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Knee

Knee and lower leg

What it is

Your knee is the hinge in the middle of your leg; VA can rate how far it bends, how close it gets to straight, whether it gives way, and torn or removed cartilage, sometimes as separate ratings.

Normal movement (what VA counts as normal)

  • Flexion (bend)0 to 140°
  • Extension (straighten)0 (fully straight)

VA's code numbers for this: 5256, 5257, 5258, 5259, 5260, 5261, 5262, 5263, 5055, 5003, 5010

What the examiner will do

  • The examiner asks how and when the problem started, what treatment you have had, and how it affects work and daily life.
  • They ask about flare-ups: how often, how long, what sets them off, and what you cannot do during one.
  • They measure how far you can move the joint yourself (active motion) with a goniometer. They should note where pain begins.
  • They move the joint for you (passive motion). They test it with weight on it and without weight on it. They compare it to your other side if that side is healthy. (Correia v. McDonald, 2016; 38 CFR 4.59.)
  • They have you repeat each motion at least 3 times, then measure again (repetitive-use testing).
  • They check strength, muscle loss (atrophy), tenderness, and whether the joint is stuck (ankylosis).
  • They look at X-rays or other imaging, or order them.
  • They ask about braces, canes, or other devices and how often you use them.
  • Stability tests: the examiner pushes and pulls the lower leg in set directions (for example Lachman or drawer tests) to check the ligaments and the kneecap.
  • Meniscus questions: locking, catching, swelling (fluid), and any cartilage surgery.
  • Questions about whether a medical provider PRESCRIBED a brace, cane, crutch, or walker. The 2021 rules tie instability ratings to a prescription.

The examiner fills out a form called a DBQ. You can read it ahead of time: Knee and Lower Leg Conditions DBQ (updated 2026-07-31) (opens VA's site).

The rating levels, in plain words

VA rates most joints by how far they move. The less you can move, the higher the level.

Flexion (bend)

  • Up to 60°

    0%

    Can bend to 60 degrees but not past it: 0% (unless painful; see the painful-motion row).

    Rule: 38 CFR 4.71a, DC 5260

  • Up to 45°

    10%

    Can you bend your knee only to about 45 degrees (half of a right angle)? That is 10%.

    Rule: 38 CFR 4.71a, DC 5260

  • Up to 30°

    20%

    Only to about 30 degrees: 20%.

    Rule: 38 CFR 4.71a, DC 5260

  • Up to 15°

    30%

    Only to about 15 degrees, barely bends: 30%.

    Rule: 38 CFR 4.71a, DC 5260

Extension (straighten)

  • Stays 5° or more short of straight

    0%

    Stays 5 degrees short of straight: 0%.

    Rule: 38 CFR 4.71a, DC 5261

  • Stays 10° or more short of straight

    10%

    Cannot straighten; stays 10 degrees bent: 10%.

    Rule: 38 CFR 4.71a, DC 5261

  • Stays 15° or more short of straight

    20%

    Stays 15 degrees bent: 20%.

    Rule: 38 CFR 4.71a, DC 5261

  • Stays 20° or more short of straight

    30%

    Stays 20 degrees bent: 30%.

    Rule: 38 CFR 4.71a, DC 5261

  • Stays 30° or more short of straight

    40%

    Stays 30 degrees bent: 40%.

    Rule: 38 CFR 4.71a, DC 5261

  • Stays 45° or more short of straight

    50%

    Stays 45 degrees bent: 50%.

    Rule: 38 CFR 4.71a, DC 5261

Instability (ligament)

  • 10%

    Knee gives way from a sprain or ligament tear (repaired or not), and no provider has prescribed a brace, cane, crutch, or walker for walking: 10%.

    Rule: 38 CFR 4.71a, DC 5257

  • 20%

    Sprain, partial tear, or repaired complete tear with ongoing giving way AND a provider prescribed a brace and/or cane/crutch/walker; OR an unrepaired or failed-repair complete tear with a prescription for a cane/crutch/walker OR a brace: 20%.

    Rule: 38 CFR 4.71a, DC 5257

  • 30%

    Unrepaired or failed-repair complete ligament tear with ongoing giving way AND a provider prescribed BOTH a brace AND a cane, crutch, or walker for walking: 30%.

    Rule: 38 CFR 4.71a, DC 5257

Kneecap instability

  • 10%

    Kneecap keeps slipping (with or without past surgery) and no prescription for a brace, cane, or walker: 10%. After surgical repair with a prescription for one of brace, cane, or walker: 20%. After surgical repair with a prescription for a brace AND a cane or walker: 30%.

    Rule: 38 CFR 4.71a, DC 5257

Torn meniscus (cartilage)

  • 20%

    Torn/dislocated cartilage with frequent locking, pain, and swelling (fluid) in the joint: 20%.

