Diagnostic Code 5261 · 38 CFR §4.71a
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 |
|---|---|
| 0% | Extension limited to 5 degrees. The veteran cannot fully straighten the knee but the restriction is minimal. |
| 10% | Extension limited to 10 degrees. A noticeable inability to fully straighten the knee. |
| 20% | Extension limited to 15 degrees. |
| 30% | Extension limited to 20 degrees. Significant restriction in straightening the knee. |
| 40% | Extension limited to 30 degrees. Severe restriction — the knee remains substantially bent. |
| 50% | Extension limited to 45 degrees. The knee cannot straighten beyond a significantly bent position. This is the maximum rating under DC 5261. |
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.
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.
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.