How does the VA rate knee conditions?

Under 38 CFR 4.71a DC 5256 through 5263. DC 5256 covers ankylosis. DC 5257 covers recurrent subluxation or lateral instability (slight 10, moderate 20, severe 30 percent). DC 5258 covers dislocated semilunar cartilage with frequent locking, pain, and effusion (20 percent). DC 5259 covers removal of semilunar cartilage that is symptomatic (10 percent). DC 5260 covers limitation of flexion (0 to 30 percent). DC 5261 covers limitation of extension (0 to 50 percent). DC 5262 covers impairment of the tibia and fibula. DC 5263 covers genu recurvatum (10 percent). Each knee is evaluated separately and a single knee may receive simultaneous ratings for distinct functional impairments.

Can one knee get two separate ratings at the same time?

Yes. VAOPGCPREC 23-97 (July 1997) held that a knee with both arthritis-based limitation of motion AND instability can receive simultaneous ratings under DC 5260/5261 (motion) AND DC 5257 (instability). VAOPGCPREC 9-98 extended this. Esteban v. Brown, 6 Vet. App. 259 (1994), establishes the general anti-pyramiding principle: distinct manifestations of the same injury can be separately rated if each manifestation is evaluated under criteria addressing different functions. Knee instability (joint stability) and limitation of motion (range of arc) are different functions. Separate ratings combine under 38 CFR 4.25.

What are the limitation of flexion thresholds (DC 5260)?

Flexion limited to 60 degrees = 0 percent. Limited to 45 degrees = 10 percent. Limited to 30 degrees = 20 percent. Limited to 15 degrees = 30 percent. Normal flexion is 140 degrees per Plate II to 4.71a. A knee that bends to 90 degrees is normal for rating purposes (above the 60-degree threshold). A knee that bends only to 40 degrees crosses into the 10 percent bracket. The DeLuca framework applies: pain on motion and loss after repetitive use are factored in.

What are the limitation of extension thresholds (DC 5261)?

Extension limited to 5 degrees = 0 percent. Limited to 10 degrees = 10 percent. Limited to 15 degrees = 20 percent. Limited to 20 degrees = 30 percent. Limited to 30 degrees = 40 percent. Limited to 45 degrees = 50 percent. Normal extension is 0 degrees (a fully straight leg). A knee that cannot extend past 15 degrees of flexion (lacks the last 15 degrees of straightening) falls in the 20 percent bracket. Loss of extension is functionally more disabling than loss of flexion because it produces a flexion contracture and altered gait.

How is a total knee replacement rated?

DC 5055 governs prosthetic replacement. For one year after the surgery, the rating is 100 percent under the convalescence provisions of 38 CFR 4.30 plus the post-prosthesis 100 percent assignment. After the one-year period, the minimum rating is 30 percent. Above 30 percent, the rating is determined by chronic residuals consisting of severe painful motion or weakness in the affected extremity (60 percent) or by intermediate degrees of residual weakness, pain, or limitation of motion rated by analogy to DC 5256, 5261, or 5262. Hospitalization itself triggers a 100 percent temporary rating under 38 CFR 4.29 if it lasts more than 21 days.

Does the DeLuca framework apply to knees?

Yes. DeLuca v. Brown, 8 Vet. App. 202 (1995), and Mitchell v. Shinseki, 25 Vet. App. 32 (2011), apply to all musculoskeletal ratings, including the knee. The C&P examiner must measure range of motion at rest, repeat the motion three times, and document any additional loss in degrees. Pain that limits function counts. Pain that does not limit function does not. Sharp v. Shulkin, 29 Vet. App. 26 (2017), requires the examiner to elicit and document flare-up information. Correia v. McDonald, 28 Vet. App. 158 (2016), requires testing in both active and passive motion, and in both weight-bearing and nonweight-bearing positions when possible.

What counts as instability under DC 5257?

Recurrent subluxation (the joint partially dislocates and self-reduces) or lateral instability (the knee gives way under load). Slight = occasional giving way without falls, no brace needed (10 percent). Moderate = frequent giving way, brace worn at least intermittently (20 percent). Severe = persistent giving way, falls, brace worn at all times, significant limitation of activity (30 percent). Findings on examination: positive Lachman, anterior drawer, posterior drawer, varus or valgus stress test. The schedule does not require imaging or arthroscopic confirmation; clinical findings and credible history of giving way support the rating.

