Inside the exam room
1. You will be asked about injury, surgery, swelling, braces, and walking aids. Explain any falls, giving way, or locking.
2. You will be asked to bend and straighten your knee. The examiner measures both movements and may check stability and cartilage. Fully straight is 0 degrees. Tell them about pain, catching, or a movement you cannot safely do.
3. You may be asked to repeat the movements at least three times, if safe. Explain trouble with stairs, walking, or standing, including worse days and recovery time.
The examiner measures joint movement with a goniometer (angle-measuring tool).
How VA rates knee condition
The examiner measures how far your knee bends and how far it stays bent when you try to straighten it. A fully straight knee is 0 degrees. These are separate measurements. This tool uses your highest selected example once; it does not decide whether VA can give separate ratings for bending and straightening. Source: 38 CFR 4.71a (2025 edition) .
VA’s guide shows a straight knee (extension) as 0 degrees and a full bend (flexion) as 140 degrees. A knee bent at 90 degrees is not straight.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| Flexion (DC 5260) | Listed limits: 60 degrees = 0%; 45 degrees = 10%; 30 degrees = 20%; 15 degrees = 30%. |
| Extension (DC 5261) | Listed deficits from straight: 5 degrees = 0%; 10 = 10%; 15 = 20%; 20 = 30%; 30 = 40%; 45 = 50%. |
| Other findings | Instability, knee-cartilage (meniscus) conditions, painful motion, or fixation need their own rating rules and review. No automatic additional percentage is assigned here. |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- A clinician's records show knee bending (flexion) limited to 60 degrees (DC 5260 movement rule without monthly payment)0%
- A clinician's records show knee bending (flexion) limited to 45 degrees10%
- A clinician's records show knee bending (flexion) limited to 30 degrees20%
- A clinician's records show knee bending (flexion) limited to 15 degrees30%
- A clinician's records show knee straightening (extension) limited to 5 degrees short of straight (DC 5261 movement rule without monthly payment)0%
- A clinician's records show knee straightening (extension) limited to 10 degrees short of straight10%
- A clinician's records show knee straightening (extension) limited to 15 degrees short of straight20%
- A clinician's records show knee straightening (extension) limited to 20 degrees short of straight30%
- A clinician's records show knee straightening (extension) limited to 30 degrees short of straight40%
- A clinician's records show knee straightening (extension) limited to 45 degrees short of straight50%
What may happen in the exam room
- The examiner may ask you to move the joint, then move it for you. They may check it with and without weight on it when safe. Follow their directions and tell them when something hurts.
- The examiner checks strength, pain, and what changes after doing the movement several times. One result alone does not decide the diagnosis.
What the measurements tell you
- Keep the farthest bend separate from how far the knee stays bent when trying to straighten. Watch where the example stops, not an angle it passes through.
- Tell the examiner about giving way, clicking, or swelling. The rating for an unstable knee or damaged knee cartilage (meniscus) needs more than those symptoms alone.
Questions the examiner may cover
- How do symptoms affect stairs, walking, kneeling, standing, or getting out of a chair?
- Describe giving way, locking, swelling, and any support such as a brace prescribed by your provider, without diagnosing the cause yourself.
Questions to expect
How far does the knee bend, and how close to fully straight does it get?
Explain: Describe pain onset, stopped movement and changes after stairs or repeated walking. The examiner records bend and straightening separately; 0 degrees is fully straight.
Rating connection: DC 5260 rates limited bending; DC 5261 rates loss of straightening. A straight knee does not establish how far it can bend.
Does it give way, lock or swell?
Explain: Describe falls, catching, swelling, surgery, and prescribed braces or walking aids, with frequency and dates.
Rating connection: Instability and meniscus findings have requirements separate from motion. VA considers whether distinct findings support separate ratings without duplicating the same impairment.
Your answer outline
My [left/right/both] knee affects [task]. I can usually [what you can do], then [what changes]. I manage this by [actual adjustment or prescribed support]. This happens [frequency], and [what changes on a worse day, if you have them].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Explain what you can and cannot do, how often limitations occur, and what changes with repeated use or flare-ups.
Common mistakes to avoid
- Describe a usual day and a worse day, including how often symptoms get worse and how long that lasts. Do not make your symptoms sound better or worse than they are.
- Keep taking medicines as prescribed unless your health care provider tells you otherwise. If a movement hurts or feels unsafe, tell the examiner and follow their directions.
Records to get ready before the exam
- Your treatment records, movement measurements already recorded by a health care provider, and medicine list.
- Notes about daily tasks, what changes after repeating them, and worse periods. Send personal records through VA’s official channels.
Preparation notes
- Use the picture to understand the measurement. At the exam, follow the examiner’s directions and do not force unsafe movement.
- Explain where pain starts, where movement stops, and what changes after repeated activity or during worse periods.
- VA reviews your whole record, including whether the condition is linked to service. The highest box you check here does not decide your rating.
Pain, repeated use, and worse periods
Tell the examiner where pain begins and how far you can move. Those may be different points. Pain alone does not set a percentage. Explain what becomes harder after repeating an activity or during worse periods (flare-ups). The examiner uses your records and description to estimate those changes, and explains if there is not enough information to do so.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
Bring records of changes in how you walk and the right-hip diagnosis. Ask your provider to explain whether the knee problem caused it or made it worse.
Using the other leg more does not prove it caused a problem. Bring records over time and ask your provider to explain the connection.
Bring records showing how your walking changed. Ask your provider to explain how that change affected your back.
Bring records of the knee giving way or changing how you put weight on the leg. A provider must explain any link to the diagnosed ankle problem.
Bring records of changes in how you walk and the left-hip diagnosis. Ask your provider to explain whether the knee problem caused it or made it worse.
Using the other leg more does not prove it caused a problem. Bring records over time and ask your provider to explain the connection.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.