Knee Conditions: Limitation of Flexion vs Extension

Knee problems are one of the most common reasons veterans file for disability. Years of carrying gear, jumping, marching, and hard landings add up. But when the VA evaluates a knee, it doesn't just ask "how bad does it hurt?" It measures specific things — how far your knee bends, how far it straightens, and whether the joint gives out. Each of those gets rated under a different diagnostic code, and understanding the difference is the key to making sure your knee VA rating reflects what you actually live with.

This guide breaks down limitation of flexion versus limitation of extension, the instability rating, and when the VA can — and can't — combine them.

DC 5260 (flexion) vs DC 5261 (extension)

The VA splits basic knee range of motion into two separate diagnostic codes found in the rating schedule at 38 CFR 4.71a.

• •Flexion is bending your knee — bringing your heel toward your backside. Limited flexion is rated under DC 5260.
• •Extension is straightening your knee back out flat. Limited extension is rated under DC 5261.

Think of it this way: flexion is how far the knee closes, extension is how far it opens. A normal knee bends to about 140 degrees of flexion and straightens to 0 degrees of extension.

These measure different motions, which is why — as you'll see below — they can sometimes be rated at the same time. The worse your knee bends, the higher your DC 5260 rating climbs. The worse it straightens out, the higher your DC 5261 rating climbs.

How measurements convert to percentages

During your exam, the examiner uses a goniometer (a protractor-style tool) to measure your range of motion in degrees. Those numbers convert directly to a percentage under the schedule.

For limitation of flexion (DC 5260):

For limitation of extension (DC 5261):

A quick way to read the extension table: the number is how many degrees short of fully straight your knee stops. If your knee won't go past 20 degrees of bend when you try to straighten it, that's "extension limited to 20 degrees" and rates 30%.

Because the worse measurement equals the higher rating, the examiner needs to capture your true limited motion — including any reduction caused by pain or repeated movement. Want to know what numbers your evidence points to before you file? The Evidence Gap Analyzer can flag where your records are thin.

Instability and recurrent subluxation (DC 5257)

Range of motion isn't the whole story. A knee can bend and straighten fine but still give out under you. That's knee instability, and it's rated separately under DC 5257 for "recurrent subluxation or lateral instability."

• •Subluxation means the knee partially slips out of alignment.
• •Lateral instability means the joint shifts side-to-side because the ligaments are loose.

DC 5257 is rated on severity:

This code is based on the examiner's clinical findings and your reported symptoms — how often the knee buckles, whether you use a brace, and the results of stability tests like the Lachman or anterior/posterior drawer test. Note that DC 5257 is not based on degrees of motion at all. It's a different question entirely: does the joint stay put?

If you wear a brace, fall, or have to catch yourself on furniture, that detail matters. Document it. Tell the examiner. Keep buddy statements from people who've seen it happen.

When separate ratings are allowed

Here's where many veterans leave points on the table. The VA generally can't pay you twice for the same symptom — that's called pyramiding, and it's prohibited under 38 CFR 4.14. But it can pay separately when the ratings cover distinct disabilities.

The VA's General Counsel has issued precedential opinions on exactly this:

• •VAOPGCPREC 23-97 held that a veteran can receive separate ratings for arthritis with limited motion (rated under the motion codes) and for instability under DC 5257, because they reflect different problems.
• •VAOPGCPREC 9-98 clarified that point further regarding painful motion and arthritis.

So in practice, a single knee might carry:

1. 1.A rating for limitation of flexion (DC 5260), and
2. 2.A rating for instability (DC 5257).

Separately, the Court of Appeals for Veterans Claims addressed flexion versus extension in Lyles v. Shulkin (2017) and related case law has supported the idea that limitation of flexion and limitation of extension measure different functions. That means a knee with both a flexion loss and an extension loss can, in the right circumstances, be rated under both DC 5260 and DC 5261 — because they're not the same motion.

The limit is real, though: you can't get a separate rating for the same lost motion under two codes, and the VA caps the total at the level for full loss of use of the joint. Each rating must be supported by its own measured findings.

If you've already gotten a decision and you're not sure whether the VA stacked your ratings correctly, run the letter through Commander Decode for a plain-English breakdown of what they granted and under which codes.

Painful motion and flare-ups

The number the examiner writes down at rest isn't always the number that should drive your rating. Under 38 CFR 4.40 and 4.45, the VA must consider functional loss — including loss caused by pain, weakness, fatigue, and lack of endurance.

The landmark case here is DeLuca v. Brown (1995), which requires the examiner to address whether your function drops further during flare-ups or with repeated use, and to put that in degrees if possible. A later case, Mitchell v. Shinseki (2011), reinforced that a bare statement of "pain on motion" isn't enough — the examiner has to explain the effect of that pain on your motion.

Under DC 5003 and 38 CFR 4.59, painful motion in an arthritic joint generally warrants at least the minimum compensable rating (often 10%) even when your measured range is nearly normal. So pain alone, when tied to documented arthritis, can carry weight.

What this means for you:

• •Describe your worst days, not your average day.
• •Tell the examiner what your knee does after activity — does it swell, lock, or lose motion?
• •If the exam happens on a good day, say so plainly and explain how flare-ups differ.

The knee C&P exam

Your Compensation & Pension (C&P) exam is where most of these measurements get locked in, so it's worth preparing for. The examiner uses a standardized Disability Benefits Questionnaire (DBQ) for the knee and lower leg.

Expect the examiner to:

• •Measure flexion and extension with a goniometer, in both knees.
• •Test stability (Lachman, drawer, and side-to-side tests) for DC 5257 findings.
• •Check for repeated-use loss by having you move the joint multiple times.
• •Ask about flare-ups, assistive devices, and how the knee affects your work and daily life.

Be honest and complete. Don't push through pain to "perform well" — the exam is meant to capture your real limitation, not your toughest effort. If your knee gives out three times a week, say that. If you can't kneel to play with your kids, say that too.

You can rehearse the whole thing first. Try our C&P Exam Simulator to practice answering the questions out loud and get coaching, or build a knee-specific checklist with the C&P Exam Prep tool so you walk in knowing exactly what the examiner is measuring and why.

Finally, because knee evidence often hinges on small details — degrees, brace use, frequency of buckling — consider having a VA-accredited representative review your file before your exam so nothing gets overlooked.