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ACL Tear Residuals

Residual knee instability following an anterior cruciate ligament (ACL) tear or reconstruction. IMPORTANT — DC 5257 was REWRITTEN in the 2021 revision of 38 CFR 4.71a. The old criteria were a clinical judgement call: slight, moderate or severe recurrent subluxation or lateral instability, at 10, 20 and 30 percent. Those words are gone. The rating now turns on two objective facts: whether the ligament tear was complete and whether the repair failed, and WHETHER A MEDICAL PROVIDER HAS PRESCRIBED a brace and/or an assistive device for walking. A prescription in your records is now worth more to this rating than any description of how unstable the knee feels.

Code: 5257
Criteria: 38 CFR 4.71a, DC 5257
Exam length: ~30-45 minutes
Form: Knee and Lower Leg DBQ

Rating steps

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will perform ligament stability tests: Lachman test (most sensitive for ACL), anterior drawer test, and pivot shift test to assess the integrity of the ACL or the surgical reconstruction.
Knee range of motion (flexion and extension) will be measured with a goniometer, including the point at which pain begins.
Repetitive-use testing (3 repetitions) will assess whether pain increases, range of motion decreases, or the knee feels less stable after repeated loading.
The examiner will ask about episodes of giving way, buckling, and instability — how often it happens, what activities trigger it, and whether you have fallen because of it.
If you had ACL reconstruction surgery, the examiner will assess the surgical outcome: residual laxity, graft site pain, range of motion compared to pre-surgical measurements, and any hardware-related symptoms.

What the examiner is actually filling in

01Lachman test, anterior drawer, and pivot shift results, and whether any ligament tear is complete or incomplete — under the current DC 5257 (rewritten effective February 7, 2021) the level turns on the tear and its repair status plus what is prescribed for ambulation, not on a slight/moderate/severe label.
02Knee flexion and extension range of motion in degrees.
03Additional functional loss after repetitive use (DeLuca factors).
04Whether the knee joint has effusion (swelling/fluid).
05Overall impact on weight-bearing activities, occupational function, and the need for bracing or assistive devices.

Rated under 38 CFR 4.71a, DC 5257. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

When the examiner performs the Lachman test, try to relax your leg muscles completely. If you guard by tensing your hamstrings, the test may appear falsely negative even with a lax ACL.
Describe the instability in functional terms: "I cannot trust my knee when I step off a curb," "I have to plan every step on uneven ground," "I have fallen twice in the past 6 months."
If you feel a "shift" or "clunk" during the pivot shift test, say so — this is a key indicator of rotational instability that the examiner should document.
Mention any activity you have completely given up because of the ACL injury — running, basketball, hiking, skiing — loss of recreational activities reflects the lasting functional impact.
If you had surgery years ago and instability has returned, emphasize the timeline: "The reconstruction was in 2018 and my knee started giving way again in 2023" — this suggests graft stretching or failure.

What costs veterans points

Not understanding that ACL instability is rated separately from range of motion limitation. You can receive a rating for instability (DC 5257) AND for limited flexion (DC 5260) or extension (DC 5261) — make sure all are assessed.
Downplaying instability because it does not happen during the exam. Instability is episodic — describe the pattern even if the knee feels stable while sitting on the exam table.
Not mentioning secondary meniscal damage. Many ACL tears are accompanied by meniscal tears — if you had meniscus work done during ACL surgery, it should be documented.
Forgetting to report graft site pain (anterior knee pain from a patellar tendon graft or hamstring weakness from a hamstring graft) — these are surgical residuals.
Not describing activity modifications: no running, no pivoting sports, avoiding uneven terrain, bracing for any physical activity — these reflect real functional impairment.

