DC 5261 · 38 CFR 4.71a
Knee and Lower Leg C&P Exam Prep
To document the current severity and functional impact of a knee or lower leg condition rated under DC 5261 (limitation of extension of the knee), ensuring the examiner captures all findings necessary for an accurate VA disability rating under 38 CFR - 4.71a.
- Format:
- Interview + Physical
- Typical duration:
- 30-45 minutes
- DBQ form:
- Knee_and_Lower_Leg (Knee_and_Lower_Leg)
- Examiner:
- Physician or Physician Assistant
What the examiner evaluates
- Active and passive range of motion (ROM) of knee flexion and extension with goniometer
- Pain on active motion, passive motion, weight-bearing, and non-weight-bearing
- ROM testing after repetitive use (3 repetitions) to capture DeLuca functional loss
- Flare-up history and estimated additional ROM loss during flare-ups
- Muscle weakness, fatigability, incoordination, and lack of endurance
- Joint instability (lateral, medial, anterior, posterior)
- Joint effusion, swelling, locking, and crepitus
- Ankylosis (fixed position) and severity
- Surgical history (meniscectomy, ACL/PCL repair, total knee replacement, resurfacing)
- Assistive devices used (cane, crutches, brace, walker, wheelchair)
- Leg length discrepancy
- Muscle atrophy measurements
- Scars and other residuals
- Functional impairment with sitting, standing, and locomotion
- Imaging and diagnostic test results
Exam typically conducted in a clinical setting. ROM will be measured with a goniometer. You will be asked to stand, walk, sit, and perform knee movements. Wear loose-fitting clothing or shorts for easy access to the knee. Bring your brace or assistive device if you use one regularly. You have the right to request that the exam be recorded in most states - confirm your state's law in advance.
Measurements and tests
Knee Flexion - Active Range of Motion
What it measures: How far you can actively bend your knee toward your buttock; normal is 0-140-.
What to expect: The examiner will ask you to bend your knee as far as you can while seated or prone. A goniometer is placed along the leg to measure degrees of movement.
Critical thresholds
- Less than 45- Significant impairment; may support higher rating under related DCs
- Less than 60- Moderate-to-severe limitation
- Less than 90- Moderate limitation of flexion
Tips
- Move only as far as pain allows - do not push through pain to appear more capable.
- If the exam is on a good day, tell the examiner your motion is typically worse and describe your worst-day ROM.
- Request that the examiner document where pain begins, not just where motion ends.
Pain considerations: Inform the examiner immediately when pain starts during motion, even if you can move further. Under DeLuca, pain that limits motion should be documented as a separate point from the anatomical end-range.
Knee Extension - Active Range of Motion (DC 5261 Key Measurement)
What it measures: How fully you can straighten your knee; normal is 0- (full extension). DC 5261 rates limitation of extension specifically.
What to expect: The examiner will ask you to straighten your leg as fully as possible while seated or lying down. They will measure the angle at which you can no longer extend further. A lack of full extension (e.g., knee stuck at 15- from straight) is a 'flexion contracture.'
Critical thresholds
- Extension limited to 45- (45- flexion contracture) 60% rating under DC 5261
- Extension limited to 30- 50% rating under DC 5261
- Extension limited to 20- 40% rating under DC 5261
- Extension limited to 15- 30% rating under DC 5261
- Extension limited to 10- 20% rating under DC 5261
- Extension limited to 5- 10% rating under DC 5261
Tips
- Fully relax your leg - active guarding due to pain may make extension appear better than it truly is.
- Tell the examiner if your knee locks or catches before full extension.
- If extension is worse after activity or on bad days, clearly state your worst-day limitation.
- Bring documentation of prior goniometric measurements from physical therapy or orthopedic records.
Pain considerations: Pain-limited extension is separately rateable under DC 5260 (limitation of flexion) or via DeLuca functional loss. Tell the examiner: 'My knee pain stops me from straightening fully - it is not just mechanical stiffness.'
