Musculoskeletal Conditions Rating Guide

Joint, spine, and bone conditions are the largest single category of VA disability claims, and every one of them is rated under the same schedule: 38 CFR § 4.71a. A knee, a lower back, a shoulder, and an ankle are scored by the same handful of rules. Learn those rules once and you understand your whole claim. This guide explains the rules that decide every musculoskeletal rating, then points you to the detailed guide for your specific condition.

The Rules That Decide Every Musculoskeletal Claim

Most joint and spine codes are rated on limitation of motion: the examiner measures how far the joint bends and straightens with a goniometer, then compares it to the normal range in 38 CFR § 4.71 (Plate I and II). Less motion means a higher rating. But a string of rules sitting on top of that measurement decide far more claims than the raw degrees do.

1. Painful motion earns the minimum (38 CFR 4.59)

A joint that hurts when it moves is entitled to at least the minimum compensable rating (usually 10 percent) even if the range of motion is close to normal. Pain that limits function is a disability in itself. If the exam records painful motion and the rating still came back at 0 percent, that is a common and appealable error.

2. Functional loss and flare-ups (38 CFR 4.40 and 4.45, the DeLuca rules)

The rating is not just your range of motion on a calm day in the exam room. Under DeLuca v. Brown and Mitchell v. Shinseki, the VA must account for additional loss from pain, weakness, fatigability, and incoordination, including during flare-ups and after repeated use. The examiner is supposed to measure your motion again after repetitions and estimate how much more you lose during a flare.

3. The exam must test all four ways (Correia v. McDonald)

Since Correia v. McDonald (2016), a joint exam must record range of motion in active and passive motion, and in weight-bearing and non-weight-bearing, and test the opposite undamaged joint for comparison where relevant. An exam that skips these is legally inadequate and is grounds to ask for a new one. Under Sharp v. Shulkin, if the exam was not during a flare, the examiner must still estimate the extra loss a flare causes or explain why they cannot.

4. Ankylosis is rated higher than stiffness

Ankylosis is a joint frozen in one position, from disease, injury, or surgical fusion. Because a fused joint has no usable motion, it is rated higher than mere limitation of motion, and an unfavorable position (fixed at a bad angle) rates higher than a favorable one.

5. The bilateral factor (38 CFR 4.26)

When you have compensable disabilities of both arms, both legs, or paired skeletal muscles, for example a right knee and a left knee, the VA adds an extra 10 percent of the combined value of those bilateral disabilities before combining with the rest. It is easy to miss, and it quietly raises many two-sided claims.

6. Instability and limited motion can stack (no pyramiding)

The anti-pyramiding rule (38 CFR § 4.14) says you cannot rate the same symptom twice. But different manifestations of one joint get separate ratings. Under VA General Counsel opinions, a knee with both instability (DC 5257) and limitation of motion or arthritis (DC 5003, 5260, 5261) carries a rating for each, because giving way and losing bend are two different problems. This is one of the most valuable and most-missed stacking opportunities in the whole schedule.

7. The amputation rule is a ceiling (38 CFR 4.68)

The combined rating for one limb cannot exceed what an amputation at the elective level of that limb would pay. It is a cap, not a floor, and it rarely bites unless a single extremity carries several high ratings.

Arthritis has its own floor. Degenerative or traumatic arthritis (DC 5003 and 5010) is rated on the limitation of motion of the affected joint. If that limitation is too small to be compensable on its own, X-ray-confirmed arthritis still earns 10 percent per major joint group, or 20 percent for two or more groups with incapacitating flare-ups. See the arthritis guide.

Find the Guide for Your Condition

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific joint, open the dedicated guide:

Area	Guide	DC codes
Knee	Knee Claims Guide	5055, 5256-5263
Lower back	Lumbar Spine Guide	5235-5243
Neck	Cervical Spine Guide	5237, 5241, 5242
Shoulder, elbow, wrist, hip, ankle	Joint Motion Guide	5200-5274
Flatfoot (pes planus)	Flatfoot Guide	5276
Bunion, hammertoe, foot injuries	Foot Conditions Guide	5279-5284
Arthritis (degenerative, traumatic)	Arthritis Guide	5003, 5010
Widespread pain (fibromyalgia)	Fibromyalgia Guide	5025
Radiating nerve pain (sciatica)	Sciatica & Radiculopathy Guide	8520

Radiating pain down a leg or arm is rated under the neurological schedule, not 4.71a, but it is so often paired with a back or neck claim that it belongs on this map. For any code not listed, open its condition lookup page for the rating levels and Board data.

