Joint Motion Claims Guide: Knee, Shoulder, Ankle, Hip, Foot, and Shin Splints

How the VA Rates Limited Motion (the Shared Rules)

Every joint is rated under 38 CFR 4.71a by measuring range of motion in degrees with a goniometer. But the degrees on the exam are only the starting point. Four rules can change the result, and they apply to the knee, shoulder, and ankle alike.

• Painful motion gets at least the minimum rating (38 CFR 4.59). If a joint is painful on motion, it is entitled to at least the minimum compensable rating for that joint (usually 10%), even if the measured range is technically "normal."
• Functional loss counts, not just degrees (38 CFR 4.40 and 4.45). Weakness, fatigue, incoordination, and lack of endurance that reduce how you actually use the joint must be factored in.
• Flare-ups matter (DeLuca v. Brown). The rating must account for additional loss of motion during flare-ups and after repeated use over time, not just your best single measurement in the exam room. (Pain alone, without extra functional loss, may not raise the rating, Mitchell v. Shinseki.)
• The exam must test motion both ways (Correia v. McDonald). A proper joint exam tests range of motion in active and passive motion, and in weight-bearing and non-weight-bearing. If the C&P exam skipped this, the exam may be inadequate.

How Service Connection Works, At a High Level

Before getting into the rating tables and pathways below, it helps to understand the three things every joint or range-of-motion claim ultimately has to show. This is the same basic test that applies to any VA disability claim, just applied to these conditions (Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)).

1. A current diagnosis. Medical proof that you actually have the condition now, or during the claim. This is the cornerstone of the claim; a claim can fail on this element alone when the record contains no current diagnosis, which is a common denial pattern in shin splint claims specifically, discussed further below.
2. An in-service event, injury, or the physical demands of your job. Something that happened or was documented during your service, such as a fall, an acute injury, or repetitive overuse from your duties, or a service-connected condition behind it for a secondary claim. The places, types, and circumstances of your service can help establish this (38 USC 1154(a)); physically demanding duties such as air assault or helicopter operations have supported findings of an in-service back or shin injury even without a treatment note in the file.
3. A medical nexus. A doctor's opinion connecting your current joint condition to service, or to the service-connected condition behind it, and explaining the reasoning, not just stating a conclusion.

What VA Looks For: Tests, Records, and Diagnostic Codes

Whether you are filing directly or secondary to another condition, the record VA actually reviews centers on a small set of documents and data points.

• Range-of-motion measurements in degrees, taken with a goniometer at the C&P exam, in active, passive, weight-bearing, and non-weight-bearing motion, plus an estimate of any additional loss during flare-ups and after repetitive use. These degrees are what the rating tables in this guide translate into a percentage.
• Treatment history and duration. For treatment-response codes like plantar fasciitis (DC 5269) and shin splints (DC 5262), what matters is not degrees but how long you've been treated and whether non-surgical and surgical treatment relieved the symptoms.
• Imaging and clinical findings: X-ray or MRI evidence of arthritis, instability testing, meniscus findings, or confirmation of a flail joint or nonunion, which support ratings that don't turn on motion alone.
• The diagnostic codes involved: the specific joint code, for example DC 5260 and 5261 (knee flexion/extension), 5257 (knee instability), 5201 (shoulder), 5271 (ankle), 5252 and 5253 (hip), 5269 (plantar fasciitis), or 5262 (shin splints/tibia and fibula), plus whatever code applies to a condition you're connecting it to, for example a back condition (lumbosacral strain) or degenerative arthritis (DC 5003).
• The actual form the examiner fills out: a joint-specific Disability Benefits Questionnaire (DBQ), discussed in more detail later in this guide.

Knee (Instability, Limited Motion, Meniscus)

The knee is the most-claimed joint, and one where a single knee can carry more than one rating at once, because instability (DC 5257), limitation of flexion (DC 5260), limitation of extension (DC 5261), and meniscus damage (5258 / 5259) are separate problems the VA rates on their own.