What is genu recurvatum (DC 5263)?

Hyperextension of the knee beyond the normal 0-degree position. Rated at 10 percent when acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated. Less common than the other knee DCs but matters when ligamentous laxity allows the tibia to extend past neutral, producing a back-knee gait and instability under load.

Knee Conditions VA Rating

By Shirley Chia. Published 2026-05-29. Source: 38 CFR 4.71a.

TL;DR. Knee conditions are rated under 38 CFR 4.71a DC 5256-5263. The strategic insight most veterans miss: a single knee CAN receive simultaneous ratings for limitation of motion (DC 5260 or 5261) AND instability (DC 5257) per VAOPGCPREC 23-97 and the anti-pyramiding analysis in Esteban v. Brown. The DeLuca framework adds functional loss on repetition. Total knee replacement gets one year at 100 percent followed by a 30 percent minimum under DC 5055. Each knee is rated separately; bilateral knees with simultaneous motion + instability ratings produce four schedular numbers that combine under 38 CFR 4.25, often pushing the combined number materially higher than the motion-only rating alone.

The knee diagnostic code map

DC 5256: ankylosis of the knee

Favorable angle (full extension or in slight flexion between 0 and 10 degrees) = 30 percent. Flexion between 10 and 20 degrees = 40 percent. Flexion between 20 and 45 degrees = 50 percent. Extremely unfavorable, in flexion at an angle of 45 degrees or more = 60 percent. Surgical fusion or congenital ankylosis is the usual cause. Total knee replacement is rated under DC 5055, not 5256.

DC 5257: recurrent subluxation or lateral instability

Slight = 10 percent. Moderate = 20 percent. Severe = 30 percent. The schedule does not define the degrees of severity. In practice: slight is occasional giving way without falls and no brace; moderate is frequent giving way with intermittent brace use; severe is persistent giving way with falls and full-time brace use. Findings on examination of positive Lachman, drawer, or varus/valgus stress support the rating, but credible lay history is sufficient under Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), if the veteran is competent to report symptoms within his or her own knowledge.

DC 5258: semilunar cartilage, dislocated

Dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint = 20 percent. A single fixed rating, not a graduated scale. Requires both a current torn or dislocated meniscus AND ongoing symptoms of mechanical locking, pain, and effusion. Imaging confirms the meniscal pathology.

DC 5259: semilunar cartilage, removed, symptomatic

Symptomatic following removal of semilunar cartilage = 10 percent. Applies after meniscectomy when residual pain or effusion persists. Cannot be assigned simultaneously with DC 5258 (the cartilage is either present and dislocated or removed and symptomatic; not both).

DC 5260: limitation of flexion

Rating	Flexion limited to
0%	60 degrees
10%	45 degrees
20%	30 degrees
30%	15 degrees

Normal flexion is 140 degrees. The schedular brackets do not engage until flexion is below 60 degrees. Most veterans with painful but functional knees flex to 100-120 degrees and rate at 0 percent under 5260 alone, with the compensable rating coming from 5257 (instability) or 4.59 (painful motion with X-ray arthritis).

DC 5261: limitation of extension

Rating	Extension limited to
0%	5 degrees
10%	10 degrees
20%	15 degrees
30%	20 degrees
40%	30 degrees
50%	45 degrees

Normal extension is 0 degrees (full straightening). Limitation of extension produces a flexion contracture: the knee cannot fully straighten. Functionally more disabling than equivalent flexion loss because it alters gait, shortens functional leg length, and stresses the contralateral hip and back.

DC 5262: impairment of tibia and fibula

Malunion with slight knee or ankle disability = 10 percent. With moderate disability = 20 percent. With marked disability = 30 percent. Nonunion with loose motion requiring a brace = 40 percent. Applies when a tibial or fibular fracture has healed with deformity or failed to heal, producing knee dysfunction.

