findings for VA review. It is not a treatment visit, and the examiner does not issue the final benefits decision.

  • Describe ordinary limitations and flare-up effects accurately rather than trying to perform for a result.
  • Follow the examiner's instructions and do not force movement beyond what can be performed safely.
  • A brace, surgery, MRI, or diagnosis does not replace route-specific findings.
  • The completed examination should be understood with the other evidence of record.

Records to review: C&P examination report; Knee and Lower Leg DBQ; medical records.

Measurement Guide

How knee range of motion is described

These are clinical examination terms and published reference values, not instructions for measuring your own knee. A clinician uses a goniometer and records each knee's degree values together with pain and functional context.

Knee flexion

Bending the knee so the lower leg moves toward the back of the thigh.

Normal reference: 0 to 140 degrees is the reference shown on the Knee DBQ and Plate II.

Why it matters: DC 5260 uses documented flexion endpoints at 60, 45, 30, and 15 degrees.

Knee extension

Straightening the knee toward the neutral 0-degree position.

Normal reference: 0 degrees represents the published full-extension reference.

Why it matters: DC 5261 uses documented extension limitation at 5, 10, 15, 20, 30, and 45 degrees.

How an examination adds context

Initial testing
The examiner records active and passive flexion and extension and notes whether pain contributes to functional loss.
Repeated-use testing
The examination records whether at least three repetitions produce additional loss of motion or function.
Flare-ups
The examiner may estimate flexion and extension during flare-ups from the veteran's description, the record, and medical expertise. RatingScope uses only documented values.
Painful motion
Pain may be documented in active, passive, weight-bearing, or nonweight-bearing motion. It does not become an automatic percentage in RatingScope.
Functional loss
Weakness, fatigability, lack of endurance, incoordination, swelling, and interference with movement may add context without becoming hidden scoring.

Evidence

Evidence that may clarify the published criteria

Knee and Lower Leg DBQ

Collects side-specific motion, repeated-use and flare-up findings, ankylosis, instability, meniscus, lower-leg, procedure, device, testing, and functional-impact information.

A DBQ is useful structured evidence, but RatingScope does not decide what evidence VA must accept.

Range-of-motion measurements

Provide side-specific knee flexion and extension values in degrees, including supported repeated-use or flare-up estimates.

Broad limited-motion language is not a substitute for a documented degree value.

Instability testing

May document ligament or patellar findings, persistent or recurrent instability, surgical history, and the clinical basis for a route.

A report of giving way does not independently establish every DC 5257 finding.

MRI

May show meniscus, ligament, cartilage, tendon, or other soft-tissue findings that add diagnostic context.

MRI severity does not independently assign a percentage or replace current examination findings.

X-rays

May document arthritis, alignment, prosthesis, fracture, nonunion, or other bony findings.

An X-ray finding does not independently establish motion, instability, or functional severity.

Orthopedic treatment notes

May document diagnosis, examination findings, procedures, recovery, symptoms, treatment response, and longitudinal function.

A treatment history does not replace the specific criteria facts for the selected route.

Physical therapy records

May provide repeated motion measurements, strength, gait, activity tolerance, treatment response, and observed functional limits.

Therapy goals or general progress language should not be converted into undocumented criteria.

Brace and assistive-device prescriptions

Can show whether a provider prescribed a brace, cane, walker, crutch, or other device when a specific route asks for that fact.

Owning or using a device does not automatically satisfy a route that requires a provider prescription or additional findings.

Functional limitations

Describe concrete effects on walking, standing, stairs, kneeling, squatting, driving, sleep, work, and other ordinary activity.

Functional impact adds context but should not be converted into an unrecorded measurement or route.

Personal and firsthand lay evidence

May describe observable pain, swelling, locking, giving way, flare-ups, falls, device use, and activity limits over time.

Lay evidence should report firsthand observations and should not invent a diagnosis, measurement, prescription, or clinical finding.

DBQ

What the Knee and Lower Leg DBQ commonly documents

The official Knee and Lower Leg DBQ gathers structured medical information for VA. The examiner documents findings and does not issue the final benefits decision. Describe the actual condition honestly; do not exaggerate, minimize, invent degree values, or rehearse an outcome.

