Dislocated Semilunar Cartilage (Meniscus) VA Disability Rating
Diagnostic Code 5258 · 38 CFR §4.71a
What Is It?
DC 5258 has exactly one step. The schedule reads "Cartilage, semilunar, dislocated, with frequent episodes of 'locking,' pain, and effusion into the joint" — 20 percent. There is no 10, no 30, and no partial credit. Either the criteria are met and the evaluation is 20 percent, or they are not and this code assigns nothing. That structure makes the wording unusually important. The criterion names three things — frequent episodes of locking, pain, and effusion into the joint — and they are joined by "and." A knee that hurts and swells but does not lock, or locks but has never been documented to swell, is a knee that has trouble under this particular code. This is the single most common reason a well-founded meniscus claim comes back at zero, and it is fixable with evidence rather than argument: what the record needs is documentation of all three, occurring often enough to be called frequent. Semilunar cartilage is the older name for the meniscus, the two crescent-shaped pads that cushion the knee between the femur and tibia. The neighboring code, DC 5259, covers removal of semilunar cartilage where it remains symptomatic, at 10 percent — which is where many veterans land after a meniscectomy, since a meniscus that has been taken out can no longer dislocate or lock. The knee is one of the few joints where the schedule genuinely supports more than one evaluation at once, because the codes address different things. DC 5257 covers knee impairment and patellar instability, and was rewritten to turn on whether a brace, cane or walker is prescribed. DC 5260 and DC 5261 cover limitation of flexion and extension in degrees. DC 5003 covers the arthritis that so often follows a meniscal injury. 38 CFR 4.14 forbids evaluating the same manifestation twice — but locking and effusion, instability, lost motion, and arthritis are not the same manifestation.
Rating Criteria
| Rating | Criteria |
|---|---|
| 20% | Cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint. This is the only evaluation available under DC 5258, and all three elements — frequent locking, pain, and effusion into the joint — appear in the criterion. Where the knee is more disabled than this figure reflects, the additional evaluation comes from the other knee codes rather than from a higher step here. |
Evidence Needed
- MRI or arthroscopic findings identifying the tear and, where possible, describing it as displaced. Imaging establishes the anatomy; it does not by itself establish the criterion.
- Treatment records documenting locking episodes — a knee that catches and will not straighten — with dates. "Frequent" is the operative word and it is proved by a pattern in the record, not by a single note.
- Documented effusion. This is the element most often missing: swelling noticed at home is rarely in the chart, while an aspiration, a measured joint circumference, or an examination note recording an effusion is.
- A symptom log kept before the examination listing each locking episode, each swelling episode, the date, the duration and the activity that triggered it.
- Range of motion in degrees for flexion and extension, since DC 5260 and DC 5261 are separate evaluations from this one.
- Findings on instability and whether a brace, cane or walker has been prescribed — the current DC 5257 criteria turn on that prescription.
- X-ray evidence of degenerative change, which supports a DC 5003 evaluation and is common after meniscal injury and after meniscectomy.
- Operative reports for any meniscectomy or repair. Where the meniscus was removed and symptoms persist, DC 5259 rather than DC 5258 is usually the fitting code.
C&P Exam Tips
- Bring a written log of locking and swelling episodes. This code turns on frequency, and frequency is the one thing an examination on a single day cannot observe.
- Say the word locking and describe what it means for you — the knee catches, will not straighten, and has to be worked free. Examiners distinguish that from giving way, and the two are different criteria under different codes.
- Report swelling specifically as swelling. Ask whether an effusion is present on examination and ask that the finding be recorded either way.
- Do not let the visit become a range-of-motion appointment only. Flexion and extension are separate codes; locking, pain and effusion are what this one needs.
- Say whether a brace, cane or walker has been prescribed and by whom. The rewritten DC 5257 criteria key directly to that prescription.
- Mention every instance where the knee gave way, and whether you have fallen.
- If you have had the meniscus removed, say so — the applicable code may be DC 5259 for symptomatic removal rather than DC 5258 for a dislocated cartilage that is no longer there.