The rating criteria, in plain language

Rating levels for ACL Tear Residuals under 38 CFR 4.71a, DC 5257
Rating	Rating criteria	What that means for you
0%	In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.	Your knee is service-connected but the examination does not establish persistent instability — ligament testing is stable and the record documents no giving way. Every rung of DC 5257 requires persistent instability from a sprain or ligament tear, or recurrent instability of the patellofemoral complex, so an examination without it fails even the 10 percent criterion. DC 5257 prints no 0 percent rung of its own; 38 CFR 4.31 supplies it: no monthly payment, but the condition is on record and a later increase runs from this date. The lowest compensable level under this code is 10 percent.
0%	What supports this level Negative Lachman, anterior drawer and pivot-shift testing recorded No episodes of the knee giving way documented in treatment records No prescription from a medical provider for a brace, cane, crutches or walker A dated record of the condition so that a later increase claim has a starting point
10%	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 (e.g., cane(s), crutch(es), walker) or bracing for ambulation.	You have a sprain, an incomplete ligament tear, or a complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability — but NO provider has prescribed a brace, cane, crutches or walker for walking. Without that prescription, 10 percent is the ceiling under this code however unstable the knee is.
10%	What supports this level Persistent instability documented on examination Positive anterior drawer test or Lachman test History of ACL tear with surgical repair or conservative treatment Whether the tear was complete or incomplete stated in the record Absence of a prescribed brace or assistive device noted
20%	One of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation.	Either (a) you have a sprain, incomplete tear, or successfully repaired complete tear causing persistent instability AND a provider has prescribed a brace and/or an assistive device; or (b) you have an unrepaired or failed-repair complete tear causing persistent instability AND a provider has prescribed EITHER an assistive device OR bracing.
20%	What supports this level Written prescription for a knee brace and/or assistive device in the record Whether the complete tear was repaired, unrepaired, or a failed repair Persistent instability documented on examination Positive instability testing
30%	Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.	You have an unrepaired or failed-repair complete ligament tear causing persistent instability, AND a provider has prescribed BOTH an assistive device and bracing for walking. Both, not either — that is the whole difference between 20 and 30 percent under this code. This is the ceiling of DC 5257.
30%	What supports this level Prescriptions for BOTH a brace AND a cane, crutches or walker, in writing Imaging or operative report confirming an unrepaired or failed complete tear Persistent instability documented on examination Significant functional impairment in weight-bearing activities

The middle column is our transcription of the criteria at 38 CFR 4.71a, DC 5257, condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Bringing symptom descriptions instead of prescriptions. Since 2021 the whole DC 5257 ladder keys on what a medical provider PRESCRIBED — nothing, one item, or both a brace and an assistive device. If you use a brace or a cane that you bought yourself, ask your provider to prescribe it and put that in the record before the exam.

Not getting the tear characterised. The code distinguishes a sprain or incomplete tear from a COMPLETE tear, and a repaired complete tear from an unrepaired or failed repair. Make sure the operative report and the exam both state which one you have — it is the difference between the 20 and 30 percent rows.

Not knowing DC 5257 also carries a separate PATELLAR INSTABILITY ladder. If your problem is the kneecap rather than a cruciate or collateral ligament, that ladder (also 10/20/30) is the one that applies, and Note (2) says an arthroscopy that did not repair a patellofemoral component does not count as surgical repair.

Not requesting instability testing during the C&P exam — the examiner must perform anterior drawer, Lachman, and valgus/varus stress tests to document instability.

Not understanding that instability (DC 5257) can be rated separately from limitation of motion (DC 5260/5261) — VAOPGCPREC 23-97 allows separate ratings for both.

Not documenting the use of a knee brace or assistive device — this supports the severity of instability.

Failing to report how often the knee gives way and in what activities — frequency and functional impact determine the rating level.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

Tick these off as you gather them. Nothing here is required — the exam happens either way — but each one is something the examiner cannot record if it is not in front of them.

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Take it with you

Print the whole guide — what the examiner records, the folder list with your ticks, the criteria table and the mistakes to avoid — and bring it to the appointment.

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C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

ACL Tear Residuals

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

ACL Tear Residuals

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam