How VA Rates Knee Conditions: Instability, Flexion, and Extension

Under 38 CFR 4.71a, the knee is one of the few joints where multiple ratings can be granted for the same joint without violating the pyramiding rule (38 CFR 4.14). A veteran may receive distinct, combinable evaluations for limitation of flexion (bending), limitation of extension (straightening), and recurrent instability, provided each reflects a separate functional impairment.

Flexion limitation is rated under Diagnostic Code 5260 based on measured degrees of movement: 0% if flexion is limited to 60 degrees; 10% if limited to 45 degrees; 20% if limited to 30 degrees; and 30% if limited to 15 degrees. Normal knee flexion reaches 140 degrees.

Extension limitation is rated under Diagnostic Code 5261 based on how far the leg is prevented from straightening fully: 0% for limitation to 5 degrees; 10% for limitation to 10 degrees; 20% for limitation to 15 degrees; 30% for limitation to 20 degrees; 40% for limitation to 30 degrees; and 50% for limitation to 45 degrees.

Instability is evaluated under Diagnostic Code 5257 based on ligament laxity (ACL, PCL, MCL, LCL) or patellar dislocation: slight instability (10%), moderate instability (20%), and severe instability (30%). Documentation of prescribed stabilizing braces, giving-way episodes, and objective clinical laxity tests (such as Lachman or drawer tests) support these ratings.

Dislocated or torn semilunar cartilage (meniscus) is evaluated under DC 5258 at 20% when frequent joint locking, pain, and effusion are documented. Symptomatic removal of meniscus cartilage is rated under DC 5259 at 10%.

Under 38 CFR 4.59, documented pain during active or passive movement warrants a minimum compensable rating (10%) even if range-of-motion measurements are otherwise normal. Furthermore, 38 CFR 4.40 requires examiners to assess additional functional loss during flare-ups.

Knee conditions frequently alter a veteran's walking gait, creating asymmetric biomechanical stress. This often leads to secondary service connection for conditions affecting the opposite knee (bilateral compensation), hips, or the lower spine.