Shoulder / Arm (DC 5201, Limitation of Arm Motion)

The shoulder is rated by how far you can raise the arm (flexion and abduction), and the level depends on whether it is your dominant (major) or non-dominant (minor) arm.

Related shoulder codes cover other problems: DC 5200 (ankylosis, the joint fused), DC 5202 (humerus, including recurrent dislocation and flail/false joint), and DC 5203 (clavicle or scapula). The painful-motion and flare-up rules apply here too.

Ankle (DC 5271, Limited Motion)

The 38 CFR 4.71a definitions of "moderate" and "marked" for the ankle are spelled out in degrees, which is unusual and helpful.

Limitation of motion, DC 5271

Ankylosis, DC 5270

Total ankle replacement, DC 5056

Intermediate residuals after ankle replacement are rated by analogy to DC 5270 or 5271, whichever is more favorable.

Hip and Thigh (DCs 5250-5255, 5054)

The hip is a synovial joint with multiple planes of motion: flexion, extension, abduction (leg out), adduction (leg toward midline), and rotation. Each plane is a separate diagnostic code, and a veteran can receive ratings under more than one as long as they are not pyramiding the same symptom. All of these fall under 38 CFR 4.71a.

Hip ankylosis (joint fused), DC 5250

An ankylosed hip has no range of motion and therefore no painful-motion minimum (38 CFR 4.59 does not apply to a fused joint). The rating depends on the position the joint is frozen in and whether the foot reaches the ground.

Limitation of extension, DC 5251

Extension loss (inability to push the leg behind neutral) is difficult to measure and rarely rated above 0% unless there is painful motion, which may qualify for the minimum 10%.

Limitation of flexion, DC 5252

Flexion (raising the knee toward the chest) is the most commonly rated hip motion. Normal hip flexion is approximately 125 degrees; the rating table measures how severely it is restricted. Painful flexion with near-normal degrees still qualifies for the minimum 10% under 38 CFR 4.59.

Thigh impairment (adduction, abduction, rotation), DC 5253

DC 5253 covers the planes of motion frequently missed at rating: how far the leg swings outward (abduction), whether the legs can cross (adduction), and whether the foot can toe outward (rotation). Each criterion is separate. An examiner who skips the "can you cross your legs" question or the toe-out rotation test may miss a 10% rating.

Hip flail joint, DC 5254

A diagnosis of flail joint must be supported by X-ray or other imaging. Because the 80% rating already compensates for all planes of motion loss, a separate rating for limitation of flexion or extension in the same hip would be pyramiding under 38 CFR 4.14.

Femur impairment, DC 5255

Malunion of the femur is evaluated under DC 5256, 5257, 5260, or 5261 for the knee, or DCs 5250-5254 for the hip, whichever produces the highest evaluation. The location of the fracture along the femur determines whether the knee or hip DBQ applies.

Total hip replacement, DC 5054

"Prosthetic replacement" under DC 5054 means a total replacement of the head of the femur or the acetabulum. A partial replacement or resurfacing does not qualify for the prosthetic-replacement criteria. After resurfacing, the VA evaluates residuals under DCs 5250-5255 with no minimum rating floor.

Foot / Plantar Fasciitis (DC 5269) and Pes Planus (DC 5276)

Plantar fasciitis is rated under DC 5269 in 38 CFR 4.71a. Unlike most joint conditions, it is not rated by range of motion or by degrees. It is rated by whether the condition has responded to treatment and whether surgery has been performed. The foot DBQ is used for all plantar fasciitis claims regardless of whether the pain is closer to the heel or midfoot.

Plantar fasciitis, DC 5269

Relationship to pes planus (flat feet), DC 5276

When a veteran has both plantar fasciitis (DC 5269) and pes planus (DC 5276) that are related, the M21-1 manual requires rating them together under the higher of the two diagnostic codes, rather than separately. Because pes planus can rate as high as 50%, it is typically the primary code in combined cases. Separately, metatarsalgia (pain in the forefoot) can be evaluated alongside plantar fasciitis (heel pain) because the two symptoms involve different anatomical areas and do not generally overlap, unless the evidence shows the symptoms are the same disability under different labels.

Shin Splints / Medial Tibial Stress Syndrome (DC 5262)

Shin splints (medial tibial stress syndrome, MTSS) are rated under DC 5262 (tibia and fibula impairment) in 38 CFR 4.71a, regardless of whether the pain is closer to the knee or the ankle. Like plantar fasciitis, shin splints are rated by treatment duration and response, not by range of motion degrees.

The DBQ used at the C&P exam depends on where symptoms are located. Shin splints closer to the knee use the knee DBQ, and shin splints closer to the ankle use the ankle DBQ. The rating code remains DC 5262 either way.

Shin splints (MTSS), DC 5262

The Bilateral Factor (38 CFR 4.26)

If you are service-connected for the same joint on both sides (both knees, both ankles, both arms), the VA adds a bilateral factor: it takes the combined value of the paired disabilities and adds 10% of that value before combining with your other ratings. It is easy for the VA to miss, so it is worth checking your code sheet. The VA Math calculator applies the bilateral factor automatically so you can see whether your combined rating looks right.

Getting These Joints Service Connected: Direct and Secondary Pathways

• Direct: an in-service injury (a fall, a parachute landing, a sports or training injury) or documented overuse, a current diagnosis, and a nexus. Continuity of symptoms since service helps.
• Secondary, altered gait or overcompensation: a service-connected knee or ankle that changes how you walk can cause or worsen the opposite knee, the hip, or the low back. A bad shoulder can overload the other shoulder. These are common, well-recognized secondary paths. See service connection.
• Secondary, plantar fasciitis from a foot or gait condition: flat feet (pes planus), a service-connected knee injury that alters stride, or leg-length discrepancy can be nexus sources for plantar fasciitis. A private nexus letter connecting the conditions is the typical evidentiary vehicle.
• Secondary, shin splints from overuse during service: high-mileage training, parachute operations, or combat marching documented in service records supports direct service connection. Shin splints can also flow from a gait-altering condition (pes planus, ankle, or knee) as a secondary claim.
• Aggravation: service made a pre-existing joint problem permanently worse.

Four documented pathways come up often enough in published Board decisions on joint and range-of-motion claims to lay out on their own, alongside the altered-gait and shin-splints-overuse pathways above.

Evidence That Wins

Across the Board's published DC 5262 decisions, whether a private nexus opinion is in the file makes a real difference in outcome, shown below.

• A current diagnosis, clearly documented. This is the cornerstone of any joint claim. Shin splint claims in particular are denied outright when the record contains no current diagnosis at all, discussed further in Why Claims Get Denied below.
• Range-of-motion measurements in degrees, taken with a goniometer, including after repetitive use. The numbers drive the table for motion-rated joints.
• Documented flare-ups. Tell the examiner how often they happen, what triggers them, and how much more motion you lose during one. A dated symptom log makes this concrete, since the examiner is expected to estimate flare-up loss from your reports even without observing a flare firsthand.
• A Correia-compliant exam, testing active, passive, weight-bearing, and non-weight-bearing motion. If your C&P skipped weight-bearing testing, that can be grounds to challenge the exam.
• Imaging and clinical findings (X-ray, MRI, instability testing, meniscus findings) that support a separate rating.
• A private nexus opinion that explains its reasoning, reviews the file, and applies its conclusion to your specific facts rather than stating a bare conclusion. This kind of opinion has carried claims for the spine, shin splints, shoulder, hip, and back alike in the Board's published decisions. See our Nexus Letters Guide.
• Proof of the in-service duties or event, including the places, types, and circumstances of your service (38 USC 1154(a)). Physically demanding duties, such as air assault, helicopter operations, or documented ruck marching, have supported in-service back and shin injuries even without a same-day treatment note.
• Consistent lay statements about onset and continuity, along with statements from people who observed your symptoms (limping, favoring a leg, difficulty with stairs) during or shortly after service. See our Buddy & Lay Statements Guide.
• The right DBQ. The joint-specific Disability Benefits Questionnaire captures degrees, painful motion, flare-ups, and stability. See the DBQ guide and the C&P exam prep.

