Knee Claims Guide

What a Knee Claim Covers

The VA does not rate "a bad knee" as one thing. It rates specific impairments, each with its own diagnostic code under the musculoskeletal schedule (see 38 CFR § 4.71a). The knee codes you are most likely to see:

• Instability or recurrent subluxation: the knee gives way or slips. DC 5257.
• Limitation of flexion: how far you can bend the knee. DC 5260.
• Limitation of extension: how far you can straighten it. DC 5261.
• Meniscus (semilunar cartilage): a dislocated meniscus with locking, pain, and effusion (DC 5258) or a symptomatic meniscus that was removed (DC 5259).
• Ankylosis: the knee is fused or frozen in one position. DC 5256.
• Tibia and fibula impairment: nonunion or malunion of the lower-leg bones. DC 5262.
• Knee replacement: a prosthetic joint. DC 5055.

How a Knee Gets Service Connected

• Direct: an in-service knee injury or onset (a fall, a training injury, years of rucking and jumps) with a current diagnosis and a medical link back to service. See service connection.
• Secondary (the commonly missed path): a service-connected condition changes how you walk and wears the knee out. An altered gait from a service-connected back, hip, ankle, or the opposite knee can service-connect the knee as secondary. So can extra load on one knee after the other is injured. See secondary conditions and the lumbar spine guide.
• Aggravation: a knee problem that existed before service, or a non-service condition, that service made permanently worse. See aggravation.

Knees often come in pairs and chains: one bad knee overloads the other, and a bad back or ankle overloads both. When both knees are service-connected, they are a paired extremity, so the bilateral factor can add to the combined rating.

Across published DC 5257 decisions, here is how often the Board granted by the legal theory the claim was argued on:

Common Secondary Conditions

A service-connected knee rarely travels alone. Because it changes how you walk, it drives problems higher up the leg and in the back, and it is itself often secondary to a condition that started elsewhere. Each bar below is the Board's grant rate for DC 5257 in that pairing, with the number of decisions under it. They describe the published record across many veterans, not a prediction about any one claim.

Conditions that can cause a bad knee (knee as the secondary)

Claims where the knee was argued as secondary to an already service-connected condition, most often an altered gait from the back, the hip, or the opposite knee:

Conditions a bad knee can cause (knee as the primary)

Conditions veterans have claimed as caused or aggravated by a service-connected knee, as one overloaded joint wears down the rest of the chain:

How the VA Rates the Knee

Instability and lost motion are the two ratings most knee claims turn on. Instability (DC 5257) is scored by how much the knee gives way; it does not depend on range of motion.

Range of motion is scored separately, and flexion (bending) and extension (straightening) are two different codes. A normal knee bends to about 140 degrees and straightens to 0.

Other knee codes fill in the rest of the picture:

Why One Knee Can Carry More Than One Rating

This is the part most veterans, and some raters, miss. Because instability and lost motion compensate different problems, the VA's own General Counsel has held they can be rated separately on the same knee. So can limited flexion and limited extension.

These combine through VA math, not simple addition, and they are not pyramiding, because each pays for a distinct loss. If your rating decision paid only one code for a knee that both gives way and will not bend, that is a common under-rating worth a closer look.

Painful Motion and the 10% Floor

A knee can hurt long before it loses enough motion to reach a 10% row on the table. The rating schedule accounts for that: a joint with painful motion is entitled to at least the minimum compensable rating, generally 10%, even when the measured range of motion is nearly normal (see 38 CFR § 4.59). The VA must also consider how pain, weakness, fatigue, and flare-ups further limit you, not just your best single measurement (DeLuca v. Brown, 1995).

Evidence That Wins

• Goniometer range-of-motion numbers, in degrees, for flexion and extension, tested active and passive and with weight-bearing, so the rater can place you on the table.
• Objective instability testing (Lachman, drawer, or varus/valgus laxity findings) documenting how much the knee gives way, which is what DC 5257 turns on.
• Imaging and operative records: X-ray, MRI, or surgical notes showing arthritis, a meniscus tear, or a replacement.
• The Knee and Lower Leg DBQ, which captures range of motion, stability, flare-ups, and the functional loss the rating depends on. See the DBQ guide.
• A nexus for a secondary claim: a medical statement linking the knee to a service-connected back, hip, ankle, or opposite knee. See nexus letters.
• Your own account of flare-ups and give-way, including how often the knee buckles and what it stops you from doing, which supports the DeLuca and instability findings.

Common Mistakes

The same handful of missteps account for most lost or under-rated knee claims. Each follows from how the knee codes are scored. Among the Board's classified service-connection denials for the knee, here is what claims most often fell short on:

Frequently Asked Questions