Knee Instability VA Rating: 10%, 20%, 30% (DC 5257, 2026)

What is knee instability and how does it affect veterans?

Knee instability — clinically described as recurrent subluxation or lateral instability — occurs when the ligaments that hold the knee joint together are damaged or stretched, allowing the joint to shift or give way during movement. The knee has four primary ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Damage to any of these can cause instability.

Military service frequently causes knee ligament injuries and instability. ACL and MCL tears are common in service members from running, jumping, pivoting during training, parachute landings, dismounted operations over rough terrain, and direct trauma. Even without a complete ligament tear, years of repetitive stress can stretch and weaken the ligaments to the point where the knee becomes chronically unstable. Many veterans also develop instability after meniscal injuries or knee surgery during service.

Knee instability profoundly affects daily functioning. The knee may give way without warning — on stairs, walking on uneven ground, pivoting, or simply standing. This creates a constant risk of falls and secondary injuries. Veterans with knee instability often develop a guarded, cautious gait, consciously or unconsciously trying to protect the unstable knee. This altered walking pattern frequently leads to problems in the opposite knee, hips, and lower back.

The unpredictability of an unstable knee also takes a psychological toll. The fear of the knee giving out during normal activities creates anxiety and limits what veterans are willing to do, contributing to social isolation and depression.

VA diagnostic code for knee instability

Knee instability is rated under Diagnostic Code (DC) 5257 (knee, other impairment of) per 38 CFR § 4.71a, Schedule of Ratings — Musculoskeletal System. DC 5257 has two separate scales: one for recurrent subluxation or instability caused by a ligament sprain or tear, and one for patellar (kneecap) instability.

Critical point: DC 5257 is rated on instability alone, not on limitation of motion or arthritis. This means it can be — and should be — rated separately from limitation of motion codes (DC 5260 for flexion, DC 5261 for extension) per VAOPGCPREC 23-97 and VAOPGCPREC 9-04. If your knee has both instability and limited motion, you are entitled to separate ratings for each distinct impairment.

Other knee diagnostic codes that may apply alongside DC 5257:

• DC 5260 — Limitation of flexion (0%, 10%, 20%, 30%)
• DC 5261 — Limitation of extension (0%, 10%, 20%, 30%, 40%, 50%)
• DC 5258 — Dislocated semilunar cartilage (meniscus) with locking, pain, and effusion (20%)
• DC 5259 — Removal of semilunar cartilage, symptomatic (10%)
• DC 5003 — Degenerative arthritis confirmed by X-ray (rated on limitation of motion; 10% or 20% by X-ray only when there is no limitation of motion)

Rating criteria for knee instability (DC 5257)

The VA rates knee instability at three compensable levels. The rating does not depend on grading laxity as slight, moderate, or severe. It depends on the type of ligament or patellar problem causing persistent instability and on whether a medical provider has prescribed a brace and/or an assistive device (such as a cane, crutches, or a walker) for walking.

0% rating

Criteria: Under 38 CFR § 4.31, a 0% rating is assigned when the requirements for a compensable rating are not met — for example, a service-connected knee injury that does not cause persistent instability.

Monthly payment: $0 (but establishes service connection)

What this looks like: You have a history of knee ligament injury, but the knee does not currently show persistent instability. Service connection is established, protecting you if the condition worsens.

10% rating — $180.42/month

Ligament instability criteria: Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device or bracing for ambulation.

Patellar instability criteria: 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.

What this looks like: Your knee gives way or shifts because of a ligament or kneecap problem, but no provider has prescribed a brace or walking aid for it.

20% rating — $356.66/month

Ligament instability criteria (either one):

• Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (such as cane(s), crutch(es), or a walker) for ambulation; or
• Unrepaired or failed repair of a complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation.

Patellar instability criteria: 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.

What this looks like: Your instability is significant enough that a provider has prescribed a brace or walking aid for getting around.

30% rating — $552.47/month

Ligament instability criteria: Unrepaired or failed repair of a complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (such as cane(s), crutch(es), or a walker) and bracing for ambulation.

Patellar instability criteria: 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.

What this looks like: You have a complete ligament tear that was never repaired or whose repair failed (or recurrent kneecap instability after surgery), and a provider has prescribed both a brace and a cane, crutches, or walker.

Patellar instability notes: The patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. A surgical procedure that does not repair one or more of those components contributing to the instability (for example, arthroscopy to remove loose bodies or joint aspiration) does not count as surgical repair.

What evidence do you need?

