VA Rating for Knee Pain: Compensation and Rating Guide

Knee injuries represent among the most common service-connected musculoskeletal disabilities for veterans. Whether from combat operations, training injuries, or military occupational demands, knee pain affects work capacity and quality of life. Many veterans don't realize that knee conditions receive VA disability ratings ranging from 10% to 100%, with monthly compensation based on severity and functional impact.

Understanding Knee Conditions in Military Service

The VA recognizes various knee conditions as service-connected:

Anterior Cruciate Ligament (ACL) Tears - Most common knee injury in military personnel. ACL tears from jumping, rapid direction changes, or trauma significantly impair knee stability and function.

Meniscal Tears - Cartilage damage affecting knee mechanics. Can develop from acute injury or degenerative changes over years of service.

Osteoarthritis of the Knee - Degenerative joint disease from wear-and-tear during military service. More common in those with prior injuries or high-impact occupations.

Medial/Lateral Collateral Ligament Injuries (MCL/LCL) - Side ligament tears from lateral impact or twisting injuries.

Patellofemoral Pain Syndrome - Damage to cartilage behind kneecap; common in runners and those with repetitive impact duties.

Chondromalacia Patella - Cartilage softening under the kneecap causing pain with activity.

Post-Traumatic Arthritis - Joint disease developing after injury, often years later.

Military occupations with high knee injury rates:

Infantry and combat roles (high impact, heavy load carrying)
Airborne/Ranger training (jumping operations)
Physical training instructors
Combat support roles requiring extended patrols
Aviation personnel (ejection seat injuries)

VA Rating System for Knee Conditions

The VA uses multiple diagnostic codes for knee disability, rating on functional limitation rather than diagnosis alone. Key codes include:

DC 5003 - Arthritis, Hypertrophic DC 5020 - Knee, Instability DC 5099 - Knee, Other Conditions

Rating Criteria

The VA's 2019 Schedule for Rating Disabilities uses the following criteria for knee ratings:

0% (Not Rated) - No functional limitation or occasional mild pain without restriction

10% Rating - Slight functional limitation:

Occasional pain with strenuous activity
No swelling or instability documented
Full range of motion maintained
Minimal medication needed
No work restriction

20% Rating - Mild functional limitation:

Pain with moderate activity
Slight swelling or occasional instability
Near-normal range of motion
Occasional medication
Minimal work restrictions

30% Rating - Moderate functional limitation:

Pain with everyday activities and rest
Documented swelling or instability
Limited range of motion (10-20% limitation)
Regular pain medication
Some work restrictions (can't stand 8 hours daily)

40% Rating - Moderately severe functional limitation:

Significant pain throughout day
Marked swelling or instability
Range of motion 20-40% limited
Multiple medications or other treatments
Cannot perform occupational duties without limitation

50% Rating - Severe functional limitation:

Constant pain even at rest
Severe swelling and instability
Range of motion 40-60% limited
Requires multiple treatment modalities
Unable to work in occupational field

60%-100% Rating - Very severe to total disability:

Severe functional limitation affecting employment
May require surgery or special footwear
Often combined with other conditions
100% typically via TDIU (Total Disability Individual Unemployability)

Factors Determining Rating Percentage

The VA considers:

Pain severity - Mild, moderate, or severe
Functional limitation - Impact on standing, walking, climbing
Range of motion - How much knee can bend/straighten
Stability - Evidence of ligament damage causing instability
Swelling - Degree of edema present
Treatment status - Medications, physical therapy, surgery
Work capacity - Ability to perform occupational duties

Monthly Compensation for Knee Conditions

Monthly compensation varies by rating percentage and dependent status. As of 2025:

10% Rating:

Veteran alone: $175-$185/month
With spouse: $195-$210/month
With child: $210-$230/month

20% Rating:

Veteran alone: $253-$270/month
With spouse: $280-$305/month
With child: $315-$345/month

30% Rating:

Veteran alone: $330-$350/month
With spouse: $365-$390/month
With child: $395-$425/month

40% Rating:

Veteran alone: $470-$490/month
With spouse: $515-$545/month
With child: $565-$600/month

50% Rating:

Veteran alone: $605-$625/month
With spouse: $665-$690/month
With child: $720-$755/month

100% Rating (often TDIU):

Veteran alone: $3,737-$3,850/month
With spouse: $4,095-$4,230/month
With child: $4,450-$4,600/month

These amounts increase annually with COLA. Your effective date determines your rate, with back pay calculated from service-connection approval date.

