Condition Guide · Bilateral common
Knee VA rating 2026 — DC 5257–5261
Updated June 2026 · CFR source: 38 CFR §4.71a
Knee conditions are among the most common service-connected musculoskeletal disabilities. They are rated under multiple diagnostic codes in 38 CFR §4.71a depending on the type of impairment. When both knees are service-connected, the bilateral factor applies — adding a 10% bonus that frequently pushes veterans up a full rating tier.
Rating schedules
DC 5260 — Limitation of flexion, knee
| Rating | 2026 monthly | Flexion limited to |
|---|---|---|
| 30% | $552.47 | 15° or less |
| 20% | $356.66 | 30° or less |
| 10% | $180.42 | 45° or less |
| 0% | $0 | 60° or less |
DC 5261 — Limitation of extension, knee
| Rating | 2026 monthly | Extension limited to |
|---|---|---|
| 50% | $1,132.90 | 45° or more |
| 40% | $795.84 | 30° |
| 30% | $552.47 | 20° |
| 20% | $356.66 | 15° |
| 10% | $180.42 | 10° |
| 0% | $0 | 5° |
DC 5257 — Knee, other impairments (instability/subluxation)
| Rating | 2026 monthly | Criteria |
|---|---|---|
| 20% | $356.66 | Moderate recurrent subluxation or lateral instability. |
| 10% | $180.42 | Slight recurrent subluxation or lateral instability. |
Service connection for knee conditions
Establishing service connection for a knee condition requires three elements:
- Current diagnosis. A physician-confirmed diagnosis of the knee condition — whether meniscus tear, ligament injury, patellofemoral syndrome, degenerative joint disease, or arthritis.
- In-service event or injury. Documentation of in-service knee trauma, sustained physical activity (road marching, airborne operations, heavy lifting), or symptoms during service. Service treatment records showing knee complaints are the strongest evidence.
- Nexus. A medical opinion linking the current knee condition to in-service activity. For degenerative conditions developing years after service, a nexus letter from an orthopedist or physician stating the condition is "at least as likely as not" caused by military service is often required.
Secondary service connection is also available: knee conditions can be service-connected as secondary to other SC conditions. Common examples include knee degeneration secondary to an SC ankle or hip condition that altered gait, or knee degeneration secondary to years of SC lower-back pain causing abnormal weight-bearing.
C&P exam — what to document
The knee C&P exam focuses on range of motion measurements. Maximize your rating by being thorough:
- State the angle at which pain begins, not just maximum ROM. Under 38 CFR §4.59 (painful motion), pain onset matters even when maximum flexion/extension is within the compensable range.
- Describe flare-ups. Explain how often your knee flares up, how long flares last, and what you cannot do during a flare (walking, climbing stairs, kneeling). Flare-up frequency supports a higher effective functional rating.
- Report instability. Describe any giving-way, buckling, or locking episodes — these may support a separate DC 5257 (instability) rating in addition to a ROM rating.
- Both knees. If both knees are affected, ensure both are examined so the bilateral factor (§4.26) can be applied. Do not allow the examiner to evaluate only the worse knee.
- Bring imaging. MRI reports documenting structural changes (meniscus tears, cartilage loss, ligament damage) support the objective findings the examiner records.
Bilateral factor impact on knee ratings
If both knees are service-connected, the bilateral factor adds 10% to the combined knee sub-total. Example:
- Left knee 20% + right knee 20% (bilateral group): combined = 36%.
- Bilateral bonus: 36% × 1.10 = 39.6%.
- With PTSD 50%: 50 + (39.6% of 50%) = 50 + 19.8 = 69.8% → rounds to 70%.
- Without bilateral: 50 + (36% of 50%) = 50 + 18 = 68% → rounds to 70%. (Same in this case.)
- Without PTSD — knee-only combined: 39.6% → 40% vs 36% → 40%. Same bracket, but pre-rounding difference may matter with more conditions.
Pain on use — extra credit
Under 38 CFR §4.59 (painful motion), VA must assign at least a minimal compensable rating (10%) for a joint that is painful on use, even if the measured range of motion technically falls in the 0% bracket. Document pain during the C&P exam — stating "pain begins at X degrees" on the examiner's ROM worksheet matters.
FAQ
Which knee diagnostic code gives the highest rating?
DC 5261 (limitation of extension) allows ratings up to 50% and generally produces higher ratings than DC 5260 (limitation of flexion) for the same degree of impairment. VA will rate whichever code — 5257, 5260, 5261, or analogous — produces the highest combined result for your specific knee impairment.
Do I get separate ratings for my left and right knee?
Yes. Each knee is rated separately. If both knees are service-connected, the bilateral factor (38 CFR §4.26) applies — adding a 10% bonus on the combined knee sub-total before folding with other ratings. This is often the difference between 40% and 50% combined.
Can I get rated for both instability (5257) and limited range of motion (5260/5261) of the same knee?
Generally no — this would be pyramiding under 38 CFR §4.14. VA rates the single diagnostic code that best reflects the overall knee impairment. However, if you have genuinely distinct manifestations (e.g., instability AND degenerative arthritis causing separate functional limitations), separate ratings may be warranted under different diagnostic codes.
What is the standard range of motion exam for knee rating?
Normal knee flexion is 0–140°. Normal extension is 0° (full extension). VA measures both during a C&P exam. Limitation of flexion rated under DC 5260: 15° = 30%; 30° = 20%; 45° = 10%; 60° = 0%. Limitation of extension (DC 5261): 45° = 50%; 30° = 40%; 20° = 30%; 15° = 20%; 10° = 10%; 5° = 0%.
Related: Bilateral factor · Lower back · Shoulder