How does the VA rate knee conditions?
Yes. A single knee can carry separate ratings for instability, limited bending, and limited straightening at the same time, because the VA treats them as different impairments rather than one.
This is one of the most commonly under-claimed situations in the rating schedule. Many veterans have one knee rated once and assume that is the ceiling.
The three main knee codes
Under 38 CFR 4.71a 1:
- DC 5257, recurrent subluxation or lateral instability: rated 10, 20, or 30 percent based on severity. This is the knee giving out or feeling unstable.
- DC 5260, limitation of flexion: rated 0 to 30 percent based on how far the knee bends.
- DC 5261, limitation of extension: rated 0 to 50 percent based on how far short of straight the knee stops.
There are further codes for cartilage conditions, ankylosis, and knee replacement.
Why they can stack
The rule against pyramiding in 38 CFR 4.14 prohibits rating the same symptom twice under different codes. 2 Instability and limitation of motion are not the same symptom. A knee that gives way and a knee that will not fully straighten are distinct functional problems, so ratings under 5257 and 5261 do not pyramid.
Similarly, limitation of flexion and limitation of extension measure movement in opposite directions and can be rated separately when both are compensably limited.
The bilateral factor
When both knees are service-connected, 38 CFR 4.26 adds a bilateral factor. 3 The ratings for the paired extremities are combined, then 10 percent of that combined value is added before combining with anything else. Two bad knees are worth more than the same two ratings would be on unrelated body parts.
Painful motion
A joint that is painful on use can warrant at least the minimum compensable rating for that joint even where motion is not limited enough to meet the criteria on paper. 4 This is why range-of-motion numbers alone do not always tell the whole story, and why what happens after repeated use matters.
What the exam measures
A knee examination generally records flexion and extension in degrees using a goniometer, tests stability, and notes pain, weakness, fatigability, and any additional loss after repetitive use. An examination that skips range-of-motion testing or does not address function after repeated use may not adequately support the rating.
Reading a knee decision
A decision listing only one diagnostic code for a knee is worth reading carefully against what that knee actually does. If the record documents instability and limited motion but only one is rated, that gap is visible in the decision itself.
An accredited VSO can review a rating decision at no cost.