Knee VA Rating

VA's fiscal year 2025 Annual Benefits Report counts 2,312,985 service-connected disabilities for limitation of knee flexion among compensation recipients. Only tinnitus is more common, and it is the most common musculoskeletal disability in the report. The number that matters for your claim is smaller: how many ratings one knee can carry. A knee can be rated for instability under DC 5257 and for lost motion under DC 5260 or 5261 at the same time, because the VA General Counsel has said those are different problems, not one problem counted twice. Many rating decisions still assign one code and stop.

TL;DR

• Knee conditions are rated under 38 CFR § 4.71a: DC 5256 (ankylosis), 5257 (instability), 5258 and 5259 (meniscus), 5260 (limited flexion), 5261 (limited extension) and 5263 (genu recurvatum). DC 5055 covers knee replacement.
• Normal knee motion is 0 to 140 degrees of flexion, with full extension at 0 degrees. Flexion limited to 45 degrees is 10 percent; extension limited to 10 degrees is also 10 percent.
• Instability and limited motion can be rated separately on the same knee (VAOPGCPREC 23-97 and 9-98), and so can limited flexion and limited extension (VAOPGCPREC 9-2004).
• Since February 7, 2021, DC 5257 rates instability by the ligament injury and whether a medical provider prescribed a brace or an assistive device.
• A total knee replacement rates 100 percent for four months after the one-month § 4.30 rating, then at least 30 percent, and no other § 4.71a rating is added for that knee unless the schedule directs it.
• The other knee, a hip or the low back can be service connected secondary to the knee through altered gait, if the opinion explains your walking history and addresses aggravation.
• A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 107,856 decided Board rulings on knee claims from 2021 to 2026, 21.6% were granted, 28.1% denied and 50.3% remanded. The data codes overall outcome rather than a per-diagnostic-code breakdown, so I can't read the DC 5260 vs DC 5257 split directly from it.

Knee VA rating criteria (DC 5256 to 5263)

The knee section of 38 CFR § 4.71a reads as follows.

DC 5256, Knee, ankylosis of. The joint is frozen in place.

Extremely unfavorable, in flexion at an angle of 45° or more: 60%

In flexion between 20° and 45°: 50%

In flexion between 10° and 20°: 40%

Favorable angle in full extension, or in slight flexion between 0° and 10°: 30%

DC 5257, Knee, other impairment of. It has one ladder for instability and one for the kneecap.

Recurrent subluxation or instability:

Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation: 30%

One of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation: 20%

Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation: 10%

Patellar instability:

A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker: 30%

A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker: 20%

A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker: 10%

DC 5258 and DC 5259, the meniscus codes.

Cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint: 20%

Cartilage, semilunar, removal of, symptomatic: 10%

DC 5260, Leg, limitation of flexion of.

Flexion limited to 15°: 30%

Flexion limited to 30°: 20%

Flexion limited to 45°: 10%

Flexion limited to 60°: 0%

DC 5261, Leg, limitation of extension of.

Extension limited to 45°: 50%

Extension limited to 30°: 40%

Extension limited to 20°: 30%

Extension limited to 15°: 20%

Extension limited to 10°: 10%

Extension limited to 5°: 0%

DC 5263, Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated): 10%.

DC 5262 rates the tibia and fibula, including shin splints, and sends a malunion back to the knee or ankle codes, whichever gives the highest evaluation. Arthritis has no knee code of its own: DC 5003 rates X-ray arthritis on limitation of motion under the knee codes, and when that limitation is noncompensable but objectively confirmed by swelling, muscle spasm or painful motion, it assigns 10 percent for the knee as a major joint.

Knee range of motion VA rating

The examiner measures against Plate II of 38 CFR § 4.71: flexion from 0 to 140 degrees, with full extension at 0 degrees. Flexion is how far the knee bends. Extension is how close it comes to straight, so a knee that stops 15 degrees short of straight has extension limited to 15 degrees. The General Counsel held in VAOPGCPREC 9-2004 that separate ratings under DC 5260 and DC 5261 "may be assigned for disability of the same joint," because a knee limited both ways has more functional loss than a knee limited one way.

Most knees never reach the flexion numbers in DC 5260. A knee that bends to 100 degrees is far from the 45 degrees that 10 percent requires. Three rules keep that knee from rating zero by default.

