Degenerative and Post-Traumatic Arthritis of the Knee
The cartilage is worn through and bone is working against bone. It is stiff in the morning and it never fully goes away.
Arthritis is the knee code that quietly pays when nothing else does. Under 38 CFR §4.71a, Code 5003, degenerative arthritis established by X-ray is rated on limitation of motion — but when the limitation is noncompensable, the regulation still assigns 10 percent for each major joint affected by painful or limited motion. Code 5010 applies the same rules to traumatic arthritis. And §4.59 independently entitles an actually painful joint to the minimum compensable rating. That is three separate routes to a payment on a knee whose degrees look "normal."
The Diagnostic Codes
Conditions Rated In Knee & Lower Leg
These are the codes the VA will actually stamp on a decision in this group. The code you are granted under decides which formula is used — and that decides your percentage. Knee Arthritis is highlighted below.
DC 5257
Knee Instability — Recurrent Subluxation and Patellar Instability
The knee gives way underneath you. The ligaments no longer hold the joint where it belongs.
Read the full page
DC 5260 · 5261
Limitation of Range of Motion of the Knee — Flexion and Extension
The knee will not bend far enough, or will not straighten all the way. Both are measured in degrees on a goniometer — and each direction is its own rating on the same knee.
Read the full page
DC 5258 · 5259
Semilunar Cartilage — Dislocated Meniscus and Meniscectomy Residuals
The shock absorber in the knee is torn, displaced, or has been cut out. The joint locks, swells, and hurts.
Read the full page
DC 5003 · 5010
Degenerative and Post-Traumatic Arthritis of the Knee
The cartilage is worn through and bone is working against bone. It is stiff in the morning and it never fully goes away.
You are reading this page
DC 5256
Ankylosis of the Knee
The knee is fused. It does not move at all — and the angle it is frozen at decides the rating.
Read the full page
DC 5262
Impairment of the Tibia and Fibula, and Medial Tibial Stress Syndrome
The shin bones themselves — a fracture that never knitted straight, or shin splints that never stopped.
Read the full page
Before Anything Gets Rated
What The VA Is Actually Looking For — And What Service Connection Really Means
Before the VA ever opens the rating schedule, it asks one question: is this disability the government’s responsibility? That is what “service connection” means. It is not a diagnosis, it is not sympathy, and it is not a reward for having served. It is a legal finding that a current, diagnosed disability is linked to something that happened to you in uniform. Percentages come later. If service connection is not established, there is nothing to rate and the claim is denied — no matter how bad the knee arthritis is.
The three elements the VA must find. All three. Every time.
These come out of Caluza v. Brown and Shedden v. Principi, and they are the checklist a rating officer works through on your file. Miss one and the claim fails on that element alone.
A current, diagnosed disability
A doctor has to have written a diagnosis in a medical record — knee arthritis. Symptoms by themselves are not a disability the VA can rate. Saunders v. Wilkie held that pain causing functional impairment can be a disability, but you still need a clinician to document it as diagnosed and impairing. The diagnosis must exist now, during the claim period — not only years ago.
An in-service event, injury, illness or aggravation
Something in service had to have happened — an injury, an exposure, a documented sick call, or steady wear over a career. It does not have to be one dramatic moment and it does not have to be spelled out in your service treatment records: buddy statements, unit records, performance evaluations and your own competent lay testimony can establish it.
A medical nexus linking the two
A qualified medical opinion that says the current diagnosis is at least as likely as not related to the in-service event. That phrase matters: at least as likely as not means 50 percent or better. Under 38 C.F.R. §3.102, when the evidence is evenly balanced, the benefit of the doubt goes to you and the claim must be granted.
The five ways service connection is established
Most veterans only know the first one. The other routes are lower-effort paths to the same grant — and the secondary route is the one most often left on the table.
Direct — 38 C.F.R. §3.303(a)
The injury or disease began in service and never went away. The classic route: three elements, one nexus opinion.
Chronicity and continuity — §3.303(b)
A chronic condition shown in service, plus continuity of the same symptoms from separation to now, can establish the link without a formal nexus opinion. Your own testimony about symptoms you can observe is competent evidence.
Presumptive — §3.307 and §3.309
Certain chronic diseases are presumed service connected if they manifest to a compensable degree within a set window after separation. You do not have to prove causation at all.
Secondary — §3.310(a) and (b)
A disability proximately due to, or aggravated by, an already service-connected condition is itself service connected. This is how the downstream conditions knee arthritis sets off get on the rating sheet.
Aggravation of a pre-service condition — §3.306
If you entered service with a condition and service made it permanently worse, the increase is compensable. The VA must rebut the presumption of soundness by clear and unmistakable evidence — a bar it frequently fails to meet.
VA medical care — 38 U.S.C. §1151
An additional disability caused by VA treatment, surgery, or a failure to diagnose is compensated as if it were service connected.
The bottom line — there is no way around this
No diagnosis, no rating. It has to be chronic. It has to cause impairment.
Without a diagnosis, the VA will not rate your claim.
The rating schedule is a list of diagnosed conditions and the codes attached to them. If no clinician has put a name on your condition in a medical record, there is no code to assign. Symptoms reported to a claims examiner are not a diagnosis. Get in front of a doctor and get it written down.
