Knee VA Claim Field Manual

Mission Brief

Limitation of knee flexion is the VA’s #2 most-awarded new disability—153,205 veterans added it to their files in FY 2024.1 Use this playbook to pin down ROM, instability, and meniscus findings so the rating schedule can’t be misapplied.

Knee ratings revolve around Diagnostic Codes 5256–5263 in 38 C.F.R. §4.71a. You need precise flexion/extension measurements, proof of recurrent instability, and evidence of dislocated cartilage or tibia/fibula impairment where applicable.

Pair this manual with the Claim Prep Checklist and your daily mobility logs. Every kneeling, squatting, or stair incident should be documented before the C&P exam.

  • Capture accurate ROM: have a clinician record flexion and extension with a goniometer per 38 C.F.R. §4.46 and note the angle where pain starts.
  • Document instability: submit Lachman, pivot shift, or varus/valgus stress test results to support ratings under Diagnostic Code 5257.2
  • Show functional loss: describe flare-ups, locking, swelling, or giving way and tie them to §4.40, §4.45, and §4.59.
  • Rate every component: evaluate arthritis (Diagnostic Code 5003), meniscus damage (5258/5259), and tibia/fibula impairment (5262) separately when the symptoms are distinct.

Situation Brief

Meniscus tears, instability, or post-traumatic arthritis can all support compensable ratings, but only if you show the VA how each symptom limits motion or stability. Plate II of 38 C.F.R. §4.71 lists normal knee ROM as 0° extension to 140° flexion—anything less must be documented with precision.

Signals You Need This

  • Post-service or service-connected records show chronic knee pain, swelling, or limited motion.
  • You use a brace, cane, or have documented episodes of the knee giving way or locking.
  • Imaging confirms degenerative joint disease, meniscal damage, or residuals from an ACL, MCL, or patellar injury.

Stay on Course

Write a knee-specific pain journal that covers walking distance, stairs, and flare-ups. The rater should see how each activity erodes your reliability and productivity.

  • Note the frequency of injections, aspirations, or physical therapy sessions that address instability or pain.
  • Record work accommodations, limited duty waivers, or missed formations tied to knee symptoms.
  • Photograph or video brace use, stair modifications, or other adaptive equipment at home.

Align your journal entries with medical visits so the story is consistent from the clinic to the claims file.

Prep Checklist

Do not walk into a C&P exam cold—stage every data point before you file or appeal.

  • Print the Knee and Lower Leg DBQ and complete it with a treating clinician.
  • Capture flexion and extension ROM after three repetitions and during flare-ups, noting when pain starts.
  • Collect instability test results (Lachman, pivot shift, drawer tests) and note prescribed braces or assistive devices.
  • Gather imaging—X-rays, MRIs, arthroscopy reports—showing cartilage damage, arthritis, or loose bodies.
  • Document meniscus symptoms (locking, effusion) and surgeries for ratings under Diagnostic Codes 5258 and 5259.
  • Upload lay statements from supervisors or family describing how your knee limits employment, driving, or caregiving.

Label uploads by diagnostic code (e.g., “DC-5260-ROM-Log.pdf”) so raters instantly see the connection.

Step-by-Step Playbook

  1. Map the Medical Record: List every diagnosis, surgery, injection, and PT cycle. Match each to the relevant diagnostic code so you know what the VA should rate.
  2. Log Functional Loss: Use a daily tracker to capture flare-ups, instability episodes, and the distance you can walk before resting.
  3. Prep the DBQ & Imaging Bundle: Complete the DBQ, attach imaging, and highlight sections that align with Diagnostic Codes 5257, 5260, and 5261.
  4. Rehearse the C&P Exam: Practice describing painful motion, instability, and assistive device use. Bring your brace and logs to the exam.
  5. Audit the Decision: Compare the VA’s findings against §4.71a. Appeal quickly if the rater ignored painful motion, repetitive-use findings, or instability.

Evidence Arsenal

Blend measurable data with credible narratives so adjudicators see both structural damage and real-world impact.

Medical Proof

  • Goniometer-based ROM worksheets showing flexion/extension limits and pain onset.
  • Instability testing (positive Lachman, pivot shift, varus/valgus stress) with clinician commentary.
  • Imaging: MRI, arthroscopy reports, or X-rays documenting ligament tears, arthritis, or cartilage loss.
  • Operative notes and rehabilitation summaries for knee replacements, meniscus repairs, or ligament reconstructions.

Lay & Occupational Proof

  • Daily pain and mobility logs tracking stairs, squats, or time on feet.
  • Workplace accommodations, duty limitation chits, or FMLA/leave documents tied to knee flare-ups.
  • Statements from battle buddies or family covering instability episodes, falls, or assistive device reliance.
  • Photos/video of bracing, taping, or orthotic adjustments.

Pro Tip Explain how flare-ups limit additional ROM per §4.40 and §4.45; raters must consider functional loss beyond static measurements.

Intel & Tools

Target the resources that move knee claims across the finish line.

Related Questions

Related Tips

Update your file whenever new imaging, injections, or assistive devices are prescribed so later reviews show a worsening trajectory.

Next Actions & Support

Stay Organized

  • Refresh ROM logs quarterly or after major flare-ups.
  • Add every PT progress note and injection report to your evidence binder.
  • Schedule follow-up appointments when instability worsens or new bracing is prescribed.

More Routes

  • Secondary playbook. Connect hip, ankle, or back issues aggravated by altered gait.
  • Denied already? File a Supplemental Claim with updated ROM or instability testing.
  • Scan the Intel Archive for knee-specific tactics veterans used to challenge low ball ratings.

Knee Claim FAQs

Yes, when symptoms are distinct. Rate limitation of flexion under Diagnostic Code 5260, limitation of extension under 5261, and recurrent instability under 5257. Make sure the evidence differentiates each limitation.2
Submit a statement requesting compliance with §4.46 and §4.59. Provide private ROM measurements showing the exact angle where pain begins and how far you can move despite the pain.
Have your orthopedist note frequent episodes of locking, pain, and effusion into the joint—those are the criteria for a 20% rating under DC 5258. Include arthroscopy reports or MRI results showing dislocated cartilage.2

Stay in the Knee Intel Loop

Short briefs when VA knee rating guidance shifts—new DBQs, exam procedures, or diagnostic code updates.