Knee Conditions
Diagnostic Codes 5256–5261 • 38 CFR § 4.71a
Separate ratings are often allowed on the same knee (flexion, extension, instability)—not pyramiding when distinct functional losses are shown.
DC range
5256–61
Knee Ratings at a Glance (2024 $, veteran alone)
Examples below use common DCs—5260 flexion, 5261 extension, 5257 instability. Your decision may list different codes for meniscus, ankylosis, or replacement residuals.
Flexion ≤30° (DC 5260)
$524/mo
Flexion ≤45°
$338/mo
Flexion ≤60° / painful motion
$171/mo
Instability (5257) — occasional to frequent
$171–524/mo
Extension limitation (5261) by angle
$171–$1,075/mo
Bilateral factor: When both knees have qualifying ratings, VA combines them then adds an extra proportional amount—often a meaningful bump to combined %.
Complete regulatory criteria, CFR citations, and official rating notes for knee conditions
Three Compensation Scenarios
Stacked ratings — one knee
Example: Flexion 30% + extension 10% + instability 10% on the same knee (illustrative).
Combined VA math ≈ low–mid 40% range → roughly $600–855/mo band (verify with calculator).
Bilateral knees
Example: 20% right knee + 20% left knee + bilateral factor.
Combined + bilateral
~40%
Approx. monthly
$755–855/mo
Exact % depends on combined calculation order.
Knee + spine + mental health
Combined often reaches 70–90% territory depending on exact percentages—use the Rating Calculator.
Evidence Requirements
Goniometer ROM
Separate measurements for flexion and extension; stop at pain.
Stability testing
Drawer/Lachman/varus-valgus stress—positive findings support 5257 when documented.
Imaging & surgical notes
MRI for meniscus/ACL; operative reports if applicable.
Bracing / assistive devices
Prescriptions for hinged braces, cane, or PT restrictions.
Lay statements
Buckling, swelling after activity, inability to kneel or run.
Common Secondary Conditions
🦵 Opposite knee
STRONG5260 • Compensatory loading
🦴 Hip strain
STRONG5252 • Gait change from knee pain
🫳 Lumbar strain
STRONG5237 • Limping and pelvic tilt
🦶 Ankle strain
MODERATE5271 • Altered weight-bearing
🧠 Depression
MODERATE9434 • Chronic pain / mobility loss
⚙️ TKR residuals
STRONG5256+ • Post–1-year rating on residuals
Claim Timeline
Gather evidence
STR, imaging, PT notes, brace prescriptions
File 526EZ
Claim each knee separately if needed; list instability
C&P orthopedics
Confirm flexion, extension, and stability tests
Decision
Check for missing stacked ratings
Secondaries
Hip, back, opposite knee, depression as supported
What Gets You Higher Ratings
10% → 20–30%
Show flexion at or below 45°/30° or document extension deficit with measured angles—not estimates.
Add instability
If ligaments are loose and the knee gives way, a separate 5257 evaluation may apply on top of ROM.
Both knees
Service-connect both sides when applicable—bilateral factor increases combined compensation.
Common Mistakes
Only one rating for one knee
Miss flexion + extension + instability when each is supported.
No instability exam
If you report buckling, the exam should address ligament tests.
Ignoring bilateral factor
If both knees are SC, ensure the factor is applied.
TKR timing
After total knee replacement, understand the 1-year convalescence and residual rules.
FAQs
▸ Can I get three ratings on one knee?
Often yes—when the evidence shows distinct limitation of flexion, limitation of extension, and instability without improper pyramiding. Final codes are fact-specific.
▸ How does the bilateral factor work?
After combining bilateral knee ratings, VA adds a percentage of the combined value—this is not the same as adding two ratings arithmetically.
▸ What about knee replacement?
TKR generally has a temporary 100% window after surgery for a prescribed period, then residuals are rated— often not less than certain minimums per schedule. See your decision and § 4.71a notes.
DC Reference & Tools
Official criteria (selected)
Official VA rating criteria — Knee (selected codes)
DCs 5256–5261 cover flexion, extension, instability, and meniscus disabilities. You may qualify for more than one rating for the same knee when the schedule allows (for example flexion plus instability).
| Rating | VA criteria (selected examples) | Key evidence at this level |
|---|---|---|
| 30% | Extension: knee cannot straighten past 20 degrees. Instability: marked (frequent giving out)—when rated under the instability code with severe findings. | Goniometer showing severe extension limitation; orthopedic notes on instability and brace use. |
| 20% | Flexion limited to 45 degrees and/or extension cannot straighten past 15 degrees—per the applicable motion code’s row in § 4.71a. | Documented ROM restriction in flexion or extension on exam. |
| 10% | Flexion limited to 60 degrees and/or painful motion warranting the minimum compensable rating for the joint. | Moderate flexion limitation or painful motion documented on C&P exam. |
| 0% | Limitation of motion not meeting compensable thresholds, without qualifying painful motion. | Service connection may still exist below 10%. |
Source: 38 CFR § 4.71a — Diagnostic Codes 5256–5261 (read full rows for each code).
⚠️ 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.