The Knee and Lower Leg

Topics:

Loss of Use/Amputation of the Knee
Knee Replacement
Knee and Lower Leg Limitation of Motion
Too Much Motion or Dislocation
The Meniscus
Lower Leg Bones
Shortening of the Leg
Other Knee and Leg Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Loss of Use/Amputation of the Knee:

Code 5256: If the knee joint is frozen in place and cannot move at all, then it is rated depending on where it is frozen. If it is frozen in flexion 45° or more, then it is rated 60%. If it is frozen in flexion between 20° and 45°, then it is rated 50%. Between 10° and 20° is rated 40%, and between 0° and 10° is rated 30%.

flexion of the knee

Code 5163: If the leg has been amputated but the stump is bad and a second amputation at thigh level is recommended, then it is rated 60%. (This one is a bit odd and is probably only rarely used.)

Code 5164: If the amputation is at a place around the knee where the knee cannot be used at all, then it is rated 60%.

Code 5165: If the amputation is below the knee, and the knee can still move, then it is rated 40%.

Your condition may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

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Knee Replacement:

Code 5055: If the knee has been replaced by a prosthesis, then the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion, then it is rated 60%. If the pain is not severe, but does limit the range of motion, then it is rated under code 5256 if it is frozen, or under codes 5261 or 5262, discussed below, if it is not frozen. The minimum rating for a knee replacement, however, is 30% regardless of how much motion it has.

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Knee and Lower Leg Limitation of Motion:

Code 5261: If the knee is not frozen, but is limited in extension and cannot straighten all the way, then it is rated under this code. If the leg can only straighten to within 45° of being completely straight, then it is rated 50%. If it can straighten to 30°, it is rated 40%. To 20°, it is rated 30%. To 15°, it is rated 20%, To 10°, it is rated 10%, and to 5°, it is rated 0%.

extension of the knee

Code 5260: If the knee can straighten, but cannot bend all the way, then it is rated under this code. If the knee can only bend to 15°, then it is rated 30%. If it can bend to 30°, it is rated 20%. To 45°, it is rated 10%, and anything 60° or more is rated 0%.

Now if the knee can move, but cannot either bend all the way or straighten all the way, then it can be rated TWICE—once under code 5261, and once under this code 5260.

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Too Much Motion or Dislocation:genu recurvatum of the knee

Code 5263: Genu recurvatum is a condition where the knee bends too far backward. This is sometimes a genetic condition that does not really cause any problems. In these cases, it is not ratable. If it is a result of an accident or injury, however, and causes weakness and insecurity in the knee, then it is rated 10%.

Code 5257: The knee can also have too much motion from side to side or dislocate regularly. This can happen when the tendons and cartilage are damaged and can no longer support the knee joint properly. If there is only slight instability, then it is rated 10%. If there is more instability that might cause the knee to buckle or dislocate every now and then, then it is rated 20%. If, however, it is so unstable that it gives out or dislocates regularly, it is rated 30%.

Note: Instability can be rated in addition to other ratings for the knee.

So, if the knee has both limited motion and instability, it can be rated for both.

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The Meniscus:

The meniscus is a cartilage that helps pad the knee joint. Any cartilage condition in the knee can be rated under these codes.

Code 5258: If the cartilage frequently dislocates, causing pain, swelling and locking in the knee, it is rated 20%.

Code 5259: If the cartilage is removed, and there is pain or other symptoms in the knee, it is rate 10%.

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Lower Leg Bones:the tibia and fibula bones

Code 5262: Any problems with the tibia or fibula bones in the lower leg are rated under this code. If there is a complete break in either bone that cannot heal and requires a brace, then it is rated 40%. All other conditions are rated by how they affect the knee or ankle joint. If they cause serious problems (can barely use the joint at all), then it is a 30% rating. If the joints can be used, but the condition significantly limits the amount of activity, then it is rated 20%. If the knee or ankle joint is affected only slightly, then it is rated 10%.

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Shortening of the Leg:

Code 5275: If the bones in the lower leg have been shortened, it is rated under this code. The shortening of the lower leg can occur because of trauma or surgery. This does not refer to amputation, which is rated under a different code. This code and any other code for the bones of the leg CANNOT be used together. Only one or the other.

If the leg is more than 4 inches shorter, it is rated 60%. If it is 3.5 to 4 inches shorter, it is rated 50%. If it is 3 to 3.5 inches shorter, it is rated 40%. If it is 2.5 to 3 inches shorter, it is rated 30%. 2 to 2.5 inches is 20%, and 1.25 to 2 inches shorter is 10%.

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Other Knee and Leg Conditions:

All other knee or leg injuries or conditions will either be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings or on the condition itself. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact. So, if you have osteoporosis that affects the knee, search in the database for osteoporosis and then rate the condition appropriately. If the condition does not have an underlying disease to rate it under, then rate it on the condition above that best describes its symptoms.

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Principles that Apply:

The Amputation Rule: Any ratings for the knee and leg cannot be combined to be more than 40% for the leg below the knee and 60% for the knee down.

Painful Motion: If pain is present with motion, then the minimum rating must be given.

Special Monthly Compensation: If your condition makes it impossible to balance on or push off with your foot, you may qualify for the VA’s Special Monthly Compensation. You may also qualify if your leg has been amputated.

The Joints: When rating arthritis, the knee is considered a major joint.

Pyramiding: A single condition can only be rated once! However, if a nerve condition exists that is additional to the knee and leg condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. All ranges of motion should be measured with a goniometer. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For muscle conditions, see The Foot and Lower Leg Muscles page and The Buttock, Hip, and Thigh Muscles page.

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