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Nexus Letters for Knee Pain
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA musculoskeletal evaluations and independent medical opinions • Last updated: June 2026
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Knees take the pounding in service. Running, jumping, rucking, and hard landings wear down the joint, and a lot of veterans claim both knees. But knee claims still get denied when the injury was treated once at sick call and never followed up.
A nexus letter can fix that. Our physicians connect your knee condition to your service, or to another joint that changed how you walk, in the language the VA expects. One flat fee of $1,500, and the first consultation is free.
How VA Rates the Knee
VA rates the knee under 38 C.F.R. § 4.71a. Two things drive the rating: how far the knee moves and whether it gives out. The table below covers motion, how far the knee bends and whether it fully straightens. Instability is rated on its own, explained just below.
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 10% | Knee bends only to about 45 degrees; or does not fully straighten (off by about 10 degrees); or painful motion (4.59); or a removed cartilage that still hurts (DC 5259).Most Common | ~$180/mo |
| 20% | Knee bends only to about 30 degrees; or will not straighten past about 15 degrees off; or torn cartilage that locks, catches, and swells (DC 5258). | ~$357/mo |
| 30% | Knee bends only to about 15 degrees; or will not straighten past about 20 degrees off. | ~$552/mo |
| 40% and up | Knee will not straighten past about 30 degrees off; or the knee is fused (ankylosis), rated 30% up to 60% by the angle it is stuck at. | ~$796/mo+ |
Instability is rated on its own under DC 5257: 10% if the knee gives way without a prescribed brace or assistive device, 20% if a doctor prescribes a brace or a cane, crutch, or walker for it, and 30% if a doctor prescribes both. The same code has a separate branch for kneecap (patellar) instability, also rated 10%, 20%, or 30%: 10% for a diagnosed kneecap condition that keeps giving way but needs no prescribed brace or device, 20% if it keeps giving way after surgery and a doctor prescribes a brace, cane, or walker, and 30% if it keeps giving way after surgery and a doctor prescribes a brace plus a cane or walker. Because instability and lost motion are different problems, the VA can rate them separately on the same knee and combine them. A knee that will not bend AND will not fully straighten can also carry two motion ratings. This is why knee claims often carry more than one rating.
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
Estimate your likely knee rating
This estimates your likely knee rating from instability and from how far the knee moves. A doctor measures motion and stability at an exam, so treat this as a rough guide, not a rating.
Making a VA Disability Claim for Knee Conditions
When you file a VA disability claim for your knee, three things need to line up:
A current diagnosis
A diagnosed knee condition, usually backed by an exam and imaging such as an X-ray or MRI.
A service connection
Either a knee injury or repeated strain in service, or a link to another service-connected joint that changed how you walk.
A medical nexus
A qualified opinion that the knee condition is 'at least as likely as not' connected to your service.
The nexus is where most knee claims fall apart, especially when a twist or a hard landing was treated once and never followed up. A nexus letter supplies it: a written medical opinion tying your knee to your service. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect Your Knee to Service
There are a few ways to tie a knee condition to your service. For knees, claiming both the injury and the joints it later strained is often the difference.
Direct connection
A knee injury or repeated strain happened in service.
- A specific injury. A twist, a fall, a hard landing, a parachute jump, or a torn ligament or cartilage.
- Wear and tear. Years of running, jumping, and rucking. A sick-call visit in your records helps a lot.
Secondary connection
Another service-connected condition changed how you walk and overloaded the knee (38 C.F.R. § 3.310).
- Altered gait. A bad back, hip, ankle, or the other knee makes you walk differently, which wears this knee down.
- Overcompensation. Favoring a service-connected leg loads the other knee harder.
Aggravation
You had knee problems before service, and service made them permanently worse.
- Worsened by service. Symptoms got worse during active duty, beyond normal aging.
Secondary Conditions
Knee problems rarely stop at one knee. These links can add to your combined rating, so they are worth documenting.
A knee condition may be secondary to
- The other knee. Favoring one knee overloads the other over time.
- Hip, ankle, or foot conditions. A changed gait from another joint strains the knee.
- Back conditions. An altered stride from the back loads the knees unevenly.
Conditions that may be secondary to a knee
- The other knee, hip, or back. A limp from one knee strains the opposite knee, the hips, and the back.
- Depression or anxiety. Chronic pain and lost mobility wear on mood and can be claimed as secondary.
- Ankle or foot strain. Walking differently to protect the knee can overload the ankle and foot.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. Tick each off as you go.
Frequently Asked Questions
How does the VA rate the knee?
Two ways, and they can stack. Motion is rated by how far the knee bends and whether it fully straightens, under 38 C.F.R. 4.71a. Instability, the knee giving way, is rated separately under DC 5257. A meniscus tear that locks and swells is rated on its own.
Can I get more than one rating for one knee?
Yes. Instability and lost motion are different problems, so the VA can rate them separately on the same knee and combine them. A knee that will not bend and will not fully straighten can also carry two motion ratings.
My knee bends fine but it hurts. Does that count?
Yes. Under 38 C.F.R. 4.59, painful motion earns at least the minimum rating, usually 10%, even if your motion looks near-normal. The VA should also account for weakness, fatigue, and flare-ups.
Can a bad knee cause other claims?
Yes, and it is common. A service-connected knee that changes how you walk can strain the other knee, the hips, and the back over time. Those are secondary claims under 38 C.F.R. 3.310.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help.
The miles add up. Let your records show it.
Let our physicians prepare a knee nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 38 CFR 4.71a, Schedule of ratings, musculoskeletal system, including the knee codes (eCFR) https://www.ecfr.gov/current/title-38/section-4.71a
- 38 CFR 4.40, Functional loss (eCFR) https://www.ecfr.gov/current/title-38/section-4.40
- 38 CFR 4.45, The joints (eCFR) https://www.ecfr.gov/current/title-38/section-4.45
- 38 CFR 4.59, Painful motion (eCFR) https://www.ecfr.gov/current/title-38/section-4.59
- 38 CFR 3.303, Principles relating to service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.303
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107