• Painful motion. Section 4.59 says the schedule intends "to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint."
• Functional loss. Section 4.40 says "weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled," and § 4.45 adds excess fatigability, incoordination and pain on movement. VAOPGCPREC 9-98 says these sections must be considered when a knee is rated on motion or for arthritis, and that raters must clearly explain the effect of pain.
• Flare-ups. Under Sharp v. Shulkin, 29 Vet. App. 26 (2017), when you are not examined during a flare-up, the examiner still has to estimate the flare-up limits from what you report.

The rating should rest on how far the knee moves once pain, repetition and flares are counted, not on the best reading of the day.

Meniscus tear and knee instability VA ratings

A meniscus tear does not earn a rating by name. DC 5258 pays 20 percent when dislocated semilunar cartilage causes frequent episodes of locking, pain and effusion, which means fluid collecting in the joint. DC 5259 pays 10 percent when cartilage was removed and the knee is still symptomatic. Your imaging, the operative report and your current symptoms decide which description fits. VAOPGCPREC 9-98 adds that removing cartilage can cause motion loss, so a DC 5259 knee also has to be looked at for functional loss under §§ 4.40 and 4.45.

Knee instability is rated under DC 5257. Since February 7, 2021, three facts set the level: whether the instability is persistent, what ligament injury caused it (a sprain, an incomplete tear, or a complete tear that was repaired, left unrepaired or failed), and whether a medical provider prescribed a brace, cane, crutches or walker for walking. A brace you bought on your own is not a prescription. For patellar instability, Note (2) says surgery that did not repair part of the patellofemoral complex, such as arthroscopy to remove loose bodies, does not count as surgical repair.

Separate ratings need separate symptoms. Section 4.14 says "the evaluation of the same manifestation under different diagnoses" is to be avoided, so the same locking or giving way cannot be counted under two codes just because two diagnoses appear in the record.

Sources: 38 CFR § 4.71a, DCs 5257, 5258 and 5259 (opens in a new tab) and § 4.14, avoidance of pyramiding (opens in a new tab).

Separate ratings on one knee

The largest swing in most knee ratings is whether the instability code and a motion code are both applied. Two General Counsel opinions set the basis.

• VAOPGCPREC 23-97 held that "a claimant who has arthritis and instability of the knee may be rated separately under diagnostic codes 5003 and 5257." DC 5257 rates instability without reference to motion, while DC 5003 rates arthritis on limitation of motion, so the two cover different manifestations and the separate rating is not pyramiding under § 4.14.
• VAOPGCPREC 9-98 held that the motion loss under DC 5260 or 5261 "need not be compensable but must at least meet the criteria for a zero-percent rating," and that the separate rating could also rest on X-ray findings and painful motion under § 4.59.

Both opinions predate the 2021 wording of DC 5257, but the current code still rates instability by ligament injury and prescriptions with no measure of motion, so the distinction holds. With VAOPGCPREC 9-2004 on flexion and extension, one knee can carry three ratings.

Here is the math. Instability at 20 percent (DC 5257), flexion limited to 45 degrees (10 percent, DC 5260) and extension limited to 10 degrees (10 percent, DC 5261) combine under § 4.25: 20 and 10 make 28, and 28 and 10 make 35, which rounds to 40 percent if these are the only ratings. DC 5257 alone tops out at 30.

Each code needs its own proof: goniometer measurements for flexion and extension; the ligament diagnosis, your description of the knee giving way and any brace or cane prescription for instability; locking, effusion, surgery or imaging for the meniscus. If a decision says instability is "encompassed" in the motion rating, cite the General Counsel opinions and file the next review with the missing findings. An evidence checklist keeps each code's proof separate.

Total knee replacement VA rating (DC 5055)

Knee, resurfacing or replacement (prosthesis): For 4 months following implantation of prosthesis or resurfacing: 100%

Prosthetic replacement of knee joint: With chronic residuals consisting of severe painful motion or weakness in the affected extremity: 60%

With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.

Minimum evaluation, total replacement only: 30%

Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5256 through 5262; there is no minimum evaluation for resurfacing.

Three notes to the prosthetic implant codes matter.

