Need a Knee Injury Nexus Letter?
REE Medical orthopedic specialists document knee instability, ROM limitation, and post-surgical residuals in nexus letters that address DC 5257–5262 criteria with clinical precision.
Explore REE Medical's Knee Nexus Letters →claim.vet may receive a referral fee if you use this link. Veterans never pay more.
VA's rating schedule for knee injuries under 38 CFR Part 4 covers multiple distinct pathologies. Understanding which code applies to your specific diagnosis is the first step:
| DC | Condition | Rating Basis | Max Rating |
|---|---|---|---|
| 5257 | Recurrent subluxation or lateral instability | Severity of instability | 30% |
| 5258 | Cartilage, semilunar (meniscus), disabling | Locking, swelling, pain | 20% |
| 5259 | Cartilage, semilunar, removed — symptomatic | Post-op symptoms | 10% |
| 5260 | Limitation of flexion | Degrees of flexion lost | 30% |
| 5261 | Limitation of extension | Degrees of extension lost | 50% |
| 5262 | Impairment of tibia and fibula | Nonunion, malunion, shortening | 40% |
| 5263 | Genu recurvatum (knee hyperextension) | Traumatic arthritis present | 10% |
Under 38 CFR § 4.14, VA cannot rate the same disability under multiple diagnostic codes when doing so would compensate the veteran twice for the same limitation. However, if your knee has distinct, separately ratable pathologies — for example, ligament instability (DC 5257) AND a separate ROM limitation from post-surgical scarring (DC 5260/5261) — these can sometimes be rated separately. VA must apply the most favorable applicable code, and veterans should request evaluation under all applicable codes when claiming.
DC 5257 is the primary code for knee instability — including ACL and PCL tears that result in ongoing instability, lateral collateral ligament (LCL) or medial collateral ligament (MCL) injuries, and any condition producing recurrent subluxation (partial dislocation).
| Rating | Instability Level | Clinical Indicators |
|---|---|---|
| 10% | Slight | Occasional giving way, mild laxity on stress testing, functional limitations in demanding activities |
| 20% | Moderate | Frequent giving way, moderate laxity on Lachman/anterior drawer/varus/valgus stress tests, functional limitations in daily activities |
| 30% | Severe | Constant instability, severe laxity, inability to trust the knee for weight bearing, assistive device use |
The C&P examiner (or your treating physician for the nexus letter) should perform specific stress tests to document the degree of instability:
Positive stress tests documented in medical records — especially if graded (Grade I, II, or III laxity) — provide strong objective evidence for instability ratings. Grade I = slight, Grade II = moderate, Grade III = severe, which maps directly to the 10%, 20%, and 30% DC 5257 rating levels.
DC 5258 covers the semilunar cartilage (meniscus) when it remains in place but produces disabling symptoms. The rating is binary — 20% if disabling, 0% if not. "Disabling" means the condition significantly limits activities and requires medical management. To qualify, the medical record should document:
DC 5259 applies after the meniscus has been removed (meniscectomy — either partial or total) and symptoms persist. The rating is 10% if symptomatic — meaning ongoing pain, swelling, or mechanical symptoms despite the surgical removal. Many veterans who had meniscus surgery during service or after service should be rated under DC 5259 for post-operative symptoms.
Note that total meniscectomy (complete removal) is associated with significantly accelerated development of knee osteoarthritis — this is a documented consequence that can support a future secondary claim for knee degenerative arthritis under DC 5003 as the knee further degrades over time.
Range of motion limitation of the knee is rated under DC 5260 (limitation of flexion) or DC 5261 (limitation of extension). These are separate codes — extension limitation is more severely rated than flexion limitation because inability to fully extend the leg significantly impairs walking.
| Motion | Normal Range |
|---|---|
| Flexion | 0° to 140° |
| Extension | 0° (full extension) |
| Flexion Limited To | Rating |
|---|---|
| 45° | 30% |
| 60° | 20% |
| 90° | 10% |
| More than 90° | 0% (painful motion may still apply) |
| Extension Limited To | Rating | Note |
|---|---|---|
| 45° (cannot straighten past 45° flexion) | 50% | Severe functional impairment |
| 30° | 40% | Significant impairment |
| 20° | 30% | Moderate-severe |
| 15° | 20% | Moderate |
| 10° | 10% | Slight extension lag |
Extension limitation is critical because even mild extension deficits (10°–20°) cause a visible limp and significant functional limitation in walking and stair climbing. Veterans with post-surgical extension lag should specifically document this — it's often missed when physicians focus only on flexion.