The condition must be chronic.
Chronic means persistent and ongoing — not something that resolved decades ago. The VA compensates a disability you carry today, which is why a documented, continuing treatment history matters more than the single worst day you ever had.
It must cause actual impairment.
Under 38 C.F.R. §4.1 and §4.10, VA compensation exists to pay for reduction in earning capacity. A diagnosis that costs you nothing gets a zero percent rating. The function you have lost is what converts a diagnosis into a percentage.
What this means for you before you file: get the diagnosis in writing, get the treatment history documented so the chronicity is undeniable, and describe the impairment in functional terms — what you can no longer do, and what it costs you at work and at home. Everything on the rest of this page is built on top of those three things.
The Percentages
Rating Schedule — Degenerative Arthritis of the Knee, Diagnostic Codes 5003 and 5010
Code 5003 governs degenerative arthritis and Code 5010 directs that traumatic arthritis be rated as degenerative arthritis. The knee is a major joint under 38 CFR §4.45(f). The percentages below apply only when the limitation of motion is noncompensable under Codes 5260 and 5261 — where motion is compensable, you are rated on the motion code instead.
10%
Degenerative arthritis established by X-ray findings, with limitation of motion that is noncompensable under the appropriate diagnostic code, rated at 10 percent for each major joint or group of minor joints affected. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.
10%
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups — 10 percent.
20%
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations — 20 percent.
Note
The 20 percent and 10 percent ratings based on X-ray findings above will not be combined with ratings based on limitation of motion, and will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. Diagnostic Code 5010, traumatic arthritis, is rated as degenerative arthritis under Code 5003.
§4.59
Separately, 38 CFR §4.59 provides that it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. For the knee that is 10 percent.
Service Connection
Advice from the Advocate
The advocate's notes on causation — Knee Arthritis
The separate arguments that decide this code: where the VA will attack, the regulation that answers it, and the evidence that closes the gap.
1Painful motion alone earns the minimum compensable rating — §4.59
38 CFR §4.59 is the most under-used sentence in the rating schedule. It provides that actually painful joints due to healed injury are entitled to at least the minimum compensable rating for the joint — 10% for a knee — regardless of whether the measured degrees reach a compensable level. Burton v. Shinseki, 25 Vet. App. 1 (2011) confirmed §4.59 is not limited to arthritis claims. A knee that hurts through its arc should not be rated 0%.
2Traumatic arthritis is the direct continuation of the in-service injury — §3.303(a) and Code 5010
Code 5010 exists because the schedule recognizes that trauma causes arthritis. Under 38 CFR §3.303(a), disability resulting from an injury incurred in the line of duty is service-connected, and the arthritis now visible on X-ray in the same knee that was injured in service is that disability, matured. The imaging is the nexus evidence.
3Arthritis is a chronic disease with a presumptive route — §3.307 and §3.309(a)
Arthritis is expressly listed as a chronic disease at 38 CFR §3.309(a). Under §3.307(a)(3), if it manifested to a degree of 10 percent or more within one year of separation, service connection is presumed — no nexus opinion required. Post-service X-rays and treatment records from that first year are worth digging out of storage.
4Arthritis and instability are two ratings on one knee — §4.14
VA General Counsel precedent confirms that arthritis with painful or limited motion and instability under Code 5257 compensate different functional losses and may be separately rated. 38 CFR §4.14 bars only duplicate rating of the same disability. Where a decision grants one and is silent on the other, the omission is the error, not the law.
5It spreads — the other knee, the hips, and the spine follow under §3.310
An arthritic knee changes gait, and altered gait loads everything above and beside it. 38 CFR §3.310(a) covers disability proximately due to a service-connected condition and §3.310(b) covers aggravation of a nonservice-connected one. Contralateral knee arthritis, hip degeneration, and lumbar strain are all standard, provable secondary claims off a service-connected knee.
Exposure & Aggravation
How Knee Arthritis Happens In Service — And How It Gets Worse
How veterans pick this up in uniform — Knee Arthritis
Knee Arthritis rarely announces itself with one dramatic moment. It is built by what service asked of your body over months and years — and once it is service-connected, it is compensated for how it keeps getting worse, not for how it started. Below is how veterans pick this up in uniform, and who is most prone to it.
- Post-traumatic arthritis following a documented in-service knee injury — this is Code 5010 by name
- Accelerated wear after an in-service meniscectomy removed the joint’s shock absorber
- Twenty years of running in boots on concrete, flight lines, and piers
- Ruck marches with 60 to 100 pounds compressing the joint over thousands of miles
- Repeated hard landings from aircraft, vehicles, and obstacle courses
- Chronic instability from a ligament injury grinding the joint surfaces out of alignment
- Cold-weather deployments and the joint insults that came with them
Who is most prone to it
Career infantry, airborne, artillery, armor, engineers, and aviation and vehicle maintainers — and any veteran who had a knee injury or knee surgery in service, because post-traumatic arthritis is the predictable end of that story.
The Symptoms
What Knee Arthritis Actually Feels Like
- Deep, aching pain inside the joint rather than on the surface
- Morning stiffness that takes 20 to 30 minutes to work out
- Grinding and crunching you can feel through your hand on the kneecap
- It gets worse with weather changes and with cold
- It hurts more after rest than during activity, then hurts after activity too
- The knee is warm and slightly swollen much of the time
- Standing up after sitting is the worst single moment of the day
- The joint is visibly wider or knobbier than it used to be
How this one is rated
On limitation of motion first, under Codes 5260 and 5261. If the motion loss is noncompensable, Code 5003 assigns 10% per major joint with painful or limited motion confirmed by X-ray. Where there is X-ray evidence of involvement of 2 or more major joints with occasional incapacitating exacerbations, the schedule reaches 20%. Those 10% and 20% ratings under 5003 cannot be combined with a compensable motion rating for the same joint.
What you are measured against
X-ray findings of joint space narrowing, subchondral sclerosis, and osteophyte formation, read together with the goniometric motion measurements taken at the exam.
Each One On Its Own Page
Secondary Conditions — Aggravated or Caused by a Current Service-Connected Condition
Under 38 CFR §3.310(a), a disability that is proximately due to a service-connected condition is service-connected in its own right — and under §3.310(b), so is any additional disability caused when a service-connected condition aggravates a problem you already had. Each condition below is a separate evaluation with its own diagnostic code and its own percentage. They do not fold into the knee arthritis rating — they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.
The weight gain the joint forces on you
An arthritic knee that hurts to move drives you into a chair. The forced inactivity puts on weight, and the extra weight loads the joint even harder — a documented cycle. Under §4.40 and §4.45, the functional loss that keeps you sedentary is part of the disability, and the weight gain itself can support secondary claims when it aggravates other service-connected conditions.
The sleep it takes from you every night
A degenerative joint aches at rest, and the ache is worst when you lie still. Broken sleep from knee pain is a real, ratable consequence of the disability and it feeds fatigue, mood, and daytime function. Describe it plainly — how many times a night it wakes you and what you do to get back down — because it is evidence of severity the rating should reflect.
The spread to the other knee, the hips, and the spine
An arthritic knee changes how you walk, and altered gait loads everything above and beside it. §3.310(a) covers disability proximately due to a service-connected condition and §3.310(b) covers aggravation. Contralateral knee arthritis, hip degeneration, and lumbar strain off a bad knee are standard, provable secondary claims — each one its own separate rating.
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Knee & Lower Leg, In Detail
Knee & Lower Leg — Service Connection In Depth
Here is each claimable condition in this group on its own terms — what it is, what service did to it, and what the VA requires before it will connect it.
Knee Instability — Recurrent Subluxation and Patellar Instability
Instability is a separate rating from range of motion, and that single fact is worth thousands of dollars a year to veterans who are never told it. The VA General Counsel has confirmed that a knee with instability under Code 5257 and arthritis with limitation of motion under Codes 5003/5260/5261 can carry both ratings at once, because they compensate different functional losses and therefore do not violate the anti-pyramiding rule at 38 CFR §4.14. Most veterans are rated for one and never learn they qualified for two.
Read the full Knee Instability pageLimitation of Range of Motion of the Knee — Flexion and Extension
Range of motion in the knee is two separate measurements, and each one is its own diagnostic code. Flexion is the bend, rated under Diagnostic Code 5260; extension is the straighten, rated under Diagnostic Code 5261. Flexion tops out at 30%, extension climbs to 50%, and — this is the part veterans lose money on — 38 CFR §4.14 lets both be rated separately on the same knee, because they compensate opposite movements. Every percentage under both codes is a number on a goniometer, which means the rating is won or lost on how and when the measurement was taken. 38 CFR §4.59 requires that painful motion be treated as at least the minimum compensable rating, and DeLuca v. Brown, 8 Vet. App. 202 (1995) requires the examiner to account for additional loss during flare-ups and after repeated use. A single good-day number, taken cold and seated, is not a lawful rating picture.
Read the full Range of Motion pageSemilunar Cartilage — Dislocated Meniscus and Meniscectomy Residuals
The menisci are two crescents of fibrocartilage sitting on the tibial plateau, and they are the reason your knee survives being landed on. Once one is torn and displaced, the joint mechanically catches. The VA rates this separately from motion and separately from instability, under two codes: 5258 for a dislocated meniscus with locking, pain, and effusion, and 5259 for symptomatic residuals after the cartilage has been removed. Both are frequently swallowed into a single motion rating that pays less.
Read the full Meniscus pageDegenerative and Post-Traumatic Arthritis of the Knee
Arthritis is the knee code that quietly pays when nothing else does. Under 38 CFR §4.71a, Code 5003, degenerative arthritis established by X-ray is rated on limitation of motion — but when the limitation is noncompensable, the regulation still assigns 10 percent for each major joint affected by painful or limited motion. Code 5010 applies the same rules to traumatic arthritis. And §4.59 independently entitles an actually painful joint to the minimum compensable rating. That is three separate routes to a payment on a knee whose degrees look "normal."
You are reading this page now
Ankylosis of the Knee
Ankylosis is the end of the road for a joint: bony or fibrous fusion, no usable motion in any direction. It is the highest-paying knee code, running from 30% to 60%, and — counter-intuitively — the straighter the fusion, the lower the rating. A knee fused at full extension is still a leg you can stand and walk on. A knee fused at 45 degrees or more is a leg you drag. The angle is the whole rating.