  • Diagnosis, side, and medical history
  • Flare-ups and functional loss in the veteran's own words
  • Initial active and passive flexion and extension
  • Observed repetition, repeated use over time, and flare-up estimates
  • Pain, crepitus, tenderness, atrophy, and contributing factors
  • Ankylosis
  • Recurrent subluxation, ligament instability, and patellar instability
  • Meniscus conditions and surgical history
  • Tibia or fibula nonunion or malunion, MTSS, and replacement or resurfacing findings
  • Genu recurvatum and objective weight-bearing findings
  • Assistive devices, diagnostic testing, and occupational impact

Terminology

Plain-English terms

Knee flexion

It records how far the lower leg can move toward the back of the thigh.

DC 5260 distinguishes 0%, 10%, 20%, and 30% pathways through documented endpoints.

Knee DBQ; goniometer measurement; range of motion

Knee extension

An extension limitation records how many degrees the knee remains from full straightening.

DC 5261 distinguishes pathways from 0% through 50% using documented extension limitation.

Knee DBQ; goniometer measurement; range of motion

Goniometer

It helps the examiner record knee flexion and extension consistently.

Numeric degree measurements are required for the current DC 5260 and DC 5261 comparison.

range-of-motion examination; 38 CFR 4.46

Painful motion

The record explains where pain appears and whether it causes functional loss.

Painful motion provides important functional context, but the current deterministic comparison does not create a stand-alone percentage from pain alone. 38 CFR 4.59's own text states actually painful joints are entitled to at least the minimum compensable rating for the joint -- disclosed here as genuine CFR text, not computed automatically.

Knee DBQ; orthopedic examination; functional loss; 38 CFR 4.59

Functional loss

It describes what the knee cannot do normally and why.

Functional context may clarify repeated-use and flare-up effects without becoming hidden scoring.

Knee DBQ; treatment notes; lay evidence; repeated use; flare-ups

Recurrent subluxation

The knee or kneecap repeatedly shifts partly out of its expected position.

DC 5257 uses route-specific ligament or patellofemoral findings and may also ask about repair and prescribed devices.

Knee DBQ; orthopedic examination; instability; patellar instability

Lateral instability

The knee is not held stable in the expected way because of a documented ligament condition.

The route distinguishes ligament status, persistent instability, and prescribed-device facts.

stability testing; ligament diagnosis; device prescription; giving way

Patellar instability

The kneecap repeatedly becomes unstable in a documented patellofemoral condition.

The schedule distinguishes diagnosis, recurrence, surgical repair, and prescribed-device combinations. DC 5257's Note (1) defines the patellofemoral complex as the quadriceps tendon, the patella, and the patellar tendon. DC 5257's Note (2) states that a surgical procedure not involving repair of one or more of those patellofemoral components does not qualify as surgical repair for this route, including (but not limited to) arthroscopy to remove loose bodies and joint aspiration.

Knee DBQ; surgical history; device prescription; patellofemoral complex

Genu recurvatum

The knee bends backward beyond the normal straight position, with weakness and insecurity in weight-bearing that the examination objectively demonstrates rather than only reports.

DC 5263 has no higher or lower tier of its own; the required finding is acquired, traumatic genu recurvatum with weakness and insecurity in weight-bearing that is objectively demonstrated on examination.

Knee DBQ; orthopedic examination; objective weight-bearing findings; weight-bearing insecurity

Semilunar cartilage

It refers to the cartilage structures commonly called the menisci.

DC 5258 addresses dislocation with frequent locking, pain, and effusion; DC 5259 addresses symptomatic removal.

MRI; operative report; Knee DBQ; locking; effusion

Ankylosis

The knee does not move through ordinary flexion and extension.

DC 5256 uses the fixed flexion angle to distinguish 30%, 40%, 50%, and 60% pathways.

Knee DBQ ankylosis section; orthopedic examination; fixed angle

MTSS

A lower-leg condition whose DC 5262 pathway uses treatment duration, treatment response, and affected side count.

The listed educational levels range from 0% through 30% under route-specific treatment facts.

treatment records; orthopedic notes; treatment duration; treatment response

Nonunion

The tibia and fibula remain unhealed at the relevant site.

The current DC 5262 comparison requires nonunion, loose motion, and a brace requirement for the 40% route.