DC 5262 covers impairment of the lower leg bones — tibia and fibula — from fracture with malunion or nonunion, deformity from injury, or bone loss. This code applies when a veteran sustained a lower leg fracture during service or a knee injury involving the proximal tibia (tibial plateau fracture).
| DC 5262 Criteria | Rating |
|---|---|
| Nonunion with loose motion | 40% |
| Malunion with marked knee or ankle disability | 30% |
| Malunion with moderate knee or ankle disability | 20% |
| Malunion with slight knee or ankle disability | 10% |
Veterans with tibial plateau fractures from vehicle accidents, falls, or blast injuries should verify whether DC 5262 applies to their claim in addition to or instead of the ROM-based codes. A tibial plateau fracture that healed with residual deformity affecting knee alignment can support both DC 5262 and DC 5260/5261 ratings depending on what limitation is most prominent.
ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) tears are among the most common significant knee injuries in military service — especially for infantry, airborne, and combat support veterans who performed demanding physical activities. The rating approach depends on the post-injury or post-surgical status:
If the ACL or PCL was torn and not surgically repaired, the primary functional consequence is instability. Rate under DC 5257:
After ACL reconstruction (graft surgery), many veterans have improved stability but residual issues including:
After ACL reconstruction, the examiner should test stability with stress tests and measure ROM. Many veterans underestimate post-surgical instability because they've compensated with other muscles — but stress testing can objectively document remaining laxity.
Veterans who require total knee replacement — often as a long-term consequence of service-connected knee injuries and subsequent degenerative arthritis — receive special rating treatment. Under 38 CFR § 4.68 and the diagnostic codes for prosthetic replacement, a 100% rating is assigned for one year following the surgery. After one year, VA re-evaluates based on ROM and functional status of the replaced joint.
If the TKA results from a service-connected knee condition, the entire course of treatment — including the replacement and post-replacement residuals — is covered under service connection.
Many veterans have bilateral knee problems — affecting both the left and right knee. Each knee is rated independently, and when both have service-connected conditions, the bilateral factor under 38 CFR § 3.383 applies — adding 10% to the combined value of the bilateral knee ratings before combining with other disabilities.
For veterans who had bilateral knee injuries during service — common in infantry, airborne, and athletes — filing bilateral claims from the outset is important. The VA does not automatically rate both knees if you only file for one. Each knee requires its own documentation, nexus, and rating decision.
See our guide on VA Bilateral Factor and Combined Ratings for detailed calculation examples.
Knee injuries often have documented in-service events — a specific fall, training accident, vehicle accident, jump injury, or combat injury. These acute events create straightforward service connection pathways. More complex are chronic degenerative knee conditions that developed over time from cumulative service stress.
For chronic degenerative knee conditions (osteoarthritis, meniscal wear) without a single acute injury, the nexus letter must explain cumulative loading mechanisms and reference research on accelerated knee degeneration in military occupational groups.
Bilateral Knees + ACL Instability = Significant Combined Rating
Veterans with both knees rated at 20–30% under DC 5257 often see combined ratings of 40–50% for knee conditions alone, before accounting for associated back, hip, or ankle conditions. REE Medical orthopedic specialists can document knee instability and ROM with VA-ready precision.
Get a Knee Nexus Letter from REE Medical →claim.vet may receive a referral fee if you use this link. Veterans never pay more.
Editorial Standards: Written by Marcus J. Webb, veterans benefits researcher. Verified against current 38 CFR regulations. Last reviewed: July 2026. Not legal advice — for representation, talk to a VA-accredited attorney.
Knee claims under DC 5257–5262 have multiple rating pathways. A free review can identify which code and which evidence produces your highest rating.
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