Read the full Knee Ankylosis pageImpairment of the Tibia and Fibula, and Medial Tibial Stress Syndrome
Code 5262 covers the two long bones between the knee and the ankle, and since the February 7, 2021 revision it does two very different jobs. The first is structural failure of the bone — a fracture that healed crooked (malunion) or never healed at all (nonunion). The second is medial tibial stress syndrome, which the schedule added by name — the condition every veteran knows as shin splints, which for decades had no code of its own and was routinely denied because of it.
Read the full Tibia & Fibula pageThe C&P Exam
What To Expect At The Knee Arthritis Exam
This is the encounter your rating is built on. The examiner has a checklist and a limited window — what follows is exactly what happens in that room, so none of it surprises you.
Clinical Section — What To Expect at the Exam
What to Expect at Your Knee Arthritis C&P Examination
Diagnostic Codes 5003 and 5010 — the exam where imaging does half the work
This exam has two halves: what the X-ray shows and what your knee does. **Code 5003 requires X-ray confirmation** — without imaging in the file, the arthritis route is closed no matter how much the joint hurts. With imaging, a knee whose degrees are technically normal still rates **10 percent** if painful motion is objectively confirmed. Make sure both halves are actually completed.
Condition
Knee Arthritis — DC 5003 · 5010
Governing questionnaire
VA Form 21-0960M-9, Knee and Lower Leg Conditions Disability Benefits Questionnaire
Click the form number to open the official questionnaire on VA.gov.
01In The Room
What happens during the exam
The tests and maneuvers for this condition
- X-ray of both knees, weight-bearing views if possible
- Goniometric flexion and extension, active and passive
- Weight-bearing and non-weight-bearing measurement
- Three-repetition testing with re-measurement
- Palpation for crepitus, warmth, and effusion
- Patellar grind test
- Gait observation and assessment of assistive device use
What gets measured, and to what number
X-ray findings
Joint space narrowing, sclerosis, and osteophytes — the predicate for Code 5003.
Flexion and extension
Full goniometric measurement, because a compensable motion rating supersedes the 5003 rating.
Objective evidence of painful motion
Grimacing, guarding, spasm, or the veteran stopping the arc — must be written down.
Crepitus
Palpable grinding on movement of the patella and through the arc.
Swelling and warmth
Objective inflammatory signs at the joint.
Number of joints involved
Whether 2 or more major joints are affected — that changes the 5003 percentage.
Incapacitating exacerbations
Frequency of flares that stop you functioning, which is what reaches 20%.
02Orientation
What to expect during this exam
What makes this exam different from every other C&P exam
1No X-ray, no Code 5003 rating
The regulation says "established by X-ray findings." If imaging has not been done, or is not in the file, request it before or at the exam. This is the most common reason an arthritic knee comes back 0%.
2Painful motion must be objectively confirmed
The regulation asks for findings "such as swelling, muscle spasm, or satisfactory evidence of painful motion." The examiner has to actually record that you had pain through the arc. Make sure you demonstrate it and say it.
3Crepitus is a documentable finding
The grinding you feel is palpable to the examiner. Ask that crepitus be noted — it is objective corroboration of joint surface damage.
See it before you sit in the room
03Preparation
Know your symptoms and secondary factors
What the report must actually say about knee arthritis — dc 5003 · 5010
- "It hurts through the whole movement, not just at the end."
- "It is stiff for the first half hour every morning."
- "You can feel it grinding" — and ask them to put a hand on it.
- "It flares badly about X times a month and I cannot function on those days."
- "My other knee and my hip are now hurting because of how I walk."
- "Getting up after sitting is the worst part of my day."
Pain level, frequency, lost work and functional loss — how to say them
Say "it hurts when I move it" — those exact words
Arthritis is rated on limitation of motion, but §4.59 independently entitles an actually painful joint to the minimum compensable rating. The word that triggers §4.59 is painful motion — pain felt through the arc as the joint moves, not just at rest. Tell the examiner it hurts when you bend it and when you straighten it, and exactly where in the arc the pain starts.
Point to where in the bend the pain begins, and say whether it is there every single time you move it.
"It hurts the moment I start to bend it and it hurts again when I straighten it — painful the whole way through, every time."
Describe the morning stiffness and how long it lasts
Morning stiffness that takes many minutes to work out is a classic degenerative-arthritis pattern and helps distinguish it from a simple strain. Give the examiner a duration — "thirty minutes before I can walk normally" — because a measured, repeatable stiffness supports the diagnosis and the functional-loss picture under §4.40 and §4.45.
Say what you have to do to loosen it up and how many times a day the stiffness returns after sitting.
"Every morning it is locked up solid for about half an hour. It stiffens again any time I sit for a while and have to get up."
Report the flare-ups — frequency, trigger, and severity
The rating must account for additional loss during flare-ups and after repetitive use under §4.40, §4.45, and the DeLuca and Correia case law. If the exam happens on a good day and you do not describe the bad days, that loss is invisible. Tell the examiner how often flares happen, what brings them on, and how much more the joint loses when they hit.
Estimate how much less you can bend it during a flare and how long each flare keeps you down.
"After I am on it too long it flares — two or three times a week — and on those days I can barely bend it at all and I am down for the rest of the day."