• Timing. Note (5) says the four months at 100 percent begin after the one-month total rating under § 4.30 following hospital discharge. Sources that describe a full year at 100 percent for a knee describe the code as it read before February 7, 2021.
• No stacking. Note (1) says that when a joint is rated for resurfacing or replacement, "an additional rating under § 4.71a may not also be assigned for that joint, unless otherwise directed." Separate instability and motion ratings on that knee end.
• Total means total. Note (3) says "prosthetic replacement" means a total replacement. The 30 percent floor is for total replacement only and resurfacing has no minimum, so a partial replacement turns on how the surgical record describes it.

Keep the operative report, physical therapy notes, and records of residual pain, weakness and any cane or brace, because the 60 percent level and the analogy codes depend on them. The surgical scar is a separate rating question covered on the scars page.

How to prove a knee condition is service connected

Direct service connection needs a current knee diagnosis, an injury or event in service, and a medical link between them. The in-service record is often a sick call note, a profile, a line-of-duty report or physical therapy during training. When the record is thin, a buddy letter from someone who saw the injury or the limp can fill in what happened.

Arthritis has a shortcut. It is on the chronic disease list in 38 CFR § 3.309(a), and under § 3.307(a)(3) it can be presumed service connected if it became manifest to a degree of 10 percent or more within one year of separation.

If a knee problem was noted on your entrance exam, the claim is about in-service aggravation under 38 CFR § 3.306. The knee is treated as aggravated when the record shows an increase in disability during service, unless clear and unmistakable evidence shows the increase was the natural progress of the condition. VA then rates only the part above the entrance level when that level can be measured in rating terms (§ 3.322).

The knee C&P exam and DBQ

The exam follows the knee and lower leg DBQ. These are the parts that most often decide the rating.

• Active and passive motion, weight-bearing and nonweight-bearing, and the other knee. Section 4.59 says joints "should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." The Court of Appeals for Veterans Claims held in Correia v. McDonald, 28 Vet. App. 158 (2016), that VA exams should include that testing, and the DBQ tells examiners to test the opposite joint unless it is medically contraindicated.
• Repetitive use. The DBQ asks for motion after at least three repetitions.
• Flare-ups. The DBQ asks the examiner to estimate motion in degrees during a flare, based on relevant sources including your lay statements. That is the estimate Sharp requires.
• Instability. The DBQ asks whether there is persistent instability, whether a ligament tear exists and was repaired, and whether a medical provider prescribed a cane, crutches, walker or brace. Those answers map directly onto DC 5257.
• Meniscus. It records a meniscal tear or dislocation and frequent locking, pain and effusion, the DC 5258 language.

Before the exam, write down how far the knee bends on a bad day, how often it gives way, and how long a flare lasts. A symptom tracker gives you dates instead of guesses, and C&P exam prep walks through the questions. Bring the brace or cane prescription itself.

Why VA denies knee claims

Knee claims fail for a short list of reasons, and each has a fix.

No link to service. The examiner points to age, weight or later work. The fix is a nexus letter that addresses those causes by name, cites the in-service records and explains why the injury still matters.

Instability folded into the motion rating. The fix is the General Counsel opinions above plus the facts DC 5257 asks for: the ligament diagnosis and any provider prescription for a brace or assistive device.

A rating that ignores pain and flares. One good-day measurement and no flare-up estimate. Describe your flares in a personal statement and ask for the estimate Sharp requires.

An incomplete exam. No passive motion, no weight-bearing testing, no comparison with the other knee. Those gaps are grounds for a new exam under § 4.59 and Correia.

Imaging that stops at X-ray. X-rays show bone, not ligaments or cartilage. Without an MRI or an orthopedic note documenting a tear, DC 5257 and DC 5258 are hard to apply.

The Board section below shows how knee appeals were decided from 2021 to 2026, how often they were sent back for more work, and how the Board ruled when a private medical opinion was in the record.

Secondary claims built on a knee condition

A service-connected knee changes how you stand and walk, which is why it anchors more secondary claims than most joints. Under 38 CFR § 3.310, a condition is service connected when your knee caused it (at least as likely as not), or when it is aggravated by your service-connected knee, meaning it would be less severe but for the knee (M21-1 V.ii.2.D). VA rates only the part above the baseline, which has to come from medical evidence, so the opinion should describe the baseline. An opinion that addresses only causation and not aggravation is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)).

The conditions most often claimed this way are the low back, the hip, the other knee and the ankle. Secondary conditions to a knee covers each one, which to file first and the Board's numbers for every pair. What wins is the same in every pair: a documented gait change, a time line from the knee to the new problem, and an opinion that deals with age, weight and other injuries instead of ignoring them.

Altered gait and the other knee

VA does not rate altered gait by itself. No diagnostic code covers it; the schedule treats disturbance of locomotion as one factor in rating a joint (§ 4.45(f)). A gait change matters because it can be the link in a secondary claim. VA's own page on types of claims gives this example: a veteran with a service-connected knee injury walks with a limp and later develops arthritis in the hip, and service connection may be established if the arthritis is a result of the knee condition. That is a pathway, not a presumption.

The research on the other knee is less simple than "the good knee picks up the slack."

• In the Multicenter Osteoarthritis Study, adults with mild to moderate pain in one knee were followed for two years, and 17.1% developed new pain in the other knee. At their usual walking pace, people who spent more time on the nonpainful leg had lower odds of that new pain, not higher (Corrigan and colleagues, 2023).
• In VA records of men aged 40 and older, knee pain in the intact leg of above-knee amputees was about 3.3 times as common as in men without an amputation, but symptomatic arthritis in that knee was not clearly more common, and below-knee amputees showed no clear difference in knee pain (Norvell and colleagues, 2005).
• In 58 women aged 45 to 64 with X-ray arthritis in one knee, 34% developed it in the other knee within two years, and obesity was the most important factor (Spector and colleagues, 1994).

The other knee often develops problems for reasons unrelated to gait, and a limp does not prove the link on its own. Here is what VA needs to see.

1. A current diagnosis in the other knee and the date it was first documented.
2. Records of the gait change: a limp, a brace, a cane or favoring one side, ideally from before the other knee started hurting. Your own description counts as lay evidence.
3. An explanation of how that gait change loaded the other knee, and for how long.
4. A direct answer on other causes, such as age, weight, a sports injury or a physical job.
5. If the other knee had problems first, an answer on aggravation and the records that show its baseline. An old injury in the file sets the baseline instead of sinking the claim.

The Board has granted on this reasoning. In decision A25008276 (January 30, 2025), it granted both knees and a hip secondary to service-connected flat feet after a private clinician explained how the foot condition altered the veteran's gait, and it found the VA opinions inadequate because they used a proximate-cause standard and never addressed aggravation. That decision binds only that appeal. If both knees end up service connected, each is rated on its own findings and the bilateral factor applies.

The bilateral factor when both knees are rated

Under 38 CFR § 4.26, when both legs carry disabilities, "the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations." The result is treated as one disability when everything else combines.

Two knees at 30 percent each combine to 51. Without the bilateral factor, 51 rounds to 50 percent. With it, 51 plus 5.1 is 56.1, which rounds to 60 percent.

The conditions do not have to match. Section 4.26(a) treats each leg as a whole, so a rated knee on one side and a rated foot or ankle on the other count. Each side has to be compensable (§ 4.26(c)), and if including a bilateral disability would lower the result, VA leaves it out and uses the more favorable calculation (§ 4.26(d)).

Questions veterans ask about knee conditions

What is the VA rating for knee pain?

It depends on what the pain does to the knee. Painful motion from a healed injury or arthritis supports at least the minimum compensable rating for the joint under § 4.59, which is 10 percent for the knee, and higher ratings come from limited motion, instability or meniscus findings.

Can you get separate VA ratings for knee instability and limited motion?

Yes. VAOPGCPREC 23-97 and 9-98 allow an instability rating under DC 5257 alongside a motion-based rating, as long as the motion loss at least meets the zero-percent level or the knee has X-ray arthritis with painful motion.

What is the VA rating for a meniscus tear?

A dislocated meniscus with frequent locking, pain and effusion rates 20 percent under DC 5258. A meniscus that was removed and still causes symptoms rates 10 percent under DC 5259.

What is the VA rating for a total knee replacement?

DC 5055 assigns 100 percent for four months, starting after a one-month total rating under § 4.30, and then at least 30 percent. Severe painful motion or weakness afterward rates 60 percent.

Can I get VA disability for my other knee because of my service-connected knee?