DC 5263: genu recurvatum

Acquired traumatic, with weakness and insecurity in weight-bearing objectively demonstrated = 10 percent. Hyperextension of the knee beyond neutral. Less common; usually associated with chronic ligamentous laxity.

The simultaneous ratings doctrine: motion plus instability

VAOPGCPREC 23-97 and Esteban v. Brown

The VA General Counsel addressed in VAOPGCPREC 23-97 (July 1, 1997) whether separate ratings under DC 5257 (instability) and DC 5003 / 5260 / 5261 (arthritis-based limitation of motion) could be assigned for the same knee without violating the anti-pyramiding rule of 38 CFR 4.14. The opinion held: yes, separate ratings are permitted when each is supported by sufficient findings of the functional impairment for which it is rated. VAOPGCPREC 9-98 confirmed and extended the framework.

The underlying principle comes from Esteban v. Brown, 6 Vet. App. 259 (1994): distinct manifestations of the same injury can be separately rated if each is evaluated under criteria addressing different functions. Knee instability (joint stability under load) and limitation of motion (arc of available motion) are different functions. Therefore separate ratings do not constitute prohibited pyramiding.

What this looks like in practice

A veteran with right knee ACL deficiency and chronic post-traumatic arthritis after an in-service jump injury:

Findings: positive Lachman with frequent giving way under load, brace worn during activity. Imaging confirms moderate medial compartment osteoarthritis. ROM: flexion to 95 degrees, extension to neutral, painful motion throughout.
DC 5257: moderate instability = 20 percent.
DC 5260: flexion 95 degrees does not meet a compensable bracket. But under 38 CFR 4.59 and Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991), painful motion of a joint with X-ray-confirmed arthritis warrants the minimum compensable rating = 10 percent.
Combined for the right knee under 38 CFR 4.25: 20 combined with 10 = 28, which contributes to the overall combined rating.

Without the simultaneous-rating doctrine, this veteran would receive only 20 percent for the knee. With it, the contribution to the combined rating is materially higher.

Limits of the doctrine

Separate ratings under DC 5260 AND DC 5261 for the same knee are also permitted because flexion and extension are distinct functions (VAOPGCPREC 9-04). However, separate ratings under DC 5258 (dislocated cartilage) and DC 5259 (removed cartilage) for the same knee are NOT permitted because they address the same anatomic structure in mutually exclusive states. Separate ratings under DC 5257 and DC 5258 are also generally disfavored when the findings overlap because dislocated cartilage producing locking and instability may already be captured by DC 5258's higher fixed rating.

The DeLuca and Correia framework applied to knees

What the examiner must measure

DeLuca v. Brown, 8 Vet. App. 202 (1995), requires the examiner to measure ROM at rest, repeat the motion three times, and document any additional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011), held that pain alone without functional loss does not raise the rating. Sharp v. Shulkin, 29 Vet. App. 26 (2017), requires the examiner to elicit flare-up information and estimate the additional functional loss during a flare even if the exam is not conducted during one.

Correia v. McDonald, 28 Vet. App. 158 (2016), added a specific knee requirement: the examiner must test ROM in active motion, passive motion, weight-bearing, and nonweight-bearing positions when possible. A C&P exam that measures only active nonweight-bearing ROM is inadequate under Correia, and the veteran can request a corrective exam.

How this shifts the rating

A veteran whose flexion is 70 degrees at rest (noncompensable under DC 5260) but drops to 40 degrees after three repetitions falls into the 10 percent bracket on the post-repetition figure. A veteran whose extension is 10 degrees in nonweight-bearing but 25 degrees in weight-bearing falls into the 30 percent bracket on the weight-bearing figure if Correia is properly applied.

Total knee replacement: DC 5055

The schedule

Prosthetic replacement of the knee joint:

Prosthetic replacement of the knee joint: 100 percent for one year following implantation of prosthesis.
With chronic residuals consisting of severe painful motion or weakness in the affected extremity: 60 percent.
With intermediate degrees of residual weakness, pain or limitation of motion: rate by analogy to DC 5256, 5261, or 5262.
Minimum rating: 30 percent.

