VA Rating for Knee, Hip and Shoulder Conditions

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Joint conditions are rated by measured range of motion, instability, and painful motion — often with more than one rating per joint. This guide quotes the actual rating criteria from 38 CFR Part 4 for diagnostic code 5257 / 5260 / 5261, explains what the C&P examiner measures, covers the presumptive and secondary routes to service connection, and lists the reasons these claims come back denied — and how each gets fixed.

How the VA rates knee, hip and shoulder conditions in 2026 — the exact criteria

These are the criteria a VA rater applies, quoted from the rating schedule (§ 4.71a). Your rating is the highest level whose wording your evidence meets — and evidence that never uses these words tends to be rated at the bottom.

DC 5257 — Knee, other impairment of (instability)

Patellar instability has its own 10/20/30 ladder keyed to recurrent instability after surgical repair and whether a brace, cane or walker is prescribed.

DC 5260 — Leg, limitation of flexion of

DC 5261 — Leg, limitation of extension of

Flexion, extension and instability of the same knee can each be rated separately (VAOPGCPREC 9-2004; 23-97). Hips use DC 5250–5255 (for example DC 5252 thigh flexion: 40% at 10°, 30% at 20°, 20% at 30°, 10% at 45°). Painful motion is compensable at the minimum rating (§ 4.59).

Honest ceiling: 30% at flexion limited to 15°.

What the C&P examiner measures

Range of motion in degrees with a goniometer, repeated three times, with pain onset noted; stability testing (Lachman, drawer, varus/valgus) for the knee; whether a brace, cane or walker is prescribed; flare-up estimates. Bring the brace you use and say when you use it.

The questions that get at the rating criteria — answer them for yourself before the exam:

• Which side do you favor when you walk? Has that started bothering the other side?
• Do stairs bother you? Getting in and out of a truck?

Service connection: presumptive, direct, or secondary

Arthritis shown within one year of separation is presumptive (38 CFR 3.309(a)). Otherwise: direct service connection from an in-service injury or the cumulative load of the job, or secondary to another service-connected joint or foot condition.

Every service-connection claim has three legs: a current diagnosis (the C&P exam can supply it), an in-service event, injury, exposure or an already-connected condition, and a link between the two — which the VA's own examiner addresses at the exam for direct and secondary claims, and which the law supplies for presumptive ones. You do not need a private opinion to file; you need one only if the VA denies for lack of nexus, and a supplemental claim within one year keeps your effective date.

Secondary conditions veterans miss

Conditions that commonly develop because of this one can be service-connected on top of it, each with its own rating:

• Opposite knee / hip / back overcompensation
• Depression secondary to chronic pain

Secondary-claim guides for this condition: Knee & Hip Conditions secondary to Flat Feet →Back Pain secondary to a Knee Injury →

What the medical literature says

Cameron K.L. et al., Arthritis & Rheumatism 63(10) (2011) — Incidence of physician-diagnosed osteoarthritis among active duty United States military service members
OA incidence significantly higher in the military than the general population — highest relative burden in career soldiers. Why it matters: Any degenerative joint claim.

Knapik J.J. et al., Military Medicine 169(1):45-56 (2004) — Soldier load carriage review
Load carriage and military movement produce knee, ankle, hip and shoulder overuse injury. Why it matters: Tie his MOS duties to the specific joint.

Why knee, hip and shoulder conditions claims get denied — and the fix

• Instability rated but limited motion not separately rated (or vice versa) — VA General Counsel precedent allows both.
• Painful motion ignored — § 4.59 requires at least the minimum compensable rating for painful motion.
• Flare-ups not estimated.

A denial is a grade on the evidence packet, not a verdict on you. Filed as a supplemental claim within one year, the fix keeps your original effective date.

Filing it right the first time

1. Intent to File first. It locks your effective date for a year — back pay runs from that day, not from the day the package is ready.
2. File everything at once. Every condition with a real symptom and a plausible route — direct, presumptive, secondary, increase — goes in one claim. The VA's duty to assist schedules the exam and pulls your records; a condition held back "for more evidence" only starts its clock later.
3. Your statement in the criteria's words. A Statement in Support of Claim (VA Form 21-4138) that describes your worst days and your typical days using the language in the table above is the evidence the rater reads first.
4. Your records. VA records through Blue Button, decision letters and code sheet from VA.gov, and private records from each doctor's office or patient portal — or a signed 21-4142 so the VA pulls them.
5. Prepare for the exam. Know what the examiner measures (above) and answer honestly, including the bad days.

Frequently asked questions

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Rating criteria verified against eCFR (38 CFR Part 4) — last reviewed 2026-09-19. Regulations change; confirm anything decision-critical at ecfr.gov.