Passive Range of Motion
What it measures: How far the examiner can move your knee without your active effort; helps distinguish muscle guarding from true joint restriction.
What to expect: The examiner will gently move your knee while you relax. They will note whether passive ROM exceeds active ROM, whether there is pain or crepitus.
Critical thresholds
- Passive ROM same as active ROM Suggests true structural limitation, not guarding
- Passive ROM greater than active ROM Indicates pain-limited active motion - both findings are ratable
Tips
- Relax your muscles fully so the examiner can get an accurate passive measurement.
- Note if passive movement causes pain - tell the examiner verbally.
- Per Correia v. McDonald, passive ROM testing is required and must be documented.
Pain considerations: Even if passive motion reaches normal range, pain during passive movement is a ratable finding under DeLuca. Do not stay silent.
Weight-Bearing vs. Non-Weight-Bearing ROM
What it measures: Whether your knee's range of motion changes when you are standing (weight-bearing) versus sitting or lying (non-weight-bearing); required per Correia v. McDonald.
What to expect: The examiner may test your knee both standing and seated. Some veterans have significantly worse ROM when weight is placed through the joint.
Critical thresholds
- ROM significantly worse with weight-bearing Supports higher functional impairment; documents DeLuca factors
Tips
- If you cannot bear weight on the affected knee, tell the examiner immediately.
- Report any increased pain, buckling, or giving-way when standing.
- If the examiner skips weight-bearing testing, you can politely note: 'I believe weight-bearing testing is required.'
Pain considerations: Weight-bearing often dramatically increases pain and limits motion. Describe this clearly: 'When I put weight on it, I can straighten my leg even less, and the pain is much worse.'
Repetitive-Use ROM Testing (DeLuca Testing)
What it measures: Whether repeated use of the knee over time causes additional loss of motion, pain, weakness, or fatigability beyond the initial measurement.
What to expect: The examiner may perform ROM measurements after you have used the joint (e.g., after walking or repeated bending). Alternatively, you may be asked to describe how your knee functions after prolonged use.
Critical thresholds
- ROM decreases after repetitive use Documents DeLuca functional loss; may support higher effective rating
- Pain, weakness, or fatigability increases after repetitive use Required by DeLuca v. Brown - must be documented
Tips
- Come prepared with specific examples: 'After walking two blocks, my knee extension worsens and I need to stop.'
- Mention how long it takes to recover after activity.
- If the examiner does not test after repetitive use, describe the DeLuca factors verbally and ask that they be documented.
Pain considerations: DeLuca functional loss is often the difference between rating levels. Provide concrete examples of how your knee deteriorates during the day: 'By afternoon, I cannot straighten my leg as far, and the pain is significantly worse.'
Muscle Circumference / Atrophy Measurement
What it measures: Thigh or calf circumference compared to the unaffected side; atrophy suggests disuse and chronic impairment.
What to expect: A measuring tape is placed around the thigh or calf at a specified distance from a bony landmark to compare both legs.
Critical thresholds
- -2 cm difference between limbs Documents clinically significant atrophy and chronic functional loss
Tips
- Mention if your affected leg has become visibly smaller or weaker over time.
- Note any activities you can no longer perform that contribute to muscle loss.
Pain considerations: Atrophy resulting from pain-limited use (disuse atrophy) supports the overall picture of functional impairment.
Joint Instability Assessment
What it measures: Whether the knee gives way, buckles, or is unstable on stress testing (valgus/varus stress, anterior/posterior drawer tests).
What to expect: The examiner will apply gentle stress to the knee from different directions to assess ligament integrity. You may experience pain or sense of giving-way.
Critical thresholds
- Moderate instability documented 20% under DC 5257 - may be rated separately or in combination
- Severe instability documented 30% under DC 5257 - evaluate pyramiding rules
Tips
- Report all episodes of the knee 'giving out,' buckling, or feeling unstable.