Make sure the X-ray is actually in the file
Code 5003 requires X-ray confirmation of the arthritis. Without imaging in the record, the arthritis route is closed no matter how much the joint hurts. Ask the examiner directly whether current knee films are in the claims file, and if they are not, request that they be ordered — a missing X-ray is the single most common reason an obvious arthritis claim comes back at 0%.
Bring copies of any prior knee X-rays or MRI reports and hand them to the examiner at the start.
"Do you have my knee X-rays in the file? If not, I need them ordered — the arthritis has to be confirmed on imaging."
Secondary conditions to raise in the same appointment
The weight gain the joint forces on you
An arthritic knee that hurts to move drives you into a chair. The forced inactivity puts on weight, and the extra weight loads the joint even harder — a documented cycle. Under §4.40 and §4.45, the functional loss that keeps you sedentary is part of the disability, and the weight gain itself can support secondary claims when it aggravates other service-connected conditions.
The sleep it takes from you every night
A degenerative joint aches at rest, and the ache is worst when you lie still. Broken sleep from knee pain is a real, ratable consequence of the disability and it feeds fatigue, mood, and daytime function. Describe it plainly — how many times a night it wakes you and what you do to get back down — because it is evidence of severity the rating should reflect.
The spread to the other knee, the hips, and the spine
An arthritic knee changes how you walk, and altered gait loads everything above and beside it. §3.310(a) covers disability proximately due to a service-connected condition and §3.310(b) covers aggravation. Contralateral knee arthritis, hip degeneration, and lumbar strain off a bad knee are standard, provable secondary claims — each one its own separate rating.
How to prepare for this specific exam
- Make sure recent knee X-rays exist and are in the VA file — request them if not.
- Bring records of any first-year-after-service treatment; that opens the §3.309(a) presumption.
- Log incapacitating flare days for 90 days with dates and duration.
- Note any other joints involved — 2 or more major joints changes the rating.
- Bring documentation of NSAID use, injections, or bracing.
- Do not take extra pain medication right before the appointment.
04The Protocol
What procedures are required during the exam
These are not courtesies. Each comes out of the regulation or out of binding case law. Take this list in with you and tick them off as they happen.
01X-ray confirmation — the imaging that opens the code
38 C.F.R. §4.71a
The examiner must confirm that current knee films are in the file showing the degenerative changes — joint-space narrowing, osteophytes, and subchondral sclerosis. For Code 5003 this imaging is not optional: it is the foundation the entire arthritis rating is built on. If no films exist, the exam should not be completed until they are ordered.
Without X-ray confirmation the arthritis route is legally closed. This is the single most important step in the entire exam and the one most often skipped.
02Crepitus palpation — feeling the joint grind
38 C.F.R. §4.71a
The examiner places a hand flat over your kneecap while you bend and straighten the joint, feeling for the grinding and grating that comes from bone rubbing on roughened bone. Palpable crepitus is an objective sign of cartilage loss that corroborates the imaging and the painful-motion finding.
Documented crepitus is objective evidence the joint surfaces are damaged — it turns your report of grinding into a clinical finding the rater cannot dismiss.
03Weight-bearing alignment — standing assessment
38 C.F.R. §4.71a
The examiner has you stand so both knees can be assessed under load for varus (bowing out) or valgus (knocking in) deformity. Advanced knee arthritis wears the joint unevenly and bends the leg out of alignment, and that deformity must be observed while you are bearing weight, not lying on the table.
Correia requires that motion and function be tested in weight-bearing where feasible. A standing alignment assessment captures the real, loaded deformity a table exam misses.
04Effusion check — the ballottement test
38 C.F.R. §4.71a
The examiner presses down on the kneecap of the swollen joint to feel the tap of fluid underneath — a positive ballottement confirms an effusion. Arthritic joints swell with activity, and documented effusion supports both the severity of the arthritis and any associated functional loss under §4.40 and §4.45.
Objective effusion on exam day corroborates your account of a joint that swells and stiffens, and adds to the functional-loss picture the rating must capture.
05Goniometric range of motion — the compensable overlay
38 C.F.R. §4.71a
The examiner measures flexion and extension with a goniometer, active and passive, and repeats the arc three times. A compensable limitation of motion is rated on its own under Codes 5260 or 5261 and supersedes the Code 5003 arthritis rating — so this measurement can move you from a fixed 10% or 20% to a higher motion-based figure. It must be recorded in degrees, not described as "limited."
Arthritis with a compensable loss of motion is rated on the motion, not the 5003 minimum. An exam that confirms the X-ray but never measures the arc in degrees leaves the higher rating on the table.
05The Standard
What makes an exam adequate
Read your exam report against these. An exam that fails the standard is legally inadequate, and an inadequate exam is something you challenge rather than accept.
The range of motion has to be MEASURED, not estimated
38 CFR §4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. An examiner who eyeballs your bend and writes a number has not complied with the regulation. This is the most common defect in a spine exam and it is the easiest one to spot from the chair.
Joints must be tested in every required condition
Under Correia v. McDonald, a joint examination for pain must, wherever possible, record active motion, passive motion, motion in weight-bearing and motion in non-weight-bearing — and where relevant, the range of the opposite undamaged joint. An exam that records one set of numbers and stops is incomplete on its face, and that incompleteness is grounds to challenge it.