Common Secondary Conditions

Musculoskeletal injuries rarely stay in one place. Because the body compensates for a bad joint, one service-connected condition often opens the door to several secondary claims:

The opposite joint. Favoring an injured knee, hip, or ankle overloads the other side. A service-connected right knee that causes a left-knee condition is a classic secondary claim.
Up and down the chain. An altered gait travels: a bad ankle strains the knee, a bad knee strains the hip and back, and a fused or painful joint changes how you walk.
Radiculopathy from the spine. A back or neck disability that pinches a nerve root produces radiating leg or arm pain, rated separately under the nerve codes. See the sciatica guide.
Mental health from chronic pain. Long-term pain and lost mobility drive depression and anxiety, which can be claimed as secondary to the physical condition. See secondary conditions.

Each dedicated guide above shows the live Board grant rates for that joint's most common secondary pairings.

Evidence That Wins

Range-of-motion measurements in degrees, taken with a goniometer, active and passive, weight-bearing and non-weight-bearing. Vague notes like "reduced motion" do not rate; numbers do.
A flare-up record. A dated log of how often the joint flares, how bad it gets, and what you cannot do during a flare gives the examiner the DeLuca and Sharp estimate the rating depends on.
Imaging. X-rays or MRI confirming arthritis, joint-space loss, or structural damage, the objective backbone of the claim.
Buddy and lay statements describing the limits others have watched over time, especially the flare-ups a single exam never sees.
The right DBQ for the joint, which prompts the examiner to capture painful motion, repetitive-use loss, and the Correia measurements. See the DBQ guide.

Evidence Cited in Published Back and neck (spine) Decisions

We analyzed 294,193 published Board decisions involving back and neck (spine) for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 45.1%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Range of motion measured in degreesfavorable 66.3%

n = 71,958

In-service back or neck injury documentedfavorable 51.8%

n = 66,220

Flare-ups and additional functional loss addressedfavorable 60%

n = 62,119

Radiculopathy or EMG/nerve-conduction findingsfavorable 62.9%

n = 50,897

MRI or imaging of the spinefavorable 54.9%

n = 35,940

Physician-prescribed bed rest (incapacitating episodes)favorable 65.7%

n = 27,134

By diagnostic code

These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. Codes retired in the schedule rewrites are left out, because their old decisions were judged under criteria that no longer apply.

DC 5237 Lumbosacral or cervical strainfavorable 39.1%

n = 173,747 decisions · 8,068 granted

DC 5243 Intervertebral disc syndromefavorable 55.7%

n = 82,438 decisions · 7,819 granted

DC 5242 Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)favorable 61%

n = 51,165 decisions · 4,377 granted

DC 5235 Vertebral fracture or dislocationfavorable 55.5%

n = 14,687 decisions · 1,129 granted

DC 5238 Spinal stenosisfavorable 59.3%

n = 4,689 decisions · 550 granted

Evidence Cited in Published Knee and lower-leg conditions Decisions

We analyzed 162,120 published Board decisions involving knee and lower-leg conditions for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 44.9%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Range of motion measured in degreesfavorable 66.6%

n = 49,297

Meniscal pathology documentedfavorable 58.3%

n = 40,192

Knee MRI or X-ray findingsfavorable 54.3%

n = 33,077

Instability testing (Lachman, drawer, McMurray)favorable 61.2%

n = 29,377

Giving way, buckling, or locking reportedfavorable 62.5%

n = 27,876

Knee replacement (arthroplasty) documentedfavorable 57.7%

n = 16,390

By diagnostic code

DC 5257 Knee, other impairment offavorable 40.5%

n = 117,168 decisions · 5,005 granted

DC 5260 Leg, limitation of flexion offavorable 62.2%

n = 27,494 decisions · 1,559 granted

DC 5262 Tibia and fibula, impairment offavorable 59.4%

n = 18,486 decisions · 957 granted

DC 5258 Cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the jointfavorable 65%

n = 14,028 decisions · 1,065 granted

DC 5261 Leg, limitation of extension offavorable 61.9%

n = 10,999 decisions · 442 granted

DC 5259 Cartilage, semilunar, removal of, symptomaticfavorable 64.1%

n = 8,829 decisions · 594 granted

DC 5055 Knee, resurfacing or replacement (prosthesis)favorable 56.5%

n = 7,966 decisions · 654 granted

DC 5256 Knee, ankylosis offavorable 62.1%

n = 5,460 decisions · 224 granted

Evidence Cited in Published Arthritis Decisions

We analyzed 135,274 published Board decisions involving arthritis for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 56.9%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Range of motion measured in degreesfavorable 67.1%

n = 43,443

X-ray confirmation of arthritisfavorable 61.9%

n = 42,982

Objective painful motion findingsfavorable 66.9%

n = 37,210

Flare-ups and additional functional loss addressedfavorable 64.2%

n = 34,653

Repetitive-use testing performedfavorable 73.1%

n = 17,556

By diagnostic code

DC 5003 Degenerative arthritis, other than post-traumaticfavorable 58.4%

n = 116,274 decisions · 9,374 granted

DC 5010 Post-traumatic arthritisfavorable 54.4%

n = 12,745 decisions · 931 granted

DC 5002 Multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active processfavorable 41.5%

