Rating Schedule for the Knee and Lower Leg
IMPORTANT NOTE:
For the purposes of Range of Motion (ROM), the examiner/rater are REQUIRED to consider flair ups in your conditions. Meaning, if you do not happen to have an Examination on your worst day, the examiner is required to reasonably estimate your impairment on your worst day! The rater is required to use this estimate, unless your ROM is somehow noted as being worse during ROM testing during the exam. In any event, the rater is to use the most impaired ROM measurements noted by the examiner!
5163, 5164, 5165 Amputation
Veterans must be aware of the Amputation Rule. It boils down to a Veteran cannot be rated higher for disabilities of a limb that would Combine to be more than a Veteran who has had an amputation that resulted in a loss of those areas.
NOTE:
Veterans who have had these amputations are entitled to Special Monthly Compensation.
| Rating |
Degree of Amputation |
|---|---|
| 40% |
Below the knee. |
| 60% | Amputation not improvable by prosthesis controlled by natural knee action. |
| 60% | With defective stump, thigh amputation recommended. |
Knee Replacement (Prosthesis) or Resurfacing
IMPORTANT NOTES:
If the knee joint had ANY other musculoskeletal knee evaluations (ankylosis, instability, range of motion, etc.) they WILL BE discontinued the date of the procedure!
If AFTER, your temp 100% ends you think your evaluation should be higher you CAN file an Increase claim.
As knee resurfacing does not have a minimum evaluation an examination after the temp 100% ends is REQUIRED!
Since the total knee replacement has a minimum evaluation a reexamination is NOT required.
Medical evidence MUST show:
Date of admission;
Date of discharge;
Date of surgery; AND
Procedure performed.
If the procedure is noted for a non-service-connected condition then the VA will get a medical opinion to determine if the non-service-connected condition is a progression of the service-connected condition.
RATER NOTES:
Do NOT keep an open ended 100%! If you do not have an examination conducted AFTER the 100% ends for a resurfacing - you will return the knee to the evaluation(s) it had before the procedure and order an At once examination and END the temp 100%!
Temp 100% includes a bonus 1 month due to 38 CFR 4.30, so while it says 4 months it is actually 5 months total!
Example: Admitted for surgery June 12, 2025 and release June 12, 2025.
Effective date of 100% due to 38 CFR 4.30 is June 12, 2025 to August 1, 2025. Then 4 months due to the schedule ending on December 1, 2025. So in the end, temp 100% runs from June 12, 2025 to December 1, 2025.
Example rollover: Admitted for surgery February 28, 2025 and released March 2, 2025.
Effective date of 100% due to 38 CFR 4.30 is February 28, 2025 to May 1, 2025. Then 4 months due to the schedule ending on September 1, 2025. So in the end, temp 100% runs from February 28, 2025 to September 1, 2025.
Remember to check for temporary entitlement to SMC S and to discontinue it as appropriate!
Any residual Scars?
Temporary 100% CANNOT be the basis of the award of Permanent and Total… It is in the name…
Separate musculoskeletal knee evaluations are NOT allowed while the knee is rated under this Diagnostic code! In the rare event it would be better to continue to rate under a different diagnostic code(s) this is allowed so long as this diagnostic code is made secondary.
5055 Total Knee Replacement (Prosthesis)
| Rating |
Description |
|---|---|
| 30% |
Minimum rating. |
| 60% | Chronic residuals consisting of severe painful motion or weakness in the affected extremity. |
| 100% | For 4 months following the replacement. |
Ratings Based Off Limitations of Range of Motion (ROM)
How well you can move your knee joint.
PYRAMIDING NOTE:
The Veteran CAN receive two separate ROM ratings. If the Veteran's flexion and extension are both affected by their disability!
5260 Flexion of Leg
Veteran can straighten their leg but they CANNOT bend it fully.
| Rating |
Can Bend To |
|---|---|
| 0% |
46°-60°. |
| 10% | 31°-45°. |
| 20% | 16°-30°. |
| 30% | 15° or less. |
Ratings Based Off Too Much Motion
When your Knee is Gumby.
IMPORTANT NOTE:
There MUST be objective evidence of a prescribed assistive device in order to get the increased evaluation for it. Meaning, unless you give evidence showing it was prescribed you CANNOT rate over 10%!
PYRAMIDING NOTES:
The Veteran CAN receive separate ratings for instability and ROM limitations!
The Veteran can NOT receive more than one instability rating!
5257 Recurrent Subluxation or Lateral Instability
Subluxation refers to partial or incomplete dislocation of the knee joint (tibiofemoral dislocation/subluxation) or tendency for the kneecap to dislocate from its track (patellar dislocation/subluxation).
| Rating |
Description |
|---|---|
| 10% |
Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing knee to give out regularly, WITHOUT a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for walking. |
| 20% | Either a OR b: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing knee to give out regularly, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for walking. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for walking. |
| 30% | Unrepaired or failed repair of complete ligament tear causing knee to give out regularly, and a medical provider prescribes BOTH an assistive device (e.g., cane(s), crutch(es), walker) AND bracing for walking. |
5257 Kneecap Instability (Patellar Instability)
Instability
Patellar instability due to recurrent patellar subluxation or patellar dislocation, and/or;
Any other instability or laxity of the knee that involves other stabilizing structure of the knee such as the collateral or cruciate ligaments.