- Instability may be ratable under a separate diagnostic code (5257) in addition to extension limitation.
- Describe real-world events: 'My knee buckled going down stairs last month and I nearly fell.'
Pain considerations: Instability episodes are often painful and frightening; describe both the physical sensation and the functional consequences.
Rating criteria by percentage
60%
Knee extension limited to 45 degrees (flexion contracture of 45-) - knee cannot be straightened within 45 degrees of full extension.
Key symptoms
- Permanent fixed-knee bend of 45- or more
- Inability to fully extend knee even passively
- Severe gait disturbance
- Significant functional limitation in all weight-bearing activities
- May require assistive devices
From 38 CFR: DC 5261: Extension limited to 45- = 60%. This is the maximum schedular rating for this diagnostic code. Consider whether total knee replacement (DC 5055) or ankylosis (DC 5256) may yield a higher evaluation.
50%
Knee extension limited to 30 degrees (flexion contracture of 30-).
Key symptoms
- Fixed flexion contracture at 30-
- Significant antalgic gait
- Inability to stand for prolonged periods
- Pain with all weight-bearing activity
- Difficulty with stairs, slopes, and prolonged walking
From 38 CFR: DC 5261: Extension limited to 30- = 50%.
40%
Knee extension limited to 20 degrees (flexion contracture of 20-).
Key symptoms
- Cannot fully extend knee; 20- contracture
- Moderate-to-severe gait disturbance
- Pain on weight-bearing and activity
- Frequent need for rest
- Difficulty with prolonged standing or walking
From 38 CFR: DC 5261: Extension limited to 20- = 40%.
30%
Knee extension limited to 15 degrees (flexion contracture of 15-).
Key symptoms
- 15- flexion contracture
- Moderate limitation of extension with pain
- Pain with walking and prolonged activity
- Noticeable limp
- Difficulty with stairs and uneven terrain
From 38 CFR: DC 5261: Extension limited to 15- = 30%.
20%
Knee extension limited to 10 degrees (flexion contracture of 10-).
Key symptoms
- 10- flexion contracture
- Pain with walking and weight-bearing
- Mildly antalgic gait
- Fatigability with prolonged use
- Difficulty with prolonged standing
From 38 CFR: DC 5261: Extension limited to 10- = 20%.
10%
Knee extension limited to 5 degrees (flexion contracture of 5-).
Key symptoms
- 5- flexion contracture
- Mild-to-moderate pain with activity
- Minimal visible limp but pain-limited use
- Occasional swelling
- Fatigability with extended use
From 38 CFR: DC 5261: Extension limited to 5- = 10%. Note: Even at 10%, DeLuca factors documenting additional functional loss during flare-ups or repetitive use remain critical to capture the full picture of impairment.
Describing your symptoms accurately
Pain - Location, Character, and Triggers
How to describe it: Describe pain using specific terms: burning, aching, stabbing, sharp, or throbbing. Identify the exact location (front of knee, back of knee, medial/lateral side, entire joint). Describe what makes it worse (walking, stairs, standing, bending, cold weather) and what provides relief (rest, elevation, ice, medication).
Example: On my worst days, the pain in my right knee is a constant 8/10 burning ache that starts when I try to get out of bed. I cannot fully straighten my leg - it feels locked about 20 degrees short of straight. Even just standing at the kitchen counter for 5 minutes causes the pain to spike to 9/10, and I have to sit down immediately.
Examiner listens for: Specific pain triggers, rest pain vs. activity pain, pain that limits end-range extension, pain during passive motion, pain that worsens through the day with use.
Avoid: Do not say 'it is fine' or 'I manage.' Do not minimize rest pain. Do not describe only your best days. If you say you walk a mile a day without mentioning you pay for it with hours of pain afterward, the examiner may record artificially high function.