Flare-ups have to be addressed, not dodged
Under Sharp v. Shulkin, when a veteran describes flare-ups, the examiner is obligated to estimate the additional loss of motion during a flare based on all the available evidence — including your own account of it. "I cannot opine without resorting to mere speculation" is not automatically acceptable; the examiner has to have actually sought the information first and explained why an estimate is impossible.
Repetitive use and functional loss must be factored in
Sections 4.40 and 4.45, and the DeLuca line of cases, require that pain, weakness, fatigability, incoordination and lack of endurance after repeated use be considered — and expressed in additional degrees of lost motion where that is feasible. Your rating is supposed to reflect what you can do on the fifth repetition and on a bad day, not just the first careful bend of the morning.
Neurological findings must be separately documented
Note (1) to the General Rating Formula requires that any associated objective neurologic abnormality be evaluated separately under an appropriate diagnostic code. If your leg symptoms were mentioned in the narrative but never tested and never assigned, the exam did not do what the schedule requires of it.
The examiner must review the record when the question requires it
Where a medical opinion on cause, aggravation or a secondary relationship was requested, the examiner is expected to review the relevant evidence and give a reasoned explanation. A bare conclusion — "less likely than not related to service" with no reasoning attached — carries little weight, and an opinion with no rationale is challengeable.
The examiner has to be qualified for the body system
The VA may use its own clinicians or a contract vendor. Either way, the examiner is expected to have the competence to evaluate the system being examined. If a spinal exam with a neurological component was performed by someone who never tested a reflex, that is a problem worth raising.
The exam has to be CURRENT
A rating is supposed to reflect your condition now. An exam performed before a documented worsening, or years before the decision, may not support the current evaluation — and you can request a new one on that basis.
06Afterward
What happens after your exam is complete
The examiner writes the report and submits it, it is reviewed for completeness, and only then does the claim move toward a rating decision. Here is what actually controls the clock.
The examiner writes and submits the report
Days 1–5 after the exam
The examiner compiles the history, the physical findings, the measurements and any testing into the questionnaire, adds any requested medical opinion, and submits it. Contract vendors typically have a turnaround requirement measured in days, not weeks.
Nothing about your claim moves while this is happening, and nothing you do speeds it up. What matters is that the report is written from notes taken in the room — which is exactly why what you said, and how the examiner recorded it, is already locked in by the time you get to your car. Request your copy now rather than later.
Quality review — and the request for clarification
Days 3–30
The report is reviewed for completeness. If it is internally inconsistent, missing a required field or missing the opinion the VA asked for, it goes back for correction or a second opinion. This is the single most common cause of a claim appearing to stall after the exam.
Understand what a finished exam actually means: it means the appointment happened, not that your claim is ready for a decision. If the reviewer finds a blank range-of-motion field, an opinion that does not answer the question that was asked, or findings that contradict each other, the file goes back out for more information. That is a normal quality control step, not a rejection of your claim, and it is not a sign that you did something wrong — but it does add weeks, and it is the reason so much of what you read online sounds like the system is broken.
Your status tracker moves backward — and it is usually not bad news
Any time after the exam
The online tracker shows eight steps. Veterans watch it reach step 7 or 8, then find it back at step 3 or 4 a week later. That regression almost always means one thing: the file went back for additional information, most often a returned or clarified exam.
This is the number one thing veterans panic about, and it is misread constantly. The tracker is not a countdown — it is a location marker. When the VA decides it needs one more piece of evidence, a corrected exam, a clarifying medical opinion or an outstanding record, the claim is routed back to the evidence gathering step and the bar redraws itself where the file physically is. It does not mean a denial. It does not mean your case was thrown out or restarted. It does not erase anything already in the file, and it does not change your effective date. What it does mean is that something in the record was not good enough to decide on yet — which is worth knowing, because if the weak link is the exam, this is the window where a corrective statement or a private opinion from your own doctor does the most good.
Evidence gathering closes
Varies
Before anyone rates your claim, the file has to be built. This is the stretch where the Regional Office pulls together everything the decision will rest on: your service treatment records, your VA medical records, any federal records, the C&P exam report, and any private records it has requested on your behalf. The claim sits here until the VA is satisfied the record is complete enough to decide — which is exactly why a status tracker can appear to stall or slide backward at this step. You are not powerless while it sits here. Anything you put into the file yourself lands the day you send it, and every relevant record you add now is one less thing the rater can later say was missing.
A VA request to a private provider is a letter that may or may not be answered, and the VA will wait on it for weeks before moving on — sometimes without ever getting a response. A record you walk in yourself, or upload through your claim, is in the file the day you send it. So do not sit and wait to be asked. If you know a treatment record, an imaging report, a surgical note or a buddy statement exists and it matters, send it now, with a VA Form 21-4138 statement that explains in plain words what the document is and what it shows. This is also the window where a corrective statement or a private medical opinion from your own doctor does the most good — before the rater has locked in a decision, not after. Once the evidence gathering step closes, the file goes to a rating specialist, and your chance to shape the record cheaply and quickly closes with it.