Service records

• Service treatment records documenting knee ligament injuries — ACL/MCL/PCL/LCL tears, sprains, or strains
• Operative reports for any in-service knee surgery (reconstruction, repair)
• Line of duty determinations for knee injuries
• DD-214 showing MOS involving high-risk activities (airborne, infantry, special operations)
• Physical profiles or duty limitations for knee instability
• Records of knee brace or assistive device prescriptions during service

Medical evidence

• MRI showing ligament damage, laxity, or post-surgical changes
• Physical examination findings from stability testing (Lachman, anterior/posterior drawer, varus/valgus stress tests)
• Orthopedic evaluation documenting the diagnosis causing instability (sprain, incomplete tear, or complete tear) and whether any tear was repaired, left unrepaired, or the repair failed
• Treatment records documenting persistent or recurrent instability
• Current prescriptions from a medical provider for a knee brace and/or an assistive device (cane, crutches, walker) for walking
• Documentation of falls or injuries resulting from the knee giving way
• Physical therapy records addressing instability and strengthening

Nexus letter

A medical opinion connecting your knee instability to military service. The letter should reference specific service events — a training injury, parachute landing, sports injury during PT, or combat-related trauma — that damaged the knee ligaments. If instability developed gradually from repetitive stress, the letter should explain how cumulative service demands weakened the ligament structures.

Buddy statements

Statements from fellow service members who witnessed the original knee injury or can describe the physical demands that caused it. Statements from family and friends describing episodes of the knee giving way, falls they’ve witnessed, the need for braces or assistive devices, and how the instability limits your daily activities and participation in family events.

Personal statement

Describe the original injury or onset of instability, how often your knee gives way, what activities trigger buckling episodes, any falls or injuries from the knee giving out, what braces or devices you use, and how instability limits your work and daily life. Be specific — frequency of episodes per week or month, activities you avoid, and situations where you feel unsafe.

C&P exam tips for knee instability

What the examiner evaluates

• Ligament stability testing: anterior drawer, posterior drawer, Lachman test, varus stress (lateral stability), valgus stress (medial stability)
• The diagnosis causing instability (sprain, incomplete tear, complete tear; repaired, unrepaired, or failed repair) or patellar instability
• Evidence of recurrent subluxation (partial dislocation) or persistent instability
• Whether a medical provider has prescribed a brace and/or an assistive device (cane, crutches, walker) for ambulation
• Gait assessment for guarding or compensatory patterns
• History of falls or giving-way episodes
• Functional impact on daily activities and employment

How to prepare

1. Report every giving-way episode. Before the exam, think through how often your knee gives out or feels unstable. Keep a log if possible — how many times per week or month, what you were doing, whether you fell.
2. Bring your brace, walking aid, and prescriptions. If a provider prescribed a knee brace, cane, crutches, or walker, bring the device and the prescription. Under DC 5257, the rating depends on whether these were prescribed for walking.
3. Don’t brace or tighten your knee during testing. During stability tests, try to relax your leg muscles. If you unconsciously guard by tightening your thigh muscles, the examiner may not detect instability that is present.
4. Describe when your knee gives way. Explain how often it happens, on stairs, carrying something, or on uneven ground, and any falls or injuries.
5. Mention separate motion limitation. If your knee also has limited range of motion, make sure the examiner documents both instability AND range of motion findings. These can be rated separately under different diagnostic codes.
6. Explain employment impact. If knee instability limits what work you can do — standing, walking, climbing, carrying — explain this clearly.

Common mistakes

• Guarding (tensing the muscles) during stability testing, which can mask instability
• Not reporting the frequency and circumstances of giving-way episodes
• Forgetting to bring or mention a prescribed brace or assistive device
• Not asking the examiner to also evaluate range of motion for potential separate ratings
• Minimizing the impact of instability on daily activities and employment
• Failing to mention falls or near-falls caused by the knee giving way

Common secondary conditions linked to knee instability

Knee instability frequently causes or worsens other conditions:

• Back pain — Altered gait from an unstable knee changes spinal mechanics. Limping, guarding, and compensatory movement patterns place abnormal stress on the lumbar spine.
• Opposite knee — Favoring the unstable knee overloads the other one. If your left knee is service-connected for instability, you can claim the right knee as secondary to the altered gait pattern.
• Hip conditions — The same compensatory gait that affects the back also stresses the hips, frequently causing hip pain and accelerated degeneration.
• Depression and anxiety — Chronic pain, fear of falling, loss of mobility, and inability to participate in physical activities significantly increase the risk of mental health conditions.
• Arthritis — Knee instability accelerates cartilage wear and joint degeneration. An unstable knee develops degenerative arthritis faster than a stable one because the abnormal movement patterns grind down cartilage unevenly.

How to calculate your monthly payment

Your total VA disability payment depends on your combined rating across all service-connected conditions. Remember that knee instability (DC 5257) can be rated separately from limitation of motion (DC 5260/5261), meaning a single knee can receive multiple ratings. If both knees are affected, each is rated independently, and bilateral conditions receive a bilateral factor boost.

Use our VA disability calculator to:

• Calculate your combined rating including separate instability and motion limitation ratings
• See how VA math handles multiple ratings for the same joint and bilateral conditions
• Estimate your monthly payment including dependents

For the full breakdown of payment amounts at every rating level, see our 2026 VA disability pay rates page.

Correction — October 21, 2026: Removed a positive stability-test requirement that DC 5257 does not impose, and updated advice on describing when your knee gives way.

Disclaimer: This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance on your VA disability claim, consult a VA-accredited Veterans Service Organization (VSO), attorney, or claims agent. You can find accredited representatives at VA.gov.