Evidence Requirements for Knee Claims

Medical Documentation

Imaging Studies:

X-rays showing joint damage, arthritis, or alignment problems
MRI showing ligament tears, meniscal damage, cartilage loss
CT scans if available

Diagnostic Reports:

Orthopedic surgeon evaluation documenting findings
Range of motion measurements
Stability testing results (Lachman test, anterior drawer test)
Swelling assessment
Diagnostic arthroscopy reports if applicable

Treatment Records:

Physical therapy notes showing treatment frequency and progress
Medication list for pain management
Surgical records if knee surgery performed
Injection records (cortisone, hyaluronic acid)
Follow-up medical records

Baseline Military Records:

Military medical records documenting initial knee injury
Training records documenting injury circumstances
Medical profiles limiting activities during service

Lay Evidence

Personal Statements:

Detailed description of knee injury (when, how it occurred)
Impact on daily activities
Functional limitations (difficulty walking, standing, climbing stairs)
Medication side effects
Work performance impacts
Sleep disruption from pain

Supporting Statements:

Family members describing functional limitations
Employers noting work restrictions needed
Service members witnessing injury event

Nexus Letter for Knee Claims

A nexus letter from an orthopedic surgeon or primary care physician establishes connection between military service and knee condition.

Essential Nexus Components

Medical Opinion Statement that knee condition is "at least as likely as not" caused or aggravated by military service.

Service-Related Cause Explanation of how service caused the condition:

Specific injury during training or combat
Repetitive impact from occupational duties
Heavy load carrying during deployment
Jump training injuries

Medical Evidence Review Reference diagnostic imaging, surgical findings, and exam results supporting service connection.

Timeline Clear explanation of condition onset relative to military service.

Quality Nexus Providers

VA Orthopedic Surgeons: Free through VA (may wait for appointments)
Private Orthopedic Specialists: Board-certified surgeons ($400-$800)
Sports Medicine Physicians: Specialists in athletic injuries
VSO-Affiliated Providers: Approved providers for veteran claims
Telehealth Services: Specialized VA services ($300-$600)

Best nexus letters come from orthopedic specialists familiar with military occupational demands and common service-related injuries.

C&P Exam Preparation for Knee Claims

The VA frequently schedules C&P exams for knee disability claims. Thorough preparation improves your rating chance.

Exam Components

Medical History: Detailed knee injury history and development

Imaging Review: Examiner reviews available MRI, X-rays, CT scans

Physical Examination:

Visual inspection for swelling, skin changes
Range of motion testing (flexion/extension measurements)
Stability testing (ACL, MCL, PCL tests)
Strength testing
Gait assessment

Functional Assessment:

Can you stand for extended periods?
Can you walk up/down stairs?
Can you kneel or squat?
What activities increase pain?

Key Questions During C&P Exam

When did the knee injury occur and how?
What specific activities cause pain?
How far can you walk before pain becomes limiting?
Can you stand all day for work?
Do you have swelling or instability episodes?
What medications do you take for pain?
Have you had surgery on this knee?
How has the knee affected your occupational duties?
Do you use any assistive devices (brace, cane)?

Preparation Tips

Bring Imaging: Provide copies of all MRI, X-ray, and CT reports
Wear Appropriate Clothing: Wear shorts so examiner can inspect knee fully
Document Functional Impact: Prepare specific examples: "I can't stand more than 30 minutes," "Climbing stairs causes severe pain"
Medication List: Bring list of all pain medications and side effects
Treatment History: Document all physical therapy, injections, or surgeries
Occupational Impact: Be specific about work restrictions needed
Be Truthful About Function: Don't exaggerate, but be honest about limitations
Demonstrate Pain: If pain occurs during exam movements, show it; don't try to hide it

The examiner will perform standardized tests and compare your results to normal values to determine functional limitation percentage.

Real Claim Examples

Case 1: ACL Tear from Combat

A former Army infantryman suffered ACL tear during combat patrol. He filed with:

Military medical records documenting injury
ACL reconstruction surgery records
Current MRI showing post-surgical changes
Orthopedic report documenting 30% range of motion limitation
Employer statement noting inability to perform field duties

Outcome: 40% rating. Combined with 10% back pain = 46% overall. Monthly compensation: $410. Back pay: $6,200.

Case 2: Degenerative Arthritis from Service

A 20-year military service veteran with multiple patrols and load-carrying duties filed for progressive knee arthritis. Evidence included:

X-rays showing significant joint space narrowing
Medical records documenting progressive symptoms over 5 years
PT notes showing range of motion decrease
Orthopedic specialist assessment of severe osteoarthritis
Occupational restrictions preventing field duties

Outcome: 50% rating. Combined with 20% lower back pain = 60% overall. Monthly compensation: $825.