Rating decision and promulgation
Typically several weeks after the last piece of evidence lands
This is the stage where your evidence finally becomes a number. A rating specialist — not the examiner, and not a doctor — takes everything in the file and applies the rating schedule to it: the exam findings, your range-of-motion measurements, your lay statements, your private records and any medical opinions. They assign a diagnostic code to each condition, pull a percentage from the schedule, set your effective date, and either grant, deny or defer each issue. The decision is then reviewed and authorized — promulgation is simply the VA’s word for making it official — and the decision letter and code sheet are generated and mailed. Where an award is made, payment follows the effective date rules, and back pay is calculated to that date.
Read the code sheet, not just the percentage. It names the diagnostic code used, the exact measurements relied on and the effective date assigned — and that is where most mistakes live. This is a human being reading a file under a production quota, and the two things that go wrong most often are a rater using the pre-repetition range-of-motion numbers instead of the worst-case figures §4.59 and §4.40 require, and a claimed condition being decided on a thin record or quietly left out. Check whether painful motion was accounted for, whether your radiculopathy was rated separately under Note (1) or folded into the spine rating, and whether every condition you claimed was actually addressed. A decision you do not read is a decision you cannot challenge — and the deadline to challenge it starts the day the letter is dated, not the day you understand it.
C&P examination is the decision letter
The day it lands in your mailbox
The envelope holds two different documents: the narrative decision letter, and the code sheet. Together they are the single most important piece of paper in your claim, because every deadline, every appeal option and every dollar of back pay is set by what is printed on them — not by what you were told at the exam.
Most veterans read one thing on that letter: the percentage. Then they either celebrate it or get angry at it, and file it in a drawer. That is the mistake. The percentage is the conclusion; the reasons section is the reasoning, and the reasoning is what you attack. It tells you which diagnostic code the rater used, which range-of-motion figures they relied on and which they ignored, whether painful motion under §4.59 was accounted for, whether your neurological findings were rated separately under Note (1) or folded into the spine rating, which conditions were decided, which were deferred, and which were never addressed at all. It also assigns your effective date, which controls back pay. A rating that looks low is very often not a disagreement about how bad your neck is — it is a rater who used the pre-repetition numbers, or missed the radiculopathy, or rated one side and not both. You cannot see any of that from the percentage. Do not go by the percentage alone, and do not decode it by yourself if you are not sure what you are looking at — have someone who reads these for a living read it with you before the clock runs out. You have one year from the date on that letter to file a Higher-Level Review (VA Form 20-0996), a Supplemental Claim (VA Form 20-0995) or a Board appeal, and the deadline runs from the date printed on the letter, not the date you opened it. Bring it to this office and we will go through it line by line, at no cost, and tell you plainly whether it is right.
What normal looks like: 30 to 60 days for a simple claim, longer for a complex one
After your exam you should expect some kind of notification from the VA — a decision, a request for more information, or a notice that another exam has been scheduled. For a straightforward, single-issue claim that often lands within 30 to 60 days. But 30 to 60 days is a rough guide, not a rule, and it is not a ceiling. A claim with several conditions, a toxic-exposure or presumptive question, a returned exam, or missing records routinely takes 90 days or more, and that alone does not mean anything is wrong — the more moving parts your case has, the longer the VA takes to work it. Inside the window that is normal for a case like yours, silence is expected and there is nothing to fix, and a tracker that jumps backward is normal too.
What matters is not a fixed number of days — it is whether the claim is still moving and whether you can get a straight answer about where it is. Once you are well past what is normal for a case like yours and the VA either goes silent or cannot tell you what the claim is waiting on, stop waiting. That is usually where the real trouble hides — an exam that came back twice, a records request that was never answered, a claimed condition that got dropped, or a file sitting in the wrong queue. Call the VA at 800-827-1000, ask specifically what the claim is waiting on and who it is assigned to, and write down the answer. If you cannot get a straight answer, or the answer tells you the exam is the problem, that is the moment to bring it to this office rather than sitting on it for another three months. Problems raised early get fixed inside the claim. Problems discovered in a denial letter get fixed on appeal, and that costs you a year.
Other things that control the clock
Six things decide how long you wait, and none of them are visible from the tracker alone.
The average is a moving number
Check it at the source, not second-hand
The VA publishes an average days-to-complete figure for disability claims that moves month to month; check the current number on the VA’s own claim status page rather than relying on any second-hand figure. In practice, most veterans see a decision somewhere between roughly three and eight months from the date the claim was filed, with the exam usually falling in the middle of that window.
The exam is not the last step
Three stages still sit in front of you
The exam is not the last step. The clock does not start at the exam and it does not stop there either — the claim still has to clear evidence gathering, the rating decision and authorization.
A returned exam is the invisible delay
The reason a tracker slides backward
A returned or clarified exam is the most common invisible delay, and it is why a tracker can slide backward. Expect some contact from the VA within 30 to 60 days of the exam. Past 60 days with nothing at all, call and ask specifically what the claim is waiting on.
30 to 60 days is a guide, not a deadline
A complex case can take 90 days or more
Thirty to sixty days is a rough average for a simple, single-issue claim — not a hard rule and not a ceiling. A claim with several conditions, a presumptive or toxic-exposure question, a returned exam, or missing records can easily take 90 days or more, and that alone does not mean anything is wrong. Watch whether the claim is still moving, not the calendar. Only when it stalls well past what is normal for a case like yours, and no one can tell you what it is waiting on, should you stop waiting — call 800-827-1000 and ask what the claim is waiting on and who it is assigned to.
