38 CFR Part 4 — 38 CFR § 4.71a

Leg Limitation Of Extension

dc-5261-leg-limitation-of-extension

Musculoskeletal

Diagnostic code

5261

Why your DC matters: DC 5261 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.

Last verified against 38 CFR (eCFR Part 4): April 2, 2026

Rating criteria (38 CFR Part 4)

Diagnostic code 5261 — Leg Limitation Of Extension — is listed under 38 CFR § 4.71a in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.

Schedule summary (educational, not a substitute for the regulation): Knee disability; rated on instability, limitation of motion, or ankylosis as described in the schedule.

Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (5261) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “5261”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.

Effective dates & which schedule version applies

Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).

For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.

The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.

Notes for your claim

Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 5261 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.

C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.

If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.

This site does not provide legal advice.

Official source

38 CFR Part 4 (eCFR) — locate diagnostic code 5261 in the subpart for your body system (use Find in Page if needed).

DC 5261 is the sibling of 5260 — and it's the one veterans most often miss. Extension is rated in degrees of LOST extension (degrees the knee can't straighten). Even a 10° lag from full extension is compensable. Per VAOPGCPREC 9-2004, this rating CAN be combined with DC 5260 for the same knee.

Rating Tiers — What Each Percentage Requires

Rating	What It Takes	Evidence That Supports It
50%	Extension limited to 45° (knee permanently bent ~45°).	Goniometer reading, often combined with imaging showing severe end-stage degeneration or post-surgical residual.
40%	Extension limited to 30°.	Goniometer reading; pronounced flexion contracture on exam.
30%	Extension limited to 20°.	Goniometer reading documenting persistent extension lag.
20%	Extension limited to 15°.	Goniometer measurement showing 15° extension deficit.
10%	Extension limited to 10°.	Goniometer showing inability to fully straighten knee by 10°.
0%	Extension limited to 5° (noncompensable but documents baseline).	Mild extension deficit on goniometer.

What Qualifies as 'Limitation of Extension of the Knee' Under DC 5261?

Documented inability to fully straighten the knee

Measured as degrees of extension LOSS from neutral (0°). 'Extension to 10°' under DC 5261 means the knee lacks the final 10° of straightening — a flexion contracture or extension lag.

Mechanical degree thresholds

Per § 4.71a, ratings ladder steeply with extension loss:

• 0% — extension limited to 5°
• 10% — extension limited to 10°
• 20% — extension limited to 15°
• 30% — extension limited to 20°
• 40% — extension limited to 30°
• 50% — extension limited to 45°

Language Your Rater Needs to See

These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.

10%+

“Extension lacks [X] degrees from neutral”

Extension is measured as DEGREES OF LOSS from 0° (straight). 'Extension to 10°' means the knee won't straighten the last 10° = compensable at 10%. Examiners sometimes write 'extension to 10°' meaning the knee CAN extend 10° beyond straight (hyperextension) — confusing language. Make sure the DBQ is explicit about lag vs hyperextension.

All tiers

“Flexion contracture / extension lag”

These are the medical terms for a knee that won't fully straighten. If your DBQ uses either phrase, that's the gate to 5261 — even mild contracture qualifies for 10%.

Evidence Checklist — Specific to This Condition

Knee DBQ with BOTH flexion and extension measured

CRITICAL

Many examiners only measure flexion. Insist on extension goniometer reading too — that's the only path to a separate 5261 rating.

Imaging (X-ray, MRI)

IMPORTANT

Arthritis, meniscal damage, or ACL/PCL injury supports the extension deficit and may add 5003.

Post-surgical / post-injury records

IMPORTANT

If you had ACL repair, meniscectomy, or TKR, extension deficits are common residuals. The op notes establish baseline.

C&P Exam Tips

✓

Lie flat for the extension measurement

Extension is best measured supine. If the examiner only checks it standing, ask them to do it lying down — extension lag is more obvious that way.

❌

Don't compensate with the other knee

Some veterans unconsciously hyperextend the good knee to look 'balanced.' Let each knee be measured independently.

Common Mistakes That Cost Veterans Points

Not filing extension alongside flexion

Veterans file 'limited motion of the knee' and the rater only applies 5260 (flexion). If your knee won't fully straighten, file specifically under 5261 with extension goniometer reading.

Confusing extension lag with hyperextension

Hyperextension (knee bending backward) is NOT rated under 5261 — only deficit FROM full extension is. Make sure the DBQ wording matches the rating intent.

Tactical Plays

⚡ Don't leave 5261 off the table — even 10° lag is worth filing

Extension deficits as small as 10° are compensable at 10%. If your knee won't fully straighten — and most arthritic, post-surgical, or ACL-injured knees don't — file separately under 5261. It stacks with 5260.

⚡ Total knee replacement = automatic 100% for 4 months, then 30% minimum

Per DC 5055, after TKR you get 100% for 4 months following implantation, then rated based on residuals — but never below 30%. Make sure your file shows the surgery date so the 4-month window is correctly applied.

Secondary Conditions to File With This One

Knee, limitation of flexion

STRONG

DC 5260

Rated separately from extension on the same knee per VAOPGCPREC 9-2004.

Knee instability

STRONG

DC 5257

Separate compensable rating per VAOPGCPREC 23-97.

TOTAL

$1,132.90/mo

Extension limited to 45°.

Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.

Key Definitions

🔒What is a Flexion Contracture?

Permanent bending of the knee from scar tissue, muscle/tendon tightness, or joint capsule contracture. The knee cannot fully straighten. Even a 10° contracture = 10% rating under DC 5261.

📐What is an Extension Lag?

Active extension is limited but passive extension may be intact. Common after ACL reconstruction or quadriceps weakness. Rated the same as a contracture — the rating is degrees of active extension loss.

❓Why is DC 5261 underclaimed?

Extension is awkward to measure and many examiners default to flexion-only DBQs. Veterans (and raters) think 'knee ROM = flexion.' If your knee won't fully straighten, demand an extension goniometer reading.

How to File Your Claim

Demand extension goniometer reading on the DBQ

Many examiners only measure flexion. If your knee doesn't fully straighten, insist extension be measured supine (lying flat) — the most accurate position for detecting lag.

File DC 5261 separately from DC 5260

Per VAOPGCPREC 9-2004, flexion and extension on the same knee are separately compensable. File both on the 526EZ if both are limited.

Attach imaging + surgical records

Post-surgical (ACL repair, meniscectomy, TKR) records anchor the extension limitation's cause and document its persistence.

Ensure 'extension lag' or 'flexion contracture' appears in the DBQ

These are the medical terms that match the schedule. 'Knee doesn't fully straighten' is colloquial — the rater may not connect it to DC 5261.

Stack with 5260 + 5257 + 5003 where appropriate

One knee can carry multiple ratings. Audit your existing rating decision for missing companion codes.

Typical Claim Timeline

File initial claim

Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file

VA acknowledges claim

Week 1–2: Receive confirmation letter and claim tracking number

C&P examination scheduled

Month 1–3: VA contracts an exam vendor and sends you appointment notice

Attend C&P exam

Bring your full evidence package; describe symptoms on your worst days, not your best

Decision & rating notice

Month 3–6: Decision letter with rating percentage and effective date

First payment & retro back pay

Within 15 days of decision; retroactive to claim date (or effective date if earlier)

Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.

Important Considerations

✅

Even 10° extension loss is compensable

Extension deficits as small as 10° qualify for 10% under DC 5261. If your knee won't fully straighten — and most arthritic, post-surgical, or ACL-injured knees don't — file.

⚠️

Confusion between extension lag and hyperextension

Hyperextension (knee bending backward beyond neutral) is NOT rated under DC 5261. Only EXTENSION DEFICIT (knee won't fully straighten) qualifies. Make sure the DBQ wording is precise.

🦴

Post-TKR = DC 5055 instead

After total knee replacement, residual extension loss is rated under DC 5055 (with 30% minimum), not DC 5261. Verify which code applies if you've had TKR.

🧮

Combine math, don't just add

Per VAOPGCPREC 9-2004, flexion + extension combine under § 4.25, not by simple addition. A 20% flexion + 10% extension = combined 28%, rounded to 30%.

Related Tools & Resources

📋Evidence Checklist Generator

Build your evidence collection plan

🔗Secondary Condition Mapper

Find all potential secondary claims

📊Rating Estimator

Calculate your combined rating

💰SMC Guide

Understand Special Monthly Compensation

Frequently Asked Questions

Can I claim DC 5261 if I haven't had surgery?

Yes. Extension lag can come from arthritis, ACL/PCL injury, quadriceps weakness, or contracture without surgery. Imaging supports but is not required — goniometer reading is sufficient.

What's the difference between DC 5260 and 5261?

DC 5260 = flexion limitation (can't bend enough). DC 5261 = extension limitation (can't straighten enough). Same knee can have both, rated separately.

Does VAOPGCPREC 9-2004 mean I always get 5260 + 5261 stacked?

Only if both motions are limited. If your knee bends fine but won't straighten, you get only 5261. The precedent simply removes the pyramiding objection to having both when both apply.

How is hyperextension rated?

Hyperextension (genu recurvatum) is rated by analogy under DC 5263 (genu recurvatum, acquired, traumatic) at a maximum 10%. DC 5261 doesn't apply.

What if my extension lag is only 5°?

5° extension lag = 0% under DC 5261 (noncompensable). However, painful motion + imaging-confirmed arthritis still triggers a 10% floor under DC 5003. File DC 5261 for the baseline + DC 5003 for the floor.

Official Regulatory Source

Knee limitation of extension is rated under 38 CFR § 4.71a, Diagnostic Code 5261.

38 CFR § 4.71a — Musculoskeletal System (eCFR) →

Scroll to DC 5261. Companion codes 5260 (flexion) and 5257 (instability) follow.

⚠️ Verify with a VSO

Extension and flexion can be combined per VAOPGCPREC 9-2004, but the rater must compute the combined rating under § 4.25, not simply add the percentages. Verify the combined rating math with a VSO.

Next Steps

If your rating decision lists DC 5261, compare your current symptoms and documentation against the criteria above. Consider:

Requesting a copy of your rating decision and C&P exam report from the VA
Gathering all relevant medical records (VA and private providers)
Documenting functional limitations and how they impact work and daily activities
Obtaining a nexus letter if needed to establish or strengthen service connection
Filing for secondary conditions that may be related to this primary condition
Contacting a VA-accredited VSO, claims agent, or attorney to review your file

This is general educational information only — not legal or medical advice.

Also: DC code lookup (tools) lists the same index in a compact layout.

Source: 38 CFR Part 4, Diagnostic Code 5261 • va.gov

⚠️ Important Disclaimer

This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.