Why These Claims Get Denied

Beyond a missing nexus generally, a few specific denial patterns show up often enough in the Board's published decisions for these joints to call out on their own.

Common Mistakes

The same few errors quietly cost veterans range-of-motion ratings and, separately, a few procedural missteps quietly cost veterans an otherwise winnable case. Each one ties back to a rule already covered above.

Do's and Don'ts

A condensed version of everything above, in the order it actually matters when you sit down to build your file.

Secondary Conditions Linked to Shin Splints (DC 5262)

These are the conditions most often linked with tibia and fibula impairment (DC 5262) in the Board's published decisions. Each bar is the BVA grant rate, with the number of decisions below it. They describe what the Board's record shows across many veterans, not a prediction about any one claim.

Ways to connect via another condition (shin splints as the secondary)

Claims where a shin or tibia/fibula condition was argued as secondary to an already service-connected condition, for example a gait-altering knee, ankle, or foot condition:

Conditions secondary to shin splints (DC 5262 as the primary)

Conditions veterans have claimed as caused or aggravated by a service-connected tibia/fibula condition once it is already service-connected, including degenerative arthritis from years of altered mechanics and a lumbosacral or cervical strain from compensating for the leg:

Quick Checklist Before You File

Bring these together before you submit anything.

For the mechanics of actually submitting the claim, see the Standard Claim Guide and the Fully Developed Claim Guide (filing with all your evidence up front can speed up the decision).

The Claims Process, Step by Step

Once you file, your claim moves through a series of hand-offs. Understanding who does what helps you know who to contact, and what to expect, at each stage.

1. You file the claim. Directly with VA, through VA.gov, or with the help of an accredited representative.
2. VA acknowledges the claim and assigns it for development. A Veteran Service Representative (VSR) is assigned to gather your service treatment records, VA and private medical records, and any other evidence needed.
3. The VSR orders a Compensation & Pension (C&P) exam if one is needed. Most joint and range-of-motion claims require one, and secondary claims typically require a nexus opinion as part of it.
4. The C&P exam is conducted. By a VA clinician or a contracted examiner, who completes the joint-specific Disability Benefits Questionnaire (DBQ), documenting range of motion, painful motion, flare-up estimates, and, where relevant, a nexus opinion.
5. The file goes to a Rating Veteran Service Representative (RVSR), the "rater." The rater reviews the complete file, including the exam results, and decides whether service connection is warranted and at what percentage.
6. A senior reviewer may review the decision before it's finalized, depending on the complexity of the claim.
7. VA issues the decision letter. This states whether the claim is granted or denied, the rating percentage if granted, and the reasons behind the decision.
8. If you disagree, you choose an appeal lane. Higher-Level Review, Supplemental Claim, or a Board appeal, covered later in this guide.

Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner

For the full walkthrough of every stage with more detail, see Inside Your Claim and Claim Stages.

DBQs and Your C&P Exam

A Disability Benefits Questionnaire (DBQ) is the standardized form an examiner completes for your condition. For joint conditions, it structures the exam into the specific data points the rating schedule requires: range of motion in degrees (active, passive, weight-bearing, and non-weight-bearing), whether motion is painful, an estimate of additional loss during flare-ups and after repetitive use, and, for treatment-response codes like shin splints and plantar fasciitis, the treatment history itself. See the DBQ Guide for how these forms work, including whether a private DBQ completed by your own doctor can be submitted instead of relying solely on a VA exam.

Before your C&P exam, bring a clear, specific account of your symptoms, focus on your worst days and how the condition affects daily function, not just how you feel on an average day. Tell the examiner how the joint performs without pain medication if you use it. Be consistent with what's already in your medical records and prior statements. For a full walkthrough of what to expect and how to prepare, see the C&P Exam Prep Guide.

Reading Your Decision Letter, and What to Do If Denied

Your decision letter has two parts: a narrative section explaining the reasoning (often called "reasons and bases"), and a codesheet showing the actual rating percentage, the effective date, and the diagnostic code used. See the Reading Your Decision Letter Guide for how to find and interpret each part, or use the Letter Interpreter tool to upload your own letter and get a plain-English breakdown.