Watch your status yourself — in one of three places
Weekly, not daily
Check your own status in one of three places: your VA.gov claim status page, the VA Health and Benefits mobile app, or by calling 800-827-1000. Check it weekly, not daily. And understand exactly what a status check can tell you: if a decision is posted in your account, it is live; if it is not posted, it is not ready. That is the whole rule. This is not something your representative or your attorney can speed up — we see the same thing you see, at the same time, and calling us to ask does not move it. Calling the VA to ask for an update does not move it either. Watch it yourself, weekly, and the moment a decision posts, bring it to us.
Your decision letter arrives — read it, then start the appeal clock
What to do the day it lands in your mailbox
The decision letter is the finish line of the claim and the starting line of the appeal — and the moment it arrives, a one-year clock starts running. Read it the same day. Find the combined rating, the percentage assigned to each condition, and the effective date, because the effective date controls how far back your back pay reaches. Then request a copy of your C&P exam report so you can see whether the rater used your real range-of-motion numbers or ignored the radiculopathy. If any part of the decision is wrong — a low rating, a denied condition, or a bad effective date — you have three appeal lanes, and you must choose one within one year of the date printed on the letter: a **Higher-Level Review (VA Form 20-0996)**, where a senior reviewer re-decides on the same evidence; a **Supplemental Claim (VA Form 20-0995)**, when you have new and relevant evidence such as a private DBQ or your own range-of-motion exam; or a **Board Appeal (VA Form 10182)** to a Veterans Law Judge. Miss that one-year deadline and the decision becomes final. You can still file again later, but you lose the original effective date — and that lost time is lost back pay you never get back. Bring the letter to this office before the year runs out and we will read it with you, line by line, at no cost.
07Remedy
How to report a bad exam
Where this exam goes wrong
The classic bad outcome here is a 0% grant: "Degenerative changes noted. Range of motion within normal limits." That report ignores **§4.59** entirely. A joint confirmed arthritic on X-ray, with objectively painful motion, is entitled to at least the minimum compensable rating for that joint. A 0% on those facts is a legal error in the rating decision — and it is fixable on Higher-Level Review without any new evidence at all.
Write it down the moment you get to your car
Date, start time, end time, the examiner’s name and credentials, the vendor, every test that was performed, and every test that was not. A contemporaneous note written the same day is evidence. A memory reconstructed four months later is not.
Get the exam report and the questionnaire
Request a copy through VA.gov, through a written request to the Regional Office, or by calling 800-827-1000. You cannot challenge what you have not read. Compare it line by line against what actually happened in the room.
Name the defect specifically, with the citation
Never write "the exam was unfair." Write "no goniometer was used, contrary to 38 CFR §4.46" or "flare-ups were reported and not addressed, contrary to Sharp v. Shulkin" or "repetitive use testing was not performed, contrary to 38 CFR §4.40 and DeLuca." A specific, citable defect is what forces action.
Submit a statement asking for a new examination
VA Form 21-4138, Statement in Support of Claim, filed through VA.gov or mailed to the Evidence Intake Center. State the defect, cite the authority, and request a new or supplemental examination. Do this BEFORE the decision if the claim is still open — it is far easier than undoing a decision afterward.
Report examiner conduct separately
If the problem is behavior rather than methodology — you were rushed out, dismissed, never touched, or treated with hostility — file a complaint with the VA facility’s Patient Advocate, or with the vendor directly for a contract exam, and copy the Regional Office. Conduct complaints and adequacy challenges are two different tracks and you can run both.
If a decision has already issued, pick the right lane
A Higher-Level Review (VA Form 20-0996) argues the VA erred on the evidence it had — the right vehicle when the exam was inadequate on its face. A Supplemental Claim (VA Form 20-0995) is the vehicle when you are adding new and relevant evidence, such as your own private range-of-motion examination or a completed DBQ from your treating provider.
Put your own measurements on the table
A private examination with full goniometric measurements, or a DBQ completed by your own provider, creates a conflict in the evidence that the VA has to resolve — and under 38 CFR §3.102 reasonable doubt is resolved in your favor.
End of clinical section
Knee Arthritis — DC 5003 · 5010
See It Before You Sit In The Room
How Osteoarthritis Develops — Animation
AniMed
Osteoarthritis of the Knee
OrthoInfo
The Questions Veterans Actually Ask
Knee Arthritis Claims — Frequently Asked Questions
Straight answers to the questions that decide knee arthritis claims — the ratings, the separate evaluations, and the exam mistakes that cost veterans money.
Knee Arthritis is evaluated under DC 5003 · 5010. The scale runs across 5 rating levels, and the highest is 10%, which the VA assigns for: degenerative arthritis established by X-ray findings, with limitation of motion that is noncompensable under the appropriate diagnostic code, rated at 10 percent for each major joint or group of minor joints affected. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Where your evaluation actually lands depends on how your exam and records document those criteria — not on how bad the condition feels on an average day.
Every condition in Knee & Lower Leg
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