n = 8,005 decisions · 576 granted

DC 5021 Myositisfavorable 58.2%

n = 4,720 decisions · 262 granted

Evidence Cited in Published Shoulder and arm conditions Decisions

We analyzed 47,615 published Board decisions involving shoulder and arm conditions for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 57.4%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Rotator cuff pathology (tear, impingement)favorable 62.1%

n = 16,304

Range of motion measured in degreesfavorable 66.9%

n = 14,508

Dislocation or instability documentedfavorable 57.4%

n = 10,437

Shoulder MRI or X-ray findingsfavorable 58%

n = 9,483

Dominant (major) extremity addressedfavorable 65.8%

n = 8,434

Motion limited to shoulder level or belowfavorable 65%

n = 6,913

By diagnostic code

DC 5201 Arm, limitation of motion offavorable 57%

n = 29,711 decisions · 1,745 granted

DC 5203 Clavicle or scapula, impairment offavorable 53.5%

n = 7,657 decisions · 542 granted

DC 5202 Humerus, other impairment offavorable 51.6%

n = 6,725 decisions · 455 granted

DC 5200 Scapulohumeral articulation, ankylosis offavorable 71.1%

n = 5,759 decisions · 225 granted

DC 5303 Group III. Function: Elevation and abduction of arm to level of shoulder; act with 1 and 2 of Group II in forward and backward swing of arm. Intrinsic muscles of shoulder girdle: (1) Pectoralis major I (clavicular); (2) deltoidfavorable 64.8%

n = 3,907 decisions · 363 granted

Evidence Cited in Published Ankle conditions Decisions

We analyzed 53,965 published Board decisions involving ankle conditions for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 49.3%. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Dorsiflexion / plantar flexion measured in degreesfavorable 67%

n = 11,460

In-service ankle sprain or fracture documentedfavorable 57%

n = 10,380

Ankle X-ray or MRI findingsfavorable 54.3%

n = 9,708

Instability, giving way, or brace usefavorable 63.7%

n = 9,600

Marked or moderate limitation characterizedfavorable 69.7%

n = 7,555

Evidence Cited in Published Hip and thigh conditions Decisions

We analyzed 27,142 published Board decisions involving hip and thigh conditions for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 63.8%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Hip range of motion measured in degreesfavorable 72.1%

n = 7,847

Flare-ups and additional functional loss addressedfavorable 75.6%

n = 6,747

Hip X-ray or MRI findingsfavorable 57.5%

n = 5,004

Antalgic gait or limp documentedfavorable 67.7%

n = 4,302

Hip replacement (arthroplasty) documentedfavorable 58.2%

n = 3,594

By diagnostic code

DC 5252 Thigh, limitation of flexion offavorable 67%

n = 23,030 decisions · 1,264 granted

DC 5253 Thigh, impairment offavorable 60.3%

n = 3,986 decisions · 228 granted

DC 5054 Hip, resurfacing or replacement (prosthesis)favorable 56%

n = 3,791 decisions · 320 granted

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Symptoms Recorded in Granted Back and neck (spine) Decisions

We analyzed 19,827 granted Board decisions involving back and neck (spine) for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Chronic or constant painshare of granted 31.2%

n = 6,185

Muscle spasmshare of granted 19.2%

n = 3,808

Radiating painshare of granted 12.5%

n = 2,486

Numbnessshare of granted 7.6%

n = 1,503

Weaknessshare of granted 6.6%

n = 1,313

Stiffnessshare of granted 5.7%

n = 1,134

Symptoms Recorded in Granted Knee and lower-leg conditions Decisions

We analyzed 8,450 granted Board decisions involving knee and lower-leg conditions for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Swellingshare of granted 40.3%

n = 3,405

Instabilityshare of granted 40%

n = 3,384

Popping or crepitusshare of granted 19%

n = 1,609

Weaknessshare of granted 16.5%

n = 1,398

Lockingshare of granted 16.2%

n = 1,369

Giving way or bucklingshare of granted 14%

n = 1,187

Stiffnessshare of granted 12.3%

n = 1,038

Symptoms Recorded in Granted Arthritis Decisions

We analyzed 10,863 granted Board decisions involving arthritis for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Instabilityshare of granted 6%

n = 648

Swellingshare of granted 3.8%

n = 412

Stiffnessshare of granted 1.6%

n = 171

Tendernessshare of granted 1.4%

n = 157

Flare-upsshare of granted 1.3%

n = 145

Muscle spasmshare of granted 1.2%

n = 132

Grinding or popping (crepitus)share of granted 1.1%

n = 121

Symptoms Recorded in Granted Shoulder and arm conditions Decisions

We analyzed 2,911 granted Board decisions involving shoulder and arm conditions for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Shoulder painshare of granted 78.9%

