Knee, other impairment of — VA Diagnostic Code 5257

Persistent instability

The schedule does not define it. Our reading: ongoing instability, not one episode. 38 CFR § 4.6 (Evaluation of evidence) requires a decision “equitable and just.” 38 CFR § 4.7 (Higher of two evaluations) assigns the higher rating when the picture “more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.”

Prescribes … for ambulation

The 20 and 30 percent ligament lines say “a medical provider prescribes” a brace and/or assistive device “for ambulation.” Ten percent is that instability “without a prescription from a medical provider.” A brace with no prescription for walking does not meet those words.

Repaired, unrepaired, or failed repair

At 20 percent, (a) is a sprain, incomplete tear, or repaired complete tear plus a brace and/or device. (b) is an unrepaired or failed complete tear plus either a device or bracing. Thirty percent needs that failed or unrepaired complete tear and both prescriptions.

Patellofemoral complex

Note (1) names the quadriceps tendon, the patella, and the patellar tendon. Note (2): a procedure that does not repair one of those parts “shall not qualify as surgical repair,” including arthroscopy to remove loose bodies and joint aspiration.

The same knee, rated under other codes

The same findings under more than one code

Both knees

What is the VA rating for knee instability under DC 5257?

38 CFR § 4.71a rates recurrent subluxation or instability, and patellar instability, under Diagnostic Code 5257 at 10, 20, or 30 percent. Ten percent on the ligament track is a sprain or ligament tear causing persistent instability without a prescribed brace or assistive device for ambulation. Twenty percent adds a medical provider’s prescription, and the (a) and (b) paths depend on the tear and the repair. Thirty percent is an unrepaired or failed repair of a complete tear with prescriptions for both an assistive device and bracing. Patellar instability has its own 10, 20, and 30 percent track. Education only; VA decides on the evidence.

Does wearing a knee brace raise a DC 5257 rating?

Under the current text of 38 CFR § 4.71a, the 20 and 30 percent ligament levels depend on whether “a medical provider prescribes” the brace or assistive device for ambulation, not on owning one. The 10 percent line is persistent instability without that prescription. The patellar track uses the same idea: a prescription for a brace, cane, or walker after surgical repair. Keep the prescription or DME order, and check that the Knee and Lower Leg DBQ records it. Education only.

What is the difference between 10, 20, and 30 percent under DC 5257?

On the ligament track, 10 percent has no prescribed brace or assistive device for ambulation. Twenty percent adds that prescription. Paths (a) and (b) differ by the tear and by whether both a device and bracing are required. Thirty percent is an unrepaired or failed complete tear plus both prescriptions. Patellar instability has its own 10, 20, and 30 percent lines, and Note (2) limits surgical repair.

Can instability be rated along with limited motion?

DC 5257, DC 5260, and DC 5261 are different lines in § 4.71a. This page does not state that they are combined. 38 CFR § 4.14 says the same disability is not evaluated under various diagnoses. Whether more than one code applies is a question for the decision and an accredited representative.

What is the maximum under DC 5257?

The highest line under DC 5257 is 30 percent, on both tracks. No higher percentage is printed for this code. If the compensable criteria are not met, § 4.31 assigns 0 percent because the code has no 0 percent line. Other knee codes have their own maximums. VA decides from the record.