Knee, Shoulder, and Ankle Claims Guide

How the VA Rates Limited Motion (the Shared Rules)

Every joint is rated under 38 CFR 4.71a by measuring range of motion in degrees with a goniometer. But the degrees on the exam are only the starting point. Four rules can change the result, and they apply to the knee, shoulder, and ankle alike.

• Painful motion gets at least the minimum rating (38 CFR 4.59). If a joint is painful on motion, it is entitled to at least the minimum compensable rating for that joint (usually 10%), even if the measured range is technically "normal."
• Functional loss counts, not just degrees (38 CFR 4.40 and 4.45). Weakness, fatigue, incoordination, and lack of endurance that reduce how you actually use the joint must be factored in.
• Flare-ups matter (DeLuca v. Brown). The rating must account for additional loss of motion during flare-ups and after repeated use over time, not just your best single measurement in the exam room. (Pain alone, without extra functional loss, may not raise the rating, Mitchell v. Shinseki.)
• The exam must test motion both ways (Correia v. McDonald). A proper joint exam tests range of motion in active and passive motion, and in weight-bearing and non-weight-bearing. If the C&P exam skipped this, the exam may be inadequate.

Knee (Limitation of Flexion / Extension, Instability)

The knee is unusual: you can often receive more than one rating for the same knee, because limitation of motion and instability are separate problems.

Limitation of flexion, DC 5260 (bending the knee)

Limitation of extension, DC 5261 (straightening the knee)

Instability, DC 5257 (recurrent subluxation or lateral instability)

Shoulder / Arm (DC 5201, Limitation of Arm Motion)

The shoulder is rated by how far you can raise the arm (flexion and abduction), and the level depends on whether it is your dominant (major) or non-dominant (minor) arm.

Related shoulder codes cover other problems: DC 5200 (ankylosis, the joint fused), DC 5202 (humerus, including recurrent dislocation and flail/false joint), and DC 5203 (clavicle or scapula). The painful-motion and flare-up rules apply here too.

Ankle (DC 5271, Limited Motion)

20% is the maximum for simple limited motion. A higher rating requires ankle ankylosis (the joint fused in place) under DC 5270, which ranges from 20% to 40% depending on the angle it is frozen at. As with the other joints, a painful ankle with motion is entitled to at least the 10% minimum even if degrees look near-normal.

The Bilateral Factor (38 CFR 4.26)

If you are service-connected for the same joint on both sides (both knees, both ankles, both arms), the VA adds a bilateral factor: it takes the combined value of the paired disabilities and adds 10% of that value before combining with your other ratings. It is easy for the VA to miss, so it is worth checking your code sheet. The VA Math calculator applies the bilateral factor automatically so you can see whether your combined rating looks right.

Getting These Joints Service Connected

• Direct: an in-service injury (a fall, a parachute landing, a sports or training injury) or documented overuse, a current diagnosis, and a nexus. Continuity of symptoms since service helps.
• Secondary, altered gait or overcompensation: a service-connected knee or ankle that changes how you walk can cause or worsen the opposite knee, the hip, or the low back. A bad shoulder can overload the other shoulder. These are common, well-recognized secondary paths. See service connection.
• Aggravation: service made a pre-existing joint problem permanently worse.

Evidence That Wins

• Range-of-motion measurements in degrees, taken with a goniometer, including after repetitive use. The numbers drive the table.
• Documented flare-ups. Tell the examiner how often they happen, what triggers them, and how much more motion you lose during one. A dated symptom log makes this concrete (the examiner is supposed to estimate flare-up loss).
• A Correia-compliant exam, testing active, passive, weight-bearing, and non-weight-bearing motion. If your C&P skipped weight-bearing testing, that can be grounds to challenge the exam.
• Imaging and clinical findings (X-ray, MRI, instability testing, meniscus findings) that support a separate rating.
• The right DBQ. The joint-specific Disability Benefits Questionnaire captures degrees, painful motion, flare-ups, and stability. See the DBQ guide and the C&P exam prep.

Frequently Asked Questions