Reviewed by Jonathan Teplitsky · Updated June 2026
How does the VA rate bilateral knee conditions?
When both knees are service-connected, the VA applies a special rule called the bilateral factor under 38 CFR § 4.26. It adds 10% of the combined value of your two knee disabilities before that value is combined with the rest of your ratings. In plain terms: having both knees rated gives you a bonus you would not get if only one knee were service-connected. This is one of the most overlooked boosts in the entire rating schedule — many veterans with two bad knees never realize the bump exists, and rating decisions occasionally miss it too. Each knee is rated separately first, under 38 CFR § 4.71a, and then the bilateral factor is layered on.
Common knee diagnostic codes
The VA does not have a single "knee" rating. Your knee is rated under whichever diagnostic code (DC) matches your specific findings — and you may fall under more than one. These are the codes you will see most often:
| Code | What it rates | Percentage range |
|---|---|---|
| DC 5257 | Recurrent subluxation / lateral instability | 10% / 20% / 30% |
| DC 5260 | Limitation of flexion (bending) | 0% / 10% / 20% / 30% |
| DC 5261 | Limitation of extension (straightening) | 0% / 10% / 20% / 30% / 40% / 50% |
| DC 5258 / 5259 | Dislocated or removed semilunar cartilage (meniscus) | up to 20% / 10% |
| DC 5256 | Ankylosis (joint fused / frozen) | 30% – 60% |
DC 5257 instability is rated on a slight / moderate / severe scale, while DC 5260 and 5261 turn on how many degrees of motion you have lost. You can read the full musculoskeletal schedule at the 38 CFR Part 4 source.
The strategy most veterans miss: two ratings per knee
Here is a key point that can meaningfully raise your combined rating. Instability and limitation of motion are distinct functional losses, so the VA can assign a separate rating for instability (DC 5257) AND a separate rating for limitation of motion (DC 5260 or 5261) on the same knee. This is not pyramiding — VA General Counsel opinions and the rating schedule expressly allow it, because a loose, buckling knee and a stiff, limited knee are two different problems. If your knee both gives out and won't fully bend or straighten, make sure your C&P exam documents both, and check that your decision reflects two codes per knee where the evidence supports it. Across two knees, that can mean up to four separate knee ratings feeding into your combined total.
Worked example: the bilateral-factor math
The most important thing to understand is that VA ratings combine, they do not add (38 CFR § 4.25). Suppose your right knee is rated 10% and your left knee is rated 10%. Here is how the bilateral factor works:
- Step 1 — combine the two knees. Using the combined-ratings table, 10% combined with 10% is 19% (not 20%).
- Step 2 — add the bilateral factor. Take 10% of that combined value: 10% of 19 ≈ 1.9. Add it: 19 + 1.9 = 20.9%.
- Step 3 — combine with everything else. That ~21% bilateral value is then combined with your other service-connected conditions, and the final number is rounded to the nearest 10%.
Without the bilateral factor, two 10% knees would combine to just 19%. The factor nudges you up — and on larger knee ratings, or when those few extra points push your final rounded total from, say, 40% to 50%, the dollar difference can be substantial. If you also stack instability and limitation-of-motion ratings on each knee (the strategy above), the bilateral factor is applied to that larger combined knee value, compounding the benefit.
How does the VA rate a knee replacement (total knee arthroplasty)?
A total knee replacement is rated under 38 CFR § 4.71a, Diagnostic Code 5055 — the same convalescence-then-residuals structure the VA uses for hip replacements. You get an automatic 100% rating for one year following the month your prosthesis is implanted. After that year, the VA schedules a mandatory re-examination and drops you to a long-term residual rating based on how the artificial knee actually performs.
The residual ratings under DC 5055 are 60% for chronic residuals consisting of severe painful motion or weakness in the leg, or a minimum 30% that applies no matter how well the knee recovers. Intermediate results — a knee that works reasonably well but still has some limitation — are rated by analogy to the ankylosis (DC 5256), extension-loss (DC 5261), or tibia/fibula impairment (DC 5262) codes, always with that 30% floor as the lowest possible outcome. If you are searching for a "va disability rating knee replacement" or "va rating knee surgery," DC 5055 is the code your claim runs through — and both knees replaced can each carry their own DC 5055 rating, feeding into the bilateral factor above.
How is knee arthritis rated (DC 5003 and DC 5010)?