Limitation of Extension - The Core DC 5261 Finding
How to describe it: Be precise about how far you can straighten your knee. Use comparisons: 'My knee cannot straighten all the way - it is like there is a block stopping it about where my leg makes a noticeable bend.' Describe whether this is constant or variable. Describe morning stiffness vs. end-of-day stiffness.
Example: On bad days, I cannot straighten my knee past about 20 to 25 degrees from fully straight. I walk with a noticeable limp because my knee stays bent. I cannot stand with my leg straight even when I am resting. The contracture is worse in the morning and after sitting for any period of time.
Examiner listens for: Fixed vs. flexible contracture, degree of extension loss on worst days, whether pain or mechanical block causes limitation, functional consequences of inability to extend.
Avoid: Do not demonstrate your best-effort extension and call it typical. If your knee is worse after activity, say so. Do not perform movements that do not represent your daily reality.
Fatigability and Lack of Endurance
How to describe it: Describe how your knee deteriorates with use over time. Quantify: 'After 10 minutes of walking my knee gives out on me,' or 'By the afternoon, I can barely bend or straighten it compared to the morning.' Mention recovery time needed.
Example: I can walk to the mailbox, about 100 feet, before my knee starts shaking and I feel profound weakness. After I sit down, it takes 30 to 45 minutes for the pain and fatigue to subside enough to try again. By the end of the day, I cannot extend my knee even close to what I could in the morning.
Examiner listens for: Time-limited activity tolerance, progressive worsening through the day, need for rest periods, inability to sustain even light activity.
Avoid: Do not describe endurance based on what you can push through. Describe what you can do without suffering consequences afterward.
Weakness and Incoordination
How to describe it: Describe episodes of buckling, giving-way, or feeling that the leg will not support weight. Mention difficulty pushing off the floor, climbing stairs, or rising from a chair.
Example: My knee gave out on me three times last month going down stairs. I have to hold the railing every time. Getting out of a chair requires using my arms to push up because my knee cannot bear my weight through the full extension movement.
Examiner listens for: Objective weakness on testing, history of falls or near-falls, compensatory strategies, functional tasks that require strength through extension range.
Avoid: Do not skip mentioning falls or near-falls out of pride. These are medically significant and support the rating.
Flare-Ups
How to describe it: Describe how often flare-ups occur, how long they last, what triggers them, and how much worse your knee becomes during them. Estimate the additional extension loss during a flare-up if possible.
Example: I have major flare-ups about 2 to 3 times a month, usually triggered by overdoing activity or cold weather. During a flare-up, my knee swells significantly, the pain goes to 9 or 10 out of 10, and I cannot straighten it at all - it stays locked at nearly 30 to 35 degrees. I am bedridden for 2 to 3 days. Between flare-ups I am at about 15 to 20 degrees of extension loss.
Examiner listens for: Frequency, duration, triggers, estimated ROM loss during flare-ups, functional impact, whether flare-ups require medical treatment.
Avoid: Do not assume the examiner will ask about flare-ups. Proactively volunteer this information. The examiner must document it under DeLuca requirements.
Functional Impact on Daily Life
How to describe it: Describe specific activities you can no longer do or can only do with difficulty or pain: walking distances, stairs, standing at work, driving, shopping, recreational activities, sleeping. Mention job limitations and how the condition affects your employment.
Example: I cannot stand at a checkout counter or wash dishes without leaning on something. I have not been able to return to my pre-injury job in construction because I cannot kneel, squat, climb ladders, or stand for more than 10 minutes. I take public transportation sitting down because I cannot stand on the bus. I sleep with a pillow under my knee because I cannot lie with it fully straight.
Examiner listens for: Concrete, measurable functional limitations; employment impact; activities of daily living affected; compensatory strategies that reveal the true extent of disability.
Avoid: Do not say 'I get by' without explaining the cost of getting by. Do not omit sleep disturbance or employment impact.
Common mistakes to avoid
Performing maximum effort during ROM testing when your typical function is much worse
Why: The VA rates your condition based on what is documented. If you push through pain and demonstrate greater ROM than you normally have, the rating will reflect the measured value, not your actual impairment.