    Rule: 38 CFR 4.71a, DC 5258

Meniscus removed

  • 10%

    Cartilage was surgically removed and you still have symptoms: 10%.

    Rule: 38 CFR 4.71a, DC 5259

Painful motion

  • 10%

    Knee moves close to normal but motion is painful from injury or arthritis: at least 10%.

    Rule: 38 CFR 4.59; DC 5003

Ankylosis (knee fused/stuck)

  • 30%

    Stuck straight or bent 0-10 degrees: 30%. Bent 10-20: 40%. Bent 20-45: 50%. Bent 45 or more: 60%.

    Rule: 38 CFR 4.71a, DC 5256

Measured at home? Check which level your number falls in.

Measure it at home

With a helper and a cheap tool. Your home numbers help you describe your bad days honestly at the exam.

The tool to get

  • Best: a clear plastic goniometer (say GO-nee-OM-eh-ter). It looks like a protractor with two long arms joined by a pin. A 12-inch, 360-degree one costs about $5 to $10 online or at a medical supply store. This is the same kind of tool most examiners use.

  • Free: a phone goniometer or inclinometer (angle-measuring) app. Many are free. Tape or hold the phone flat along the body part, set it to zero at the start, then move.

  • No money and no phone: print a paper protractor (half circle, 0 to 180 degrees) on stiff paper. Tape two straws or paper strips to the center with a brad so they swing. Lay it against the joint.

  • A pen and the log sheet below. A second person (spouse, adult child, friend) to hold the tool, because you cannot measure yourself well.

No tool yet? Print our paper protractor below.

Step by step, with a helper

  1. 1. Flexion (bend)

    How to stand or lie
    Lie on your back on a firm bed or the floor. Slide your heel toward your rear end. (Or lie on your stomach and bend the knee up.)
    Where the tool goes
    Pin on the outside of the knee, at the bony bump on the side of the thigh bone. Fixed arm points up the outside of the thigh toward the bony bump at the side of the hip. Moving arm points down the outside of the shin toward the outside ankle bone.
    Who holds what
    Helper keeps the pin on the knee bump, follows the lower leg, and reads the number when you say 'pain' and when you stop. Do not let the helper push your leg for this count.

  2. 2. Extension (straighten)

    How to stand or lie
    Lie on your back with a rolled towel under your ankle (not under the knee). Let the knee straighten as much as it can.
    Where the tool goes
    Same placement as flexion. Fully straight reads 0. If it stays bent, the number you read is how many degrees short of straight.
    Who holds what
    Helper reads how many degrees bent the knee stays. Write it as 'lacks __ degrees.'

  3. 3. Giving way (no tool)

    How to stand or lie
    Daily life, not a test. Do not try to make your knee give out.
    Where the tool goes
    No tool. Log each time the knee buckles or slips: date, what you were doing, whether you fell.
    Who holds what
    Spouse writes down falls or near-falls they see. These can go in a lay statement (VA Form 21-10210).

Stop at the first real pain. Never force a joint to get a number. Stand close for balance during back and hip tests.

Check your number

1. Which motion did you measure?

Type the number where you had to stop.

degrees

Type your number above to see where it falls.

This is only to help you understand. The VA examiner measures and the VA decides.

The levels for flexion (bend):

  • 0° to 15°30%
  • 16° to 30°20%
  • 31° to 45°10%
  • 46° to 60°0%

If your number is close to the next level, VA may give the higher one (38 CFR 4.7).

Your log: what to write each time

  1. DateExample: 10/12
  2. TimeExample: 7 pm
  3. Good day or flare-up day?Example: Flare-up day
  4. Body part and side (R/L)Example: Right knee
  5. MotionExample: Bend knee
  6. Degrees where pain STARTSExample: 70
  7. Degrees where you had to STOPExample: 85
  8. After 3 tries: degrees where you stopExample: 75
  9. Pain 0-10Example: 7
  10. Medicine taken today (what and when)Example: Ibuprofen 8 am
  11. Who measuredExample: Spouse
  12. Notes (clicking, giving way, swelling)Example: Hurt more after the 3rd try

Write it down (one line per try):

Measure on a normal day and again on a bad day. Do it 2 or 3 times over a few weeks. Bring the sheet to the exam.

Tap Print this page to get a blank log sheet and your exam-day checklist on paper.

Printable paper protractor

01801516530150451356012075105909010575120601354515030165151800Center: push a brad through this dot
  • Print at 100% scale; check the 90° line with a square corner (like the corner of a sheet of paper).
  • Glue it to stiff paper or a cereal box. Push a brad through the center dot.
  • Tape two paper strips or straws to the brad so they swing. One stays on the body part that doesn't move. The other follows the moving part.
  • The top numbers count from the left. The small numbers count from the right. Use whichever side starts at 0.

This is only to help you understand. The VA examiner measures and the VA decides.

