Diagnostic Code 5257 · 38 CFR §4.71a
DC 5257 covers two categories of knee impairment: recurrent subluxation or instability from ligament injuries, and patellar instability involving the patellofemoral complex. For ligament-related instability, ratings depend on the type of injury (sprain, incomplete tear, or complete tear), whether surgical repair was attempted and succeeded, and whether a medical provider has prescribed bracing or assistive devices for walking. Patellar instability is rated based on whether surgical repair was performed and what devices are prescribed. DC 5257 can be rated alongside limitation of motion codes (DC 5260 and 5261) for the same knee because instability and limitation of motion are different types of disability.
| Rating | Criteria |
|---|---|
| 10% | Recurrent subluxation or instability: Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a medical provider prescribing an assistive device or brace for walking. Patellar instability: A diagnosed patellofemoral complex condition with recurrent instability (with or without surgical repair history) that does not require a prescribed brace, cane, or walker. |
| 20% | Recurrent subluxation or instability: Either (a) sprain, incomplete tear, or repaired complete tear causing persistent instability with a prescribed brace and/or assistive device for walking, or (b) unrepaired or failed complete tear causing persistent instability with a prescribed assistive device or brace for walking. Patellar instability: A diagnosed patellofemoral complex condition with recurrent instability after surgical repair requiring a prescribed brace, cane, or walker. |
| 30% | Recurrent subluxation or instability: Unrepaired or failed repair of a complete ligament tear causing persistent instability, with a medical provider prescribing both an assistive device (such as a cane, crutches, or walker) and bracing for walking. Patellar instability: A diagnosed patellofemoral complex condition with recurrent instability after surgical repair requiring a prescribed brace plus either a cane or walker. |
The key evidence includes MRI or surgical records showing the type of ligament injury (sprain, incomplete tear, or complete tear) and whether repair was attempted. Prescriptions from a medical provider for bracing or assistive devices (cane, crutches, walker) are now critical to the rating level. The C&P examiner will perform stability tests including the anterior drawer test, Lachman test, and varus/valgus stress tests. For patellar instability claims, documentation of the patellofemoral complex diagnosis and any surgical repair history is needed. Lay statements describing instability episodes remain valuable supporting evidence.
Yes. Under VAOPGCPREC 23-97, the VA can assign separate ratings for knee instability (DC 5257) and limitation of motion (DC 5260 and/or 5261) for the same knee. These represent different types of disability and are evaluated independently.
The examiner typically performs the anterior and posterior drawer tests (testing ACL and PCL integrity), the Lachman test (ACL), and varus/valgus stress tests (testing lateral and medial collateral ligaments). These tests assess whether the ligaments adequately stabilize the knee joint.