X-ray; orthopedic examination; brace documentation; loose motion

Tibia and fibula malunion

The bone healed, but not in proper alignment. The schedule does not give malunion its own percentage table; instead it directs evaluation under whichever knee route (DC 5256, 5257, 5260, or 5261) or ankle route (DC 5270 or 5271) results in the highest evaluation.

This is a cross-diagnostic-code comparison spanning both the knee and ankle hubs. RatingScope does not guess which comparison route applies; the interactive malunion comparison tool below lets you enter findings for each applicable route and see them side by side, with the highest result identified, matching the regulation's own instruction.

X-ray; orthopedic examination; ankylosis; flexion; extension; ankle ankylosis; ankle limitation of motion

Total knee replacement

It is distinct from resurfacing and from other knee surgery.

Procedure type, timing, and chronic residual findings distinguish the temporary 100%, severe-residual 60%, and minimum 30% routes. 38 CFR 4.71a's Prosthetic Implants and Resurfacing table Note (1) states that once an evaluation is assigned under DC 5055, an additional rating under 4.71a may not also be assigned for that same knee, unless otherwise directed -- disclosed here, not a live computational bug (this hub does not stack a separate DC 5257/5258/5259/5260/5261 finding on top of a DC 5055 rating), but a real regulatory rule this hub previously never named. The 'unless otherwise directed' clause itself has no elaboration anywhere in 38 CFR 4.71a, confirmed via fresh verbatim fetch -- who may direct an exception, or where such a direction would appear, is not stated, and RatingScope does not guess at what would satisfy it.

operative report; postoperative notes; Knee DBQ; resurfacing; chronic residuals

TDIU

Even if the schedular rating for Knee / Lower Leg does not reach 100 percent, TDIU may still provide a pathway to compensation at the 100 percent rate, based on unemployability from this and/or other service-connected disabilities combined.

A lower schedular percentage does not by itself foreclose TDIU eligibility -- this hub computes only the schedular percentage for this specific condition and does not determine TDIU eligibility.

Employment history; vocational impact documentation; occupational impairment

Common Questions

Questions veterans commonly ask

How does VA evaluate knee conditions?

VA uses several diagnostic-code pathways rather than one universal knee percentage. The relevant route may involve replacement, ankylosis, flexion, extension, instability, meniscus findings, tibia or fibula nonunion, or MTSS. RatingScope keeps each route tied to its documented facts.

Which knee range-of-motion measurements matter?

Flexion and extension are recorded separately in degrees. DC 5260 uses the flexion endpoint, while DC 5261 uses extension limitation. Broad descriptions such as stiff or limited do not replace numeric measurements.

Does knee pain automatically increase a percentage?

No. Pain can be important when it affects documented function or motion, but pain alone does not identify a specific route or measurement. The current deterministic comparison asks for more detail when painful motion cannot be tied safely to an approved pathway.

What is knee instability?

The current DC 5257 criteria distinguish ligament-related and patellar-instability routes. The record may need diagnosis or ligament status, persistent or recurrent instability, repair history, and provider-prescribed brace or assistive-device information.

What is recurrent subluxation?

It describes repeated partial displacement or abnormal shifting. Under the current knee schedule, the useful record identifies whether the route is ligament-related or patellofemoral and includes the other facts required by that route.

Do knee braces matter?

They can matter when a specific route asks whether a provider prescribed a brace or whether nonunion with loose motion requires one. Using or owning a brace does not automatically establish a percentage.

What evidence commonly helps explain a knee condition?

A Knee and Lower Leg DBQ, measured motion, orthopedic notes, physical therapy records, imaging, operative reports, instability testing, device prescriptions, and firsthand functional descriptions may each clarify different parts of the record. No single item controls every pathway.

What happens during a Knee C&P exam?

The examiner may review diagnosis and history, ask about flare-ups and function, measure active and passive motion, assess repeated use, ankylosis, instability, meniscus and lower-leg findings, review procedures and devices, and document occupational impact. The examiner gathers evidence and does not issue the final decision.

Can range of motion change during flare-ups?

Yes. The DBQ asks whether flare-ups significantly limit function and requests estimated flexion and extension when supported by all procurable information. RatingScope uses documented estimates and does not invent missing degree values.