If your claim is denied, or the rating is lower than you expected, you have three main lanes:

• Supplemental Claim: refile with new and relevant evidence, such as a new nexus opinion, updated imaging, or a longer documented treatment history. See Supplemental Claim Guide.
• Higher-Level Review (HLR): a senior reviewer looks at the same evidence again for a difference of opinion, no new evidence is added. See HLR Guide.
• Board Appeal: your case goes to a Veterans Law Judge at the Board of Veterans' Appeals, with options for a direct review, an evidence docket, or a hearing. See Board Appeal Guide.

Whichever lane you pick, file within one year of the decision notice; an appeal filed after that window is dismissed regardless of the merits. Not sure which lane fits your situation? See the Appeals decision guide for a side-by-side comparison of all three.

After You Win: Maintaining Your Rating

A grant is not always the end of the story. Keep your treatment consistent, continued follow-up documenting your range of motion, flare-ups, and any ongoing treatment protects you if VA schedules a future reexamination. Not every rating gets reexamined; understand when a rating becomes protected from future review (including Permanent and Total status) and what to do if VA proposes to reduce it. Remember that VA cannot cut a rating that lowers your compensation without first proposing the reduction and giving you 60 days to respond with additional evidence (38 CFR 3.105(e)); an improperly noticed reduction can be challenged and reversed. See Protect Your Rating and Future Reexaminations for the specifics.

If your joint condition worsens after the initial grant, for example motion narrows further or a joint that was rated for pain now shows instability or arthritis on imaging, you can file for an increased rating, or ask that a distinct, separately ratable problem in the same joint (a meniscus tear alongside limitation of motion, for example) be evaluated on its own. See the Rating Increase Guide.

Quick Reference Tables

Documented Secondary Connection Pathways

From Filing to Decision: Who Does What

Frequently Asked Questions

Sources

1. 38 CFR 4.71a, Schedule of Ratings, Musculoskeletal System, including Diagnostic Codes 5054, 5056, 5200-5203, 5250-5262, 5269, 5276
2. 38 CFR 4.59, painful motion
3. 38 CFR 4.40 and 4.45, functional loss
4. 38 CFR 4.14, avoidance of pyramiding
5. 38 CFR 4.26, the bilateral factor
6. 38 CFR 3.303, basic rules for service connection
7. 38 CFR 3.310, Secondary Service Connection
8. 38 CFR 3.306, aggravation of a pre-existing disability; 38 CFR 3.304(b) and 38 USC 1111, presumption of soundness
9. 38 CFR 3.317 and 38 USC 1117, Gulf War undiagnosed illness
10. 38 USC 1154(a), places, types, and circumstances of service as proof of an in-service event or injury
11. 38 CFR 3.102 and 38 USC 5107(b), benefit of the doubt
12. 38 CFR 3.105(e), notice required before a rating reduction
13. 38 CFR 20.302, one-year time limit for filing a Notice of Disagreement
14. 38 CFR 3.2501, new and relevant evidence for a Supplemental Claim; 38 USC 5110 and 38 CFR 3.400, effective dates
15. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004), the three-element test for service connection
16. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), pain alone can constitute a disability where it causes functional impairment
17. DeLuca v. Brown, 8 Vet. App. 202 (1995), functional loss during flare-ups and repetitive use
18. Mitchell v. Shinseki, 25 Vet. App. 32 (2011), pain alone without additional functional loss may not raise a rating
19. Correia v. McDonald, 28 Vet. App. 158 (2016), active/passive and weight-bearing/non-weight-bearing testing
20. Sharp v. Shulkin, 29 Vet. App. 26 (2017), an examiner cannot decline to estimate flare-up loss solely because the exam did not occur during a flare
21. Ingram v. Collins, 21 Vet. App. 232 (2007), rating the joint without the masking effect of pain medication where the rating criteria do not reference medication
22. CCK Law, knee ratings
23. CCK Law, shoulder/arm ratings

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