Knee Instability vs Knee Flexion Limitation: VA Rating Comparison
How the VA rates Knee Instability (diagnostic code 5257) compared with Knee Flexion Limitation (diagnostic code 5260), under 38 CFR Part 4. This is a factual side-by-side of the rating criteria, the kind veterans look up when two conditions sound similar.
Rating criteria side by side
Knee Instability
| 30% | Your knee keeps slipping out of place (subluxation) or is unstable because you have a completely torn ligament that either wasn't surgically repaired or the surgery didn't work. Your doctor has prescribed both an assistive walking device like a cane, crutches, or walker AND a knee brace that you need to use together when walking. |
|---|---|
| 20% | You qualify for 20% on either of two paths. PATH A: you have a sprain, an incomplete ligament tear, or a fully torn ligament that was successfully repaired by surgery, and your knee is still unstable enough that your doctor has prescribed a brace and/or a walking aid (cane, crutches, walker). PATH B: you have a fully torn ligament that was never repaired or the repair failed, and your doctor has prescribed either a brace OR a walking aid (not both — both gets you to 30%). |
| 10% | You have a knee injury involving damaged ligaments - either a sprain (stretched ligament), partial tear, or complete tear of a ligament that may or may not have been surgically repaired. This injury causes your knee to feel unstable or give way during normal activities, but your symptoms are manageable enough that your doctor hasn't prescribed you a cane, crutches, walker, or knee brace to help you walk. |
| 30% | You have an unstable kneecap (patella) condition where your kneecap keeps sliding out of place or dislocating, even after you've had surgery to try to fix it. A doctor must have prescribed you a knee brace AND either a cane or walker because your knee is so unstable that you need these devices to move around safely. |
| 20% | Your kneecap (patella) keeps slipping out of place or feels unstable even after you've had surgery to fix it. A doctor must prescribe you a brace, cane, or walker to help you move around safely because of this ongoing knee instability. |
| 10% | Your kneecap (patella) frequently slips out of place or feels unstable when you move, and this has been diagnosed by a doctor as a problem with how your kneecap sits in the groove of your thigh bone (patellofemoral complex). The instability happens repeatedly but is not severe enough that your doctor has prescribed a brace, cane, or walker to help you get around, whether or not you've had surgery to try to fix the problem. |
Knee Flexion Limitation
| 30% | Your leg can only bend forward 15 degrees at the knee or hip joint (flexion means bending a joint to bring two body parts closer together). To put this in perspective, a normal leg can bend about 120-140 degrees, so this represents severe limitation where you can barely bend your leg at all from a straight position. |
|---|---|
| 20% | You can only bend your leg forward at the hip or knee to a maximum of 30 degrees (flexion means bending a joint). For comparison, a normal leg can typically bend about 90 degrees or more at the hip and over 130 degrees at the knee, so this represents a severe limitation in your ability to bend your leg. |
| 10% | You cannot bend your leg forward more than 45 degrees (flexion means bending a joint forward). A normal leg can bend about 120-130 degrees at the hip, so this rating applies when your leg movement is significantly restricted and you can only lift your leg less than halfway to what's considered normal range of motion. |
| 0% | You can only bend your leg forward to 60 degrees (flexion means bending a joint forward). A normal leg can bend about 120-135 degrees at the knee, so this rating applies when your leg movement is significantly restricted and you can only achieve less than half of normal bending range. |
Criteria are summarized in plain language. The controlling text is the Schedule for Rating Disabilities, 38 CFR Part 4. Full criteria for each are on the Knee Instability and Knee Flexion Limitation code pages.
Can both be rated at the same time?
The VA generally does not rate the same disability twice. Under the anti-pyramiding rule (38 CFR 4.14), two conditions are rated separately only when they cause distinct, non-overlapping symptoms. When the symptoms overlap, the VA assigns a single rating under whichever code best fits. Whether Knee Instability and Knee Flexion Limitation can be rated separately depends on the symptoms documented in the evidence. See the pyramiding guide.
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