Can flexion, extension, instability, and meniscus findings all matter?

They may be distinct medical findings, but same-knee route interaction is more complex than choosing the highest number. The current deterministic comparison returns needs more detail for protected conflicts rather than silently combining or duplicating outputs.

How is tibia or fibula malunion evaluated?

DC 5262 does not give malunion its own percentage table. Instead, the schedule directs evaluation under whichever of DC 5256, 5257, 5260, or 5261 for the knee, or DC 5270 or 5271 for the ankle, results in the highest evaluation. RatingScope does not guess which comparison applies; the malunion comparison tool below lets you enter findings for each applicable knee and ankle route and see them side by side, with the highest result identified.

If my schedular rating for Knee / Lower Leg is below 100%, can I still be compensated at the 100% rate?

Possibly, through TDIU (Total Disability rating based on Individual Unemployability, 38 CFR 4.16) -- a separate pathway to 100 percent compensation based on unemployability, from this and/or other service-connected disabilities combined, independent of whether the schedular rating itself reaches 100 percent. This hub computes only the schedular percentage and does not determine TDIU eligibility.

Preparation

What to have nearby

  • Affected knee or lower-leg side

    The current comparison requires left, right, or bilateral context before reviewing a route.

  • Measured flexion and extension

    Have numeric degree values available and keep the two motion planes separate.

  • Instability and meniscus findings

    Review ligament or patellar route facts, locking, pain, effusion, removal history, and prescribed devices when applicable.

  • Procedure type and timing

    Replacement and resurfacing use different post-procedure instructions, so the operative record and date matter.

  • Lower-leg and MTSS details

    Nonunion, loose motion, brace requirement, treatment duration, treatment response, and side count may define these routes.

  • Functional and flare-up descriptions

    Use concrete effects on motion and ordinary activity, together with any documented degree estimates.

Ready when you are

Compare documented knee and lower-leg findings

Use only side-specific measurements, procedure details, clinical findings, and prescribed-device information already documented in your records. Do not upload records or enter Social Security numbers, claim numbers, full dates of birth, or other sensitive identifiers. RatingScope does not infer missing measurements or combine protected same-knee route conflicts.

Informational guidance only. RatingScope does not predict, decide, or guarantee VA outcomes.

Compare my knee records

Learn More

Continue Understanding

38 CFR 4.71a - Musculoskeletal rating schedule

Official eCFR source for the published knee and lower-leg diagnostic-code criteria.

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38 CFR 4.46 - Accurate measurement

Official eCFR source for accurate joint measurement and goniometer use.

Open resource

38 CFR 4.40, 4.45, and 4.59 - Joint function and painful motion

Official eCFR context for painful motion and joint function. This link does not create a RatingScope percentage from pain alone.

Open resource

VA Knee and Lower Leg DBQ

Official VA form showing diagnosis, history, motion, repeated-use, flare-up, instability, meniscus, lower-leg, procedure, testing, and functional-impact fields.

Open resource

C&P Exam Intelligence

Understand the purpose of a claim exam and the boundary between examination and final VA decision.

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VA Claim Evidence Center

Understand common medical, diagnostic, DBQ, prescription, and lay evidence categories without treating one item as a guaranteed requirement.

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Radiculopathy Condition Hub

Keep nerve-related lower-extremity findings separate from knee-joint and lower-leg musculoskeletal pathways.

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RatingScope Learn Center

Continue understanding published criteria, evidence language, and the VA claim process.

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Combined Ratings

Learn the general VA math without treating protected Knee route conflicts as approved separate outputs.

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38 CFR 4.16 - Total disability ratings for compensation based on unemployability (TDIU)

Official source for TDIU, a separate pathway to 100 percent compensation based on unemployability, independent of the schedular percentage. This hub does not determine TDIU eligibility.

Open resource

Secondary conditions

Conditions commonly connected to Knee / Lower Leg

No commonly documented secondary connections are tracked for Knee / Lower Leg yet.

Keep going

Related Tools

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Percentage Guide

See what each percentage level means for your condition, then use the whole-person calculator to combine more than one rating.

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Evidence Categories

Understand common evidence categories and what they can clarify without treating them as a checklist.

Review evidence categories