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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.
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Looseness or giving way of the knee joint. DC 5257 was rewritten effective February 7, 2021 and no longer turns on whether instability is described as slight, moderate, or severe. It now has two separate ladders — recurrent subluxation or instability, and patellar instability — and each level turns on the ligament findings plus what a medical provider has actually prescribed for walking (a brace, a cane or crutches, a walker). It can be rated separately from flexion/extension limitations.
The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.
Rated under 38 CFR 4.71a, DC 5257. The examiner records findings on the DBQ; a rating specialist makes the decision.
| 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. | Neither 10 percent ladder is met: on the recurrent subluxation or instability ladder there is no sprain and no ligament tear causing persistent instability, and on the patellar instability ladder there is no diagnosed patellofemoral condition with recurrent instability. Every rung of DC 5257 requires instability that is persistent or recurrent, so an examination that finds the knee stable falls below all of them. This code 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 it. The lowest compensable level under this code is 10 percent. |
What supports this level
| ||
| 10% | Recurrent subluxation or instability: 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. Patellar instability: 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. | Recurrent subluxation or instability ladder: you have a sprain, an incomplete ligament tear, or a complete ligament tear (repaired, unrepaired, or a repair that failed) that causes persistent instability, but no provider has prescribed a brace or a walking aid. Patellar instability ladder: you have a diagnosed patellofemoral condition with recurrent instability, with or without a history of surgical repair, that does not require a prescription for a brace, cane, or walker. |
What supports this level
| ||
| 20% | Recurrent subluxation or instability: 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. Patellar instability: 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. | Recurrent subluxation or instability ladder: either (a) a sprain, incomplete tear, or repaired complete tear causing persistent instability where a provider prescribed a brace and/or a walking aid, or (b) an unrepaired or failed-repair complete ligament tear causing persistent instability where a provider prescribed either a walking aid or bracing. Patellar instability ladder: recurrent instability after surgical repair requiring a prescription for one of a brace, cane, or walker. |
What supports this level
| ||
| 30% | Recurrent subluxation or instability: 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. Patellar instability: 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. | Recurrent subluxation or instability ladder: an unrepaired complete ligament tear, or one whose repair failed, causing persistent instability, where a provider prescribed BOTH a walking aid AND bracing. Patellar instability ladder: recurrent instability after surgical repair requiring a prescription for a brace AND either a cane or a walker. This is the maximum rating under this code. |
What supports this level
| ||
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.
Using the old slight/moderate/severe language. DC 5257 was rewritten effective February 7, 2021. A C&P examiner writing "moderate instability" no longer maps to a percentage on its own — the current criteria turn on the ligament findings plus what a provider prescribed for walking.
Not getting the brace or assistive device actually PRESCRIBED. Buying a knee brace yourself does not meet the criteria; the levels above 10% require a prescription from a medical provider. If you use one, ask your provider to document the prescription in your records.
Not knowing instability can be rated separately from range of motion — you can get both DC 5257 and DC 5260/5261 for the same knee (VAOPGCPREC 23-97).
Not reporting episodes of the knee giving way, buckling, or causing falls.
C&P examiner not performing stability testing — ask for specific ligament tests, and ask that the report state whether any ligament tear is complete and whether it was repaired.
Note (1) to DC 5257: for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. If your diagnosis names none of those three, you are on the recurrent subluxation or instability ladder, not the patellar one — the two ladders have different criteria at every level.
Note (2) to DC 5257: a surgical procedure that does not repair one or more patellofemoral components contributing to the instability — arthroscopy to remove loose bodies, joint aspiration — does not count as surgical repair for the patellar instability ladder.
These apply to every C&P exam, whatever the condition.