Do this instead: Move only to the point where pain normally stops you. Verbally state: 'This is my best effort today, but on a typical day and on my worst days, my extension is more limited.' Ask the examiner to document your worst-day and average-day function as well.
Impact: All levels - most commonly causes underrating at the 20%-40% range
Failing to report flare-ups and DeLuca functional loss
Why: The scheduled ROM measurement captures a single moment. If your condition fluctuates significantly - which is common with knee conditions - the point-in-time measurement may not represent your true disability level.
Do this instead: Proactively describe flare-up frequency, duration, estimated additional ROM loss, and all DeLuca factors (pain, weakness, fatigability, incoordination) even if the examiner does not ask. Request that flare-up information be documented in the DBQ.
Impact: Can mean the difference between 10%-20% and 30%-40% ratings
Not mentioning assistive devices or compensatory behaviors
Why: Use of a cane, brace, or other device is directly documented on the DBQ and supports the documented severity of impairment. Compensatory behaviors (holding railings, avoiding stairs, limiting walking) also reveal true functional loss.
Do this instead: Bring any assistive devices to the exam. Disclose all devices you use, even occasionally. Mention behavioral modifications you have adopted because of your knee.
Impact: Supports ratings at all levels; particularly relevant at 20%-50%
Describing only daytime or active-phase symptoms and omitting rest pain and sleep disturbance
Why: Rest pain and sleep disruption are important functional findings. Omitting them leaves an incomplete picture and may result in an understatement of the condition's overall impact.
Do this instead: Describe pain at rest, morning stiffness, inability to find a comfortable sleeping position, and nighttime awakenings due to knee pain. Mention if you require a pillow or positioning device to sleep.
Impact: Supports claims at all rating levels; particularly relevant when seeking ratings above 10%
Failing to disclose all related or secondary conditions
Why: Knee conditions frequently cause secondary conditions (contralateral knee strain from overcompensation, hip problems, low back pain from altered gait) that may be separately ratable if causally linked.
Do this instead: Mention all body parts affected by how you compensate for your knee. Ask your VSO or attorney whether secondary service connection claims are appropriate.
Impact: May result in missed separate ratings for secondary conditions
Not describing instability separately from extension limitation
Why: Instability (DC 5257) is a separately ratable condition. If you also have a knee that buckles or gives way, this may warrant an additional rating that cannot be pyramided with DC 5261.
Do this instead: Report all episodes of knee buckling, giving-way, and instability. Understand that instability and extension limitation may be ratable as separate conditions.
Impact: May result in missed additional 20%-30% rating under DC 5257
Minimizing symptoms because the examiner seems rushed or the exam is brief
Why: C&P exams are often short. Examiners may move quickly. If you do not advocate for complete documentation, critical findings may be omitted from the DBQ, resulting in an inadequate exam and potentially a lower rating.
Do this instead: Prepare a one-page symptom summary in advance. Bring it to the exam. If the examiner does not ask about flare-ups, DeLuca factors, or functional impact, politely volunteer the information. You can say: 'I want to make sure I describe how my condition affects me on bad days and during flare-ups.'
Impact: All levels
Prep checklist
- critical
Gather all relevant medical records
Collect all records related to your knee: service treatment records showing initial injury, VA treatment records, private orthopedic records, physical therapy notes, operative reports, MRI/X-ray reports, and any prior C&P exam results. Bring copies to the exam.
before exam
- critical
Document your worst-day and average-day symptoms in writing
Write a one-page summary describing your worst-day extension limitation (estimated degrees), pain level (0-10), flare-up frequency and duration, activities you cannot perform, assistive devices used, and functional impact on work and daily life. Bring this to the exam and offer it to the examiner.
before exam
- recommended
Track your symptoms in the days before the exam
Keep a simple daily pain and function diary for 1-2 weeks before the exam. Note pain scores, how far you can walk, episodes of buckling, and flare-ups. This gives you concrete data to report at the exam.
before exam
- recommended
Confirm whether your state permits recording
Veterans have the right to record C&P exams in many states. Check your state's law. If recording is permitted, bring a device and inform the examiner at the start of the exam.
before exam
- recommended
Review your DBQ fields relevant to your condition
Familiarize yourself with what the examiner will be documenting: ROM measurements, DeLuca factors, instability, assistive devices, surgical history, and functional limitations. This helps you ensure all areas are covered.
before exam
- recommended
Do not schedule the exam immediately after unusual rest or treatment
Avoid scheduling your exam the day after a cortisone injection, after unusual rest, or during an unusually good period. Your exam should reflect your typical condition.
before exam
- critical
Wear appropriate clothing
Wear shorts or loose pants that allow the examiner easy access to both knees without fully disrobing. Avoid wearing compression wraps or tight garments that could artificially support the joint during testing.
day of
- critical
Bring your assistive devices
If you use a cane, brace, crutches, or walker, bring them to the exam. Their use is documented on the DBQ and directly supports your claim. Do not leave them in the car to appear more capable.
day of
- critical
Do not take additional pain medication beyond your usual dose before the exam
Take only your prescribed, usual medications. Taking extra medication before the exam may make your condition appear less severe than it actually is on a typical day.
day of
- recommended
Arrive early and observe your own function
Notice how your knee feels walking from the parking lot. If walking to the exam room worsens your symptoms, tell the examiner. Document any difficulty sitting in the waiting room.
day of
- critical
Move to your pain limit - not your anatomical limit
During ROM testing, stop when pain stops you, not when the joint mechanically stops. State clearly: 'I am stopping here because of pain, not because my joint cannot go further.' This captures DeLuca-relevant pain-limited motion.
during exam
- critical
Volunteer flare-up information proactively
If the examiner does not ask about flare-ups, volunteer: 'I want to describe my flare-ups and how my function changes - I understand this is important for the rating.' Describe frequency, duration, triggers, and estimated worst-day ROM loss.
during exam
- critical
Describe all DeLuca factors
Proactively address all five DeLuca factors for your knee: (1) pain with motion, (2) fatigability with use, (3) weakness after use, (4) incoordination or instability, and (5) flare-up-related additional limitation. If the examiner does not ask, volunteer each one.
during exam
- recommended
Report both knees if both are affected
If your contralateral knee has also been affected (due to overcompensation), mention it. The DBQ has fields for both right and left sides.
during exam
- critical
Report all surgical history accurately
Disclose all knee surgeries: meniscectomy, ACL/PCL repair, arthroscopy, cartilage restoration, total knee replacement, resurfacing. Include approximate dates. Surgical history affects the diagnostic code and potential rating under DC 5055 (total knee replacement).
during exam
- critical
Describe functional impact on employment and daily life
Tell the examiner specifically how your knee limits your ability to work, perform household tasks, sleep, exercise, and engage in social activities. Use concrete examples rather than general statements.
during exam
- critical
Document what occurred immediately after the exam
Write down what was discussed, what the examiner measured, what tests were performed, and whether DeLuca factors, flare-ups, and functional loss were addressed. Note any concerns about inadequate examination.
after exam
- critical
Request a copy of the completed DBQ
You have the right to obtain a copy of your C&P examination report. Request it through your VBMS access, MyHealtheVet, or your VSO. Review it carefully for accuracy.
after exam
- recommended
File a Notice of Disagreement if the exam is inadequate
If the DBQ does not document DeLuca factors, flare-up information, passive ROM, weight-bearing/non-weight-bearing testing, or your reported worst-day symptoms, the exam may be inadequate under M21-1 and Correia standards. Consult your VSO, claims agent, or attorney promptly.
after exam
- optional
Continue documenting your symptoms post-exam
If your symptoms worsen after the exam (common with musculoskeletal conditions after increased activity), document this in your symptom diary. It may be useful for a future increase claim.
after exam
Your rights during a C&P exam
- You have the right to a thorough and accurate C&P examination. An inadequate exam is grounds for a remand or new examination under M21-1 and VA case law.