The one-year 100 percent window

Begins the date of hospital admission for the prosthetic implantation. Continues for 13 months total (the implantation month plus 12 months) under 38 CFR 4.30 and the DC 5055 note. At the end of the 13-month period, the rating drops to whatever the residuals support, with a 30 percent floor.

Veterans who have a total knee replacement on a service-connected knee should file for the temporary 100 percent rating promptly. The VA will need the operative report and post-op records. Delay in filing does not forfeit the 100 percent period, but compensation does not begin until the claim is filed.

After the 100 percent window closes

The minimum is 30 percent. Higher ratings require findings of severe painful motion or weakness (60 percent), or intermediate residuals rated by analogy. The minimum 30 percent is protected by 38 CFR 3.951(b) after the rating has been in effect for 20 years.

Worked example: bilateral knees with simultaneous ratings

Army veteran, 8 years airborne infantry with documented in-service knee injuries from parachute landings. Files claim 2025 for bilateral chronic knee pain with instability.

C&P exam findings — Right knee: positive Lachman with frequent giving way, intermittent brace use. Imaging confirms moderate post-traumatic osteoarthritis. ROM: flexion 100 degrees, extension neutral, painful motion throughout the arc. After three repetitions, flexion drops to 85 degrees. Left knee: mild laxity on Lachman without giving way. Imaging confirms mild osteoarthritis. ROM: flexion 110 degrees, extension neutral, painful motion. No change on repetition.

Right knee analysis. DC 5257 moderate instability = 20 percent. DC 5260 flexion to 85 degrees (post-repetition) is noncompensable on the formula, but painful motion plus X-ray arthritis triggers 38 CFR 4.59 minimum compensable = 10 percent. Right knee combines: 20 with 10 = 28.

Left knee analysis. DC 5257 slight instability = 10 percent. DC 5260 flexion 110 degrees is noncompensable on formula, but painful motion plus X-ray arthritis triggers 4.59 = 10 percent. Left knee combines: 10 with 10 = 19.

Combine both knees under 38 CFR 4.25. Starting with the highest: 28 (right) combined with 19 (left). Apply the bilateral factor: when both extremities (lower) are service-connected, 38 CFR 4.26 adds 10 percent of the combined value. 28 combined with 19 = 42. Bilateral factor: 42 plus 10 percent of 42 (= 4.2) = 46.2, rounds to 46. 46 rounds to the nearest 10 percent for compensation = 50 percent.

2026 monthly compensation. 50 percent with spouse = $1,241.90 per month. Without the simultaneous instability + arthritis ratings, the same veteran would receive 20 (right instability) combined with 10 (left instability) plus bilateral factor = 31, rounds to 30 percent at $568.05. The simultaneous-rating doctrine adds approximately $555 per month for this veteran.

Note on documentation. The simultaneous rating only works if BOTH the instability finding AND the painful-motion-with-arthritis finding are documented. The C&P examiner should report Lachman, drawer, and stress findings AND ROM AND imaging confirmation of arthritis AND painful motion on examination. If any element is missing, the rater may decline one of the two ratings. Push for a thorough exam.

Sources cited in this article

38 CFR 4.71a - Schedule of ratings, musculoskeletal system (DC 5055, 5256-5263)
38 CFR 4.25 - Combined ratings table
38 CFR 4.26 - Bilateral factor
38 CFR 4.59 - Painful motion (minimum compensable rating with X-ray arthritis)
VAOPGCPREC 23-97 (July 1, 1997) (separate ratings for instability and motion permitted).
VAOPGCPREC 9-98 (extension of 23-97).
VAOPGCPREC 9-04 (separate ratings for flexion and extension limitations).
Esteban v. Brown, 6 Vet. App. 259 (1994) (anti-pyramiding analysis: distinct manifestations rate separately).
DeLuca v. Brown, 8 Vet. App. 202 (1995) (functional loss on repetitive use).
Mitchell v. Shinseki, 25 Vet. App. 32 (2011) (pain alone without functional loss does not raise rating).
Correia v. McDonald, 28 Vet. App. 158 (2016) (ROM testing in active/passive, weight-bearing/nonweight-bearing).
Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (competent lay evidence of symptoms).

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