Exam-day checklist

Tick each one off. Nothing you tick is saved or sent anywhere.

Tell the examiner

Flare-ups

A flare-up is a time when your joint gets much worse for a while. The examiner must ask about your flare-ups and estimate, in degrees, how much motion you lose during them, even if your exam is on a good day (Sharp v. Shulkin, 2017). They can only skip this if they explain why after getting your information. Be ready to say: how often (for example, 2 times a week), how long each lasts (for example, 1 to 2 days), what triggers it, and exactly what you cannot do (for example, 'I can't lift my arm to comb my hair'). If you measured at home on a flare-up day, show that number.

Repeated use

The examiner will have you do each motion at least 3 times and then measure again. Tell them if pain, weakness, tiredness, or poor control gets worse with each try. The form also asks about repeated use over time, like at the end of a workday. Pain alone does not raise a rating; pain that actually limits how far, how strong, or how long you can move does (Mitchell v. Shinseki, 2011; DeLuca v. Brown, 1995; 38 CFR 4.40 and 4.45).

Honest exam rules

  • Move each joint until pain starts. Say 'pain starts here' out loud. Stop when pain or stiffness stops you. Do not push through sharp pain to look tough. Do not stop before pain or stiffness really stops you, either. The examiner writes down both points.
  • Give your real, full effort on strength tests. The goal is an exam that shows how you truly are.
  • Describe a typical day AND your worst days. Bad days count, but say they are bad days and how often they happen.
  • Take your medicine the way you normally do. Do not skip it, and do not take extra just for the exam. Tell the examiner what you took and when, and how you are when it wears off. (Court decisions Jones v. Shinseki (2012) and Ingram v. Collins (2025) say VA should not lower a joint rating because medicine helps, when the rating rules do not mention medicine. VA tried to change this by rule in February 2026 and took the change back on February 27, 2026.)
  • Wear or bring any brace, cane, crutches, or walker you normally use. Bring the prescription or a record showing a provider ordered it.
  • Bring a one-page list: your diagnoses, surgeries, treatments tried, medicines, how often you have flare-ups, your home measurement log, and what you can no longer do at work and at home.
  • If you do not know or do not remember, say so. Do not guess.
  • Fraud warning: knowingly giving VA false information is a federal crime (18 U.S.C. 1001) and can cost you all VA benefits (38 U.S.C. 6103). Honest, complete reporting is all you need.

Common mistakes

  • Pushing through pain so the examiner only writes down your end point. Painful motion is a key factor, and the exam should record where pain starts.

    Where this comes from: 38 CFR 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011); Mitchell v. Shinseki, 25 Vet. App. 32 (2011)

  • Saying 'I'm fine' or only describing a good day. Flare-ups that are not described cannot be estimated.

    Where this comes from: Sharp v. Shulkin, 29 Vet. App. 26 (2017); DBQ flare-up section

  • An exam that skipped passive motion, weight-bearing testing, or the opposite joint. That exam may be inadequate; you or your representative can point this out.

    Where this comes from: Correia v. McDonald, 28 Vet. App. 158 (2016)

  • Not asking for at least the minimum rating when the joint is actually painful, unstable, or out of line from an old injury.

    Where this comes from: 38 CFR 4.59; Petitti v. McDonald, 27 Vet. App. 415 (2015)

  • Getting only one rating when the knee is limited in BOTH bending and straightening. These can be rated separately.

    Where this comes from: VAOPGCPREC 9-2004; 38 CFR 4.71a DCs 5260 and 5261

  • Not claiming instability separately from loss of motion or arthritis.

    Where this comes from: VAOPGCPREC 23-97 and 9-98; 38 CFR 4.71a DC 5257

  • Not claiming the meniscus (cartilage) separately. A meniscus rating is not automatically blocked by a motion rating, as long as it is for different symptoms.

    Where this comes from: Lyles v. Shulkin, 29 Vet. App. 107 (2017); 38 CFR 4.14

  • Using a brace or cane you bought yourself, with no prescription in your records. Since Feb. 7, 2021, the 20% and 30% instability levels require a provider's prescription.

    Where this comes from: 38 CFR 4.71a DC 5257 (85 FR 76453)

Questions to ask together

A spouse, grown child or friend can read these out loud. Talk about each one before the exam, so nothing gets left out.

  1. Can you walk down a flight of stairs without holding the rail?
  2. Has your knee given out or made you fall in the last 3 months?
  3. Can you kneel or squat to pick something up off the floor?
  4. Does your knee lock, catch, or swell up?
  5. Did a doctor give you a brace or cane, or did you buy it yourself?

Sources

Checked against VA's rules on October 30, 2026.

Helping The Brave doesn't file or prepare claims. This guide is free education, not medical or legal advice. The VA examiner measures and VA decides your rating.