- Describe what the knee does at work and on stairs, and what you have stopped doing because of it.
How to File
File on the three elements the criterion actually names. DC 5258 requires frequent episodes of locking, pain, and effusion into the joint, and a claim built only on pain and imaging usually fails on the other two. Before you file, go through your records and find where locking and effusion appear; if they do not appear, get them documented, because this is an evidence problem rather than an argument. A log is the most useful single document you can produce here. Dates, duration, what you were doing, whether the knee swelled and for how long — that is what makes "frequent" a finding rather than an adjective. Then claim the rest of the knee separately. Instability under DC 5257 turns on whether a brace, cane or walker is prescribed. Limitation of flexion and extension are evaluated in degrees under DC 5260 and DC 5261. Arthritis established by X-ray is evaluated under DC 5003. These address different manifestations and can be assigned alongside a 5258 evaluation; what 38 CFR 4.14 prohibits is evaluating the same manifestation twice, not evaluating a knee under more than one code. If the meniscus has been surgically removed and the knee remains symptomatic, DC 5259 at 10 percent is usually the correct code, since a removed meniscus cannot dislocate.
Common Mistakes
Filing on pain and MRI findings alone. The criterion names frequent locking, pain, and effusion, and imaging proves the tear rather than the symptom pattern. Letting effusion go undocumented. It is the element least likely to be in the chart and the one most often missing when the claim is denied. Describing locking as giving way. Giving way is instability and belongs to DC 5257; locking is the knee catching and refusing to straighten, and it belongs here. Expecting a higher step. DC 5258 has one evaluation at 20 percent — additional disability is captured by the other knee codes, not by a larger number under this one. Filing under 5258 after a meniscectomy. Where the cartilage was removed and symptoms continue, DC 5259 is the fitting code. Not claiming arthritis. Degenerative change is common after meniscal injury and after removal, and it is separately evaluated on limitation of motion or under DC 5003.
Frequently Asked Questions
Is there a rating above 20 percent under DC 5258?
No. The schedule lists a single evaluation of 20 percent for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. A knee that is more disabled than that reaches a higher combined evaluation through the other knee codes — instability under DC 5257, limitation of flexion or extension under DC 5260 and DC 5261, and arthritis under DC 5003 — rather than through a higher step under this code.
Do I need all three of locking, pain and effusion?
The criterion lists all three joined by "and," and claims are commonly denied where only one or two are documented. The practical answer is to make sure all three appear in the record and appear more than once. Effusion is the one most often absent, because swelling that happens at home rarely reaches the chart unless someone examines the knee while it is swollen or aspirates it.
What does frequent mean?
The schedule does not define it, which makes the record decisive. A pattern of episodes documented over time — in treatment notes, in a symptom log, in statements from people who have seen it happen — is what turns frequency into a finding. A single documented episode, however severe, is difficult to describe as frequent.
I had my meniscus removed. Which code applies now?
Usually DC 5259, cartilage, semilunar, removal of, symptomatic, at 10 percent. A meniscus that has been taken out cannot dislocate or produce the locking that DC 5258 describes, so continuing symptoms after a meniscectomy are generally evaluated under 5259 — and any arthritis that develops afterward is evaluated separately.
Can I be rated for both the meniscus and knee instability?
Yes, where both are present. They are different manifestations under different codes: DC 5258 addresses locking, pain and effusion from the displaced cartilage, and DC 5257 addresses knee impairment and patellar instability, which in its current form turns on whether a medical provider has prescribed a brace, cane or walker. 38 CFR 4.14 bars evaluating the same manifestation twice; it does not bar evaluating a knee under more than one code.
Does arthritis in the same knee get its own rating?
It can. Degenerative arthritis established by X-ray is evaluated on limitation of motion under the codes for the specific joint, and DC 5003 supplies 10 percent where that limitation is noncompensable. Arthritis is a common consequence of meniscal injury and of meniscectomy, so it is worth claiming and worth having X-rayed even when the immediate complaint is locking.