NOTES:
For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon.
A surgical procedure that does NOT involve repair of one or more patellofemoral components that contribute to the underlying instability does NOT qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration).
| Rating |
Description |
|---|---|
| 10% |
A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does NOT require a prescription from a medical provider for a brace, cane, or walker. |
| 20% | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. |
| 30% | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace AND either a cane or a walker. |
5263 Knee Hyperextension (Back Knee, Genu Recurvatum)
When your knee bends the wrong direction.
Usually results in weakness and insecurity when bearing weight.
IMPORTANT NOTE:
The condition MUST be witnessed by the examiner in order to get a rating!
PYRAMIDING NOTES:
You CANNOT get a separate evaluations for this condition and limitation of extension OR under instability. You would be rated under whichever schedule produces the highest rating (or this schedule if appropriate).
You CAN get a separate evaluation for condition and limitation of flexion.
| Rating |
Description |
|---|---|
| 10% |
Condition exists. |
5258, 5259 The Meniscus (Cartilage, Semilunar, Dislocated/Removed)
That cartilage located in the Knee joint.
PYRAMIDING NOTE:
If the symptoms of this schedule are used in a separate rating, the VA CANNOT award a separate rating under this schedule! IE if the pain and swelling is accounted for in a ROM rating, a separate rating under this schedule is prohibited!
| Rating |
Description |
|---|---|
| 10% |
Cartilage is removed and there are residual symptoms. |
| 20% | Cartilage is dislocated and frequently has episodes of “locking,” pain, and swelling into the joint. |
Tibia and Fibula Bones
The bones in your calf.
PYRAMIDING NOTE:
The Veteran can only get ONE rating for tibia and fibula impairment OR Shin Splints.
5262 Tibia and Fibula Impairment
If the bones healed improperly or never heal at all.
| Rating |
Description |
|---|---|
| ?% |
If either bone healed improperly. It will be rated by how it affects ROM of the knee or Ankle joints. |
| 40% | Either bone remains broken and will NOT heal AND requires a brace. |
5262 Shin Splints (Medial Tibial Stress Syndrome (MTSS))
| Rating |
Description |
|---|---|
| 0% |
Treatment LESS THAN 12 consecutive months, 1 or both legs. |
| 10% | Requiring treatment for NO LESS than 12 consecutive months, AND unresponsive to either shoe orthotics or other conservative treatment, 1 OR both legs. |
| 20% | Requiring treatment for NO LESS than 12 consecutive months, AND unresponsive to surgery AND either shoe orthotics or other conservative treatment, 1 leg. |
| 30% | Requiring treatment for NO LESS than 12 consecutive months, AND unresponsive to surgery AND either shoe orthotics or other conservative treatment, BOTH legs. |
RATER NOTE:
Regarding pain with motion - if the Veteran's BILATERAL shin splints causes pain that impairs movement of the knee or ankle a SINGLE pain with motion rating of 10% can be granted! However, this pain with motion rating CANNOT be applied if the Veteran has a separate diagnosed knee or ankle condition in which this principle is already being applied!
Examples:
X = Has pain with motion.
| L Ankle | L Knee | L Shin | R Ankle | R Knee | R Shin | Description |
|---|---|---|---|---|---|---|
| X | X | X | X | X | X | Pain with motion CANNOT be applied to shins. |
| X | X | A single rating of 10% for bilateral shin splints. | ||||
| X | X | Left shin splints CAN get a 10% IF the shin impairs the knee. | ||||
| X | X | X | Bilateral shin splints CAN get a single 10% IF the shins impair the knee. |
5275 Shortening of the Leg
When the Veteran has their leg shortened as a result of trauma or a service-connected surgery.
PYRAMIDING NOTES:
Separate ratings for ROM and leg length ARE allowed.
Separate ratings for tibia or fibula impairment are NOT allowed (based on the same leg).
NOTE:
Measured from anterior superior spine of the ilium to the internal malleolus of the tibia.
| Rating |
Shortening of |
|---|---|
| 10% |
1.25 to 2 inches. |
| 20% |
2 to 2.5 inches. |
| 30% | 2.5 to 3 inches. |
| 40% | 3 to 3.5 inches. |
| 50% | 3.5 to 4 inches*. |
| 60% | Over 4 inches*. |
*Entitles the Veteran to Special Monthly Compensation.
Miscellaneous Ratings
The Veteran will NOT receive an additional rating if they fit the criteria of any of these miscellaneous cases. The Veteran will get a single rating for the ROM or Miscellaneous rating; Whichever rating is higher!
Pain with Motion
PYRAMIDING NOTE:
When there is an award based on pain with motion with movement of the knee. The VA will only award a SINGLE rating under range of motion per limb! No matter how many ranges of motion are impacted!
| Rating |
Description |
|---|---|
| 10% |
Pain with motion. |
Arthritis
When a Veteran's arthritis does not warrant a rating based upon ROM or other miscellaneous situations. The Veteran's condition will be rated under degenerative arthritis.
For an explanation of arthritis ratings click HERE.
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