Knee Conditions DBQ and C&P Exam Guide: ROM, Instability, and Multiple Ratings

The primary basis for evaluating knee disability is range of motion measured with a goniometer. Limitation of flexion is rated under Diagnostic Code 5260 (from 0% for flexion to 60 degrees, up to 30% for flexion limited to 15 degrees). Limitation of extension is rated separately under Diagnostic Code 5261 (from 10% for extension limited to 5 degrees, up to 50% for extension limited to 45 degrees). Normal knee motion is 0 to 140 degrees.

Knee instability occurs when torn or lax cruciate (ACL/PCL) or collateral (MCL/LCL) ligaments cause the joint to give way or sublux. Under DC 5257, instability is rated as slight (10%), moderate (20%), or severe (30%). Examiners perform manual stress tests, including the Lachman test, anterior and posterior drawer tests, and varus/valgus stress tests, or document reliance on a knee brace.

Cartilage damage is evaluated under separate meniscal codes. Diagnostic Code 5258 provides a 20% rating for a dislocated meniscus or frequent episodes of joint locking with pain and effusion. If a veteran underwent surgical removal of the meniscus (meniscectomy), Diagnostic Code 5259 provides a 10% rating for symptomatic post-operative residuals.

Under VA precedent and 38 CFR 4.71a, veterans can receive up to three distinct ratings on the exact same knee if each reflects a separate manifestation of disability: one rating for limitation of flexion (DC 5260), a second rating for limitation of extension (DC 5261), and a third rating for ligamentous instability (DC 5257). Because each code addresses a distinct functional loss, this combination does not violate the anti-pyramiding rule.

Under 38 CFR 4.40, 4.45, and 4.59, the examiner must assess functional loss caused by pain onset, repetitive motion fatigue, and flare-ups. If your knee pain begins at 90 degrees of flexion, the examiner must record that point of painful motion. Furthermore, the clinician must provide an estimate of how much further range of motion degrades during active flare-up episodes.