Knee Limitation of Extension — VA Disability Rating Criteria (DC 5261)
Diagnostic Code 5261 · 38 CFR §4.71a
What Is It?
Limitation of knee extension refers to a reduced ability to fully straighten the knee. Normal knee extension is 0 degrees (completely straight). The VA rates limitation of extension under DC 5261 based on the degree to which extension is restricted. Veterans develop this limitation from the same injuries and wear that cause flexion limitation — ligament damage, meniscus injuries, and arthritis. As noted under DC 5260, the VA can rate limitation of extension separately from limitation of flexion on the same knee under VAOPGCPREC 9-2004.
Rating Criteria
| Rating | Criteria |
|---|---|
| 50% | Extension limited to 45 degrees. The knee cannot straighten beyond a significantly bent position. This is the maximum rating under DC 5261. |
| 40% | Extension limited to 30 degrees. Severe restriction — the knee remains substantially bent. |
| 30% | Extension limited to 20 degrees. Significant restriction in straightening the knee. |
| 20% | Extension limited to 15 degrees. |
| 10% | Extension limited to 10 degrees. A noticeable inability to fully straighten the knee. |
| 0% | Extension limited to 5 degrees. The veteran cannot fully straighten the knee but the restriction is minimal. |
Evidence Needed
Range of motion measurements using a goniometer are the primary evidence. The C&P examiner measures extension in degrees from the fully straight (0-degree) position. Medical records, imaging, and DeLuca factor evidence (pain, weakness, fatigability, flare-ups) are the same as for DC 5260.
C&P Exam Tips
The same tips apply as for the flexion exam — do not push through pain to straighten your knee further than it comfortably goes. Describe flare-ups that cause additional limitation. If your knee is stiffer in the morning or after prolonged sitting, mention that pattern to the examiner.
How to File
File on VA Form 21-526EZ listing limitation of knee extension and specifying which knee. Claim it alongside limitation of flexion if both are present.
Common Mistakes
The most common mistake is not claiming extension limitation separately from flexion limitation. Under VAOPGCPREC 9-2004, these are rated independently. Another mistake is not recognizing that even small extension deficits (10-15 degrees) can significantly affect gait and function.
Frequently Asked Questions
Can I get separate ratings for limited extension and limited flexion?
Yes. Under VAOPGCPREC 9-2004, the VA rates limitation of extension (DC 5261) and limitation of flexion (DC 5260) separately when both are compensable in the same knee.
Why is extension limitation rated higher than flexion limitation at similar levels?
Extension limitation has a greater impact on walking and standing because the knee must straighten to support body weight during gait. A knee that cannot fully extend creates a more significant functional impairment for ambulation than a knee with limited flexion.