Yes, if the evidence shows the service-connected knee caused the other knee's condition or made it worse, usually through altered gait. You need a current diagnosis in the other knee and an opinion that explains the gait change and addresses both causation and aggravation.

How does VA rate both knees?

Each knee is rated on its own findings. When both are compensable, the bilateral factor adds 10 percent of their combined value before they combine with your other ratings.

Bottom Line

Knee ratings are not one number. The schedule has separate codes for instability, flexion, extension and the meniscus, the General Counsel has said they can apply to the same knee when each is supported, and the bilateral factor adds to the total when both knees are rated. Most knee claims that come up short rest on an exam that measured one thing on one day: no passive or weight-bearing testing, no flare-up estimate, no instability findings, no prescription in the file. The secondary claims a knee anchors turn on the same thing, an opinion that explains your actual gait history and answers the other causes. Same knee, different paper trail, different rating.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.71a (DCs 5003, 5055, 5256 through 5263 and the prosthetic implant notes) as published in eCFR for October 1, 2026, with normal motion from Plate II of § 4.71. General Counsel opinions VAOPGCPREC 23-97, 9-98 and 9-2004. Disability counts from VA's fiscal year 2025 Annual Benefits Report. Exam items from the Knee and Lower Leg DBQ (updated July 31, 2026). Every rule, case and study is listed under Sources.
• Board snapshot: Across 107,856 decided Board rulings on knee claims from 2021 to 2026, 21.6% were granted (including partial grants and mixed outcomes), 28.1% denied and 50.3% remanded. Dismissed, withdrawn and moot rulings are excluded. These are appealed claims, not your personal odds.
• Sample size: Patterns in this post are drawn from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings, including 116,179 Board rulings on knee claims (107,856 decided). Among the decided rulings, outcomes ran 50.3% remanded, 21.6% granted, and 28.1% denied. This read does not record whether the Board found a C&P exam adequate, so this post gives no exam-adequacy figure. The data captures overall outcome rather than a per-diagnostic-code (DC 5256-5263) breakdown.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. Stacking analysis follows the General Counsel opinions. Combined-rating math follows §§ 4.25 and 4.26.
• Limitations:
• The General Counsel opinions on separate knee ratings predate the 2021 wording of DC 5257, and application varies at the regional office level.
• The research on altered gait and the other knee comes from civilian cohorts and one study of veteran amputees. None of it decides an individual claim.
• Board-level patterns reflect cases that were appealed. Most knee claims resolve at the regional office.
• These observations reflect the regulatory text, case law and Board decisions. They are not predictions of individual outcomes.

Sources

• 38 CFR § 4.71a: DCs 5003, 5055, 5256 to 5263 and the notes to the prosthetic implant codes. eCFR (opens in a new tab)
• 38 CFR § 4.71 and Plate II; §§ 4.14, 4.25, 4.26, 4.30, 4.40, 4.45 and 4.59.
• 38 CFR §§ 3.306, 3.307(a)(3), 3.309(a), 3.310 and 3.322.
• "Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries," 85 FR 76453 (November 30, 2020), effective February 7, 2021.
• VA General Counsel, VAOPGCPREC 23-97 (July 1, 1997), VAOPGCPREC 9-98 and VAOPGCPREC 9-2004 (September 17, 2004). VA precedent opinions (opens in a new tab)
• M21-1, V.ii.2.D.
• Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017); El-Amin v. Shinseki, 26 Vet. App. 136 (2013).
• Board of Veterans' Appeals decision A25008276 (January 30, 2025).
• VA, Types of claims, secondary claim example. benefits.va.gov (opens in a new tab)
• VA, Knee and Lower Leg Conditions Disability Benefits Questionnaire; VA Annual Benefits Report, fiscal year 2025, Compensation.
• Corrigan P, Felson DT, Lewis CL, et al. Relation of Temporal Asymmetry During Walking to Two-Year Knee Pain Outcomes in Those With Mild-to-Moderate Unilateral Knee Pain: An Exploratory Analysis From the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken). 2023. PMID 36305013.
• Norvell DC, Czerniecki JM, Reiber GE, et al. The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. Arch Phys Med Rehabil. 2005. PMID 15759233.
• Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Dis. 1994. PMID 7979593.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.