Arthritis in the knee is rated under 38 CFR § 4.71a, Diagnostic Code 5003 (degenerative arthritis, confirmed by X-ray) or DC 5010 (traumatic arthritis, rated the same way as DC 5003). Both codes rate arthritis primarily through whatever limitation of motion it causes under DC 5260 (flexion) or DC 5261 (extension).
The twist is what happens when your arthritic knee still has essentially full motion. If limitation of motion is noncompensable (0%) under those motion codes but X-rays confirm arthritis, DC 5003 still entitles you to a 10% rating for that joint. If arthritis with painful, but non-compensable, limited motion affects two or more major joints or two or more minor joint groups, the rating rises to 20%, with that same 20% reserved for occasional incapacitating exacerbations. Knee arthritis pain alone, even without much measurable stiffness, is not automatically worth $0.
Knee instability and DC 5257 in detail
Knee instability — a knee that buckles, gives out, or subluxates (partially dislocates) under load — is rated under 38 CFR § 4.71a, Diagnostic Code 5257 on a three-tier scale: 10% for slight recurrent subluxation or lateral instability, 20% for moderate, and 30% for severe. This is the code that answers "va disability rating knee instability" and "knee giving out disability rating." As covered above, DC 5257 is assigned independently of any limitation-of-motion rating on the same knee, so a knee that is both unstable and stiff can carry two separate ratings at once.
Knee strain: how it's rated without a dedicated code
A simple knee strain — a soft-tissue sprain or strain without confirmed instability or arthritis — has no diagnostic code of its own. The VA rates it by analogy under the same limitation-of-motion codes used for other knee conditions, DC 5260 (flexion) or DC 5261 (extension), based on how many degrees of motion the strain actually costs you. If your measured range of motion comes back normal but movement is still painful, 38 CFR § 4.59 entitles you to at least the minimum compensable rating for that joint for painful motion — so a knee strain with normal X-rays and normal degrees of motion is not necessarily a 0%.
Secondary conditions: back, hip, and the opposite knee from gait
Bad knees rarely stay isolated. When you favor a painful or unstable knee, your gait becomes antalgic — uneven and compensatory — which over time strains the lumbar spine and hips. The VA recognizes these as secondary conditions. If your back or hip pain developed or worsened because of your service-connected knees, you can claim a lumbar spine strain or hip condition on a secondary basis. Overcompensating for one bad knee can also break down the opposite, previously healthy knee over time — a well-documented secondary claim pattern the VA recognizes right alongside the back and hip claims above. The key evidence in every one of these secondary claims is a medical nexus letter explaining that the altered gait from your knees is at least as likely as not the cause. These secondaries are commonly granted and can add meaningfully to your combined rating.
The C&P exam for bilateral knees
Your C&P exam decides which diagnostic codes and percentages apply. The examiner uses a goniometer to measure flexion and extension in degrees for each knee, tests for instability and subluxation, and documents pain, weakness, and the effect of repeated use and flare-ups. Walk in prepared: describe how each knee buckles or gives out (for the 5257 instability rating) and how far each one bends and straightens (for the 5260/5261 motion ratings). Mention that you favor the knees and how that affects your back and hips. Because the same exam drives both knees, the instability findings, and the secondary picture, it is worth documenting every symptom thoroughly. For general knee criteria, see our knee pain VA rating guide.
Estimate your combined rating
Bilateral knee math gets complicated fast — two knees, possibly two codes each, the bilateral factor, then combination with your other conditions. Use our VA disability rating calculator, which supports the bilateral factor, to see where you actually land before rounding.
Frequently asked questions about bilateral knee VA ratings
What is the bilateral factor? When both knees are service-connected, 38 CFR § 4.26 adds 10% of the combined value of the two knee ratings before they combine with your other conditions.
Do two 10% knees equal 20%? No. They combine to 19% under § 4.25, then the bilateral factor adds about 1.9, landing near 21% before combining with everything else.
Can I get two ratings on one knee? Often yes — a separate rating for instability (DC 5257) and for limitation of motion (DC 5260/5261), because they compensate different losses.
Can my knees cause a back rating? Yes. An altered, antalgic gait from bad knees commonly causes a secondary lumbar-spine or hip condition, supported by a nexus opinion.
Does the bilateral factor apply to other joints? Yes — to any paired extremities that are both service-connected, such as both hips, shoulders, or arms.