Case 3: Meniscal Tears from Training

A former Ranger with repeated meniscal tears from jump training filed disability claim with:

Military training records showing airborne operations
Arthroscopy reports documenting meniscal damage
PT records showing ongoing pain and instability
Functional limitation statement from current employer
Medical opinion on service-connection

Outcome: 30% rating. Monthly compensation: $350.

Common Mistakes to Avoid

Mistake 1: No Imaging Evidence

Filing without X-rays or MRI significantly weakens claims.

Solution: Obtain imaging from VA or civilian provider before filing.

Mistake 2: Vague Functional Impact Description

Simply saying "my knee hurts" doesn't justify high ratings.

Solution: Be specific: "I can't stand more than 2 hours," "Walking more than a quarter mile causes severe pain," "Can't climb stairs without pain."

Mistake 3: Missing Orthopedic Evaluation

Filing without specialist assessment weakens moderate-to-severe rating claims.

Solution: See VA or civilian orthopedic specialist before filing for 40%+ ratings.

Mistake 4: Poor Nexus Letter Quality

Weak medical nexus reduces approval chances.

Solution: Work with experienced nexus letter providers; ensure letter explicitly connects service to current condition.

Mistake 5: No Treatment Documentation

Failing to show ongoing treatment suggests minor condition.

Solution: Continue physical therapy or relevant treatments; document all treatment attempts.

Step-by-Step Filing Process

Step 1: Obtain Medical Evidence

Request all VA knee-related medical records
Obtain recent X-rays, MRI, or imaging reports
Compile treatment records and medication history

Step 2: Gather Service Connection Information

Review discharge papers for injury documentation
Collect service-related injury reports or witnesses
Document military occupational demands

Step 3: Seek Specialist Evaluation

Schedule VA or civilian orthopedic evaluation
Request range of motion measurements
Obtain stability testing results
Get specialist assessment of functional limitation

Step 4: Obtain Nexus Letter

Request from VA orthopedic surgeon (free but may wait)
Or obtain private orthopedic specialist letter
Ensure letter connects service to current knee condition

Step 5: Complete VA Form 21-526EZ

Available at VA.gov or Regional Office
Describe knee condition and functional impact
List military service connection explanation
Attach supporting documents

Step 6: Submit Claim

Online: VA.gov (fastest, recommended)
Mail: VA Regional Office
In-Person: Local VA office or VSO assistance

Step 7: Attend C&P Exam (if scheduled)

Bring all imaging and medical records
Wear shorts for full knee inspection
Demonstrate functional limitations honestly
Answer questions about occupational impact

Step 8: Await Rating Decision

VA responds within 60-120 days
Rating Decision explains approval and percentage
First payment arrives 30-45 days after approval

Timeline Expectations

Claim to Decision: 60-120 days Effective Date: Usually injury date or discharge date First Payment: 30-45 days after approval Back Pay: Calculated from effective date; lump sum within 60-90 days

Appeal Strategies if Denied

Denial is not final. Many knee claims succeed on appeal with better evidence.

Option 1: Supplemental Claim

File Form 21-0995 with:

Better imaging (recent MRI or X-rays)
Stronger orthopedic specialist evaluation
Superior nexus letter
Detailed functional limitation documentation

Option 2: Higher-Level Review

Request senior reviewer examine decision for errors. Can include new evidence.

Option 3: Board Appeal

For questionable denials, request Board of Veterans' Appeals hearing. Present comprehensive evidence and arguments.

Appeal Tips

Address specific denial reason with targeted evidence
File within one year of decision
Consider VSO or attorney assistance
Maintain treatment continuity showing worsening condition

Secondary Conditions from Knee Injuries

Veterans with severe knee injuries commonly develop secondary conditions:

Hip Pain (10-50% rating) - Altered gait overloading hip joint

Back Pain (10-100% rating) - Compensation patterns affecting spine

Other Knee (10-100% rating) - Overuse injury to opposite leg

Depression/Anxiety (10-100% rating) - Chronic pain effects on mental health

Sleep Disorder (10-100% rating) - Pain disrupting sleep

Filing secondary conditions increases total compensation through combined ratings.

Conclusion

Knee disability claims are highly approvable with proper medical evidence and documentation of functional limitation. The key to maximizing your rating is obtaining comprehensive imaging, specialist evaluation, and a strong nexus letter connecting your condition to military service.

Start your claim through VA.gov, your VA Regional Office, or with a veterans' service organization. The earlier your effective date, the more back pay you'll receive. With persistence and proper documentation, most veterans successfully secure knee disability ratings and meaningful monthly compensation for service-connected knee conditions.