n = 2,296

Instability or dislocationshare of granted 30.4%

n = 885

Weaknessshare of granted 17.8%

n = 518

Tendernessshare of granted 17.5%

n = 509

Flare-upsshare of granted 11.2%

n = 325

Grinding or popping (crepitus)share of granted 10.5%

n = 306

Stiffnessshare of granted 8.6%

n = 250

Swellingshare of granted 8%

n = 232

Numbnessshare of granted 6.9%

n = 202

Symptoms Recorded in Granted Ankle conditions Decisions

We analyzed 2,725 granted Board decisions involving ankle conditions for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Ankle painshare of granted 81.3%

n = 2,215

Swellingshare of granted 34.2%

n = 931

Instability or giving wayshare of granted 33.1%

n = 901

Weaknessshare of granted 17%

n = 463

Stiffnessshare of granted 12.4%

n = 337

Symptoms Recorded in Granted Hip and thigh conditions Decisions

We analyzed 1,594 granted Board decisions involving hip and thigh conditions for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Hip painshare of granted 78.3%

n = 1,248

Limp or gait disturbanceshare of granted 24.7%

n = 394

Weaknessshare of granted 12.8%

n = 204

Flare-upsshare of granted 6.8%

n = 109

Stiffnessshare of granted 6.1%

n = 97

Fatigabilityshare of granted 2.9%

n = 46

Trouble crossing legsshare of granted 2.3%

n = 37

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Common Mistakes

Accepting a 0 percent for a painful joint. Painful motion earns at least the minimum compensable rating under 4.59. A 0 percent on a joint the exam recorded as painful is appealable.
Letting an inadequate exam stand. If the C&P did not test active and passive, weight-bearing and non-weight-bearing motion (Correia), or did not estimate flare-up loss (Sharp), it is inadequate. Point that out and ask for a new exam.
Not stacking knee ratings. Instability and limitation of motion are separate ratings on the same knee. Many veterans get one when they were owed both.
Forgetting the bilateral factor. Two-sided claims (both knees, both shoulders) get an extra 10 percent under 4.26 that is easy to overlook.
Only claiming the first joint. The gait chain and the opposite joint are real secondary claims. Stopping at the original injury leaves ratings on the table.

Frequently Asked Questions

How does the VA rate joint and spine conditions?

Almost all of them are rated under 38 CFR 4.71a on limitation of motion, how far the joint bends and straightens compared to normal. On top of that, painful motion earns at least the minimum rating (4.59), functional loss from flare-ups and repeated use must be counted (the DeLuca rules), ankylosis rates higher than stiffness, and the exam must test motion in several ways (Correia).

Can I get separate ratings for my knee?

Often, yes. A knee with instability (giving way) and a knee with limited or painful motion are two different problems, so they can be rated separately under DC 5257 and the limitation-of-motion codes without pyramiding. It is one of the most-missed rating opportunities in the schedule.

Why did I get 0 percent when my joint clearly hurts?

If the exam recorded painful motion, a 0 percent is usually an error. Under 38 CFR 4.59, actually painful motion of a joint is entitled to at least the minimum compensable rating, generally 10 percent. That is an appealable decision.

What is the bilateral factor?

Under 38 CFR 4.26, when you have compensable disabilities of both arms, both legs, or paired muscles, the VA adds an extra 10 percent of the combined value of those bilateral disabilities before combining with your other ratings. It raises many two-sided claims and is often overlooked.

My exam was quick and did not test everything. Does that matter?

Yes. Under Correia v. McDonald, a joint exam must measure active and passive motion and weight-bearing and non-weight-bearing motion, and under Sharp v. Shulkin it must estimate flare-up loss. An exam that skips these is inadequate and is a valid reason to request a new one on appeal.

Related Tools and Guides

Knee Claims Guide

Stacking instability and limited-motion ratings on one knee.

Lumbar Spine Guide

The general rating formula for the back, plus radiculopathy.

Joint Motion Guide

Shoulder, elbow, wrist, hip, and ankle limitation of motion.

Arthritis Guide

How X-ray arthritis rates when motion loss is small.

Secondary Conditions

The gait chain and the opposite-joint claim.

DBQ Guide

The exam forms that capture painful motion and flares.

Sources: 38 CFR 4.71a, musculoskeletal ratings · 4.59, painful motion · 4.40 and 4.45, functional loss · 4.26, bilateral factor. Educational only, not legal advice, and not a prediction of any individual claim. Rating criteria and case law change; confirm current details in 38 CFR Part 4. For help with your claim, find a VA-accredited representative.