- You have the right to record your C&P examination in states that permit single-party consent recording. Verify your state's law before the exam.
- You have the right to review your completed DBQ/C&P examination report. Request it through MyHealtheVet, VBMS, or your VSO after the exam.
- You have the right to submit a Buddy Statement (VA Form 21-10210) from a family member, friend, or coworker who can attest to your functional limitations and worst-day symptoms.
- You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms, functional impact, and flare-ups in your own words to supplement the DBQ.
- Per DeLuca v. Brown (1995), the VA examiner is required to address additional functional loss during flare-ups and with repetitive use. If this is not addressed, the exam may be legally insufficient.
- Per Correia v. McDonald (2016), the VA examiner is required to test ROM on active motion, passive motion, weight-bearing, and non-weight-bearing where medically feasible. An exam omitting these is potentially inadequate.
- Per Sharp v. Shulkin (2017), the VA examiner must review your claims folder before conducting the exam. If the examiner indicates they have not reviewed your records, note this and report it to your VSO.
- You have the right to challenge an inadequate examination by filing a Notice of Disagreement (VA Form 10182) or requesting a new examination if the DBQ fails to address required elements.
- You have the right to representation by an accredited VSO, claims agent, or attorney at no cost for VSO representation. Strongly consider working with a representative for complex claims.
- If you have had a total knee replacement, you are entitled to a minimum 100% rating for one year post-surgery under DC 5055, followed by rating based on residuals. Ensure this is captured accurately.
- Pyramiding is prohibited - the VA cannot rate the same disability under multiple diagnostic codes to increase the rating. However, distinct disabilities (e.g., extension limitation AND instability) may be rated separately under different DCs if they represent genuinely separate impairments.
Related conditions
- Limitation of Flexion of the Knee DC 5260 (limitation of flexion) may apply to the same knee as DC 5261 (limitation of extension). They are typically not rated together on the same knee under pyramiding rules, but the examiner must evaluate which yields the higher rating.
- Knee Instability DC 5257 rates recurrent subluxation or lateral instability of the knee. This is a distinct disability from extension limitation and may be rated separately on the same knee without pyramiding if the instability is a genuinely separate condition.
- Knee Joint Ankylosis DC 5256 applies when the knee is fused or fixed. If the knee is ankylosed, DC 5256 typically yields a higher rating than DC 5261 and should be evaluated instead.
- Total Knee Replacement DC 5055 applies if you have had a total or partial knee joint replacement. It provides a 100% rating for one year post-surgery and is rated on residuals thereafter. This DC typically supersedes DC 5261 post-replacement.
- Patellofemoral Pain Syndrome Patellofemoral pain syndrome is a common co-occurring diagnosis that contributes to overall knee dysfunction and may be separately documented on the same DBQ.
- Knee Meniscal Tear Meniscal tears frequently cause or contribute to extension limitation and may be separately documented and rated depending on the evidence of record.
- Knee Osteoarthritis Degenerative arthritis (DC 5003 or 5010) in the knee is commonly associated with extension limitation. X-ray evidence of arthritis may provide an alternative rating pathway and should be evaluated in conjunction with DC 5261.
- Hip Condition (Secondary) Abnormal gait due to knee extension limitation commonly causes secondary hip strain or bursitis. This may be a separately ratable secondary condition if causally linked to the knee condition.
- Lumbar Spine Condition (Secondary) Compensatory gait from knee extension limitation can cause or aggravate lumbar spine conditions. Secondary service connection may be appropriate if a nexus can be established.
- Contralateral Knee Strain (Secondary) Overloading the unaffected knee to compensate for the service-connected knee is a recognized basis for secondary service connection claims.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.