VA Disability: Bilateral Knee Conditions

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:

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.

Secondary conditions: back and hip 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. The key evidence 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.